ICD10 Changes for October 2021, AG modifiers, Medicaid CIS updates

Medicaid's manual updated on 10/1/2021 for the new quarter.

The update is under non covered services that states:

NOTE: Children’s Intervention Services do not include educational services otherwise available through a program funded under 20 USC Chapter 3, section 1400 of the Individuals with Disabilities Education Act (IDEA). Congress reauthorized the IDEA in 2004 and most recently amended the IDEA through Public Law 114-95, the Every Student Succeeds Act, in December 2015. Information about the IDEA Act is found on the U.S. Department of Education site at: U.S. Department of Education.

I've been asked several times what this would include, so I reached out to DCH. Their response:

Services in a school setting are non-covered. The new statement advises that services otherwise available through Individual with Disabilities Education Act (IDEA) under another program area are not reimbursable under the CIS program.

Remember you need to review manual updates every quarter on GAMMIS. No log in required.

Feeding Diag code: R63.3 is no longer valid as of 10/1/2021

ICD10 coding change every October. One of the codes we often use: R63.3 for feeding is no longer a valid code. If you have been using this code, will need to know what the correct diagnosis should be:

https://www.icd10data.com/search?s=R63

I assume most will want to change to R63.31

You do not need to change your POCs that are already in place, just note that new POCs or Rx requests, billing, needs to reflect the new diagnosis.

Amerigroup modifier denials

I had a response back from a rep to say that the current speech evaluations receiving denials was a glitch they were currently working on. However, it seems further response shows that AG is requiring both modifiers for all therapies as BCBS requires now.

Example: 92523 requires GN, HA for billing.

Any claims that denied for wrong modifiers we are filing corrected claims on Availity at this time.