Outpatient Specialized Therapies - Important Changes Coming With ICD-10

The secondary diagnosis code on an outpatient specialized therapy claim is currently used to indicate which therapy discipline was involved, including ICD-9 codes V57.0 (Respiratory Therapy), V57.1 (Physical Therapy), V57.21 (Occupational Therapy), and V57.3 (Speech Therapy). Beginning with dates of service on and after October 1, 2015, the ICD-10 code Z51.89 replaces the aforementioned ICD-9 codes, but this code will not be required on the claim as a secondary diagnosis.

For dates of service starting October 1, the rendering provider taxonomy will determine the use of revenue codes and CPT codes for the appropriate therapy. Providers will still submit a primary diagnosis that supports the therapy, but the Z51.89 diagnosis code will not be required on claim submissions. If the rendering provider taxonomy code on the claim does not correspond to the revenue code or CPT code billed, the claim will deny with EOB 02313 - PROCEDURE CODE INVALID FOR RENDERING PROVIDER TAXONOMY.


Providers will continue to use the V codes as the secondary diagnosis on claims submitted for services rendered prior to October 1, but if the V codes are included on claims for services rendered on or after October 1, the claim will deny. Clinical Coverage Policy 10A Outpatient Specialized Therapies is being updated to reflect the changes for ICD-10.


Frequently Asked Questions re: Outpatient Specialized Therapies and ICD-10

Following are several frequently asked questions regarding Outpatient Specialized Therapies and ICD-10:


Q: As outpatient specialized therapies, we use V-codes. Are there ICD-10 codes for the V Codes: V571 for Speech Therapy, V572 for Occupational Therapy, V573 for Physical Therapy?


A: All the ICD-9 therapy V codes (PT, OT, and ST) map to a single ICD-10 code:  Z51.89 Encounter for other specified aftercare, which will not be required on claim submissions.


Q: We are a therapy office specializing in Physical, Occupational and Speech therapy. Currently, we have to use a V code with each claim (V57.1, V57.21, V57.3) for each therapy. Are these still required once the transition happens and if so, what would be the corresponding ICD-10 code?


A: For services rendered on October 1 and forward, a secondary diagnosis code will no longer be required to differentiate between OT, PT & ST. The rendering provider taxonomy will determine the use of the revenue codes and the CPT codes on claims submitted. The single ICD-10 diagnosis code for outpatient specialized therapies will be Z51.89 Encounter for other specified aftercare, which will not be required on claim submissions.


Q: I have noticed on the Crosswalk the codes that differentiate Physical, Occupational, and Speech therapies are the same in the ICD-10 coding. What will happen when I am billing the same codes for PT, OT, and speech therapy on the same day of service for the same patient? 


A: You are correct. The ICD-10 diagnosis code does not differentiate between the different types of therapy being provided.  The taxonomy of the rendering provider should be the differentiating factor when the same CPT code is billed on the same date of service for the same beneficiary.


For example:  Beneficiary sees the OT (rendering provider taxonomy 225X00000X) on May 5  and the OT bills for CPT Code 97530, and the beneficiary sees the PT (rendering provider taxonomy 225100000X) on the same day and the PT bills for CPT Code 97530.  When the claims are adjudicated, the NCTracks system should pay both claims even though the CPT Code and the date of service match because the rendering provider taxonomy and NPI are different.