Impairment categories guide

SGP KP Publishing

Exported on 2025-01-20 00:18:10

Page 75 of 208

Table of Contents

1 Recent updates …………………………………………………………………………………………………….. 4 2 Impairments categories guide ……………………………………………………………………………….. 5 3 Conditions …………………………………………………………………………………………………………….. 6 3.1 Autism (ASD) ………………………………………………………………………………………………………. 6 3.2 Acquired brain injury …………………………………………………………………………………………….. 6 3.3 Intellectual disability ……………………………………………………………………………………………… 6 3.4 Cerebral Palsy …………………………………………………………………………………………………….. 8 3.5 Down Syndrome ………………………………………………………………………………………………….. 8 3.6 Hearing Impairment ……………………………………………………………………………………………… 8 3.7 Visual Impairment ………………………………………………………………………………………………… 8 3.8 Other Sensory - Speech ……………………………………………………………………………………….. 8 3.9 Multiple Sclerosis …………………………………………………………………………………………………. 8 3.10 Other Neurological ……………………………………………………………………………………………. 9 3.11 Stroke ……………………………………………………………………………………………………………… 9 3.12 Other Physical ………………………………………………………………………………………………….. 9 3.13 Psychosocial disability …………………………………………………………………………………….. 10 3.14 Spinal Cord Injury …………………………………………………………………………………………… 10 3.15 Other …………………………………………………………………………………………………………….. 11

SGP KP Publishing – Impairment categories guide

This article provides guidance for an access delegate to understand what impairment categories to select for a person that meets the eligibility requirements.

Recent updates – 3 Page 77 of 208

SGP KP Publishing – Impairment categories guide

Recent updates

14 October 2024

New guidance to:

• reflect legislation changes from 3 October 2024
• decide what impairment categories to select for a person that meets the eligibility requirements.

Recent updates – 4 Page 78 of 208

Impairments categories guide

Impairments are a loss of or damage to a body’s function. When we assess an impairment to meet access, we look at:

• the body’s function
• the body’s structure
• how they think and learn. To learn more about impairment categories go to article Descriptions of impairment categories.

The following list provides you with information on:

• the condition
• the ICD 10 Code
• the required impairment category for access assessors to select
• optional impairment categories to select as relevant, based on evidence provided with access request.

Conditions

Autism (ASD)

• Autism - includes Rett and Asperger Syndrome
  • ICD 10 Codes: F84.0, F84.2, F84.5
  • Required impairment category: Neurological
  • Optional impairment categories: Intellectual, cognitive, physical, psychosocial

Acquired brain injury

• Glioblastoma ICD 10 Code: G71.9

  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, physical, psychosocial

• Hypoxic brain injury ICD 10 Code: 93.1

  • Required impairment category: Neurological
  • Optional impairment categories: Physical, psychosocial

• Traumatic brain injury - also called head injury and acquired brain damage

  • ICD 10 Code: T90
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, physical, psychosocial

Intellectual disability

• Mild intellectual disability ICD 10 Codes: F70

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive

• Moderate intellectual disability ICD 10 Codes: F71

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, physical, psychosocial

• Severe intellectual disability ICD 10 Codes: F72

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, physical, psychosocial

• Profound intellectual disability ICD 10 Codes: F73

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, physical, psychosocial

• Unspecified intellectual disability ICD 10 Codes: F79

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, sensory, physical, psychosocial

• Pervasive developmental disorder ICD 10 Codes: F84.8

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, sensory, psychosocial

• Microcephaly ICD 10 Codes: Q02

  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, neurological, sensory, physical

• Other congenital brain conditions - for example, tuberous sclerosis

  • ICD 10 Codes: Q04
  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, neurological, physical

SGP KP Publishing – Impairment categories guide

9. Spina bifidaICD 10 Codes: Q05 Required impairment category: Physical Optional impairment categories: Intellectual, cognitive, sensory, neurological

10. Foetal alcohol syndromeICD 10 Codes: Q86.0 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

11. Foetal alcohol spectrum disorder (FASD)ICD 10 Codes: Q86.0D Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, sensory, physical, psychosocial

12. Cornelia de Lange syndromeICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

13. Prader Willi syndromeICD 10 Codes: Q87.1 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, physical, psychosocial

14. Coffin-Lowry syndromeICD 10 Codes: Q87.8 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

15. Other congenital conditions (causing intellectual disability)ICD 10 Codes: Q89 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

16. Edwards syndromeICD 10 Codes: Q91 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

17. Patau syndromeICD 10 Codes: Q91 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

18. Cri du Chat syndromeICD 10 Codes: Q93.4 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

19. Angelman syndromeICD 10 Codes: Q93.5 Required impairment category: Intellectual Optional impairment categories: Cognitive, sensory, physical

20. Other chromosomal syndromes (including Kabuki & Williams syndromes)ICD 10 Codes: Q99 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

21. Fragile X syndromeICD 10 Codes: Q99.2 Required impairment category: Intellectual Optional impairment categories: Cognitive, neurological, sensory, physical, psychosocial

Cerebral Palsy

• Cerebral palsy ICD 10 Codes: G80
  • Required impairment category: Physical
  • Optional impairment categories: Intellectual, cognitive, neurological, sensory

Down Syndrome

• Down syndrome ICD 10 Codes: Q90
  • Required impairment category: Intellectual
  • Optional impairment categories: Cognitive, physical

Hearing Impairment

Hearing loss

• ICD 10 Codes: H90
• Required impairment category: Sensory
• Optional impairment categories: Cognitive

Congenital hearing condition

• ICD 10 Codes: Q16.9
• Required impairment category: Sensory
• Optional impairment categories: Cognitive

Visual Impairment

Albinism

• ICD 10 Codes: E70.3
• Required impairment category: Sensory
• Optional impairment categories: Not applicable

Visual impairment (including blindness)

• ICD 10 Codes: H54
• Required impairment category: Sensory
• Optional impairment categories: Not applicable

Congenital eye conditions

• ICD 10 Codes: Q15.9
• Required impairment category: Sensory
• Optional impairment categories: Not applicable

Other Sensory - Speech

Other sensory - speech

• ICD 10 Codes: R47
• Required impairment category: Sensory
• Optional impairment categories: Physical

Multiple Sclerosis

• Multiple Sclerosis ICD 10 Codes: G35
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, physical, psychosocial

SGP KP Publishing - Impairment categories guide

Other Neurological

1. Alzheimer’s disease ICD 10 Codes: F00 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial
2. Unspecified dementia ICD 10 Codes: F03 Required impairment category: Cognitive Optional impairment categories: Neurological, physical, psychosocial
3. Huntington disease ICD 10 Codes: G10 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, psychosocial
4. Motor neurone disease ICD 10 Codes: G12.2 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial
5. Parkinson’s disease ICD 10 Codes: G20 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial
6. Epilepsy – Mandatory TAPIB ICD 10 Codes: G40 Required impairment category: Neurological Optional impairment categories: Intellectual, cognitive, psychosocial
7. Muscular dystrophy ICD 10 Codes: G71.0 Required impairment category: Physical Optional impairment categories: Neurological
8. Other Neurological – List A and List C ICD 10 Codes: G99 Required impairment category: Neurological Optional impairment categories: Cognitive, sensory, physical

Stroke

1. Stroke ICD 10 Codes: I69 Required impairment category: Physical Optional impairment categories: Cognitive, neurological, sensory, psychosocial

Other Physical

1. Rheumatoid arthritis ICD 10 Codes: M05 Required impairment category: Physical Optional impairment categories: Not applicable
2. Other arthritis – mandatory TAPIB ICD 10 Codes: M12 Required impairment category: Physical Optional impairment categories: Not applicable
3. Other physical ICD 10 Codes: M95 Required impairment category: Physical Optional impairment categories: Psychosocial
4. Multiple traumatic amputations ICD 10 Codes: T05 Required impairment category: Physical Optional impairment categories: Psychosocial
5. Myopathy ICD 10 Codes: G72.9 Required impairment category: Physical Optional impairment categories: Not applicable

3.13 Psychosocial disability

• SchizophreniaICD 10 Codes: F20 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Schizoaffective disorderICD 10 Codes: F25.9 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Bipolar affective disorderICD 10 Codes: F31 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Major depressive illnessICD 10 Codes: F32 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Other anxiety disordersICD 10 Codes: F41 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Obsessive-compulsive disorderICD 10 Codes: F42 Required impairment category: Psychosocial Optional impairment categories: Not applicable

• Post traumatic stress disorderICD 10 Codes: F43 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• Borderline personality disorderICD 10 Codes: F60.3 Required impairment category: Psychosocial Optional impairment categories: Not applicable

• Tourette syndromeICD 10 Codes: F95.2 Required impairment category: Neurological Optional impairment categories: Cognitive, physical, psychosocial

• Other psychosocial disordersICD 10 Codes: F99 Required impairment category: Psychosocial Optional impairment categories: Cognitive

• AnorexiaICD 10 Codes: R63 Required impairment category: Psychosocial Optional impairment categories: Cognitive, physical

3.14 Spinal Cord Injury

• Malignant neoplasm of spinal cord complete and incompleteICD 10 Codes: C72.5, C72.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory

• Spinal cord injury (complete)ICD 10 Codes: T09.5 Required impairment category: Physical Optional impairment categories: Neurological, sensory, psychosocial

• Spinal cord injury (incomplete)ICD 10 Codes: T09.7 Required impairment category: Physical Optional impairment categories: Neurological, sensory, psychosocial

SGP KP Publishing - Impairment categories guide

Other

• Malignant neoplasm of brain ICD 10 Codes: C71
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, psychosocial
• Metastatic cancer ICD 10 Codes: C79.9
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive
• Malignant neoplasm of blood or immune disease ICD 10 Codes: C96
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive
• Autoimmune disorders ICD 10 Codes: D89.9
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive
• Obesity – mandatory TAPIB ICD 10 Codes: E66
  • Required impairment category: Physical
  • Optional impairment categories: Psychosocial
• Classical phenylketonuria ICD 10 Codes: E70.0
  • Required impairment category: Cognitive
  • Optional impairment categories: Psychosocial
• Disorders of pyruvate metabolism and gluconeogenesis ICD 10 Codes: E74.4
  • Required impairment category: Intellectual
  • Optional impairment categories: Neurological, physical
• Other metabolic disorders ICD 10 Codes: E88
  • Required impairment category: Intellectual
  • Optional impairment categories: Neurological, physical
• Dementia – rapidly progressing ICD 10 Codes: F03.9
  • Required impairment category: Cognitive
  • Optional impairment categories: Not applicable
• Functional neurological disorder (FND) – mandatory TAPIB ICD 10 Codes: F44.4
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, sensory, physical
• Other language disorder ICD 10 Codes: F80
  • Required impairment category: Cognitive
  • Optional impairment categories: Not applicable
• Peripheral neuropathy – does NOT require TAPIB ICD 10 Codes: F90.0
  • Required impairment category: Neurological
  • Optional impairment categories: Sensory, physical
• Oppositional defiant disorder (ODD) ICD 10 Codes: F91.3
  • Required impairment category: Cognitive
  • Optional impairment categories: Psychosocial
• Other hereditary ataxias ICD 10 Codes: G11.8
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive, sensory, physical
• Dementia – early onset ICD 10 Codes: G30.0
  • Required impairment category: Cognitive
  • Optional impairment categories: Not applicable
• Plegia ICD 10 Codes: G83.1
  • Required impairment category: Physical
  • Optional impairment categories: Neurological

SGP KP Publishing – Impairment categories guide

Conditions

• Chronic pain – mandatory TAPIBICD 10 Codes: G89.4
  • Required impairment category: Physical
  • Optional impairment categories: Sensory, psychosocial
• Postural Orthostatic Tachycardia Syndrome (POTS) – mandatory TAPIBICD 10
  • Codes: I49.8
  • Required impairment category: Neurological
  • Optional impairment categories: Physical
• Lymphoedema – mandatory TAPIBICD 10 Codes: I89.0
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• Chronic lung diseaseICD 10 Codes: J44.9
  • Required impairment category: Physical
  • Optional impairment categories:
• Chronic Obstructive Pulmonary Disease (COPD) – mandatory TAPIBICD 10
  • Codes: J44.9A
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• Osteoarthritis – mandatory TAPIBICD 10 Codes: M19.9
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• Systemic lupus erythematosusICD 10 Codes: M32
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• Ankylosing spondylitisICD 10 Codes: M45
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• FibromyalgiaICD 10 Codes: M79.7
  • Required impairment category: Physical
  • Optional impairment categories: Sensory
• Renal failureICD 10 Codes: N18
  • Required impairment category: Physical
  • Optional impairment categories:
• Ehlers Danlos – does NOT require TAPIBICD 10 Codes: Q79.6
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• DyslexiaICD 10 Codes: R48
  • Required impairment category: Cognitive
  • Optional impairment categories: Psychosocial
• Childhood apraxia of speechICD 10 Codes: R48.2
  • Required impairment category: Neurological
  • Optional impairment categories: Cognitive
• Short statureICD 10 Codes: R62.5
  • Required impairment category: Physical
  • Optional impairment categories: Not applicable
• Amputation – single limb or upper/lower limbICD 10 Codes: Z89
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, sensory, psychosocial
• Amputation – multipleICD 10 Codes: Z89.1
  • Required impairment category: Physical
  • Optional impairment categories: Cognitive, sensory, psychosocial

Standard Operating Procedure

Add or Change Disability

The content of this document is OFFICIAL. This Standard Operating Procedure (SOP) will help you change the participant’s primary and/or secondary disability in the NDIS Business System.

Recent updates

Date	What’s changed
July 2021	Clarify actions for non-delegates when requesting to add or change the participant’s disability information in the System.

Checklist

Topic	Checklist
Pre-requisites	You have:

• checked the participant’s disability information in the System.
• information or evidence the participant’s disability information needs to be updated. | | Actions | - 3.1 Add or change disability
• 3.2 Approve a request to add or change disability |

Standard Operating Procedure

OFFICIAL For Internal Use Only

Procedure

Add or change disability

1. From the participant’s NDIS Account select Add Items and select Disability.

2. Select the expander in the Reported Impairment field.

3. Search for and select the participant’s disability.

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Standard Operating Procedure

OFFICIAL For Internal Use Only

• If you are adding a secondary disability go to step 5.

4. Select the check box next to Primary to show the Reported Impairment is the primary disability. Continue to step 6.

Note: After the access decision is made there can only be one Primary disability.

5. Enter the Effective Start and Effective End dates for any secondary disabilities.

6. At Onset Date enter the date the participant first acquired, developed or experienced disability (if known).

7. At Evidence of Diagnosis select the type of evidence from the drop down list.

8. Select Submit.

9. A success message displays. The message is different depending on your role in the System. If you are a:

• Access or Planning delegate – go to 3.1.1 Complete add or change disability
• Non-delegate – go to 3.1.2 Request to add or change disability

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Standard Operating Procedure

OFFICIAL For Internal Use Only

Complete add or change disability (Access and planning delegates)

1. The Disability created successfully message displays. Select OK.

2. Create an interaction using the Interaction Template – General –Primary Disability Change Complete. If you:

• Made the request make sure the Interaction status is Completed.
• Did not make the request make sure the Interaction status is Open. Reassign the interaction back to the requestor to notify their request is complete.

Note: If you are updating a secondary disability, change the details of the interaction to reflect this.

Request to add or change disability (non-delegates)

1. The No authorization to create impairment message displays. Select OK. Your request will be drawn down by an Access or Planning delegate from Work Load Manager (WLM).

2. Create an interaction using the Interaction Template – General –Request to Change Primary Disability. Make sure the Interaction status is Completed.

Note: In your interaction make sure you include:

• details of the evidence provided
• where the evidence is recorded in the System, for example the date and description of the Inbound Document
• whether your request is for a primary or secondary disability.

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Standard Operating Procedure

OFFICIAL For Internal Use Only

3. The approver will assign an Open Interaction using the Primary disability change complete template to you when the request is complete or if you need to take further action.

Approve a request to add or change disability (access or planning delegate only)

1. From My Inbox select the Ready for Work.

Ready for Work	Unassign	Reassign

2. Select Change of Circumstances (CoC) task.

Due Status	Type	Description	NDIS Number	Customer	Team	Plan End Date	Due date	Status

3. Review the information in the Notes Log. Record additional information in the Add Note field, if required.

| Categorisation 1: | | | | | | | | | | Categorisation 2: | | | | | | | | | | Categorisation 3: | | | | | | | | | | Categorisation 4: | | | | | | | | | | Date of Effect: | | | | | | | | | | Date of Submission: | | | | | | | | | | Requested by: | | | | | | | | | | Notes Log: | | | | | | | | | 4. Once you have made a decision, select Mark as Complete.

| Re-assign | Mark as Complete | Exit |

Standard Operating Procedure

OFFICIAL For Internal Use Only

5. The Change of Circumstances task completed successfully message displays. Select OK.

3.2.1 Approve Request for Disability Update

• Complete steps in 3.1 Add or change disability.
• Create an Open Interaction using the Primary disability change complete template.
• Re-assign the interaction to the requestor advising the disability request is approved and they can start planning tasks.

3.2.2 Decline Request for Disability Update

• Create an Open Interaction and record the reason you declined the request. Reassign the interaction to the person who made the request. Note: If the request is declined due to insufficient information, note what further information or action is required in the interaction.

4. Next steps

• Make sure the participant’s disability information is updated before you commence planning activities.

5. Related procedures or resources

• Standard Operating Procedure - Create, Assign, Search and Edit an Interaction
• Interaction Templates – General

6. Feedback If you have any feedback about this Standard Operating Procedure please complete our Feedback Form.

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Standard Operating Procedure

OFFICIAL For Internal Use Only

Version control

Version	Amended by	Brief Description of Change	Status	Date
1.0	CS0074	Class 1 Approval Update guidance on assigning tasks and interactions	APPROVED	2020-02-20
3.0	NAN927	Class 1 Approval	APPROVED	2020-05-07
4.0	CS0074	Class 1 Approval Updated image of buttons in CRM to show changes from icon to text to describe their purpose.	APPROVED	2020-05-29
5.0	JS0082	Class 1 Approval Guidance included to change interaction status to Complete after submitting Change Disability requests in the System.	APPROVED	2020-12-18
6.0	JS0082	Class 1 Approval Restructure to clarify actions for non-delegates	APPROVED	2021-07-07

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