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

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

2. 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

3. 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.

4. What’s involved in making a change? • Personal Aspects • Clinical Aspects • Professional Growth/Interest • Continuing Education • Training • Materials

5. 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

6. 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?

7. 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?

8. 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?

9. 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?

10. Things to consider… • Personal Aspects • Clinical Aspects • Professional Growth/Interest • Continuing Education • Training • Materials

11. Continuing Education Topics: • Dysphagia • Cognitive decline/Dementia • Neuro disorders: Parkinsons, CVA, TBI, Huntington’s Disease, ALS, MG

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

13. 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/

14. 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

15. 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!

16. 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” willbe 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.

17. Billing and Coding: Diagnostic Codes • The “Treatment Diagnosis” willbe 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, pharyngoesophagealphases http://www.asha.org/practice/reimbursement/coding/SLPCodes.htm

18. 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

19. 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.

20. 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

21. 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

22. 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)

23. 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 Kilpatrick English and Spanish (See Handout for books, workbooks, textbooks)

24. Contact Information • Linda K Pippert, MA, CCC-SLP, MBA Pippert.linda@gmail.com 714-932-3931

25. 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

26. 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, NancyUnderstandingthe 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)