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, or Physical Therapy, Section 65 CBHDT and 28 RCS 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.
Please note that action is required. We recommend beginning to collect and input ICD-10 codes into Lumea as soon as possible to ensure your district is prepared for the October 1, 2015 implementation date and that there will be no interruption with claims submission for your district.
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 a list of resources here that may be helpful.
We will be providing webinar training regarding entering ICD-10 codes appropriately in Lumea. Please visit our Events page to sign up for an upcoming webinar. These webinars are intended for Lumea Administrators, who will be inputting ICD-10 codes into Lumea.
Please contact your Program Specialist if you have any questions or concerns.