Credible’s ICD-10 & DSM-5 Implementation Overview...

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Credible’s ICD-10 & DSM-5 Implementation Overview

(Updated as of June 22, 2015)

ICD-10

ICD-10 Transition Mandate The Centers for Medicare & Medicaid (CMS) has mandated the transition from ICD-9 to ICD-10 coding for everyone covered by the Health Insurance Portability Accountability Act (HIPAA). Claims without a valid ICD-10 code will not be paid after October 1, 2015. Background The International Classification of Diseases (ICD) is a publication of the World Health Organization (WHO). The U.S. implemented the current version (ICD-9) in 1979. This set of codes is used to indicate diagnosis for all patient encounters. The World Health Organization authorized the 10th revision (ICD-10) as ICD-9 no longer reflects current treatment, reporting and payment processes. The transition to ICD-10 applies to both electronic and manual transactions.

DSM-5

DSM-5 Transition Mandate Unlike ICD-10, DSM-5 is not federally mandated. In addition, there are only select states and payers that are requiring the utilization of DSM-5.

*Please note: Credible is aware of the following states/situations requiring DSM-5: AR, FL, PA Partners using RIM, UT, and IN Partners where the CANS and ANSA functionality uses the MRO eligible fields.

Background Diagnostic & Statistical Manual of Mental Disorders – Fifth Edition (DSM-5) - American Psychiatric Association (APA). The DSM-5 is a classification of mental disorders developed by the APA, American Psychological Association, and used by psychiatrists, psychologists, and clinicians to identify symptoms and related diagnostic criteria, as well as match the identified related disorder to an ICD code. DSM-5 descriptions are comprised of the appropriate ICD-9 code followed by the ICD-10 code in parentheses. Blank data indicates that either an ICD-9 or ICD-10 code is not applicable.

*Please note: DSM descriptions – supported by ICD codes (not DSM Codes). Clinicians have been accustomed to DSM-IV descriptions supported by ICD-9 codes, now there are DSM-5 descriptions supported by both ICD-9 and ICD-10 codes.

Effective Date of DSM-5 The DSM-5 and corresponding ICD-10 codes were scheduled to take effect October 1, 2014. However, due to the postponement of ICD-10 utilization to October 1, 2015, the utilization of DSM-5 disorder descriptions and corresponding ICD-9 codes has been strongly encouraged by the disciplines of Psychiatry, Psychology, and others.

CREDIBLE’S IMPLEMENTATION APPROACH As transition dates continued to shift, Credible devised a two-staged approach to meet Partners’ varying needs for DSM-5. Due to DSM-5 requirements varying by respective states and/or payers, Credible

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released an abbreviated solution that addressed this need prior to May 2015. Credible’s more comprehensive and permanent solution for seamless integration with DSM-5 descriptions and structure, and Credible’s ICD-10 development plan, is slated for release in May 2015. Upcoming Important Dates

May 28, 2015 – Credible will push all ICD-10 enhancements to Partners’ Live sites.

Upon request, DSM-5 descriptions with specifiers will be available June 2015. Mapping from forms using the Problem list is slated for mid-late June (web) and late July (new mobile application, Credible Care).

Comprehensive & Permanent Solution In May 2015, Credible will release a more comprehensive and permanent solution.

For all new assessments, the multi-axial diagnostic structure will be converted to a Problem List. (Please note: This is a Credible level Partner Config setting.) Clinicians will select from the dropdown and order in sequence of primary, secondary, tertiary, and so on. Through a dropdown, the codes that were previously available via Axis I, II, and III will be available.

o The “dropdown” is searchable by either code or name. Additionally, functionality has been added to all for a “search-as-you-type” feature.

DSM-5 descriptions (if any) will be listed first, followed by ICD-10, then ICD-9.

Axis I and Axis II codes that are not DSM-5 will not be selectable in the Problem List. When converting from multi-axial to problem list (by clicking the Start New Diagnoses button), only Axis 1 and Axis 2 diagnoses that are also DSM-5 (if purchased) and all Axis 3 diagnoses will copy forward.

o For additional information, see Searching for Diagnoses in Appendix A

Diagnostic details will remain the same; diagnosed by, onset, default for programs, diagnosed date, onset date, previous onset date, resolved date, notes, and the addition of required SNOMED descriptions.

The GAF score will be replaced by the ability to log a score from the World Health Organization Disability Assessment Schedule, Version 2.0 (WHODAS 2.0). (Pending Partner feedback, Credible may consider possible future enhancements that would create/have available an electronic version of WHODAS and link scores to Dx.) This self- or informant-administered scale assesses a patient’s ability to perform activities in six areas:

1. Understanding and communicating; 2. Getting around;

3. Self-care;

4. Getting along with people;

5. Life activities (e.g. household, work/school); and

6. Participation in society.


DSM-5 Descriptions (and the accompanying ICD-9 and ICD-10 Codes) will be stored in the Axis1 and Axis2 tables within Credible. The descriptions are provided under license from the APA and will not be editable.

The master list of ICD-10 Diagnoses will not be editable.

To assist Partners with the transition, Credible will assist any Partner that would like to update any code set that is missing the ICD-10 code with the correlating exact match, per the CMS GEM table.

For dates of service on/after October 1, 2015 – Partner Agencies must submit claims using ICD-10 Codes.

DSM-5 – ICD-9/ICD-10 Crossover Rules During the ICD-9 / ICD-10 crossover period, there are specific rules that dictate Billing Payer acceptability of claims. As part of Credible’s comprehensive DSM-5 – ICD-10 implementation, many safeguards have been instituted. These safeguards are intended to aid those claims getting adjudicated at first submission. Credible’s implementation may be more stringent than Partner agencies’ Billing Payer’s requirements, but this is intentional – designing to stringent standards will help ensure to an even greater degree that claims submitted to less stringent Billing Payers will be adjudicated at first submission. The enhancements that have been implemented are as follows: Generate Batch Claim File (Billing Tab > Generate Batch Claim File) Credible has created a warning that will be displayed on-screen that the Partner has claims that cross over the ICD-10 start date. ICD-9 and ICD-10 codes may exist in the same batch, but may not exist in the same claim. Credible strongly encourages Partners to batch ICD-9 and ICD-10 claims separately; this will make troubleshooting and payment posting much easier. Assigning a Diagnosis to a Visit (Sign and Submit Work-Flow) There are two ways that a diagnosis is assigned to a visit via the sign and submit process:

1. Diagnosis is automatically assigned, because Partner Configuration: Diagnosis Dropdown = False, or the Client only has one active Diagnosis; or

2. Partner Configuration: Diagnosis Dropdown = True, and the End User selects the desired diagnosis from the Diagnosis Dropdown on the Sign and Submit page

*Credible will be automatically storing both the ICD-9 and ICD-10 codes at each visit. Updating a Visit’s Diagnosis (Update Visit Work-Flow) If the Diagnosis Dropdown feature is turned on, users will have dropdowns to select the appropriate diagnoses. The “switch” button remains available to update the assessment linked to the visit.

*Credible will be automatically storing both the ICD-9 and ICD-10 codes at each visit. Automatically Assigning Multiple Diagnoses to Visits (Partner Config: Update Multi Dx Per Visit; Partner Config: Automatically Update Visit Dx) In Credible, it is possible to have the system automatically assign up to five diagnoses to a visit. This process occurs automatically, in the background of the Sign and Submit Process if:

1. Partner Config: Update Multi Dx Per Visit = True; and


2. Partner Config: Automatically Update Visit Dx = True

Payer Config Override To accommodate payers that may start ICD-10 earlier or later than 10/01/2015, a new payer config setting, ‘ICD-10 Start Date Override’ has been added. This will override the default date of 10/01/2015 for assigning ICD-10 codes to claims and for red x’ing visits with missing diagnosis codes. Red X Visits with Invalid Diagnoses (Billing Tab > Batch Claim Error Report and Generate Batch Claim File) A new automatic Red X rule has been added that will red x visits dated on/after 10/01/2015 that do not have an ICD-10 diagnosis. If the current payer on the visit has a different ICD-10 start date, that date will be used. This Red X rule is similar to existing rules that block batching for missing date of birth, missing address, etc.

FEES

Per CMS, ICD-10 will be required as of October 1, 2015 and claims without a valid ICD-10 code will not be paid after October 1, 2015. Credible has decided that we will not be charging Partners for the ICD-10 Module. Unlike ICD-10, DSM-5 is not federally mandated and does have substantial license fees associated with its utilization. Some states and payers have adopted DSM-5 classification as part of their claims requirements. Credible strongly recommends that Agencies review their current user settings and update accordingly so that Agencies are not paying for unnecessary users. For Partners opting to utilize basic DSM-5 (Codes and Disorder Names only), Credible will subsidize fifty (50%) percent of the direct cost ($15.00 annually), so the Agency cost is $7.50 per user. Due to APA's billing cycle, Credible would bill DSM-5 fees semi-annually (split fees to $3.75 per user in January and July).

A “User” is classified as anyone that has the ability to add a Dx, update a Dx, or add Dx form.

Credible will send out the DSM-5 order forms to those Partners that requested it. *Please note: If necessary, Partners may decide at a later date to add DSM-5.

CREDIBLE SUGGESTIONS FOR PARTNER IMPLEMENTATION

1. Determine if your Agency needs DSM-5 for state reporting or payer requirements. If not, Credible recommends reviewing with Agency’s clinicians the breadth and specificity of ICD-10 codes. Unless state or payer mandated, Credible does not recommend Agency’s purchase of DSM-5.

a. Credible acknowledges that purchase of DSM-5 may be required for certain Partners due to the following:

i. State/payer/licensing body requires diagnoses to use the actual text of the DSM-5 Diagnoses

OR

ii. Agency wants to turn on the Problem List AND state reports use the Axis I or Axis II lists

1. Florida, Utah, Pennsylvania Partners using RIM and Arkansas


2. Indiana – CANS and ANSA functionality uses MRO eligible fields

b. Run a report on the top ten current Dx’s per Clinician, and map for the clinician the correlating ICD-10 code.

2. Perform a consolidated audit to see that the documentation supports the transition to more specific ICD-10 codes.

3. Review assessment forms to ensure they allow for the capture of the necessary detail level of documentation.

4. As part of the May 28th ICD-10 enhancements, Credible will make available a report that compares all active ICD-9 Dx Codes to the possible correlating ICD-10 Dx codes per CSM’s GEMs mapping. If the Partner wants Credible to help with 1:1 mapping, they need to submit the Corporate Assistance form.

a. Credible may update all ICD-9 codes to ICD-10 codes if there is a one to one match per CMS’s GEMs mapping. This will update the table, but not the Client Dx until Agency clicks the button to “add ICD-10 to active Dx” or until a new assessment is created.

b. Where there are multiple ICD-10 codes to one ICD-9 code, Agency will need to review and choose the appropriate ICD-10 code.

c. Credible strongly recommends that Partners should reassess the client to validate that the updated ICD-10 codes suits the client’s Dx.

5. Determine which Agency positions need the rights to add a Dx, update a Dx, or add Dx form.

a. Credible strongly recommends that Agencies review their current user settings and update accordingly so Agencies aren’t paying for unnecessary users.

6. For a step-by-step implementation process guide, please see Appendix A.


APPENDIX A: STEP-BY-STEP ICD-10/DSM-5 GUIDE

Credible has developed a guide to walk Partners through the ICD-10 integration process, whether or not DSM-5 is incorporated into the clinical documentation process. Provided below is a step-by-step guide of the ICD-10/DSM-5 process. As a first step, Partner will need to request DSM-5 and/or GEM mappings for its TEST Domain. If Partner does not have a test Domain, please request access to Credible’s Preview Domain. Once functionality has been reviewed, Partner will then need to decide on the following options for its PRODUCTION domain:

1. Add DSM-5 Diagnoses

2. Apply GEM mappings

3. Activate Problem List If Agency opts to utilize DSM-5, the following steps are required:

1. Submit Corporate Assistance Form via Partner Domain requesting DSM-5 order form

a. Return signed DSM-5 Order Form to Corporate

2. Review Partner security matrix and restrict DxAdd, DxFormsAdd, DxUpdate rights to only those staff that truly need to add/update diagnosis information. The APA charges a PER USER licensing fee.

3. Read Credible DSM-5/ICD-10 documentation


4. Credible will add the DSM-5 diagnoses to the Axis I and Axis II tables (accessible via the Admin tab)

a. If the DSM-5 code and description match an existing Axis I or Axis II code and description, the existing record will be UPDATED. The record will be flagged as a DSM-5 diagnosis and the ICD-10 code, if there is one assigned by the APA, will be added.

i. For example: 297.1 Delusional Disorder is a DSM-IV diagnosis that also appears in the DSM-5 with the same code and description. In the DSM-5, the APA has assigned it the ICD-10 code of F22.

b. If Axis I table has a record where Axis1 Code is 297.1 AND the Description is exactly Delusional Disorder, it will be flagged as a DSM-5 diagnosis and will be coded to ICD-10.

c. If there is ANY difference (such as Delusional D/O or Delusional Disorders) a NEW record will be added to the Axis I table.

*Note: The description for a DSM-5 diagnosis text comes directly from the APA and CANNOT be edited.

5. When updating or adding a new diagnostic assessment using the Multi-Axial format, users will see BOTH DSM-5 and the existing Axis I and Axis II diagnoses in the dropdowns. DSM-5 will be listed first and have [5] in the description to aid in selecting from the DSM-5.

If (2 Apply GEM mappings) is selected, the following steps are required:

1. Submit Corporate Assistance Form via Partner Domain requesting GEM mapping

2. Credible will update the Axis I, Axis II, and Axis III (ICD9cm) tables to have ICD-10 codes where a 1:1 match exists AND there is no ICD-10 already present.

a. For Partners that have contracted for DSM-5: The GEM mapping will not overwrite the ICD-10 code provided by the APA.

3. Under the Reports tab > Export tool, run the ICD-10 Mapping List report. This will show all diagnoses linked to a client’s active assessment that do not have an ICD-10 defaulted. It will also show a list of possible ICD-10 matches based on the GEM list.

4. Go to Admin > Axis I/II/III pages and manually enter an ICD-10 code for each diagnosis.

5. On EACH Admin Axis page, click the ‘Add ICD-10 Code to active diagnoses’ button. This will update the active assessment for all clients.

If (2 Apply GEM mappings) is NOT selected and you wish to add GEMs manually:

1. Download and review the GEM mapping information from CMS (http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html)

2. Under the Reports tab > Export Tool, run the ICD-10 Mapping List report. This will show all diagnoses linked to a client’s active assessment that do not have an ICD-10 defaulted. It will also show a list of possible ICD-10 matches based on the GEM list.

3. Go to Admin > Axis I/II/III pages and manually enter an ICD-10 code for each diagnosis.

http://www.cms.gov/Medicare/Coding/ICD10/2015-ICD-10-CM-and-GEMs.html


4. On EACH Admin Axis page, click the ‘Add ICD-10 Code to active diagnoses’ button. This will update the active assessment for all clients.

If (3 Activate Problem List) is selected, the following steps are required: 1. Train clinical staff on the Problem List using Partner TEST domain (or Credible’s Preview Domain

for Partners without their own test domain)

2. Submit Corporate Assistance Form via Partner Domain requesting the Problem List be activated on the PRODUCTION domain

*Please note that the problem list is not required, but highly encouraged to maximize ICD-10 enhancements.

a. Old and existing diagnoses stay in the current Multi-Axial format

b. Diagnoses are selected using a search-as-you-type-box (Please refer to ‘Searching for Diagnoses’ section).

i. User can search by the code (301.20, F60.1) or by text.

ii. The searched word can be anywhere in the diagnosis description, it doesn’t have to be the start of the diagnosis description.

c. The Problem List allows searching and selecting of diagnoses from:

i. DSM-5 Diagnosis from the Axis I and Axis II lists

ii. The entire ICD-10, obtained from First Databank

iii. The entire Axis III (ICD-9cm) list from the Partner’s Domain

d. The search results will display DSM-5 first, then ICD-10, then ICD-9

e. When directly selecting an ICD-10 diagnosis, prompts will appear to remind the user to select an ICD-9 diagnosis and vice versa. No prompts will appear if the user selects a DSM-5 diagnosis.

f. The Problem List does NOT have Axes; any diagnosis can be in any position in the list. This can mean that the client’s primary (first) problem is an issue that previously would have been on Axis II or even Axis III.

i. NOTE: For reporting and consistency purposes, diagnoses will be stored in the database with both a Problem List order AND an axis level (Axis I is 1, Axis II is 2, Axis III is 3) and axis order (the number for that specific diagnosis on that axis – primary is 1, secondary is 2, etc.).

ii. When using the Problem List, ONLY diagnoses selected from the DSM-5 can be coded behind the scenes as Axis I and Axis II. All other selections WILL be coded as Axis III.

g. Axis IV – Psychosocial and Environmental Problems have been removed as they are not part of the DSM-5 nor are they part of the ICD-10; use V (ICD-9) and Z (ICD-10) diagnoses instead

i. The DSM-5 also includes diagnoses for documenting these issues

h. Axis V GAF scores are not part of the DSM-5 and have been replaced by the


WHODAS assessment

i. When creating a new Problem List assessment from an old Multi-Axial assessment:

i. Axis I and Axis II diagnoses that are NOT DSM-5 will NOT copy forward.

ii. If the client still has that diagnosis it must be reselected from the DSM-5 codes lists.

Problem List and Diagnosis Dropdown The Diagnosis Dropdown feature allows clinicians to select the most appropriate diagnosis for a specific service. By default, this dropdown only includes diagnoses from Axis I and Axis II. In Partner Config, the setting Include Axis III for Billing can be turned on to allow selecting from Axis III (medical issues). This setting has been relabeled as Include All Diagnoses for Billing. All Partners using the Diagnosis Dropdown and the Problem List are encouraged to turn on Include All Diagnoses for Billing. Partners without DSM-5 MUST turn on Include All Diagnoses for Billing when using the Problem List with the Diagnosis Dropdown. For all Partners:

1. Under the Reports tab > Export Tool, run the ICD-10 Mapping Client Detail List report. The report provides list of clients having an active diagnosis (Axis I, Axis II, Axis III) without an ICD-10 code. Client must have a future appointment or a billable service in the past 180 days. Due to the potential size of the report, only the number of possible ICD-10 GEMs is shown, not the full list.

2. If the client is closed prior to 10/01/2015, there isn’t a need to do the new diagnosis ahead of time. The client’s diagnosis can be updated upon their return for a new assessment.

3. Payer testing can be conducted on Partner test domain. Test domains will allow future visits to be batched in case the payer wishes to see a 10/01/2015 or later date in the test claim.

Searching for Diagnoses In the existing Multi-Axial format, there are three separate sections for categories (axes) of diagnoses. All of the diagnoses come from the Partner’s axis tables (visible under the Admin tab). No other codes/diagnoses are available. Each dropdown/picker will show all the diagnoses available in its respective axis table. For example, the Axis I dropdown will show all diagonses in the Axis I table, with any DSM-5 diagnoses listed first with [5] in the description.


In the new Problem List format, there is only one section for the client’s diagnoses. Instead of a dropdown, a search-as-you-type box is provided. The diagnoses come from the Partner’s axis tables (visible under the Admin tab). However, only Axis I and Axis II diagnoses that are also DSM-5 diagnoses will be available. ICD-10 diagnoses will also be available. The ICD-10 is obtained by Credible from First Databank and the table itself is not part of a Partner’s database; similar to the master listing of medications used to create prescriptions. The search results are sorted DSM-5 first, then ICD-10, then ICD-9.

No diagnoses will be deleted or removed from the Partner’s tables. If purchased, the DSM-5 descriptions and accompanying ICD-9/ICD-10 codes will be ADDED to the existing Axis I and Axis II tables. If the description and ICD-9 code both match an existing Axis I or Axis II diagnosis EXACTLY, the existing record will be flagged as a DSM-5 diagnosis and a new record will not be created. For example, the DSM-IV had Paranoid Personality Disorder (with an ICD-9 code of 301.0); the DSM-5 also has Paranoid Personality Disorder (with an ICD-9 code of 301.0 and an ICD-10 code of F60.0). If there already is a entry in the Axis I table for ‘Paranoid Personality Disorder’ and it has a ICD-9 code of 301.0, it will get updated to have the F60.0 ICD-10 code and be flagged as a DSM-5 diagnosis. If instead, it is listed as ‘Paranoid Per. D/O’ it will not match the DSM-5 and a new record is added.

*Note that due to the licensing requirements of the APA, the DSM-5 flag and the DSM-5 description cannot be edited. The other fields remain editable.

Once the Problem List functionality is activated, clicking ‘Start New Diagnoses’ will create a new assessment in the Problem List format. For Axis I and Axis II, only diagnoses that are DSM-5 will copy to the new list. All Axis III diagnoses will copy forward to the new list.


Billing Impact Once the Problem List is activated, all diagnoses, except ones selected from the DSM-5 as described above, will be coded as Axis III. It is HIGHLY RECOMMENED to turn on the ‘Include All Diagnoses for Billing’ partner config setting (this is the same setting as ‘Include Axis III for Billing’ but it has been relabeled). This will allow all of a client’s diagnoses to be available in the dropdowns when completing or updating a visit. The default diagnosis for a visit will continue to be determined based on the program (if any default is set), the axis and the order. If the client does not have a program-defaulted diagnosis and does not have any DSM-5 Diagnoses, the visit default will be the first diagnosis in the Problem List. This may mean a ‘medical’ diagnosis becomes associated with the visit and any subsequent claims. The ‘Diagnosis Dropdown’ feature (activated in Partner Config) is the simplest way to make sure a visit is correctly associated with the intended diagnosis. If this feature is not turned on, staff will need to use the program defaults and/or make sure that behavioral health diagnoses are ordered first in the Problem List ahead of any medical diagnoses.

ICD-10 & DSM-5 IMPLEMENTATION PLAN FAQs

Question Answer


How can I get CURRENT client diagnoses to be in ICD-10?

1. Request the GEM mappings to automatically set the exact matches in the Axis I, Axis II, and Axis III lists (Admin tab).

a. Using the exports, review the remaining diagnoses that multiple ICD-10 matches.

b. Update the ICD-10 code for each diagnosis in the Axis I, Axis II, and Axis III lists (Admin tab).

c. Click the Add ICD-10 Code to active diagnoses button. Note that each list has this button which works independently from the others – the button on the Axis I list page will only update clients’ Axis I diagnoses.

2. Review the GEM mappings available from CMS. Update the ICD-10 code for each diagnosis in the Axis I, Axis II, and Axis III lists (Admin tab). Click the Add ICD-10 Code to active diagnoses button. Note that each list has this button which works independently from the others – the button on the Axis I list page will only update clients’ Axis I diagnoses.

How can I get NEW client diagnoses to be in ICD-10?

If the GEM mapping has been done, you simply need to select a diagnosis that has an ICD-10 code configured.

Can I choose to do the GEM mapping later? Yes

If I use the GEM mapping, do I need to create a new diagnosis for all my clients?

No. However, please note that GEM mapping is NOT a replacement for clinical assessment. It is a tool to facilitate transitioning from ICD-9 to ICD-10. The client’s issues and the clinical documentation must support the more detailed criteria of ICD-10 for it to be a valid diagnosis.

I want to make sure clinicians are the ones responsible for selecting the ICD-10 code. Can I update the Axis lists to have ICD-10 codes without doing a mass update of existing clients?

Yes. Existing clients will only get updated to ICD-10 when: the Add ICD-10 Code to active diagnoses button is clicked on the Axis lists (under the Admin tab), an existing diagnosis is updated, or a new assessment is created.

What if I don’t want to use GEM mappings at all? If GEM mappings are not used at all, the Problem List must be turned on. Clinicians will need to go to each client, start a new diagnosis and select the appropriate codes.

Do I need to have the Problem List turned on to bill out claims for ICD-10?

No. If the GEM mapping has been done and the clients updated, visits will get coded to both ICD-9 and ICD-10.

What does the Problem List page do? It provides a way to directly select a specific ICD-10


code instead of using GEM mappings. It also structures the client’s diagnosis differently; the Multi-Axial structure is not part of ICD-10 and was removed in the DSM-5.

Do I need to purchase the DSM-5? Yes if the following applies:

1. Your state/payers/licensing body requires diagnoses to use the actual text of the DSM-5 diagnoses.

a. For example in the ICD-10: F50.2 Anorexia nervosa, binge eating/purging type versus the DSM-5: Bulimia Nervosa.

Or

2. You want to turn on the Problem List AND your state reports use the Axis I or Axis II lists to recode the diagnosis.

a. This applies to Florida, Utah, Pennsylvania partners using RIM, and Arkansas.

b. This also applies to Indiana where the CANS and ANSA functionality uses the MRO eligible fields.

Why are the DSM-5 fees invoiced semiannually instead of annually?

Credible is charging semi-annually for DSM-5 because that how Credible is being billed for DSM-5 by APA.

If invoiced annually, what’s the process of ensuring we are not billed twice for users who are with us throughout the year? For example, at the end of the year, will you only bill for new users since the bill for the first half of the year?

With a fee of $7.50 Partners would be invoiced $3.750 per user in July and $3.75 per user in January.

Is the user fee the same regardless of whether the user is part-time in the system?

Yes, unfortunately APA does not differentiate between any types of users and Credible is passing along the direct cost.

What if my state functionality needs the Axis 1 or Axis II lists but I don’t want to purchase the DSM-5?

In this case, the Problem List cannot be turned on. You will need to stay on the Multi-Axial format.

Wait. Won’t that mean I can’t bill in October when ICD-10 starts?

Partners using the Multi-Axial format WILL be able to bill ICD-10 as long at the GEM mapping has occurred. All billing functionality works regardless of the whether a partner is using the Multi-Axial or Problem List diagnosis page.

Are there any current limitations with the Problem List?

Yes.

1. DSM-5 Specifiers: Due to difficulties in obtaining usable data from the APA, DSM-5 specifiers will not be available 05/21. Credible is targeting early June.

2. Mapping from forms using the Problem List will


not be available 05/21. Credible is targeting mid to late June.

3. Mapping from forms using the Problem List on mobile will not be available 05/21. Credible is targeting late July for this functionality in the new Care App.

For clarification, the ICD-10 button in the Axis 1 and 2 table screen will not convert your Domain to the Problem List, it will just execute the mapping?

Yes, that is correct.

Can the ‘Add ICD-10’ button be used more than once if we update our diagnosis list in stages or should we wait until the very end?

Yes. You can click the ‘Add ICD-10’ button as many times as you want. However, it will not update a client's record that already has an ICD-10 code.

In the data dictionary, the Client Axis Detail table is where the actual clients’ diagnosis records live.

The axis code column in that table is the ICD-9 code that the client has for that specific diagnosis.

There is a separate column for the ICD-10 code (icd10_code).

Note that Axis1 and Axis2 diagnoses also use an additional column, axis ID. This is because there are multiple diagnoses (especially with the DSM-5) using the same ICD-9 code. The axis ID points to the specific diagnosis.

When you click the button, if the client’s diagnosis has an ICD-10 code set in the Admin tables, the client’s diagnosis will get updated.

Once the ICD-10 codes are added to the Admin tables, creating a new client diagnosis will automatically get coded to both ICD-9 and ICD-10. You will want to make sure you review the list and ensure it's accurate. You can do this in stages, but keep in mind clicking the button will only update a given client diagnosis once.

Should GEM mapping be done prior to running the ICD-9/ICD-10 report?

Yes. In behavioral health, most diagnoses will have a 1:1 match. You could do it manually, but it is preferred to get 1:1 matching and then go back to those with multiple matches and you’ll have a much smaller list of codes to work with.

How do you get the Axis 1 screen? You will first need access to the Admin tab. If you’re a clinician you may need to work with your administrator to get access and make these updates. The main listing is under the Admin tab. Under Lookups and Codes tables you’ll see Axis 1, 2, 3.

Are these Admin lists and diagnoses currently in our domain?

These are the only ones that will be in your domain unless you've purchased DSM-5. Earlier in the year we pushed out DSM-5 as some states mandated its use. Those codes that are in your domain are in these tables (Axis 1 and 2 and ICD-9 CM). All codes currently used reside in the Partner database. Once the Problem List is activated, the full master list of all ICD-10 codes will available to use but not be in your Partner database.


This is very similar to prescribing medication when using the drop-down box from First Data Bank and resides at Credible level so it is not editable.

Why can’t I see any DSM-5 data? You will need to purchase DSM-5 and then Credible will push to your domain.

Why can’t I see any ICD-10 codes? If the problem list is not turned on you will not be able to pick a diagnosis directly from ICD-10. However, ICD-10 codes will appear onscreen if the GEM mapping has been done.

Is Credible going to have a tool to deal with duplicated diagnosis codes?

No. That is not something Credible has built at this stage, as that would put Credible in the role of clinical decision-making.

If you have multiple diagnoses with the same ICD-9 code, but different descriptions, clinical staff chose those for a particular reason. Converting those diagnoses solely based on the code puts Credible in the role of clinical decision-making.

Credible can provide GEM mapping for 1:1 matches if requested. Those greater than 1:1 will need to be updated manually.

We want to make sure this transition is less painful, but understand that Partners will need to learn new codes and clients will need to be reassessed.

Credible has several tools in place to reduce that effort on behalf of clinicians.

Do I need to enable the Problem List before updating existing client axis?

If you have purchased the DSM-5 you will first want to have clinicians update clients’ current Multi-Axial assessments (or create new assessments) to have only DSM-5 diagnoses on Axis 1 and Axis 2. This will allow these diagnoses to carry forward to a new Problem List assessment. If you do not purchase the DSM-5 there is not a need to update the client’s assessment prior to activating the Problem List. When the Problem List is activated, nothing will appear different. The new functionality will only appear when creating a new assessment. Please note that Axis 1 and Axis 2 that are not DSM-5 will NOT appear in the Problem List and are NOT selectable. There is not a way to select old diagnoses.

For the ICD-10 mapping tool report, does it show inactive consumers who have an active diagnosis?

Yes

If we are billing for a service that transitions from September 30 to October 2, is there a way to update the assessment appropriately?

If the service is going out as one claim, it would use the end date of service (10/2) and go under ICD-10. If they are fully separate visits, then it is automatically updated to ICD-10 for the visits on/after 10/1.

If the service occurred on Sep 30, it is coded both


ways, but only goes out with ICD-9. The service rendered after Oct 1 also includes both sets of codes, but only goes out with ICD-10.

The discharge date spanning the whole time period drives whether it's an ICD-9 or ICD-10 claim.

What if our ICD-10 codes column in Live Domain is blank?

If it is blank, please request GEM mapping. If you choose not to do so, you would need to manually update the codes in the Admin tables and then click ‘Mass Update.’

Does the GEM mapping that Credible can do for us update only the Axis tables or does it update the client?

Only the Axis tables. Your agency will need to review and then hit the “Add ICD-10 Code to active diagnoses” button.

Is there a current cost for GEM mapping? Yes. It is a one-time fee of $550 per domain. So if you want this done in your Live Domain only, it is $550.

Are you recommending that all conversion be done in Test Domain and then moved to Live Domain?

No. We are only recommending that you test the functionality in the Test Domain so that you know how to use it before going live.

If we configure in Test, how will it affect the data transfer when the system is updated by Credible? Will data from Live overwrite this?

It will overwrite it on the refresh dates. We are doing a Test Domain refresh this weekend (June 6th). The next refresh after that will be in July.

While this process is being completed is billing automatically including both the ICD-9 and ICD-10 codes?

No, only the ICD-9 code is being sent, but the ICD-10 code is being saved. For any single claim, only ICD-9 OR ICD-10 can be sent.

Can the Diagnosis drop-down and the Program Specific be used interchangeably?

Yes. The Program Specific diagnosis is highlighted in yellow in the list. In the drop-down it will default, but then you can choose something else that’s clinically appropriate if needed.

How will you designate a rule-out diagnosis and will diagnoses still be functional as Program Specific?

For Program Specific, yes. If it is truly a rule-out diagnosis please use the Notes field. Under DSM-5, the rule-out aspect is no longer included as part of the assessment piece.

If you clicked override in the Payer Config will the claim go out the door with both codes?

They will never go out with both codes. It will be an either/or scenario.

Can Credible create a report for clients that are not converted to the Problem List?

Credible is reviewing to see if this is possible.

Do the prompts that come up once you have switched for override and ICD-10 only come up when you’ve switched to the ICD-10 format?

Yes. That functionality is only in the Problem List. It is also only if you pick from the ICD-10 or ICD-9 list.

Where do we find SNOMED codes for those that were are missing in the Admin Axis list?

There are two ways.

If it’s a 1:1 match, Credible has already updated the coding.

If it’s a 1 to many match, you will have a drop-down to choose from for each diagnosis.

Otherwise there is a button to search for a code from the entire SNOMED list.

* Please note that Credible will also update SNOMED


codes for those with a single match under DSM-5.

For DSM-5 Problem List, should we wait until the form aspect is ready as diagnosis is documentation heavy?

Yes, partners that use mapping questions to record the diagnosis in a form should wait. Partners that do not use mapping questions in forms and instead use the intake nav bar functionality can start using the Problem List.

If we want Axis IV and V to remain, would we still activate DSM V, do GEM mapping, and just not enter in a task ticket to have the Master Problem List activated? It is my understanding that some payers may still want the GAF captured and they are not ready to move to the WHODAS.

Yes, that is correct. You may also wish to consult with the Payer to see if it is acceptable to have Axis IV and V recorded in a clinical assessment form, but not appear on the diagnosis screen itself.

Will the system be including the decimal point when sending an ICD10 diagnosis code on 837 billing files?

No. The decimal point will not be included in the 837 files it will look like this: HI*ABK:H5006~

Once we select the ‘ICD10 start date override’ filed on the Payer Config will that be based on DOS? For example – we select 8/1/15. If it’s 8/15 and we have two claims, one with a DOS of 7/30 the other with 8/2, will the 7/30 claims use ICD9 and the 8/2 use ICD10?

Yes, this is based off of the Date of the Visit.

Credible’s ICD-10 & DSM-5 Implementation Overview...

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