ICD-10 for Providers. Differences in ICD-9 and ICD-10. No Laterality Laterality Right or Left account for >40% of codes. 4-7 digits.

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1 ICD-10 for Providers Differences in ICD-9 and ICD-10 The World Health Organization s (WHO) International Classification of Diseases has served the healthcare community for over a century. The United States implemented the current version (ICD-9) in While most industrialized countries moved to ICD-10 several years ago, the United States is just now transitioning with a final compliance date of October 1, It s time our Medical Dictionary reflected modern medicine. The main difference between the two codes sets are as follows: ICD-9-CM Diagnosis Codes ICD-10-CM Diagnosis Codes No Laterality Laterality Right or Left account for >40% of codes 3-5 digits 4-7 digits First digit is alpha (E or V) or numeric Digits 2-5 are numeric Decimal is placed after the third character Digit 1 is alpha; Digit 2 is numeric Digits 3 7 are alpha or numeric Decimal is placed after the third character No placeholder characters X placeholders 14,000 codes 69,000 codes to better capture specificity Limited Severity Parameters Limited Combination Codes Extensive Severity Parameters Extensive Combination Codes to better capture complexity 1 type of Excludes Notes 2 types of Excludes Notes 1

2 Differences in ICD-10 for Clinical and School Based Because School-Based services (SBS) and Clinical services are similar and both fall under the rules of the Health Insurance Portability and Accountability Act (HIPAA), both will need to switch over to the new ICD-10 code set. With that being said, as similar as SBS and clinical services are, they are also very different. In the clinical setting, providers are expected to diagnose the patient: this is not the case with SBS. The SBS providers are using the ICD- 10 to tell Medicaid the symptoms that they are treating for a specific patient (student). Changes in GoClaim for ICD-10 ICD-10 Code Table Within the ICD-10 table in GoClaim, it lists what the ICD-10 code is (the alpha numeric code), a description of the code, and what codes cannot be used together (Excludes 1, and Excludes 2). What do Excludes 1 and Excludes 2 mean? It is possible to select multiple codes for each service submitted. Excludes 1 is the listing of codes that cannot be used with the ICD-10 code selected. Excludes 2 is a further description of those excluded codes. With the change to ICD-10, GoClaim has also changed how to search for a code; instead of searching within one field to find your ICD code, it will now search the entire grid for your search parameters. 2

3 Caseload On the caseload screen for a provider, both the ICD-9 and ICD-10 fields will need to be populated until such time that 09/30/2015 is past the date of timely filing. At that time, the ICD-9 field will be deactivated in GoClaim, and will no longer be seen. ICD-10 lists on the Caseload screen are listed by therapy type, meaning that if you are a Speech provider, you will only see speech ICD-10 related codes. This is not a complete list, but is based off those most frequently used ICD-9 codes. Additions can be made at any time by either contacting your account manager or helpdesk@gosolutions.net. No ICD-10 codes will be populated on the caseload with the start of the school year, so therapy-specific codes will need to be selected. If a provider is using an ICD-10 code that is no longer active, it will be listed in RED. If an ICD-10 is listed in RED, it must be changed prior to any additional entry taking place. The inactive code will still be visible, but cannot be used, and is no longer active. The showing of the old code is done to help with the selection of the new or active code. Please note services cannot be submitted until this code has been updated. A provider does not need to have an ICD-10/ICD-9 selected to get to the entry screen, but will need to select one prior to saving service information. Below is what a provider will see if an ICD-9/10 code needs to be selected. Anything in RED will need to be reviewed or selected. Please note if an ICD-10 code is in RED, this code is no longer an active code and must be replaced prior to entering a service, GoClaim only shows you what is currently selected, but will not allow the inactive code to be selected for future claims. How to select an ICD from the caseload screen Anything underlined is a link to a grid or report. For the purpose of ICD-9 and ICD-10, the underlined code will link to the search grid within the ICD code set. In the image below, you will see that the new ICD9/10 grids have a search and selection tool, eliminating the need to toggle between screens within the system. The search function will search anywhere within the grid, making it easier to find the exact code needed. Select either ICD-9 or ICD-10 to link to the appropriate grid. Type in your search criteria within the search bar, select search. 3

4 Highlight the code you wish to select Select your Code, and the gird will automatically close. 4

5 Service Entry Providers and administrators can now go on to the service entry page without having an ICD code saved on the caseload screen. Prior to submission of claims though, one must be selected, and will be noted as needed by an indicator of RED script Select. Please note, that you are still able to change a selected ICD code by selecting the link to that code set. GoClaim has been set to know which code set is needed based on the date of service that is being selected. For instance, if you are selecting to document on 09/01/2015, GoClaim will pull the ICD-9 code to send to Medicaid with your claim information; if you select 10/1/2015 or later, GoClaim will know to pull the ICD-10 code instead. Because you are able to get to the entry screen without an ICD code selected, if the date of service you are entering is without the appropriate code set, you will get an error message stating Please select an active ICD-10 Code, or, Please select an active ICD-9 Code. GoClaim will not save a service until the appropriate ICD code has been selected. Please also note that if an ICD has been selected on the Service Entry page, it is a onetime use save, and will not be save for future submissions. To save for future submissions please save the ICD code on your caseload screen. 5

6 How to select an ICD10 code from the service entry screen Anything underlined is a link to a grid or report. For the purpose of ICD-9 and ICD-10, the underlined code will link to the search grid within the ICD code set. In the image below, you will see that the new ICD9/10 grids have a search and selection tool, eliminating the need to toggle between screens within the system. The search function will search anywhere within the grid, making it easier to find the exact code needed. Select either ICD-9 or ICD-10 to link to the appropriate grid. Type in your search criteria within the search bar, select search. Highlight the code you wish to select. Select your Code, and the gird will automatically close. Please note that if and ICD code is selected on the service entry page, the code selected will only be used for that specific submission and will not be saved for future submissions. Different scenarios where an ICD code will be Red No ICD-9/ICD-10 code selected on the caseload or service entry. ICD-9/ICD-10 code on student information is not listed for this therapy type. ICD-9/ICD-10 code is invalid or no longer active. ICD-10 Things to Remember Effective with dates of service 10/01/2015 forward, but GoClaim will select the appropriate ICD code set depending on the date of service selected. Make sure to have both an ICD-9 and ICD-10 code selected for each student. You are not diagnosing a student, but stating the symptom you are treating. Once an ICD code set has been selected on the caseload, it is saved for future submission. Please make sure to review periodically to ensure that it is still applicable to the symptom that you are treating. 6