ICD-10 Codes for Physical Therapy: Why You Shouldn't Trust Cheat Sheets

Bill Gates once said, “I choose a lazy person to do a hard job, because a lazy person will find an easy way to do it.” Perhaps that explains the existence of CliffsNotes, infographics, quick guides, flowcharts, cheat sheets, automated crosswalks, and a slew of other “shortcuts.” But just because there’s an easier way to do a hard job doesn’t necessarily mean it’s the right way. This is especially true when it comes to ICD-10 in the rehab therapy industry.

The US healthcare system switches to ICD-10 in a few weeks, and major players in industries with oodles of money—like hospital networks—have allocated plenty of resources to preparing their systems and staffs for the transition. But in the land of private practice—especially PT, OT, and SLP—profit margins are much more narrow. And as a result, practice owners and clinicians have had to get much more creative and frugal with their prep work. For this reason, I can totally understand the allure of cheat sheets. It seems so simple, right? A single page of therapists’ most commonly used ICD-9 codes with their corresponding ICD-10 equivalents. These uber-convenient one-pagers lead you to believe that all you need to do is print a couple copies, tape them up around the clinic, and bam! You’re ready for ICD-10. But the problem with this plan lies right in the document’s name: cheat sheet. And I’m not sure who said it first, but cheaters never prosper.

The healthcare industry has been freaking out about ICD-10 for years now—so much so that they’ve successfully delayed the transition three times. If the transition to ICD-10 could genuinely be boiled down into a cheat sheet, don’t you think we would’ve all made the switch long ago?

So, what specifically is wrong with ICD-10 cheat sheets for rehab therapists? Two words: pain codes. These are the most commonly used ICD-9 codes for PTs. In ICD-10, though, you shouldn’t use a pain code as a patient’s primary diagnosis if you can help it. ICD-10 requires a far greater degree of specificity; thus, payers want you to code for the underlying injury or condition first and foremost. Only then should you list the pain codes associated with the main diagnosis. Furthermore, some of the cheat sheets I’ve come across list “Pain in unspecified limb” as one of the ICD-10 codes therapists should reference. As I said before, ICD-10 requires you to code to the highest possible level of specificity, and “Pain in unspecified limb” doesn’t meet that standard. Why? Because you, as the therapist, should definitely know which limb is in pain.

Lastly, these cheat sheets fail to account for the seventh character, which is an absolute must for injury codes. So, if you relied solely on a cheat sheet to tell you the proper diagnosis code for a particular case, you would leave yourself vulnerable to not only using a pain code as your primary diagnosis—a big no-no—but also using incomplete codes, as the cheat sheet probably wouldn’t include instructions for affixing the correct seventh character (A, D, or S) to any codes requiring one. Why? Because as this blog post points out, “...there’s no ICD-9 equivalent of the seventh character.” Beyond that, selecting the right seventh character requires you to use your clinical expertise to determine the phase of treatment. For all of these reasons, depending entirely on a crosswalking cheat sheet could spell disaster for your practice in the form of denials or insufficient reimbursements.

Now, all of this is not to say that cheat sheets can’t be helpful, especially if they include ICD-10 equivalents of non-pain ICD-9 codes. I’m simply providing a word of caution: Don’t put all of your eggs in the cheat sheet basket. These types of charts can certainly be one resource in your robust training kit—after all, you will use pain codes as secondary diagnosis codes on many treatment plans—but they should never be the end all be all.

There are a lot of vendors out there providing all sorts of resources—including cheat sheets—to help you and your clinic better prepare for the switch. But, it’s on you to avoid the “lazy” way of doing things (i.e., steering clear of cheat sheets). Instead, amass—and thoughtfully review—all of the resources you can get your hands on, and institute proper training in your practice. Here are some materials I recommend:

• ICD-10 Crunch-Time Guide
• ICD-10 Bootcamp: Coding Exercises for PTs, OTs, and SLPs
• ICD-10 Crash Course: Last-Minute Training for PTs, OTs, and SLPs
• The Ultimate ICD-10 FAQ

Lastly, you can avoid cheat sheets altogether by simply using a documentation platform that has an intelligent and interactive ICD-10 coding tool. Take WebPT, for example. Our ICD-10 code picker allows you to search by injury, condition, partial phrases, ICD-10 code, or ICD-9 code—and we’ll alert you if greater specificity is possible with any particular code. Want to see the tool for yourself? Register now for our ICD-10 Crash Course webinar or request a free, online demonstration.