Updated 10/28/2015. During the ICD-10 “go live” timeframe, please refresh ChiroPulse immediately (when prompted or check the Live Notes are of the login page) to make sure your office has the latest ICD-10 enhancements and logic. Printable View
Helpful companion article: ICD-10 Frequent questions click here.
IMPORTANT POINTS FOR GO LIVE ICD-10:
In late September you should start inputting ICD-10 codes into the current (icd-9) claims for all actively treating patients. Claim Wizard can be quickly accessed via CTRL+F1 hotkey from scheduler & other windows.
On 10/1 all claims for currently treating patients will appear as ICD-9… however you must add ICD-10 codes to all active ICD-9 claims. In these existing claims the code that will be invoiced (ICD-9 or ICD-10) is strictly based on the ICD-10 start date per carrier. You must have ICD-9 & ICD-10 codes in these “ICD-9 claims” until treatment ends (and you end the claim). You will start new ICD-10 claims if/when patients resume care in the future.
When invoicing insurers the Visit Date & “ICD-10 Start date” determine if ICD-9 or ICD-10 codes are used on the claim form. Assuming an ICD-10+9 compliant invoice is used, Visits/CPTs prior to the ICD-10 start date use ICD-9 codes, on or after the start date use ICD-10. If you don’t add ICD-10 codes to the claims the ICD-9 code will be sent and you will get rejected. In that case add the ICD-10 codes and recreate the invoices.
You must use ICD-10+9 compliant invoices in ChiroPulse365 so the correct ICD is used as needed. The invoice is chosen in Billing Wizard Step-3 or Reinvoice/BalanceBill “Invoice Type” selection box…
CMS-1500 2014 – print to paper (HCFA2007 prints ICD-9 only)
Ansi 837 Pro 5010 – edi format: electronic file created
EDI–Plain Text 2014 – edi format: HCFA Print Image invoice, Special Config: Plain Text 2014 – electronic file created
NOTE – use “Invoice Log” to view the “invoice type” sent and to recreate (CTRL+N) invoices using new claim data when needed to reinvoice or fix mistakes.
Invoicing w/ ICD-10 or ICD-9 is entirely based on…
1. ICD-10 start date per carrier (if not reached ICD-9 is used)
2. Claim contains ICD-10 code(s) (ICD-9 used in the absence icd10 code)
3. Use Invoice that supports ICD-10 (see below, old invoices support only ICD-9)
For ACTIVE patients after ICD-10 start date… add ICD-10 codes to the active claim (you can create a new ICD-10 claim if you want also but that is not necessary and makes billing more confusing). When invoicing if you don’t see an ICD-10 code (or GET AN ERROR saving the Visit “no ICD selected”) this is because either the insurer ICD-10 start date has not yet been reached or the claim doesn’t have ICD-10 codes added. Going forward when creating new claims – for new patients or patients to begin care for a new injury – start new ICD-10 claims (unless PIP/WC/carrier still uses ICD-9.
For NEW patients after ICD-10 start date… verify the default claim created is ICD-10. If not delete the ICD-9 claim (that was created by default when adding the new patient) and create a new ICD-10 claim. With refresh .1651+ you can clone an ICD-9 clone into an ICD-10 by checking the ICD-10 box.
NOT ALL CARRIERS ACCEPT ICD-10.
If you are having CPT/ICD mapping trouble in mixed ICD-9+10 claims (Box 24e, DX Pointer SV107 – must point to a DX code in Loop 2300 ) go to Ledger and double-click to edit the line item CPT/service and make sure 1 or more ICD-10 codes are checked (mapped to the CPT). You can alternately temporarily set a carrier/clearinghouse override to force “1” for all submitted CPTs then recreate the EDI/CMS.