Skilled Nursing Facility

Q&A: ICD-10 Return to Provider codes

Question: “Physical therapy has generalized muscle weakness as a secondary diagnosis, and we are worried this will cause our claim to kick out. Why can’t they just use muscle wasting?”

Response: You are correct that generalized muscle weakness would be considered an RTP code for primary diagnosis in I0020B; however, there may be instances during which a physical and or occupational therapist needs to use this code for treatment or secondary diagnosis coding on the plan of care. Additionally, muscle wasting is not an interchangeable code, and would require testing and MD involvement to be considered for addition.

Question: “Speech has R13.12 on their dysphagia evaluation. Shouldn’t they change it to the I69 series?”

Response: Use of the “I” series codes must also adhere to the definition of “active diagnosis.” “I” codes are not interchangeable when the “R” series codes are most appropriate for the patient based on clinical presentation and medical history.

Additionally, coding principles for ICD-10 direct us to use an “R” series, which are the dysphagia phase-specific codes, to identify impaired phase when using an “I.”

“R” series swallow codes used to obtain phase specificity include R13.11 (Dysphagia, oral phase), R13.12 (oropharyngeal phase), R13.13 (pharyngeal phase), and R13.14 (pharyngoesophageal phase).

In short, an “I” code should be followed by an “R” code—they should not stand alone.

Furthermore, the “R” series codes help support the clinical elements seen in K0100 A–D; therefore, eliminating them from the medical record would create a void, which runs counter to PDPM’s aim of encouraging a greater level of congruence across care team documentation.

Question: “What do you mean we can include therapy diagnoses in I8000 as secondary diagnoses? My scrubber software is giving me alerts otherwise.”

Response: Remember to check your software parameters and settings to ensure your teams are receiving appropriate messages and making clinical decisions based on accurately reflecting patient presentation in the medical record.

Renee Kinder, MS, CCC-SLP, RAC-CT is the vice president of clinical services at Encore Rehabilitation Services.