Dsm-5/icd-10
So....Our vendor just rolled our module for DSM-5 and ICD-10. Very furstrated because the vendor has the DSM-5 but they are mapping the DSM-5 to ICD-10. With no option to change the ICD-10. They have no concept of that fact the the direct mapping does not exist.... They pretty much just mapped the 10 codes to 5 like the DSM book has it. Anyone having these issues?
And do any of you have any thoughts on the CMS FAQ that states that as long as we have the code in the right "family" they will not dinge us if we are to get an audit within the first year of ICD-10?
Question 3:
What is a valid ICD-10 code? (Revised 7/31/15)
Answer 3:
All claims with dates of service of October 1, 2015 or later must be submitted with a valid ICD-10 code; ICD-9 codes will no longer be accepted for these dates of service. ICD-10-CM is composed of codes with 3, 4, 5, 6 or 7 characters. Codes with three characters are included in ICD-10-CM as the heading of a category of codes that may be further subdivided by the use of fourth, fifth, sixth or seventh characters to provide greater specificity. A three-character code is to be used only if it is not further subdivided. While diagnosis coding to the correct level of specificity is the goal for all claims, for 12 months after ICD-10 implementation, if a valid ICD-10 code from the right family (see question 5) is submitted, Medicare will process and not audit valid ICD-10 codes unless such codes fall into the circumstances described in more detail in Questions 6 & 7.
An example is C81 (Hodgkin?s lymphoma) ? which by itself is not a valid code. Examples of valid codes within category C81 contain 5 characters, such as:
C81.00 Nodular lymphocyte predominant Hodgkin lymphoma, unspecified site
C81.03 Nodular lymphocyte predominant Hodgkin lymphoma, intra-abdominal lymph nodes
C81.10 Nodular sclerosis classical Hodgkin lymphoma, unspecified site
C81.90 Hodgkin lymphoma, unspecified, unspecified site
During the 12 month after ICD-10 implementation, using any one of the valid codes for Hodgkin?s lymphoma (C81.00, C81.03, C81.10 or C81.90) would not be cause for an audit under the recently announced flexibilities.
In another example, a patient has a diagnosis of G43.711 (Chronic migraine without aura, intractable, with status migrainosus). Use of the valid codes G43.701 (Chronic migraine without aura) or G43.719 (Chronic migraine without aura, intractable without status migrainosus) instead of the correct code, G43.711, would not be cause for an audit under the audit flexibilities occurring for 12 months after ICD-10 implementation, since they are all in the same family of codes.
Many people use the terms ?billable codes? and ?valid codes? interchangeably. A complete list of the 2016 ICD-10-CM valid codes and code titles is posted on the CMS website at
http://www.cms.gov/Medicare/Coding/ICD10/2016-ICD-10-CM-and-GEMs.html. The codes are listed in tabular order (the order found in the ICD-10-CM code book). This list should assist providers who are unsure as to whether an additional 4th, 5th, 6th or 7th character is needed. Using this free list of valid codes is straightforward. Providers can practice identifying and using valid codes as part of acknowledgement testing with Medicare, available through September 30, 2015. For more information about acknowledgement testing, contact your Medicare Administrative Contractor,