The Centers for Medicare & Medicaid Services (CMS) issued a final rule stating that October 1, 2015 will be the official compliance date for ICD-10 implementation. Based on guidance from the Maine Department of Health and Human Services, beginning October 1, 2015, the appropriate ICD-10 codes must be entered for each student receiving Speech and Hearing, Occupational Therapy, and Physical Therapy, Section 65 and Section 28 services in Lumea. Guidance and best practice indicate that practitioners who are ordering/referring IEP health-related services should be choosing the appropriate diagnosis/ICD-10 codes instead of using a default code and as a result, claims with dates of service beginning Oct 1, 2015 will require an ICD-10 code to be supplied by the district in Lumea before the claims can be processed.
Time-Saving Features in Lumea to assist with transition:
- For Existing Billing Dates records for Speech and Hearing, Occupational Therapy (OT), Physical Therapy (PT), Section 65 and Section 28 services, a new field has been added for the ICD-10 code. An ICD-10 code must be entered before claims with dates of service of October 1, 2015 or later will be submitted for each service. Please note that new Prior Authorizations (PA) will not be required for Section 65 and Section 28 services until the current PA expires.
- The Order/Recommendation/Referral Form (ORRF) has been modified to include fields for ICD-10 codes to streamline the process of obtaining and organizing ICD-10 codes.
- We are pleased to offer an ICD-10 Suggested Lumea Procedural Guide to help administrators and practitioners develop an organized and efficient approach to collect and input ICD-10 codes.
Please share this information with your licensed service practitioners so they may begin to prepare for this transition. While MSB is not professionally qualified to provide guidance regarding choosing specific codes, we have compiled some resources that may help:
- General Information relative to ICD-10 implementation: Please click here to access general information from the Centers for Medicare and Medicaid Services (CMS) regarding ICD-10 implementation. CMS has also published more specific information regarding the diagnosis coding system here.
- School-based crosswalk: To assist your practitioners with this process, they may also want to review the ICD-9 to ICD-10 crosswalk that has been provided by the State of Vermont to use in a school-based setting, as Maine, to our knowledge, does not have a crosswalk published at this time. Please note this crosswalk is not a comprehensive list of codes and has not been formally approved by the State of Maine.
- Practice specific guidance relative to ICD-10 codes: