Additional coding guidance is provided in APTA's ICD-10 FAQ resource. Access all of APTA's ICD-10 resources.
ICD-10 Official Guidelines
As with ICD-9, ICD-10 is supplemented by official guidelines that provide details on the use of the ICD-10 codes. There are different guidelines for each year, so when you access them, be sure you're using the guidelines for the correct year. Guidelines are available now for years 2015 and 2016-but you will not use the 2016 guidelines until you begin providing services on or after January 1, 2016.
CDC: ICD-10-CM Official Guidelines for Coding and Reporting (2015)
Most online booksellers carry printed versions of ICD-10-CM 2015: The Complete Official Codebook. The 2016 book is available in draft form, or you can preorder the final version.
Accessing ICD-10 Code Sets
Along with the official guidelines, CMS provides free electronic files of the complete ICD-10-CM code sets. CMS also developed a crosswalk of sorts between ICD-9 and ICD-10, called the General Equivalence Mappings (GEMs). We say "of sorts" because the change from ICD-9 to ICD-10 does not allow for a 1-to-1 crosswalk, and so it is not recommended to use the GEMs independently. Again, be sure you download the codes for the correct year; both 2015 and 2016 code sets are available.
2016 ICD-10-CM and GEMs
(First download the "2016 Code Tables and Index" (.zip/16MB). The files are titled "Index.pdf" and "Tabular.pdf.")
Common Codes Used in Physical Therapy
To help you identify appropriate ICD-10-CM codes to use, below are PDFs listing commonly used codes in physical therapist practice. The lists are not exhaustive and should not be used exclusively; accompany them with the ICD-10-CM Official Guidelines, tables, and index.
To best navigate the lists, open the expandable and collapsible bookmarks feature in the left column of each PDF.
A Note About the First-Listed Diagnosis
APTA is aware of the many questions about the first-listed diagnosis for patients receiving outpatient physical therapist services. For clarification, APTA contacted the ICD-10 Cooperating Parties, which include the American Hospital Association (AHA), the American Health Information Management Association (AHIMA), CMS, and the Centers for Disease Control and Prevention. The Cooperating Parties agree that with the transition to ICD-10 it is important that all health care providers code consistently.
The Health Insurance Portability and Accountability Act (HIPAA) requires assigning ICD-10-CM diagnosis codes according to the ICD-10-CM Official Guidelines for Coding and Reporting. The ICD-10-CM Official Guidelines for Coding and Reporting FY 2016 state:
“Codes for symptoms, signs, and ill-defined conditions from Chapter 18 are not to be used as principal diagnosis when a related definitive diagnosis has been established.” Page 96.
"List first the ICD-10-CM code for the diagnosis, condition, problem, or other reason for encounter/visit shown in the medical record to be chiefly responsible for the services provided. List additional codes that describe any coexisting conditions.” Page 102.
“Codes that describe symptoms and signs, as opposed to diagnoses, are acceptable for reporting purposes when a diagnosis has not been established (confirmed) by the provider.” Page 101.
APTA recognizes that payers have not been consistent with instructions on the first-listed diagnosis, and physical therapists may not have been coding according to the guidelines above. Going forward with ICD-10, APTA believes the first-listed diagnosis should be consistent with the ICD-10 Coordinating Parties, payers, and other organizations.
If you follow the ICD-10-CM Official Guidelines for Coding and Reporting, and your claim is delayed or
denied, complete the Online Complaint Form on APTA's website so the association can help you resolve the issue.