Overview
Every year, the Centers for Medicare & Medicaid Services (CMS) releases updates to the ICD-10 code list. Streamline will be updating SmartCare to reflect this. This updated list will be seen on all screens and documents where ICD-10 codes are used, including the Diagnosis Document, the Problem List (Client Clinical Problems), and Services (Billing Diagnosis tab). Details on Streamline’s full plan can be found here: ICD 10 Code Changes FY2025. The corresponding workbook with the detailed code lists can be found here: ICD10 Codes – FY2025.
Why This Matters
Services are not able to be completed by the overnight billing process if the service in question includes an invalid ICD-10 code on the Billing Diagnosis tab. Some current ICD-10 codes will be invalid starting 10/1/24.
What Needs to be Done
All clients who have an ICD-10 code record that will become invalid on 10/1/24 will need to have that record updated.
For diagnosis documents and services, this will require the clinician to update the diagnosis document for their programs. Since diagnosis documents are specific to each program, all diagnosis documents that include the soon-to-be invalid ICD-10 code will need to be updated.
For problem list records, this will require a user to update the problem list. This can easily be done in the Progress Note by end-dating the old ICD-10 code and adding the new ICD-10 code with a start date of 10/1/24. Since the Problem List is shared across programs and staff, updating these records should be simpler. CalMHSA does recommend that, any time the diagnosis document is updated, the problem list is also updated to reflect the diagnosis updates.
Potential Obstacles
ICD-10 codes that will become valid on 10/1/24 will not be searchable prior to 10/1/24. When updating the diagnosis document, the document must have an effective date of 10/1/24 or later, otherwise the new code will not show up on the search list.
Scenario:
- Joe Clinician is trying to update his diagnosis documents for Peggy Client in preparation for the 10/1 switch. He creates a new diagnosis document on 9/15 and tries to search for the new code. The effective date of the document defaults to today, so he can’t find the new code in the search.
If the clinician waits until after 10/1/24, there will be an invalid diagnosis until the clinician makes the change. This could lead to multiple services with invalid billing diagnosis codes that keep the services from being claimed.
Scenario:
- Maria Clinician wants to wait until after the 10/1 switch to update the diagnosis document for Sean Client, because she doesn’t want to future-date documents, even for administrative reasons. She ends up sick on 10/1 and isn’t able to update the diagnosis document until 10/5. However, Tiffany Treatment-Team saw Sean Client on 10/2 and 10/3. Beth Billing is telling Tiffany that her notes can’t be billed because there’s an invalid diagnosis.
Solution
The solution to both of these obstacles is ensuring that the diagnosis document has an effective date of 10/1/24. Whether this is created before 10/1 and is future-dated or is created after 10/1 and is back-dated, the diagnosis document’s effective date should be 10/1/24 to ensure that all services dated 10/1/24 and later have only valid ICD-10 codes.
There is also a Comments field in the diagnosis document. This field can be used to explain the diagnosis change and any difference between the document date and the signature date.
Additional Articles
Updated 9/12/24