ICD-10 - TMHP
ICD-10Special BulletinICD-10 Special Bulletin, No. 18General InformationOctober 202022021 ICD Implementation. 2Claims Filing. 2Medicaid Fee-for-Service and Managed Care Providers3Texas Medicaid ICD Updates. 3Texas Medicaid Benefit Changes. 3Home Health and Comprehensive Care Program (CCP) Providers9CCP Services Benefit Changes. 9Texas Health Steps Providers10Texas Health Steps Benefit Changes . 10HHSC Family Planning Providers10HHSC Family Planning Services Benefit Changes. 10Healthy Texas Women (HTW) Providers10HTW Providers Benefit Changes. 10Children with Special Health Care Needs (CSHCN) Services Program Providers11CSHCN Services Program Updates.11CSHCN Services Program Benefit Changes.11All Code Changes: Added, Revised, and Discontinued142021 ICD Diagnosis Code Additions. 14Discontinued Diagnosis Codes. 16Diagnosis Code Description Changes. 16Inpatient Hospital ICD-10-PCS Surgical Procedure Code Updates17Inpatient Hospital ICD-10-PCS Surgical Procedure Code Updates.172020 International Classification of Diseases, Tenth Revision, Special Bulletin, No. 18October 2020
General InformationGENERAL INFORMATION2021 ICD ImplementationOn October 1, 2020, Texas Medicaid & Healthcare Partnership (TMHP) applied the 2020 annualInternational Classification of Diseases (ICD) updates that are effective for dates of service on or afterOctober 1, 2020. The annual ICD updates include the following: ICD-10 Clinical Modification (ICD-10-CM) ICD-10 Procedure Coding System (ICD-10-PCS)This combined Special Bulletin includes the ICD updates for Texas Medicaid and the Children withSpecial Health Care Needs (CSHCN) Services Program. This bulletin is intended to notify providers ofprogram and coding changes related to the 2021 updates for ICD and Current Procedural Terminology(CPT ).All providers are encouraged to review the “General Information” section of this bulletin. Policyupdates for a specific program or provider type are discussed in designated sections of the bulletin.Claims FilingThe new 2021 ICD diagnosis codes and inpatient hospital surgical procedure codes may be billedbeginning October 1, 2020. The new 2021 ICD codes must be billed for dates of service on or afterOctober 1, 2020.Important: To avoid fraudulent billing, providers must submit the ICD codes that are most appropriatefor the services provided.The ICD-10-PCS procedure codes are inpatient hospital surgical procedure codes and must besubmitted, as applicable, only on inpatient hospital claims.Note: For professional and outpatient procedures and services, providers must continue to use theAmerican Medical Association (AMA) Current Procedural Terminology (CPT) manual and theCenters for Medicare & Medicaid Services (CMS) Health Care Common Procedure Coding System(HCPCS) manual.Use of the AMA’s copyrighted CPT is allowed in this publication with the following disclosure: “Current ProceduralTerminology (CPT) is copyright 2019 American Medical Association. All rights reserved. No fee schedules, basic units,relative values, or related listings are included in CPT. The AMA assumes no liability for the data contained herein. Applicable Federal Acquisition Regula tion System/ Defense Federal Acquisition Regulation Supplement (FARS/DFARS) apply.”The American Dental Association requires the following copyright notice in all publications containing Current DentalTerminology (CDT) codes:“Current Dental Terminology (including procedure codes, nomenclature, descriptors, and other data contained therein) iscopyright 2019 American Dental Association. All rights reserved. Applicable FARS/DFARS apply.”ICD-10 Special Bulletin, No. 1822020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersMEDICAID FEE-FOR-SERVICE AND MANAGED CARE PROVIDERSTexas Medicaid ICD UpdatesThe 2021 ICD updates for Texas Medicaid are included in the ICD tables in the “All Code Changes”section of this bulletin beginning on page 14. The 2021 ICD deletions and replacements are effectiveOctober 1, 2020, for dates of service on or after October 1, 2020, for Texas Medicaid. Providers mayrefer to the “General Information” section for more information.Texas Medicaid Benefit ChangesThe following Texas Medicaid benefit changes have been made to support the 2021 ICD-CM diagnosiscode updates and are effective for dates of service on or after October 1, 2020. For more information,call the TMHP Contact Center at 800-925-9126.Note: These changes apply to Texas Medicaid fee-for-service and Medicaid managed care claims andauthorization requests that are submitted to TMHP for processing.The policy articles in this bulletin contain the following information: Revised: The description has been revised for these diagnosis codes. Providers may refer to theappropriate copyright holder for the revised descriptions. Discontinued: Discontinued diagnosis codes are no longer reimbursed after September 30, 2020. Added: Added diagnosis codes are new diagnosis codes added by CMS.Clinician-Administered Drug – Chelating AgentsThe following diagnosis codes may reimbursed when submitted with procedure code J0895:Added Diagnosis D57431D57459D57432D57813D57433D57818Discontinued Diagnosis CodeN183Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug ServicesHandbook, subsection 7.16.3 “Deferoxamine mesylate (Desferal),” for more information.ICD-10 Special Bulletin, No. 1832020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersClinician-Administered Drug – Hematopoietic InjectionsThe following diagnosis codes may be reimbursed when submitted with procedure codes J0881, J0882,J0885, and J0888:Added Diagnosis CodesN1830N1831N1832Discontinued Diagnosis CodeN183Refer to: The current Texas Medicaid Provider Procedures Manual, Outpatient Drug ServicesHandbook, subsection 7.33, “Hematopoietic Injections,” for more information.Cytogenetics TestingThe following diagnosis code will no longer be reimbursed when submitted with procedure codes88230, 88233, 88237, 88239, 88245, 88248, 88249, 88261, 88262, 88263, 88264, 88271, 88272, 88273,88274, 88275, 88280, 88283, 88285, 88289, and 88291:Discontinued Diagnosis CodeQ5120Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physicians Assistants Handbook, subsection 9.2.39.6 “Cytogenetics Testing,”for more information.Diagnostic Doppler SonographyThe following diagnosis codes will no longer be reimbursed when submitted with Peripheral ArterialDoppler Studies procedure codes 93922, 93923, 93924, 93925, 93926, 93930 and 93931:Discontinued Diagnosis CodesN183T86848Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists, Physicians, and Physician Assistants Handbook, subsection 9.2.26.3 “Peripheral ArterialDoppler Studies,” for more information.EchoencephalographyThe following diagnosis codes may be reimbursed when submitted with procedure code 76506:Added Diagnosis CodesP91821P91822P91823P91829Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physician Assistants Handbook, 9.2.25.5 “Echoencephalography,” for moreinformation.ICD-10 Special Bulletin, No. 1842020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersEvoked Response Tests and Neuromuscular ProceduresThe following diagnosis codes may be reimbursed when submitted with electromyography (EMG) andnerve conduction study (NCS) procedure codes:Added Diagnosis 8ADiscontinued Diagnosis CodesG712Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physician Assistants Handbook, subsection 9.2.27.2, “Electromyography andNerve Conduction Studies,” for more information.Inpatient Behavioral HealthThe following diagnosis codes may be reimbursed for psychotherapy and psychiatric diagnostic evaluation procedure codes 90791, 90792, 90832, 90833, 90834, 90836, 90837, 98038, 90847, and 90853:Added Diagnosis 9130F1113F19131F1213F19132The following diagnosis codes may be reimbursed for psychological and neuropsychological testingprocedure codes 96130, 96131, 96132, 96133, 96136, and 96137:Added Diagnosis 495ARefer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and CaseManagement Services Handbook, subsection 4.2 “Services, Benefits, Limitations,” for moreinformation.ICD-10 Special Bulletin, No. 1852020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersOutpatient Mental Health ServicesThe following diagnosis codes may be reimbursed for psychotherapy and psychiatric diagnostic evaluation procedure codes 90791, 90792, 90832, 90833, 90834, 90836, 90837, 90838, 90846, 90847, and 90853:Added Diagnosis 32F19132F10932F13139F19139The following diagnosis codes may be reimbursed for psychological, neurobehavioral and neuropsychological testing procedure codes 96116, 96121, 96130, 96131, 19132, 96133, 96136, and 96137:Added Diagnosis 495ARefer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and Case Management Handbook, subsection 4.2 “Services, Benefits, Limitations,” for more information.Pediatric PneumogramThe following diagnosis codes may be reimbursed when submitted with procedure code 94772 for apediatric pneumogram in clients who are birth through 11 months of age:Added Diagnosis CodesK2080K2081K2090K2091K2100K2101Discontinued Diagnosis CodesK208K209K210Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physician Assistants Handbook, subsection 9.2.25.10, “Pediatric Pneumogram,” for more information.ICD-10 Special Bulletin, No. 1862020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersPulmonary Function StudiesThe following diagnosis codes may be reimbursed for High Altitude Simulation Test (HAST) procedurecodes 94452 and 94453. Evidence of hypoxemia must be documented in the client’s medical recordwhen billing HAST procedure codes 94452 and 94453 with one of the following diagnosis codes:Added Diagnosis CodesJ8281J8282J8283J8289J84170J84178Discontinued Diagnosis CodeJ82Refer to: The current Texas Medicaid Provider Procedures Manual, Inpatient and OutpatientHospital Services Handbook, subsection 4.2.20.3, “Pulmonary Function Studies,” for moreinformation.Renal Dialysis ServicesRenal dialysis services for acute renal failure and end-stage renal disease (ESRD) may be reimbursedwhen they are submitted with the following diagnosis codes:Added Diagnosis CodesN1830N1831N1832Discontinued Diagnosis CodeN183Refer to: The current Texas Medicaid Provider Procedures Manual, Clinics and Other OutpatientFacility Services Handbook, subsection 6.2, “Services, Benefits, Limitations, and PriorAuthorization,” for more information.Sleep StudiesThe following diagnosis codes may be reimbursed for procedure codes 95782, 95783, 95808, 95810, and95811:Added Diagnosis CodesG7120G7121G71220G71228G7129Discontinued Diagnosis CodeG712Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physician Assistants Handbook, subsection 9.2.67.3, “Polysomnography,” formore information.Substance Use Disorder ServicesThe following diagnosis codes may be reimbursed when submitted with ambulatory (outpatient)treatment services procedure codes H0004 and H0005:Added Diagnosis CodesF10130F10131ICD-10 Special Bulletin, No. 18F10132F101397F10930F10931F109322020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Medicaid Fee-For-Service and Managed Care ProvidersAdded Diagnosis 3131F19131F13132F19132F13139F19139Refer to: The current Texas Medicaid Provider Procedures Manual, Behavioral Health and CaseManagement Services Handbook, subsection 9.6, “Outpatient Treatment Services,” for moreinformation.Therapeutic ApheresisThe following diagnosis codes may be reimbursed when submitted with procedure codes 36511, 36512,36513, 36514, and 36516:Added Diagnosis 57432D57813N00AD57433D57818N01ADiscontinued Diagnosis CodeD591Refer to: The current Texas Medicaid Provider Procedures Manual, Medical and Nursing Specialists,Physicians, and Physician Assistants Handbook, subsection 9.2.71, “Therapeutic Apheresis,”for more information.Vision Services – NonsurgicalThe following diagnosis code may be reimbursed when submitted with orthoptic or pleoptic trainingprocedure code 92605:Added Diagnosis CodeH5582The following diagnosis codes may be reimbursed when submitted with polycarbonate lens procedurecode V2784:Added Diagnosis CodesG7120G7121G71220G71228G7129Discontinued Diagnosis CodeG712Refer to: The current Texas Medicaid Provider Procedures Manual, Vision and Hearing ServicesHandbook, subsection 4.3.5.8 “Orthoptic and Pleoptic Training,” and 4.3.6.1 “EyeglassLenses and Frames,” for more information.ICD-10 Special Bulletin, No. 1882020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Home Health and Comprehensive Care Program (CCP) ProvidersHOME HEALTH AND COMPREHENSIVE CAREPROGRAM (CCP) PROVIDERSCCP Services Benefit ChangesThe following Texas Medicaid CCP benefit changes have been made to support the 2021 ICD updatesand are effective for dates of service on or after October 1, 2020. For more information, call the TMHPContact Center at 800-925-9126.Blood Pressure Devices – CCPThe following diagnosis codes may be reimbursed when submitted with manual and automated bloodpressure devices procedure codes A4660 and A4670:Added Diagnosis tinued Diagnosis CodesN183Refer to: The current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment,Medical Supplies, and Nutritional Products Handbook, subsection 2.2.7.1, “Prior Authorization,” for more information.Nutritional Products - CCPNutritional products may be reimbursed without prior authorization when they are submitted with thefollowing diagnosis codes:Added Diagnosis CodesD8481D84821D84822 D8489E7081E7089E74810E74818E74819E7489Discontinued Diagnosis CodesD848E708E748Refer to: The current Texas Medicaid Provider Procedures Manual, Durable Medical Equipment,Medical Supplies, and Nutritional Products Handbook, subsection 2.2.18.2.2, “Clients whoare 20 years of age and younger,” for more information.ICD-10 Special Bulletin, No. 1892020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Texas Health Steps, HHSC Family Planning, and Healthy Texas Women (HTW) ProvidersTEXAS HEALTH STEPS PROVIDERSTexas Health Steps Benefit ChangesNo benefit changes have been made to the Texas Health Steps Services program in response to the 2021ICD updates.HHSC FAMILY PLANNING PROVIDERSHHSC Family Planning Services Benefit ChangesNo benefit changes have been made to the HHSC Family Planning Program in response to the 2021ICD updates.HEALTHY TEXAS WOMEN (HTW) PROVIDERSHTW Providers Benefit ChangesNo benefit changes have been made to the Healthy Texas Women (HTW) program in response to the2021 ICD updates.ICD-10 Special Bulletin, No. 18102020 Texas MedicaidCPT copyright 2018 American Medical Association. All rights reserved.
Children with Special Health Care needs (CSHCN) Services Program ProvidersCHILDREN WITH SPECIAL HEALTH CARE NEEDS (CSHCN) SERVICESPROGRAM PROVIDERSCSHCN Services Program UpdatesThe 2021 ICD updates for the CSHCN Services Program are included in the ICD tables in the “AllCode Changes” section of this bulletin beginning on page 14. The 2020 ICD deletions are effectiveOctober 1, 2020, for dates of service on or after October 1, 2020, for the CSHCN Services Program.Providers may refer to the “General Information” section for more information.CSHCN Services Program Benefit ChangesThe following CSHCN Services Program benefit changes have been made to support the 2021 ICDupdates and are effective for dates of service on or after October 1, 2020. For more information, call theTMHP-CSHCN Services Program Contact Center at 800-925-9126.The policy articles below contain the following information: Revised: The description has been revised for these diagnosis codes. Providers may refer to theappropriate copyright holder for the revised descriptions. Discontinued: Discontinued diagnosis codes are no longer reimbursed after September 30, 2020. Added: Added diagnosis codes are new procedure codes added by the Centers for Medicare &Medicaid Services (CMS).Blood Pressure Monitoring and DevicesThe following diagnosis codes may be reimbursed when submitted with manual and automated bloodpressure devices procedure
International Classification of Diseases (ICD) updates that are effective for dates of service on or after October 1, 2020. The annual ICD updates include the following: ICD-10 Clinical Modification (ICD-10-CM) ICD-10 Procedure Coding System (ICD-10-PCS)
ICD-9 724.02 ICD-10 M48.06 Spinal stenosis, lumbar region ICD-9 720.2 ICD-10 M46.1 Sacroiliitis, not elsewhere classified ICD-9 724.8 ICD-10 R29.898 Other symptoms and signs involving the ** musculoskeletal system ICD-9 721.42 ICD-10 M47.16 Other spondylosis with myelopathy, lumbar region ICD-9 723.1 ICD-10 M54.2 Cervicalgia ICD
More on ICD-10. ICD-10-PCS replaces ICD-9-CM inpatient procedure coding: ICD-9-CM procedure codes 3 to 4 numeric digits ICD-10-CM codes 7 alphanumeric digits ICD-10-PCS code format substantially different from ICD -9 Unlike ICD-9, ICD-10
ICD-10 Tips from PHCS The Road to ICD-10 Flyer AMA ICD-10 Project Plan Template Educational Tools Folder Precyse University ICD-10 Physician Office Solution Brochure Precyse Catalog of ICD-10 Courses ICD-10 Precyse Apps for Physicians Resources Folder Free Resources ICD-9 to ICD-10 Crosswalk of Most Common ICD-9 .
Texas Medicaid EDI Connectivity Guide Texas Medicaid Proprietary & Confidential Page 7 of 29 Last Updated: 10/27/2021 3 Technology Requirements 3.1 Telecommunications TMHP supports the TMHP virtual private network (VPN) Client, using a high-speed internet connection, to connect to the TMHP network.
Dec 14, 2010 · ICD-9. ICD-10. ICD-9. ICD-10. Inactive. Active. Combined Code Set. Core Technologies. ICD-9 and ICD-10 code values are unique. Generally, the industry is taking one of two approaches as it relates to the ICD-10 transition: Remediation: Modify/expand all systems and processes to accommodate ICD-
ICD-10 to ICD-10-CM Based on FY2017 ICD-10-CM codes Category and subcategory codes are shaded in grey and marked with an Cells shaded in pink and marked with an *indicate the preferred code when a single code maps to multiple codes (see Introduction) Reportable Neoplasms . Type of Code ICD-10 Category Chapter II (Neoplasms) ICD-10 Term . ICD .
7/13/2015 1 Tonya Mitchell, RHIT July 17, 2015 Objectives Review the History of ICD‐10 Discuss the Myths and Facts of ICD‐10 Discuss GlGeneral DttiDocumentation CtConcepts Review ICD‐10 Documentation Concepts Analyze Documentation for Top Diagnosis in ICD‐10 WHY CHANGE FROM ICD‐9 TO ICD‐10? ICD‐9 was developed in the 1970s and cannot support current
Introduction Description logics (DLs) are a prominent family of logic-based formalisms for the representation of and reasoning about conceptual knowledge (Baader et al. 2003). In DLs, concepts are used to describe classes of individuals sharing common properties. For example, the following concept de-scribes the class of all parents with only happy children: Personu has-child.Personu has .
