ICD-10 deadline, October 1, 2015 service
- For DHCS contracted services, beginning in October you may use the ICD-10 codes, for both chart medical necessity compliance and billing (required for claiming), and avoid using DSM (see DMH slides on this); per DMH: “Contract providers will provide DMH with the ICD10 diagnosis for the claim and for CSI admission.” Therefore, what most providers / EHRS vendors are planning on, is to have the clinician choose the DSM 5 and ICD-10 codes for every client (there is no longer a one-to-one relationship between DSM and ICD, so the EHRS cannot determine which ICD-10 code to use based on the DSM 4 or DSM 5 Dx chosen by the clinician. You need to train your clinicians on both ICD-10 codes and DSM 5.
- For other non DHCS contracts, such as Drug Medi-Cal / Substance Abuse, you may also need a DSM 5 Dx starting in October.
- Steps you need to take prior to October 1st service dates:
- If you are an IS DDE claimer... your IS client episode records need the ICD-10 codes entered, or your claims will be returned with a "rule fail", for all service dates beginning Oct. 1st.
- DMH
clarified for contract providers who are billing to the IS
via data entry (DDE) – DMH is looking into converting some of your client open
episodes' Dx in the IS for you (by mid-Sept.), by converting DSM 4/ICD-9 codes to ICD-10
codes (using the State ICD9 to ICD10 crosswalk).
However, there is not a one-to-one mapping of ICD-9 codes to ICD-10 codes, so
some clients’ ICD-10 codes (5 Axis) will
need to be determined by the clinician and then entered into the client’s IS
record before you can bill for their services beginning with dates of service October
1, 2015.
Note: you need to know when and if DMH does this conversion and how you will know which Dx’s need your clinicians' attention and what to do about them. - Any DDE claims for service dates beginning Oct 1st that do not have a valid ICD-10 code in the IS record (DDE) will receive a "rule fail" upon claim submission.
- Your claims need the ICD-10 codes in them, IS EDI and IBHIS EDI, for service dates beginning Oct 1st.
- Any IS EDI claims for service dates beginning Oct 1st that do not have a valid ICD-10 code in the claim, will received a "rule fail" upon claim submission. IS EDI claims will proceed without issue, if the client record does not have the ICD-10 code in it, as long as the code is in the claim, there will be no validation against the client record.
- IBHIS EDI claims for service dates beginning Oct 1st will received a "rule fail" if the claim does not have a valid ICD-10 code in it. IBHIS will not validate the claim against the client record to see if the client record has an ICD10 code; IBHIS only looks at the diagnosis on the claim.Note: you need to know if DMH will convert the IBHIS client records to the ICD-10 codes. If so, by when and how will you know which ones need your clinicians' attention.
- Your clinical staff need to be trained to select the ICD-10 codes for all intakes and clients with service dates beginning Oct 1st; for DHCS contracted services they do not need to select the DSM 4 as well, but if you want them to, then they need to also select the ICD-10 code (your EHRS can no longer map the DSM to the ICD for you). If you provide non DHCS, such as Drug Medi-Cal, you may also need your clinicians to select the DSM 5...... so seems that a best practice is going to be selecting the ICD-10 and the DSM5 beginning in October.
- NEWS! Just in from a customer (thanks Daniel!) ... LACDMH will use this training material to train their in-house clinicians: http://apps.who.int/classifications/apps/icd/icd10training/
No comments:
Post a Comment