Complementary ICD-10 document for the Platinum System Outsource Billing Service 1. Introduction The ICD-10 update is mandatory if you bill insurance claims electronically (837) or on paper (HCFA). We had to restructure Platinum s menus, patient forms, reports and processes displaying, reporting and/or using ICD-9 diagnosis codes to integrate the upcoming ICD-10 and ensure the transition is as automatically as possible. Until the compliance date of October 1, 2015, your billing will not be affected and you will see no change except the addition of the ICD-10 tab in the Patient Billing Form. If there is no unexpected changes, no additional update will be required. Platinum will automatically shift to ICD- 10 on the compliance date of October 1, 2015 once the update version 9.3.0 or a more recent version is installed in your system. Your dedicated insurance agent will install the update. Be aware that the first time you will access Platinum from October 1, 2015, you will be requested to run an index. Thereafter, Platinum will validate whether or not there is at least one valid ICD-10 code and no duplicates for the display of the Patient Billing Form. The ICD-10 codes will then be reported on claims on all patient forms, Subjective questions and answers, WORD documents and reports showing diagnosis codes. 2. Patient Billing Form You can view, clear and/or replace ICD-9 and ICD-10 codes related to the patient s insurance case by clicking on the respective tabs: ICD-9 and ICD-10. The selected tab is displayed in dark grey. Up to the compliance date, when you access the insurance case, it is the ICD-9 tab that is selected so the ICD-9 codes display. You must click on ICD-10 tab to view, clear or change ICD-10 codes in the current insurance case. Post-compliance date, it will be the opposite. The tabs will swap their position. The ICD-9 and ICD-10 tabs are not interrelated. So if you change an ICD-9 code, the corresponding ICD- 10 code will not be adjusted accordingly and vice versa. So after ICD codes conversion, if you need to change an ICD-9 code make sure you also change the corresponding ICD-10 code that is related in the ICD-10 tab in the INSUR case. Hidden ICD codes remain in the Patient Billing Form if already selected. They are still submitted but they are no longer showing in the list of available codes when you click on the drop down arrow. On October 1, 2015 and going forward, you can choose either to maintain or not to maintain the ICD-9 codes in your new insurance cases added specifically to bill ICD-10 claims. However, it will be useless to continue to add ICD-9 codes if all transactions for services rendered before October 1, 2015 have been adjudicated and closed. ICD-9 codes will then no longer be sent. We keep the ICD-9 tab in the Patient Billing Form to let you change ICD-9 codes in the event you have to replace an invalid code and rebill a rejected claim including transactions for services rendered before the compliance date. 1 P a g e
3. Conversion of ICD-9 to ICD-10 You have the responsibility to enter all your ICD-10 codes in your Patient Billing Forms. The Centers for Medicare & Medicaid Services (CMS) encourages practices to assign an ICD-10 diagnosis code directly based on clinical documentation and ICD-10 code reference sources (native coding) instead of using crosswalk mapping tools, which should be used for general knowledge. So your best option is to manually convert your codes in the insurance cases of the patients who will be active after October 1, 2015. You can use this online ICD-10 Translator: https://www.aapc.com/icd-10/codes. No tool can specifically convert ICD-9 to ICD-10 because the complexity of the coding. The use of such tools implies that you manually check afterwards the whole validity of your codes. However, to ease and speed the conversion of the ICD-9 to ICD-10, we give you the opportunity to use a crosswalk mapping tool that should convert almost all your ICD-9 to ICD-10 as a starting point. You will be involved in this process to choose the appropriate ICD-10 if more than one code is available for a single ICD-9. This external program will be released around September 2015. It will not be necessary to re-update Platinum in order to use it. We will email you in a timely manner the link to download it and a comprehensive procedure. You do not need to create new insurance cases to enter your ICD-10 codes. The Patient Billing Form can maintain both ICD-9 and ICD-10. Don t forget that you have the obligation to understand the new ICD-10 coding to choose the appropriate ICD- 10 codes combination going forward. You can visit CMS website for details: http://www.cms.gov/medicare/coding/icd10/index.html 4. INSURANCE CLAIMS (PROCESS DO INS. CLAIMS) If you print your paper claims, please refer to the appendix A. 5. HCFA If you print your paper claims, please refer to please refer to the appendix B. 6. EHR From the compliance date, the ICD-10 codes will be used and displayed in the EHR module: In the field Diagnosis of the Patient Profile (green section); In the ICD code list (Short key F5 and Touch pad s Diag. button). They are used to insert ICD to the daily SOAP note. The VIEW SOAP HISTORY reports (short key V) and Touch pad s View all SOAPs button will show both ICD-9 and ICD-10 codes if present. If ICD-9 codes have been added to former daily SOAP notes, the notes will not be updated with ICD-10 codes. 7. Subjective module From the compliance date, the ICD-10 diagnosis codes will be used and displayed for the Questions and Answers Outputs merge fields <ICD_1> to <ICD_12>. 2 P a g e
8. Patient forms and reports On the following reports and patient forms, ICD-9 codes will be reported prior the compliance date and ICD-10 codes post-compliance date: Superbill (I S All) Statement of account (I E) Special Statement of account (I 6) and (L Query 6) Patient Service History form (I T) Ins. Report #01- Daily Insurance Report (PROCESS REPORTS AND POSTING) Ins. Report #08- Policy Info report (PROCESS REPORTS AND POSTING) Ins. Report #10- ICD codes missing (PROCESS REPORTS AND POSTING) Ins. Report #11- List of patients with specific ICD codes (PROCESS REPORTS AND POSTING) Associated documents - merge fields ICD1 to ICD12 (T D) Text documents - merge fields ICD1 to ICD12 (I C O) Query criterion #44(L Q) Report Builder - merge field ICD Diagnosis (L G) 9. View, add and print ICD-9 and ICD-10 codes All ICD-10 codes have been transferred in Platinum so there is no need to add new code but the option is still existing for ICD-9. Non-chiropractic ICD-10 codes are hidden to reduce the size of the list but you can unhide codes that you need to use. To view, add, hide/unhide or print ICD-9 or ICD-10 codes, you must go in U Q Care Management Cfg. Setup ICD-10 or Setup ICD Codes (ICD-9) Setup ICD Codes. Check the box to hide a code and uncheck to unhide. ICD-9 only Check that box to not show the hidden codes 3 P a g e
Appendix A Platinum was reorganized to accommodate both ICD-9 and ICD-10 codes until all claims and other transactions for services rendered prior to the compliance date have been processed, adjudicated and closed. To achieve this, a service date validation tool is implemented to streamline the transition period going forward. Important Rules ICD-9 and ICD-10 service lines can t be submitted together in the same electronic file or on the same HCFA form. That is why you must create separate electronic claims files (837) and HCFA paper forms for ICD-9 and ICD-10 during the transition period. The dual coding period will be in force until all claims and other transactions for services rendered prior to the compliance date have been processed, adjudicated and closed. Our service date validation tool ensures that no combined claims are generated. This process is entirely automated. No intervention on your part is required. Up to the compliance date, Platinum will only generate ICD-9 claims. Claims for services provided on or after the compliance date must be submitted with ICD-10 diagnosis codes only. From the compliance date, Platinum will automatically generate ICD-10 claims and will ignore transactions for services provided prior to the compliance date since they must continue to be billed with ICD-9. This applies to the First Submission and Resubmission for the Electronic and Paper claims. Claims for services provided prior to the compliance date should continue to be submitted with ICD-9 codes post-compliance date. You will be able to generate such claims by selecting the option use ICD-9 Diagnosis code in General section of the DO INS. CLAIMS. The options use ICD-9 Diagnosis code is automatically deselected when you leave the DO INS. CLAIMS. Example 1 Patient John Smith received services prior, on and after the compliance date of October 1, 2015. On November 15, 2015, the clinic is ready to submit a claim for this patient. Transactions for the following dates have not yet been billed: 09/15/2015, 09/30/2015, 10/01/2015 and 10/15/2015. You enter the dates interval 09/01/2015 to 10/30/2015 in PROCESS DO INS. CLAIMS. You go in the First Submission form and Platinum shows only the transactions for services rendered on 10/01/2015 and 10/15/2015. Is this an issue? No, it is not. Post-compliance date, the service date validation tool selects only the transactions for services rendered on or after the compliance date of October 1, 2015. They are submitted with ICD-10 codes. The other transactions, for dates of service 09/15/2015 and 09/30/2015, must still be billed with ICD-9 codes because the services have been rendered prior to October 1, 2015. Because ICD-9 and ICD-10 transactions can t be billed together, a second claim file has to be created. You will then select the option use ICD-9 Diagnosis code. 4 P a g e
Example 2 In November 2015, you have to re-bill some transactions for the month of September 2015. These transactions must be billed using ICD-9 codes even if we are after the compliance date. Why? This is not the date of the submission that determines if the claim should contain ICD-9 or ICD-10 codes but the date the service was rendered. So you need to check the option use ICD-9 Diagnosis code in order to rebill these transactions. 5 P a g e
Appendix B You must print your ICD-10 claims on the paper official standard form version 0212 which was officially released in 2014. The ICD-9 or ICD-10 codes are printed in box 21 fields A to L. The ICD Indicator 9 or 0 is automatically sent in box 21 - field ICD Ind. The indicator 9 is used when the claim includes ICD-9 codes and 0 when it includes ICD-10 codes. 6 P a g e