Billing with ICD-10

OpenEMR Development
1

sunsetsystems wrote on Thursday, August 14, 2014:

Has anyone tested 837p billing with ICD-10 yet? Probably not because I see at least one bug – the code is forcing BK and BF diagnosis type codes whereas it appears ICD-10 requires ABK and ABF.

Just wanted to get that noticed, and also start a thread for the general topic. Last I heard we’re supposed to use ICD-10 starting 10/1/2015.

Rod
http://www.sunsetsystems.com/

2

tmccormi wrote on Thursday, August 14, 2014:

I agree, Rod. I bet no one is using it yet since it got pushed out.

3

fsgl wrote on Friday, August 15, 2014:

Jeff Guillory tried in March, before the extension had been announced, to upload a test file to Office Ally; but they were not ready to accept the file.

4

yehster wrote on Friday, August 15, 2014:

Probably best to put in a check here for the entries in the diagArray()
and switch to ABK and ABF if there are ICD-10 codes present.

I don’t believe that “mixing code” types is valid.

The only references to ICD-10 I see in the X12 guide are for
HI01-1 (principal diagnosis) (ABK or BK)
and
HI02-1 through HI08-1 (Modifier codes) (ABF or BF)

That may really be the only bug specific to ICD-10.

5

jnewlin71 wrote on Friday, August 15, 2014:

You cannot mix ICD-9 and ICD-10 codes on a claim, paper or electronic.

6

biller2 wrote on Tuesday, August 18, 2015:

I am using OpenEMR v4.2.0(3) I imported the ICD10 codes and activated them under Administration code types and clicked on “Active” It allowed me to search for the ICD10 codes and i added them to my fee sheet. The issue is occuring when I submit the TEST claim to the insurance company, in this case Molina Medicaid for Idaho. I am sending this claim directly to them via their on-line portal no middle man clearinghouse. The following is the error i’m receiving

Error Number: 1
Error ID: 0x393966a
Error Summary: ICD-10 is a required identifier when it is mandated for use.
Error Message: Value of sub-element HI01-01 is incorrect. Expected value is ‘ABK’ when ICD-10 is mandated for use. Segment HI is defined in the guideline at position 2310.
Data in Error: BK
Error Location: This error was detected at: Segment Count: 23 Composite Count: 1 Sub-Element Count: 1 Character: 795 through 797

Error Number: 2
Error ID: 0x3939631
Error Summary: ICD-9-CM Diagnosis code is invalid in Health Care Diagnosis Code.
Error Message: Value of sub-element HI01-02 is incorrect. Expected value is from external code list - ICD-9-CM Diagnosis Code (131) when HI01-01=‘BK’. Segment HI is defined in the guideline at position 2310.
Data in Error: F411
Error Location: This error was detected at: Segment Count: 23 Composite Count: 1 Sub-Element Count: 2 Character: 798 through 802

Error Number: 3
Error ID: 0x393966a
Error Summary: ICD-10 is a required identifier when it is mandated for use.
Error Message: Value of sub-element HI02-01 is incorrect. Expected value is ‘ABF’ when ICD-10 is mandated for use. Segment HI is defined in the guideline at position 2310.
Data in Error: BF
Error Location: This error was detected at: Segment Count: 23 Composite Count: 2 Sub-Element Count: 1 Character: 803 through 805

Error Number: 4
Error ID: 0x3939631
Error Summary: ICD-9-CM Diagnosis code is invalid in Health Care Diagnosis Code.
Error Message: Value of sub-element HI02-02 is incorrect. Expected value is from external code list - ICD-9-CM Diagnosis Code (131) when HI02-01=‘BF’. Segment HI is defined in the guideline at position 2310.
Data in Error: T50905A
Error Location: This error was detected at: Segment Count: 23 Composite Count: 2 Sub-Element Count: 2 Character: 806 through 813

Error Number: 5
Error ID: 0x393966a
Error Summary: ICD-10 is a required identifier when it is mandated for use.
Error Message: Value of sub-element HI03-01 is incorrect. Expected value is ‘ABF’ when ICD-10 is mandated for use. Segment HI is defined in the guideline at position 2310.
Data in Error: BF
Error Location: This error was detected at: Segment Count: 23 Composite Count: 3 Sub-Element Count: 1 Character: 814 through 816

Error Number: 6
Error ID: 0x3939631
Error Summary: ICD-9-CM Diagnosis code is invalid in Health Care Diagnosis Code.
Error Message: Value of sub-element HI03-02 is incorrect. Expected value is from external code list - ICD-9-CM Diagnosis Code (131) when HI03-01=‘BF’. Segment HI is defined in the guideline at position 2310.
Data in Error: G4700
Error Location: This error was detected at: Segment Count: 23 Composite Count: 3 Sub-Element Count: 2 Character: 817 through 822

I looked at the file ~/library/gen_x12_837.inc.php and it does appear hard coded to put both a BK and BF in the file. I was curious if I am missing turning something on so that it puts in the correct identifier ABK or ABF instead of BK and BF.

Any help or guidance in resolving this would be greatly appreciated.
Thanks in advance for your help.
John

7

teryhill wrote on Wednesday, August 19, 2015:

I commited tose changes a few months back if you are able to edit the files and make changes this is what is needed

MAKE A BACKUP OF THE FILE BEFORE YOU BEGIN

/library/gen_x12_837.inc.php

About line 668 add this
$da = $claim->diagArray();
if ($claim->diagtype == “ICD9”) {
$diag_type_code = ‘BK’;
}
ELSE
{
$diag_type_code = ‘ABK’;
}

and at about line 684 add this

  if ($claim->diagtype == "ICD9") {
     $diag_type_code = 'BF';
  }
  ELSE
  {
  $diag_type_code = 'ABF';
  }
++$tmp;
8

biller2 wrote on Wednesday, August 19, 2015:

Thanks much Terry Hill I made the changes submitted the batch and it looks like all is good. I will post back here if something else fails.
Thanks again really apprecate the help
John

9

teryhill wrote on Wednesday, August 19, 2015:

You are welcome. I have some more changes in the review process that should be commited to the code base soon.

Terry

10

fsgl wrote on Wednesday, August 19, 2015:

When was the last time anyone used the code for Onchocerciasis?

11

teryhill wrote on Thursday, August 27, 2015:

John did you pass the ICD10 test with those changes?

Terry