“Moving Over…Transition from a School to a Medical Position”

Presenter: Linda K Pippert, MA, CCC-SLP, MBA

Vice President, Clinical Operations AlphaVista Services

Adjunct Faculty: Chapman University, Extended Ed

CSU Fullerton, Adult Clinic Supervisor

Nova Southeastern University,Field Associate for Southern California

Course Objectives:Participants will be able to

• Determine if a transition from a school-based position to a medical setting is a career move to consider.

• Identify and name sources and topics related to continuing education that would prepare one for a transition to a medical placement.

• Explore options for establishing a mentoring relationship with an SLP in the targeted setting.

What’s involved in making a change?•Personal Aspects•Clinical Aspects•Professional Growth/Interest

•Continuing Education•Training•Materials

What will be the same…different?• You…will still be the SLP• You…will still be making decisions about care.• You…will still have other professionals to work with• You…will still be the “expert” on speech, language, cognitive and swallowing disorders.• You…will still be the one who knows most about hearing and hearing disorders.

• You will be called the speech-language pathologist.• You will be making decisions about communication, interacting with family and healthcare workers.• You will be working with doctors, nurses, CNAs, RNAs, PTs, OTs• You will be called upon to determine diet levels…everyday

Change:

What is change to you?

•Are you someone who shies away from change?

•Are you someone who accepts change? (but would rather stay with the status quo)

•Are you someone who chases after change?

Key Factors to Consider…•How much prep will I need?

•When will I access the continuing ed that I will need to prepare for a change in work settings?

•How much am I willing to invest in change?

•Do I have a mentor to assist me with this transition?

•What is my lead time for making a career transition?

Key Factors to Consider…

•What kind of medical setting do you envision yourself in?

•Have you had any prior experience in a medical setting?

•Did you have a great externship in grad school and “don’t want to lose” those skills?

•How far am I willing to travel for a medical position?

• Am I will to change facilities mid-day?

Key Factors to Consider…

•How many hours a week do I want to work a medical position?

•Will working with trachs and vents “gross” me out?

•Will working with swallowing disorders be disturbing?

•Do I have a strong support system should I make this change to a permanent position?

Things to consider…

• Personal Aspects• Clinical Aspects• Professional Growth/Interest

• Continuing Education• Training•Materials

Continuing Education Topics:

•Dysphagia

•Cognitive decline/Dementia

•Neuro disorders:Parkinsons, CVA, TBI, Huntington’s Disease,

ALS, MG

Continuing Education Sources:• ASHA Healthcare Institute• ASHA• CSHA• Northern Speech Services• Speechpathology.com• Medical Speech Council of California:

www.msccslpceus.org

ASHA SIDs

•Gerentology: Special Interest Group 15, Gerontology

http://www.asha.org/SIG/15/

•Dysphagia: Special Interest Group 13, Swallowing and Swallowing Disorders (Dysphagia)

http://www.asha.org/SIG/13/

•Neurogenics: Special Interest Group 2, Neurophysiology and Neurogenic Speech and Language Disorders.

http://www.asha.org/SIG/02/

On-line Networks•Facebook (FB):

Closed groups, but you can request to join.

•Medical SLP Forum• https://www.facebook.com/groups/medicalslpforum/

•Adult Rehab Speech Therapy• https://www.facebook.com/groups/adultrehabspeechtherapy/

•Brainline.org https://www.facebook.com/brainline

Other ASHA Resources•http://www.asha.org/practice-portal/about/•Clinical Topics: • Aphasia•Dementia

“Search” on the ASHA Web Site:Access to articles and many PPTs from past ASHA Conventions!

Billing and Coding: Diagnostic Codes•Diagnostic Codes: ICD-9s are still in use until October, 2015.• Here are some commonly used ICD-9s for medical facilities:

• The “Medical Diagnosis” eg the diagnosis given by a medical doctor.• The “Treatment Diagnosis” eg the diagnosis given by the SLP

• The “Medical Diagnosis” will be an illness, injury or disease, such as Parkinson’s Disease: ICD-9 332

CVA: ICD-9 436

** 2014 ICD-9-CM Diagnosis Codes: Related to Speech and Hearing Disorders is available on the ASHA Web site.

Billing and Coding: Diagnostic Codes• The “Treatment Diagnosis” will be the diagnosis which the SLP

determines• 784.3 Aphasia

• 784.3 Voice Disturbance

• 784.40  Voice and resonance disorder, unspecified

• 784.41 Aphonia

• 784.42  Dysphonia, Hoarseness

• 784.51  Dysarthria• 784.60  Symbolic dysfunction, unspecified

• 787.2 Dysphagia

• 787.20  Dysphagia, unspecified

• 787.21  Dysphagia, oral phase

• 787.22  Dysphagia, oropharyngeal phase

• 787.23  Dysphagia, pharyngeal phase

• 787.24  Dysphagia, pharyngoesophageal phases

http://www.asha.org/practice/reimbursement/coding/SLPCodes.htm

Billing and Coding: Diagnostic Codes

• “Treatment Diagnosis” related to CVA• 438 Late effects CVA

• 438.1 Late effects, CA Speech/Language Deficits

• 438.11 Late effects CVA Aphasia

• 438.12 Late effects CVA Dysphasia

• 438.81 Late effects CVA Apraxia

• 438.82 Late effects CVA Dysphagia

http://www.asha.org/practice/reimbursement/coding/SLPCodes.htm

Billing and Coding: Procedure Codes• The code to indicate what procedure that you have

completed with the patient:

• Evaluation Codes• 92521 Evaluation of Speech Fluency

• 92522 Evaluation of Speech Sound Production: artic, phono, apraxia, dysarthria

• 92523 Evaluation of Speech Sound Production with Evaluation of Language Comprehension and Expression

• 92524 Behavioral and Qualitative Analysis of Voice and Resonance

• 92610 Evaluation of Oral and Pharyngeal Swallowing Function

• 92611 Motion Fluoroscopic Evaluation of Swallowing Function by cine or video recording

• 96105 Assessment of Aphasia

• 96125 Standardized Cognitive Performance Testing (eg RIPA-G, ABCD, etc) per hour.

Billing and Coding: Procedure Codes• The code to indicate what procedure that you have completed

with the patient:• Treatment Codes• 92507 Speech Therapy, Individual

• 92508 Speech Therapy, Group

• 92626 Dysphagia Treatment

• 92532 Cognitive Treatment

Working in a Skilled Nursing Facility• Part-A: Up to 100 days of “skilled care” (nursing and/or rehab) following a 3-day “qualifying stay” in an acute hospital

• Part-B: Out-patient therapy, but may be provided at an acute hospital, rehab or Skilled Nursing Facility (SNF)

•Working with Geriatrics:• Changes in the physical condition due to aging: skin, respiratory/circulatory systems, eye sight, hearing, bone condition.•Multiple diseases/conditions/illnesses• Affects of multiple medications

Tests for use with the adult/geriatric population• Communication Activities of Daily Living (CADL-2)• ABCD• RIPA-G• WAB• BDAE• CLQT• E/ROWPVT-4• Burns Brief Inventory of Communication and Cognition (Burns

Inventory)

My Favorite Materials…•Show and Tell…•Source for…books from Linguisystems• Aphasia• Dysphagia• Alzheimer’s and Dementia• Executive Function Disorders• Also from Linguisystems• Results for Adults• Just For Adults Photo Cards

• VNA Books: Kathryn KilpatrickEnglish and Spanish

(See Handout for books, workbooks, textbooks)

Contact Information•Linda K Pippert, MA, CCC-SLP, MBA

Pippert.linda@gmail.com

714-932-3931

References• (Handout has a complete list)• ASHA Web site:• Examples of Documentation of Skilled and Unskilled Care for Medicare

Beneficiaries: Speech-Language Pathology Services

• Medicare Coding Rules for SLP Services

• Coding for Reimbursement FAQs: SLP

• 2014 ICD-9-CM Diagnosis Coding: Related to Speech and Hearing Disroders

• “Search” for the disorder that you are interested in learning more about:• Apraxia

• Dysarthria

• Dysphagia

• Aphasia

• Cognitive Decline

• Dementia

Courses on Speechpathology.com• O’Hara, Lorelei. Medicare Muscle: Creating Defensible

Documentation• Swigert, Nancy. Documenting to Demonstrate Skilled Service

and Focus on Function • Swigert, Nancy. Decoding the Coding Systems: When, How and

Why to Code What • Swigert, NancyUnderstanding the Physiology of Impaired

Pharyngeal Swallowing • Ludlow, Christy. The Effects of Transcutaneous Electrical

Stimulation During Dysphagia Management: What it does and whether it alters recovery• Prakup, Barbara. What Should I Do? Ethical Considerations for

SLPs who Work with Adults• (See handout for additional courses)