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PTA Blog Talk

ICD-9 Codes

Published January 30, 2013 5:54 PM by Jason Marketti

Just because a code is billable, doesn't make it the best possible code for a therapy diagnosis. I have certificates in billing and coding and constantly come across codes, such as 719.7, which is difficulty in walking. This can be the "catch-all" code for almost any therapy patient we see in the clinics. The same with 781.92 (abnormal posture) and 781.2 (abnormality of gait).

Perhaps 729.89 (other musculoskeletal symptoms referable to limbs) could be used because it's just as vague as the other therapy diagnoses. What I'd like to see is a separate and clearer therapy diagnosis that would better reflect why the patient is being seen for therapy.

I've come across codes like 596.0 (unspecified disorder of bladder) as the main therapy diagnosis. My first question is why would an insurance company pay for therapy services on a patient with a bladder infection? It doesn't make sense, but then again I'm not a PT who decides the diagnosis of the patients, am I? If I was the insurance carrier, I wouldn't pay for any rehab services when the best therapy diagnosis to justify treatment is a bladder infection.

If the PT isn't sure what the best diagnosis is for the patient, he should ask. Based on the evaluation, there could be several, more specific diagnoses to better justify therapy services. Some clinics may have a coder who can accurately code the patient with the best diagnosis and possibly receive a higher reimbursement rate because the patient is coded correctly. I'm sure there are many MD health clinics that hire coders specifically for that reason. With direct access, it seems that providers would want to ensure all codes are specific to the patient's condition and not some vague weakness code that seems so prevalent in the clinic today, like 780.79 (other malaise and fatigue).

1 comments

It is well know that the ICD9 system does a very poor job at describing the patient is receiving our services.  I use multiple ICD9 codes to assist in painting the picture for the insurance companies, reviewers, etc.  For example, a patient s/p TKA I will use several - 719.46, 719.56, 719.7, 715.16, V43.65, etc.  The problem with the ICD9 system is that it is not possible just by using the codes to determine the severity of the individuals dysfunction.  There could be 2 individuals for which I use those same codes but one could require only a month of treatment and the other 3-4 months.  The limitation in this system is probably the push behind the Medicare G-codes for claims based functional limitation reporting.  You often hear from Medicare that they don't know who is receiving what and why.

I believe it is ultimately the responsibility of the PT to determine the diagnosis and code appropriately.  I agree that having a coders assistance can be valuable but I am not clear how they can review documentation and choose diagnosis codes - that is the responsibility of the clinician.

In your example above, I agree that using a code such as 596.0 in isolation would most likely not be a wise decision on the part of the clinician as it does not assist in painting a clear picture to the payor and/or reviewer.  Now using 596.0 along with V15.88, 728.87, and 788.31 (incontinence) could help pain the picture of patient with bladder dysfunction contributing to incontinence, and a history of falls and muscle weakness associated with the bladder dysfunction, possibly from prolonged immobilization or attempts to get up in the night to void and contributing to falls.

I encourage my staff to pain as clear a picture as possible through the use of the ICD9.  As time moves on, progressing to newer classification systems such as ICD10, ICF, functional reporting and the Alternative Payment System will help paint a much clearer picture.

Dan January 30, 2013 10:44 PM
FL

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About this Blog


    Jason J. Marketti
    Occupation: Physical Therapist Assistant
    Setting: San Jacinto, CA
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