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Below is a list of frequently asked questions that were collected from technical assistance and informational webinars and submissions to the BHCalAIM@dhcs.ca.gov email. DHCS will update this list on a quarterly basis.
Coding Thaum Kev Ntsuam Xyuas
If a member receiving services from a MHP has a co-occurring substance use disorder (SUD), and the mental health provider’s session only focuses on the SUD need, is this acceptable? What about a DMC or DMC-ODS provider serving a member with a mental health disorder?
Reference BHIN 22-013
Clinically appropriate and covered Specialty Mental Health Services (SMHS) delivered by MHP providers are covered Medi-Cal services whether or not the member has a co-occurring SUD. The reason for the service encounter (ICD-10-CM code) must correspond to the medically necessary service provided to the member. If the service is a SMHS, then the reason for the service encounter must include a ICD-10-CM code that corresponds to their mental health (see BHIN 22-013). The session must primarily address the member’s mental health, e.g. symptom, condition, diagnosis, and/or risk factors, which can include co-occurring SUD.
Ib yam li ntawd, kev kho mob tsim nyog thiab them rau DMC cov kev pabcuam xa los ntawm DMC cov chaw muab kev pabcuam thiab DMC-ODS cov kev pabcuam xa los ntawm DMC-ODS cov chaw muab kev pabcuam raug them los ntawm DMC counties thiab DMC-ODS counties, ntsig txog, txawm tias tus tswvcuab muaj kev sib koom ua haujlwm puas hlwb. Yog tias qhov kev pabcuam yog SUD kev pabcuam (DMC/DMC-ODS), yog vim li cas rau qhov kev pabcuam ntsib yuav tsum suav nrog ICD-10-CM code uas sib raug rau lawv cov SUD (saib BHIN 22-013). Lub rooj sib tham yuav tsum hais txog tus tswv cuab txoj kev siv tshuaj, xws li Cov tsos mob, mob, kev kuaj mob, thiab/los yog tej yam kev pheej hmoo, uas tuaj yeem suav nrog kev mob hlwb uas tshwm sim.
Yog xav paub ntxiv txog kev siv ICD-10-CM cov lej kuaj mob / vim li cas rau qhov kev pabcuam ntsib, thov xa mus rau CMS code tabular (cov npe suav nrog ICD-10-CM cov lej rau SMHS thiab DMC / DMC-ODS cov kev pabcuam) thiab CMS coding cov lus qhia rau 2024. Cov lus qhia no tau hloov kho tsawg kawg ib xyoos ib zaug.
ICD-10 cov lej twg yuav tsum tus kws kho mob siv los thov rau cov kev pabcuam muab rau tus neeg txais txiaj ntsig uas tseem tsis tau txais kev kuaj mob?
Reference BHIN 22-013
MHPs, DMC and DMC-ODS programs and providers are required to use appropriate ICD-10 diagnosis codes to submit claims to receive reimbursement of Federal Financial Participation. BHIN 22-013 identifies ICD-10 codes that may be used during the assessment phase of a member’s treatment when a diagnosis has yet to be established.