Upcoming Diagnosis Code Enhancements - Updated 3/8/2022
Netsmart will be releasing diagnosis code enhancements over the next several releases. In the Production release scheduled for March 17th, Netsmart will be updating the master diagnosis code table to remove non-billable diagnosis codes and adding effective and expiration dates for each code per the CMS ICD-10 code list. For those providers using a 3rd party EVV solution, this table will be used to validate ICD-10 codes received in all 4 diagnosis code fields on inbound Rendered Services visits and reject visits if a non-billable code is received. Although our Rendered Service Feed specs has always required providers to submit valid ICD-10 codes, we did not always reject when non-billable or invalid diagnosis codes were received. After this release, any provider sending visits with ICD-10 codes that are not effective on the visit date per the master ICD-10 code table will be rejected.
We will also be marking non-billable ICD-10 codes currently on the Recipient > Payer Subscription screen in the Provider Portal as ‘voided’. Voided non-billable ICD-10 codes will not be submitted on claims going forward as this can result in rejections or denials. Any visit that doesn’t have a billable ICD-10 code will not be able to be claimed. Providers will need to enter billable diagnosis codes on the Recipient > Payer Subscription screen. The diagnosis search will be updated to only return billable ICD-10 codes for the user to select. When adding diagnosis codes, users will be prompted to save the changes to all unreleased claims so that each visit is not required to be updated. Providers will also be able to view the voided diagnosis codes on the Recipient > Payer Subscriptions screen as shown below.
Some providers have had visits denied by payers due to an invalid primary billing diagnosis. In a subsequent Production Release (currently TBD), Netsmart will be making additional enhancements to support the billing order (1-4) for ICD-10 codes, as well as any additional diagnosis codes that may need to be submitted for a recipient. The Recipient > Payer Subscription screen will be modified to separate out diagnosis codes as shown in the mockup below.
When this release is implemented, the agencies that use the Mobile Caregiver+ mobile app will be required to set the correct billing order for their recipients since there was not a concept of billing sequence prior to this release. Diagnosis codes without a billing order will be displayed in the Additional Billing Diagnoses field. They will continue to be billed in a random order, which may not be the correct billing order and may require providers to update the ICD-10 codes with the correct bill order. When updating diagnosis codes, users will be prompted to save the changes to all unreleased claims that do not currently have a diagnosis code, so that each visit is not required to be updated.