Yes Kalix is ready for the ICD-10 transition on 10/1/2015. Our update to support this change will be available Monday September 28 2015. We do want to give you a few days to become familiar with the change.

Note: ICD-10 does not come into effect until October 1. ICD-10 must not be used until this date.

What is ICD-10?

If you are not quite sure what the fuss is all about, take a look at this video. 

ICD-10 in Kalix

Kalix uses ICD diagnosis codes in two main locations: Referrals and Billing. Both these areas have been updated to support the new code set. 

Referrals

Kalix's Referrals contain important client information including the referral reason (ICD 9 or 10 diagnosis) and the referral source. When a referral is linked to a bill, Kalix automatically adds the referral reason/s (ICD-9 or 1CD-10 codes) to the bill for you. 

Creating New Referrals

Following Kalix's ICD-10 update, you will have the option of choosing between using ICD-10 or ICD-9 diagnosis codes on referrals. To add ICD-10 codes to a referral, follow the steps below: 

  1. Under the Referral Reasons section of the referral, click to select the tickbox - Use ICD-10 diagnosis codes.
  2. You will now to able to search for and add ICD-10 codes by keywords or diagnosis code.

Note: if the - Use ICD-10 diagnosis codes tickbox is unselected, ICD-9 codes will be added to the referral.

Updating Existing Referrals

You may also wish update your clients' existing referrals from ICD-9 to ICD-10 codes. Updating existing referrals can save you time in the future. All new bills created using (or linked to) the updated referral, will contain ICD-10.

To update the referral reason/s on existing referral from ICD-9 to ICD-10, follow the steps below:

  1. Open the client referral you wish to update
  2. Clear you current referral reasons
  3. Click the tickbox - Use ICD-10 diagnosis codes
  4. You will now to able to search for and add ICD-10 diagnosis by keywords or diagnosis codes.

Note: While referrals in Kalix support multiple diagnosis (or referral reasons), an individual referral can contain either the ICD-9 or ICD-10 code set, it cannot contain a mixture of both ICD-9 and ICD-10 diagnosis.

Bills

Kalix's billing functionality allows your to create three types of bills: CMS-1500 forms (insurance claims), superbills and bills using your own billing templates. All can contain ICD-9 or ICD-10 diagnosis codes. 

ICD-9 or ICD-10?

There are strict rules around whether claims should use ICD-9 or ICD-10 codes. Please read the below carefully. 

  • All bills generated before October 1 2015, must use ICD-9. Any and all claims generated before October 1, using ICD-10 will be rejected.
  • If a bill is generated on or after October 1 2015 and the service date (date of service, or date the service was rendered) is on or after October 1 2015, it must contain ICD-10 diagnosis codes only.
  • If a bill is generated on or after October 1 2015 and the service date (date of service) is before October 1 2015 it must use ICD-9 diagnosis codes only.

An individual claim can contain either the ICD-9 or the ICD-10 code set. It cannot contain a mixture of both ICD-9 and ICD-10 diagnosis.

If you are billing for a series of services conducted over a period of time starting before October 1, and ending on or after October 1, You must complete at least two separate CMS 1500 forms: one for services rendered before October 1 (using ICD-9) and a separate claim for services conducted on and after October 1 (using ICD-10).

Bills and Linked Referrals

If a bill is linked to a referral, Kalix will automatically pull information from the referral and input it into the bill. Pulled data includes the diagnosis codes (ICD-9 or ICD-10). 

Kalix will not automatically update ICD-9 codes to ICD-10 codes

Kalix will not automatically update ICD-9 codes to ICD-10 codes for you. There are several reasons why we could not design the functionality to work this way.

If your bill is linked to a referral, Kalix will copy across the diagnosis codes as they are entered into the linked referral e.g. if the linked referral contains ICD-9 codes, ICD-9 diagnosis will be automatically copied into the bill.

Kalix will warn you if the bill's diagnosis codes need to be updated from ICD-9 to ICD-10, as shown in the image below. To update, clear the diagnosis fields and type in the new ICD-10 diagnosis. 

Bills without linked referrals

Bills without linked a linked referral will automatically support ICD-10 if the billing date is on or after October 1. If the billing date is before October 1, the bill will support ICD-9.

Billing & Office Ally

Office Ally is ICD-10 ready, please click here for more information. Office Ally will accept Kalix's claims as per usual, click here for details. To test that Kalix's ICD-10 codes are transferred over to Office Ally correctly and are validated properly, you may wish to send a test claim file (created in Kalix) to Office Ally first. Click here for instructions. Note, you are an Upload User.

Frequently Asked Questions

Will Kalix automatically update ICD-9 codes to ICD-10 codes for me?

No Kalix will not automatically update ICD-9 codes to ICD-10 codes for you. However, Kalix will warn you if the bill's diagnosis codes need to be updated from ICD-9 to ICD-10. There are many more ICD-10 codes compared to ICD-9. Some ICD-9 codes can be replaced by several different ICD-10 codes. Due to this, there is was no way to 100% accurately automate code updates. We made the decision that this process should be completed by each clinician manually. 

Can the Kalix team provide me with advice on which ICD-10 codes to use?

No Kalix is not a billing company. Like always, we happy to discuss, demonstrate and support Kalix's billing functionality. We do not provide support around the specific codes you should use on a claim. We are happy to refer you onto to other services that provide billing advice and services. Just contact us for further information. 

What are some resources I can access?

Document Summary

This article went into quite a lot of detail about ICD-10 and Kalix. So here is a quick summary for you:

What you need to know about ICD-10 & Billing

  • All bills generated before October 1 2015, must use ICD-9. Any and all claims generated before October 1, using ICD-10 will be rejected.
  • If a bill is generated on or after October 1 2015 and the service date (date of service, or date the service was rendered) is on or after October 1 2015, it must contain ICD-10 diagnosis codes only.
  • If a bill is generated on or after October 1 2015 and the service date (date of service) is before October 1 2015, it must use ICD-9 diagnosis codes only.
  • An individual claim can contain either the ICD-9 or the ICD-10 code set. It cannot contain a mixture of both ICD-9 and ICD-10 diagnosis.
  • If you are billing for a series of services conducted over a period of time starting before October 1, and ending on or after October 1, You must complete at least two separate CMS 1500 forms: one for services rendered before October 1 (using ICD-9) and a separate claim for services conducted on and after October 1 (using ICD-10).
  • Please note, the change to ICD-10 does not affect CPT coding for services or procedures (the billing item).
  • A batch file can contain a mixture of claims using ICD-9 and claims using ICD-10.

Kalix & ICD-10

  • Kalix uses ICD CM diagnosis codes in two main locations: Referrals and Billing. Both these areas will be updated to support the new code set.
  • When entering new referrals into Kalix, you will have the option of choosing between using ICD-10 CM or ICD-9 CM.
  • You may wish to update your clients' existing referrals from ICD-9 to ICD-10 codes. All new bills created using (or linked to) the updated referral, will contain ICD-10.
  • If your bill is linked to a referral, Kalix will copy across the diagnosis codes as they are entered into the linked referral e.g. if the linked referral contains ICD-9 codes, ICD-9 diagnosis will be automatically copied into the bill.
  • Kalix will not automatically update ICD-9 codes to ICD-10 codes for you. However, Kalix will warn you if the bill's diagnosis codes need to be updated from ICD-9 to ICD-10. There are many resources out there for ICD-9 to ICD-10 conversion mapping, we like http://www.icd10codesearch.com/
  • Bills without linked referrals will automatically support ICD-10 if the billing date is on or after October 1.
  • Office Ally is also ICD-10 ready. Office Ally will accept Kalix's claims as per usual.
  • To test that Kalix's ICD-10 codes are transferred over to Office Ally correctly and are validated properly, you may wish to send a test claim file (created in Kalix) to Office Ally first. Click here for instructions on how to do this.
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