ICD-10 Setup & Use for your Office (10/1/2015 go date)

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 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.

In ChiroPulse365, ICD-10 use is linked to carriers and patient claims. You can turn on all your insurers for whatever date they require ICD-10 (See the insurer tab, “ICD-10 readiness Tools” button).

When ICD-10 is enabled for a carrier this will tell CP365 to create CMS forms & EDI files with ICD-10 codes instead of ICD-9. To make your life easier, ChiroPulse365 allows you to append current claims (established with ICD-9 codes for treating patients prior to 10/1) with ICD-10 codes. Then when the “turn on ICD-10 date” is reached the invoices will include ICD-10 codes for the new treatments (ICD-9 codes will be attached to claims prior to the “start ICD-10 date” only). This makes ICD-10 seamless to your staff at the start date.

We’ll roll out additional refreshes regularly with more ICD-10 niceties. We recommend you don’t “build your ICD-10 code library” yet as Medicare and local carriers have not finalized their “approved ICD-10” lists but instead familiarize yourself with ICD-10 codes, setup and perhaps test with a “test” patient.

  • ICD-10 Capability Added – Database level 5.17 released in ChiroPulse refresh .1603+ early August 2015.
  • Insurance Tab & Editor – “ICD-10 readiness Tools” button. ICD-10 “start date” added to quickly turn on all carriers for a certain date (i.1. 10/1/2015). Ability to set ICD-10 start date for all carriers at once, you can then manually change the start date for those carriers not accepting ICD-10. A visible column added in Insurer Tab to quickly see and edit these carriers.
  • Code tab – universal search added to quickly search by code and description. An ICD-10 column is feature to quickly see ICD-10 codes. ICD-10 checkbox added to further filter the ICD view (see only ICD-10 codes).
  • Code Editor – option to save ICD codes as “ICD-10″ along with setting external codes & chapter. Many ICD-10 codes are already added with more coming.
  • ICD-10 Task Manager – Insurance tab button added to quickly jump to a list of patient claims with ICD-9 codes in use with carriers that require ICD-10
  • Claim Wizard – When creating a new claim you must choose if the claim is ICD-9 or ICD-10. Each claim is defined ICD-99 or ICD-10 however you can assign ICD-10 codes to existing (ICD-9) claims. This will allow you to append current claims with new ICD-10 codes as required (i.e patients treating Sept 30 treating again Oct 1 don’t require new claims). ICD-10 replace/add capability added as per ICD-9.
  • ICD Select/Find/Replace (click for more info) improvements & better search (Claim Wizard) – Universal search by code/description. Search finds partial matches, making it easier to find the code you need. Touch friendly search filtering to narrow down ICD-10 selection with less typing. Search for spinal regions, external codes, location codes, chapters & more.