Here are the responses I received based on the question I posted earlier in the week. As the DWO does NOT require the Dx it will not have to be changed. However, the physician notes will still have to corroborate with the ICD10.
Ø I have taken many Medicare webinars, and although we include the the diagnosis/ICD9 on the form, it is my understanding is it is not a requirement on the detailed Rx.
You can contact the outreach team through to Medicare website to confirm.
Ø I have Certificates of Medical Necessity (CMNs) for patients that contain ICD-9 diagnosis codes. Do I need to submit new CMNs with ICD-10 codes for claims submitted after the transition to ICD-10?
The Centers for Medicare & Medicaid Services is not requiring suppliers to submit updated Certificates of Medical Necessity (CMNs) for claims submitted on or after the ICD-10 implementation date of October 1, 2015; however, these claims must contain a valid ICD-10 diagnosis code. CMNs created after the transition to ICD-10 must use ICD-10 codes. Suppliers should ensure that the diagnosis code(s) billed on the claim are supported by documentation in the medical record.
(FAQ12300)
https://questions.cms.gov/faq.php?id=5005&faqId=12300
Ø Detailed written orders and dispensing orders do not require the diagnosis.
Ø I’d love to know what responses you receive. We requested this information from most of our contracted insurances companies and they have no clue. We also asked them if we receive a prior auth based on the current ICD-9 codes and then deliver after October 1st, billing with
ICD-10 codes, if the claims will deny for not matching the auth. They haven’t a clue as to how to answer these.
Ø I just finished a webinar with Medicare on the ICD-10 implementation. They stated we do not need a new DWO with the updated ICD-10, but the ICD-10 will need to be on the claim along with a “0” (zero) in box 21 to the left of the dashed line and the medical record has to match with the ICD-10 being billed. They also stated the diagnosis code on the order is not a requirement. I am not confident the latter statement is true.
Ø Just had a Pulmonary MD in my office as a pt. today and we discussed that very issue. As I Understand thru his info, there will be a one year grace period to take care of such issues.
I myself and my staff are ready to go as well on Oct 1 and will certainly investigate this one year grace period
Ø We have been told that the written order would not have to be replaced. However the medical record must reflect the ICD10 specificity if date of service is after October 1st.
Ø I have been seeing both ICD-9 and ICD-10 dx codes on the prescriptions lately looking like this:
Arthritis, midfoot
ICD-9-CM:
716.97
ICD-10-CM:
M12.9
Ø If the prescription has the description of the dx not just the number it has been assigned, it should be okay without having to change it before billing
Melissa Edwards
Chief Compliance Officer
[cid:[email protected]]
4338 Williamson Rd. NW
Roanoke, VA 24012
P:(540) 366-8287
F: (540) 767-0010
[email protected]
