Preparing for ICD-10
& DSM-5 Changes in
myEvolv
Agenda
• ICD 10 & DSM 5 in General
– Join the ICD 10/DSM 5 user group
http://www.netsmartcommunity.com/group/icd-10-and-dsm-5
– Contact your Client Alignment Executive
• myEvolv Changes
– Effective date concept for pulling ICD-10 vs. ICD-9 after cutover
– UI and architecture changes to support new DSM-5 diagnosis
format
– Reports to identify open episodes with no ICD-10 code for
manual updates
What is ICD-10?
• Diagnostic Coding system implemented by
World Health Organization (WHO)
• ‘10’ indicates the 10th revision of the code set
– Was released in 1992, first used in 1999 (Australia)
– ICD-9 is the current standard vocabulary in use in the US
• Used in all industrialized nations except the
United States
• ICD-10-CM is the diagnosis code set
• ICD-10-PCS is the procedural code set
– PCS code set was developed by 3M on behalf on CMS
ICD-10-CM
Diagnosis Code
ICD-9
ICD-10-CM
Code Type
Numeric
Alpha-Numeric
Code Length
3-5 Characters
3-7 Characters
Number of Codes
17,000
70,000
Example:
Insomnia
307.42 (Persistent
disorder of initiating
or maintaining sleep)
F51.01 (Primary
Insomnia)
F51.02 (Adjustment
Insomnia)
F51.03 (paradoxical
Insomnia)
F51.04
(psychophysiologic
insomnia)
F51.051 (insomnia
due to other mental
disorder
ICD-10 Mandate
Effective October 1, 2014 – Industry is moving to ICD10 for diagnosis and inpatient procedures
• All claims for services rendered prior to October 1, 2014 MUST be
submitted with ICD-9
• All claims for services rendered on or after October 1, 2014 MUST
be submitted with ICD-10
• ICD-10-PCS does NOT replace CPT for outpatient or inpatient
physician charges – only inpatient procedures impacted
• Applies to any HIPAA covered entity
DSM-5 Facts
• Published in May 2013
– ICD-10 Changes released in Q4 2013 will incorporate changes for
DSM-5
• Provides mapping to ICD-9 and ICD-10
– Maps DSM-5 terms to ICD-9 or ICD-10
– Contains no DSM-5 specific codes
• Removes multiaxial diagnosis
– Combines Axis I, II and III and moves to a diagnosis list format
– Environmental factors (Axis IV) documented using ICD-10 Z Codes
– GAF (Axis V) no longer documented with diagnosis
• Recommend using WHODAS 2.0 for disability and functioning levels
• Copyrighted material
– Per user/per year cost for access via EHR
DSM-5 Impacts
• Who should care?
– Any organization who uses DSM-IV as a current diagnostic
standard
– Any organization responsible for submitting DSM codes to 3rd
party organizations
• Not a HIPAA supported code set, but many states use DSM as the
standard for state reporting
• When will the change occur?
– No national mandate communicated – will be determined on a
state by state basis
– Only one state has announced a timeline – Indiana
• July 1, 2014
• Is there a penalty for non compliance?
– There are no reimbursement penalties
– Funding could be impacted – contact your state to determine
their timelines
DSM-5 Impacts Continued
• What do I need to do to prepare for the change?
– Review of internal processes and systems to identify
anywhere DSM-IV Codes are used
• State reporting, client communication
– Provide end user training on the new code sets
• Diagnosis terms and classifications have changed
– Autism Spectrum Disorder
– Obsessive Compulsive and related disorder
• Diagnostic criteria has been updated
Planned Solution
• Netsmart diagnosis service that is leveraged by
myEvolv
– Will access copyrighted vocabulary content hosted by
Netsmart
– Include cross-mapping between ICD-9, ICD-10, DSM-IV,
DSM-5 and SNOMED
– 3rd party to provide content
•
•
•
•
Provides clinician friendly terms for searching
Maps to multiple vocabularies: ICD-9, ICD-10, DSM-IV, DSM-5 and SNOMED
Mappings updated 10x a year
Priced not to exceed 4% of existing software maintenance
myEvolv Changes
3 Phases
• 9.0.2 (March Release)
⁻ Capture ICD 10 & DSM 5 Terms/Codes
• 9.0.3 (April Release)
⁻ Update System Delivered Forms
⁻ Sub-Forms
⁻ Sub-Reports
• 9.0.4 (May Release)
⁻ Provide ability to bill ICD 9 vs. ICD 10
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Versions Prior to 9.0.2
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Versions Prior to 9.0.2
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Versions Prior to 9.0.2
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9.0.2 Changes
• Netsmart will turn off the ability to enter New services
with the following events
– Axis 1, Axis 2, Axis 3
– ***You still will have access to Existing Axis 1, 2, 3 events for
current clients
Clients with EXISTING Axis 1, 2, 3 Events
Search Prior to IMO Services
Search with IMO Services
IMO Search Services
9.0.2 Changes (Sub-Forms)
9.0.2 Changes (Report)
9.0.2 Changes
• What if I want to stay with DSM 4…what events do I
use?
• Diagnosis General (used for Axis 1, 2 & 3)
• Axis IV
• Axis V
• What if I want to switch to DSM 5…what events do I
use?
• Diagnosis General
9.0.3 Changes
• For this release we will “clean up” the system
delivered forms. What does this mean?
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9.0.3 Changes
– With 9.0.3 for this particular form we will create a
second version and do the following
• remove the sub-forms and sub-reports for Axis 1, 2 & 3
• Add a new diagnosis general sub-form
• Add a new Diagnoses History Sub-Report
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9.0.4 Changes
• Add Functionality to bill ICD 10 vs. ICD 9
– There will be a system wide flag setting
• We will also create an override so that for a
particular plan/receiver you can still bill ICD 9
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For more information:
Please contact your Client Alignment Executive
Next Webinar is scheduled for
March 18th, 2014 at 2:00 (ET)
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