卡拉伊姆行為健康計劃常見問題
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.
評估期間的編碼
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?
參考文獻中心 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.
同樣地，由 DMC 提供者提供的臨床適當和涵蓋的 DMC 服務，以及由 DMC-ODS 提供者提供的 DMC-ODS 服務分別由 DMC 縣和 DMC-ODS 縣提供的 DMC-ODS 服務涵蓋，無論成員是否同時發生的精神健康問題。 如果服務是 SUD 服務（DMC/DMC-ODS），則服務遇到的原因必須包括與其 SUD 對應的 ICD-10-CM 代碼（請參閱 BHIN 22-013）。 會議必須主要討論會員的物質使用，例如 症狀、狀況、診斷和/或風險因素，其中可能包括同時發生的心理健康狀況。
有關使用 ICD-10-CM 診斷代碼/服務遭遇原因的進一步指導，請參閱 CMS 代碼表（SMHS 和 DMC/DMC-ODS 服務所包含的 ICD-10-CM 代碼清單）和 2024 年CMS 編碼指南。這些準則至少每年更新一次。
提供者應使用哪些 ICD-10 代碼來索取向尚未接受診斷的受益人提供的服務？
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.