The Centers for Medicare and Medicaid Services (CMS) will require healthcare providers and governmental entities to transition from ICD-9 to ICD-10, effective October 1, 2015. Most of the ICD-9 codes identified on the DADS-Approved Diagnostic Codes for Persons with Related Conditions list convert to a single ICD-10 code. However, some codes do not have a direct match. For this reason, DADS has put into place the transition plan outlined in this IL.
To ensure there is no lapse in an individuals’ eligibility changes to processes for submission of the ID/RCs are necessary during this transition period as outlined below.
Enrollment ID/RC – Purpose Code 2
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If the ID/RC submission date is between the posting of this information letter and
September 30, 2015, the submitter must include one ID/RC version reflecting diagnosis codes matching those associated with the ICD-9 standards and one ID/RC version reflecting diagnosis codes matching those associated with the ICD-10 standards. The submitter may complete one ID/RC assessment, except for the population of diagnostic information contained in field 19, 20, 22, 23, 24, 26 and 27. The submitter may produce copies of the ID/RC in order to obtain the before described ICD-9 and ICD-10 versions of the enrollment ID/RC. Attestation by a physician must be obtained for each ICD version of the ID/RC. -
If the ID/RC submission date is on or after to October 1, 2015, the ID/RC must reflect diagnosis codes matching those associated with the ICD-10 standards. Attestation by a physician must be obtained.
Renewal ID/RC – Purpose Code 3 and E
• If the ID/RC effective date is prior to October 1, 2015, the ID/RC must reflect diagnosis codes matching those associated with the ICD-9 standards.
• If the ID/RC effective date is on or after to October 1, 2015, The ID/RC must reflect diagnosis codes matching those associated with the ICD-10 standards. Attestation by a physician must be obtained if an ICD-9 diagnosis previously recorded on the ID/RC does not directly convert to an ICD-10 diagnosis. Attestation by a physician is not required if all ICD-9 diagnosis previously recorded on the ID/RC convert directly to a ICD-10 diagnosis as indicated in the conversion widget posted by DADS.
If the ID/RC includes multiple diagnoses, all codes must be based on the same version (i.e., ICD-9 or ICD-10).
To assist Direct Service Agencies (DSAs) and DBMD providers to identify which diagnosis codes convert directly from ICD-9 to ICD-10, DADS has developed a “code look-up conversion widget” for the DADS-Approved Diagnostic Codes for Persons with Related Conditions. You can find the conversion widget along with instructions for use at the DADS ICD-10 webpage, http://www.dads.state.tx.us/providers/icd10.
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