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Proprietary Information: For Use and Our Customers Only
New Treatment Diagnosis Module
Updated for DSM-5
Release Notes
4/21/2015
2 Proprietary Information: For Use by Qualifacts and Our Customers Only
***Any Notes, Helpful Tips, or Low Priority items will be highlighted by a green, shaded box***
*** Any items that are Critical/High Priority will be highlighted by a red, shaded box***
*** Any items that are Medium Priority will be highlighted by a yellow, shaded box***
Table of Contents Feature Specifications ............................................................................................................................... 3
When does this change take place? Is it critical? ..................................................................................... 3
Who is affected, who will use? ................................................................................................................. 3
Configuration Information: ................................................................................................................... 4
Why should I use this? .............................................................................................................................. 4
How do I use this? How do I make it work? How do I report on this? ..................................................... 5
Instructions ............................................................................................................................................... 5
Additional Information............................................................................................................................ 17
Critical Priority How soon will this change need to be addressed?
High Immediate: These changes need to be addressed
immediately, as they will affect end-user experience.
Medium Coming soon: These changes will be reflected soon, but
there is time to implement (if necessary).
Low Optional: These changes can be used/implemented,
based on System Administrator discretion.
3 Proprietary Information: For Use by Qualifacts and Our Customers Only
New Treatment Diagnosis Module – Updated for DSM-5
Priority: Medium - Update or change is coming; there is time to
implement
Feature Specifications
Modules/Areas Affected: Treatment Diagnosis Module
Summary and Expected Outcomes: The Fifth Edition of the Diagnostic and Statistical Manual of Mental
Disorders (DSM-5) was released in May 2013, requiring broad changes to documentation and claiming
processes affected by this new set of diagnostic codes. Using the DSM-5 code set not only requires
changes at your agency, it has widespread effects on clinical documentation, billing and reporting.
CareLogic features are integrated with diagnosis codes throughout the application; and as a result, this
transition requires extensive and systematic development to maintain and extend functionality.
The CareLogic functionality in this initial release supports diagnosis documentation using DSM-5 with
the new Treatment Diagnosis Module. The billing and claiming part of DSM-5 functionality—along with
other system-wide changes—will be released when the new Treatment Diagnosis module is deployed to
production. These release notes only represent the new Treatment Diagnosis module, and future
release notes will detail billing and ICD-10 changes. In the meantime, CareLogic users should practice
setting up and using the new Treatment Diagnosis module in their Certification environment.
APA Message at Login
A required message from the American Psychological Association will be added to the CareLogic login
screen (see Workflow Impacts and Dependencies for details). This will appear in Certification systems on
4/22/2015 and will appear in Production systems on 5/6/2015. Note that the new Treatment Diagnosis
module will not be accessible in Production until the billing and other related functionality is released.
When does this change take place? Is it critical?
Effective Date: Certification: 4/21/2015; Production: 5/6/2015
Who is affected, who will use? Roles/Programs/Lines of Business: Clinical staff will use the new Treatment Diagnosis module when
entering psychological and general medical diagnoses for consumers. The System Administrator should
re-instance service documents containing this module before the new module is used (see Configuration
Information for details).
4 Proprietary Information: For Use by Qualifacts and Our Customers Only
Configuration Information:
Transition from DSM-IV to DSM-5
As customers begin using the new DSM5 module in Production environments, continuity of DSM versions is
important. If users complete a Treatment Diagnosis module using DSM-5 codes for a consumer and then use
the DSM-IV module on the same consumer, it will interfere with how the data is pulled from these modules.
Once agencies transition to the Treatment Diagnosis DSM-5 module for a consumer, it’s crucial to diagnose
that consumer using the DSM-5 module.
Enabling the Module
The Treatment Diagnosis DSM-5 module will be automatically deployed to your system as a standard
service document module. However, this module will be inaccessible until customers sign the APA
contract related to permissioned users for DSM-5. After Qualifacts Support receives confirmation the
contract has been signed by the agency, they will enable the new Treatment Diagnosis module in that
agency’s Certification system and alert the agency that they can setup and use the module.
Configuring the Module
To use the new Treatment Diagnosis service document module for DSM-5, the System Administrator
must create a new instance or re-instance service documents currently containing the Treatment
Diagnosis module for DSM-IV. Re-instancing the existing Treatment Diagnosis module is the suggested
method, as this will enable the module to remain in existing workflows. For details on creating and
working with service document instances, refer to the CareLogic System Administrator User Guide Part
1.
See the Instructions section for information on setting and using configurations for this module.
Why should I use this?
Benefits and Efficiencies: We have made it possible for customers to transition from DSM-IV to DSM-5
in CareLogic on their own timeline, using service document instances and administrative settings. The
CareLogic functionality detailed in this initial release supports diagnosis documentation using DSM-5
with the new Treatment Diagnosis Module. We are releasing this module to your Certification
environments to allow agency staff to practice setup and use of the Treatment Diagnosis module with
the DSM-5 diagnostic codes and to determine what configurations make the most sense for your
agency.
Scenarios: After signing the APA Service Change Form for DSM-5 permissioned users, ABC Agency will be
able to begin using the new treatment Diagnosis module in their Certification system. Their System
Administrator will re-instance all service documents that contain the Treatment Diagnosis module and
set up instance configurations in alignment with the agency’s workflows and patient population. See the
configurations part of the Instructions section for more information on using configurations to
customize this module for your agency.
5 Proprietary Information: For Use by Qualifacts and Our Customers Only
How do I use this? How do I make it work? How do I report on this?
Workflow Impacts and Dependencies: This module must be used in order to bill claims based on DSM-5
diagnosis codes. The timeline for switching to DSM-5 codes for payer authorizations or state reporting
requirements is a state-specific decision, and some states already require that DSM-5 codes be used
when requesting authorizations for all dates of service. The new Treatment Diagnosis module will be
available for use in Production systems once the billing functionality is released in Production (estimated
release by July 2015).
CareLogic users cannot use this module in Certification or Production until their agency has signed the
APA Service Change Form. Users will not be able to implement this module in their Production
environment until all billing-related components are complete (communicated via future release).
A required message from the American Psychological Association has been added to the CareLogic login
screen. This message states:
*Reprinted with permission from the Diagnostic and Statistical Manual of Mental Disorders,
Fifth Edition. ™ Copyright ©2013 American Psychiatric Association. All Rights Reserved.
Unless authorized in writing by the APA, no part may be reproduced or used in a manner
inconsistent with the APA's copyright. This prohibition applies to unauthorized uses or
reproductions in any form. The American Psychiatric Association is not affiliated with and is not
endorsing this product.
The APA message will be in certification systems until the Treatment Diagnosis module for DSM-5 is
deployed to Production systems, and will remain on the login screen in customer production systems as
required by the APA.
Customization: There are instance configurations and organization configurations for this module (see
Configuration Information for details).
Instructions
From a client’s ECR, navigate to the service document containing the Treatment Diagnosis DSM-5
module.
DSM Diagnosis Update
There have been multiple changes to the DSM Diagnosis Update functionality to standardize how this information is recorded and tracked.
On the Treatment Diagnosis landing page, a separate frame exists to display DSM Diagnosis Update information
6 Proprietary Information: For Use by Qualifacts and Our Customers Only
To access the DSM Diagnosis Update entry page, an Edit button has replaced the Update Diagnosis Date and Diagnosed by link. It has been moved to the top of this box next to the date and timestamp, so it is more visible and accessible.
Client DSM Diagnosis as of [date] now includes a timestamp, which can be revised (in addition to the date) on the DSM Diagnosis Update entry page. The addition of the timestamp to the diagnosis update reflects changes in healthcare standards where recording both date AND time is important for report data
The Description free text field on the Diagnosis Update entry page is now called Comments, and the Description field will only appear (as a drop-down menu) if External Diagnosis is set to Yes
External Diagnosis enhancements (see instructions below for images and details) If Yes is selected for External Diagnosis:
o Diagnosed By changes to Recorded By o The Description field appears as a drop-down menu with a Descriptor list
Descriptor list type is Diagnosis Update Description Examples for Diagnosis Update Description descriptors: where diagnosis was
made (Referral, Diagnosis From Primary Care), why diagnosis was updated (Additional Information Added, Modification to Diagnosis), and description of who made the External Diagnosis (Primary Care Provider)
Instructions for Diagnosis Update functionality:
1. Click Edit on the Treatment Diagnosis landing page next to Client DSM Diagnosis as of
date/timestamp
2. Enter the Effective Date/Time of the diagnosis update and ensure AM or PM is selected
accordingly
3. If the diagnosis was made internally, select No for External Diagnosis
a. Select the staff member for the Diagnosed By field
b. The Description field will not display
7 Proprietary Information: For Use by Qualifacts and Our Customers Only
4. If this diagnosis was made externally, select Yes for External Diagnosis
a. Diagnosed By will change to Recorded By; select staff member for Recorded By
b. The Description field will appear; select the appropriate description if desired
This image below shows changes made in the DSM Diagnosis Update entry page that will be reflected on
the Treatment Diagnosis landing page.
8 Proprietary Information: For Use by Qualifacts and Our Customers Only
This image below shows the following selections: Yes for External Diagnosis, Recorded By Clinical Staff,
with Description of Additional Information added selected, and comments added in the Comments text
box.
Create New / Create Copy and Create Read-Only Copy
The user has the ability to create a new Treatment Diagnosis, a copy of an existing Treatment Diagnosis,
or a read-only copy of an existing Treatment Diagnosis. The read-only copy does not allow editing of a
copied Treatment Diagnosis. This gives agencies the ability to privilege out who can modify a copied
Treatment Diagnosis (see Scenarios for suggestions on using this feature).
When creating a copy or read-only copy, the Copy Existing Diagnosis field will appear and provide a
drop-down menu with existing diagnoses to choose from, including the logged in staff member, the date
of diagnosis and the diagnostic code. Please note, the most recently signed Treatment Diagnosis will be
on the top of the list in the Copy Existing Diagnosis dropdown.
9 Proprietary Information: For Use by Qualifacts and Our Customers Only
Diagnosis
Columns of the Diagnosis table include the following (depending on configurations):
Fields: Attach, Relevant, DSM-5 Code – Description, ICD-9 Code – Description, SNOMED Code –
Description, Diagnosed Date, Status, Status Date, Priority, Comments
Buttons: Education (only visible if MU organization configuration is on), Detail
To use the Treatment Diagnosis DSM-5 module, follow the steps below:
1. To add a diagnosis to the Diagnosis table, click Add above the Diagnosis table to go to the
Diagnosis Entry page
Add Diagnosis
For clients with no existing Treatment Diagnosis, users will be taken to the Diagnosis Entry page
when entering the Treatment Diagnosis module for the first time
2. After entering a diagnosis in the DSM-5 field with the search and select function, the diagnosis
codes will crosswalk to the ICD-9 Code and SNOMED Code fields (if configured)
3. Specifiers and Severity must be entered for any DSM-5 diagnosis code that requires these
modifiers. Specifiers and severity codes must be manually entered from the DSM-5 code set,
either from the DSM-5 book or e-book.
10 Proprietary Information: For Use by Qualifacts and Our Customers Only
Diagnosis Entry page
4. Complete the remaining required and/or optional fields and click Submit
a. Associated Code: this is a new field that can be checked to include documentation of an
associated diagnosis code (for example, for specifiers or severity). Associated Codes
will not enable billing for the Associated Code that is selected. These may be entered
for any DSM-5 diagnosis code that requires these modifiers and must be entered from
the DSM-5 code set, either from the DSM-5 book or e-book.
b. Provisional: this enables the entry of a diagnosis when it may need to be revised later
(for example, differential diagnosis to further test for autism spectrum disorders)
c. Add Another Diagnosis: in both the Diagnosis Entry and General Medical Condition
Entry, the Add Another Diagnosis check box can be checked to add another entry
without leaving the module.
5. Priority for diagnoses will default to the order in which the diagnoses are entered. To change a
Priority for a diagnosis, the user can click on the menu icon in the left-hand column of the row to
drag the row up or down within the Diagnosis table. The row will turn yellow as it is moved, and the
Priority value will automatically reset based on the position of the row. Because priority can be set
by dragging these rows, the Priority column is not sortable.
6. To Attach an existing diagnosis to a service or activity, select the Attach radio button. This
functionally is used for billing, is now on an instance configuration, and is included in the Treatment
Diagnosis module itself. For DSM-IV, the Attach Diagnosis functionality was a stand-alone module.
11 Proprietary Information: For Use by Qualifacts and Our Customers Only
For DSM-5, the Attach Diagnosis functionality has now been incorporated into the new DSM-5
Treatment Diagnosis module.
Click and drag diagnosis rows for priority
General Medical Condition
To enter non-DSM-5 medical codes, select the General Medical Condition checkbox, and the page will
repopulate based on required fields for medical conditions instead of DSM-5 codes (depending on
configurations). This change was previously Axis III in DSM-IV.
When the ICD9 and SNOMED Codes are turned on, the medical diagnosis can be entered in this field
using search-and-select functionality, and it will crosswalk to the SNOMED Code.
General Medical Condition field selection for medical diagnosis (ICD and SNOMED turned on)
12 Proprietary Information: For Use by Qualifacts and Our Customers Only
General Medical Crosswalk to ICD9/SNOMED
When the ICD9 and SNOMED Codes are turned off, a Diagnosis Description text box displays instead.
General Medical Condition field selection for medical diagnosis (ICD9 and SNOMED turned off)
Psychosocial and Contextual Factors
Columns of this table include: ICD-9 Code – Description, Comments
This table was previously called Psychosocial and Environmental Problems.
Figure 1 Psychosocial and Contextual Factors table
1. Click Add to enter a new Psychosocial and Contextual Factor and enter the ICD-9 V-code with the
search and select function. In the previous Treatment Diagnosis module, this was reflected as
13 Proprietary Information: For Use by Qualifacts and Our Customers Only
Severity and Description {which was a descriptor list} as well as a free text comments field, but
DSM-5 requires V-codes to be entered here (pp 874-876 in the DSM-5 book).
2. Enter Comments if desired, and click Submit or click Add Another Factor for additional entry
Figure 2 Psychosocial and Contextual Factors Entry
Disability Table
This table displays the following columns: Disability Score, Description. The Disability table can show
disability scores to replace the Axis V entry of the GAF score. The APA recommends using the WHODAS
assessment for disability scoring, but descriptive text and/or scoring results from any assessment
instrument can be used here.
The table can be configured to display only Score, only Description, or Both Score and Description. The
columns will adjust for display accordingly. Also, this table can be configured to never show or be
required. As with the Diagnosis table functionality, click Add to add a new Disability score on the
Disability Entry page, or click on the row of an existing score to edit or view.
Figure 3 Disability Table
Figure 4 Disability Table Entry
Reconciled Problems
This data is pulled in from reconciling CCDAs through the Clinical Information Reconciliation module.
This is controlled by an instance configuration and the table will only populate if you have set up and
reconciled a problem in the Clinical Information Reconciliation module.Previous Disability Entries Table
This table displays the following columns: Disability Score, Description, Date, Staff, Source
14 Proprietary Information: For Use by Qualifacts and Our Customers Only
Previously completed Disability entries will display in this table. The Previous Disability Entries Table
should only be turned on in the instance configurations if the Disability table is configured to display in
the Treatment Diagnosis.
Figure 5 Previous Disability Entries Table
Diagnostic Formulation Table
This table displays free text entry of Diagnostic Formulation data. This previously appeared at the top of
the DSM-IV module and is now at the bottom of the Treatment Diagnosis.
Figure 6 Diagnostic Formulation Table
Instance and Organization Configurations
The image below shows the Treatment Diagnosis module with all instance configurations and
organization configurations turned off.
Go to the DSM-5 Treatment Diagnosis Instance Configurations document to view a list of all instance
configurations and descriptions in a table. Instance Configurations can be set by the System
Administrator when completing the Service Document Instance.
15 Proprietary Information: For Use by Qualifacts and Our Customers Only
Organization configurations are not visible to customers and are set by Qualifacts staff. To change any of
these configurations, customers will need to submit a Support request. All current Organization
configurations will automatically transfer from DSM IV to DSM-5 for your organization.
Note that the configurations are listed in this document in a different order than they appear in
CareLogic. They are grouped here by the way the related functionality appears in the module, but
CareLogic lists configurations alphabetically.
Configurations: Diagnosis Entry for DSM Diagnoses
The image below shows the Diagnosis Entry for DSM diagnoses with all configurations turned on. Each
field that is behind a configuration is described after this image.
SNOMED Code:
(Instance Configuration) Enable SNOMED for DSM Diagnosis Entry is set to Yes so the SNOMED Code
field displays on the Diagnosis Entry page.
Diagnosed Date, Status and Status Date:
16 Proprietary Information: For Use by Qualifacts and Our Customers Only
(Organization Configuration) Use Diagnosed Date, Status and Status Date is enabled so these fields are
added to the Diagnosis Entry page for both DSM-5 and General Medical Condition diagnoses.
Configurations: Diagnosis Entry for General Medical Condition
The image below shows the Diagnosis Entry for DSM diagnoses with all configurations turned on. Each
field that is behind a configuration is described after this image.
ICD-9 Code and SNOMED Code:
(Instance Configuration) Enable ICD-9 and SNOMED for General Medical Condition is set to Yes, so
fields for ICD-9 and SNOMED codes display for General Medical Condition. This will be an ICD-9 search
and select field that crosswalks to SNOMED (instead of a free text box). If set to No, the ICD-9 and
SNOMED fields will be replaced by a text box labeled Diagnosis Description.
(Organization Configuration) Use Diagnosed Date, Status and Status Date is set to Yes, so these fields
are added to the Diagnosis Entry page for both DSM-5 and General Medical Condition diagnoses.
Instance Configurations for Disability Table and Previous Disability Table
Show Disability Table – new configuration for Disability table (replacing GAF/CGAS); if set to Yes, the
Disability Table will display
Disability Entry Type – new configuration for Disability table (replacing GAF/CGAS); the administrator
can choose to set the Disability Entry Type to either Score, Description, or Both.
Show Previous Disability Table – should be turned on ONLY if Disability Table is turned on; otherwise
this table will appear blank
Mandatory Disability Entry – new configuration for Disability table (replacing GAF/CGAS); if set to Yes,
the Disability Entry Type is required
17 Proprietary Information: For Use by Qualifacts and Our Customers Only
Additional Instance Configurations for Treatment Diagnosis Module
Enable Attach to Diagnosis Functionality – new configuration to replace the stand-alone Attach
Diagnosis module; if set to Yes, an Attach column is added to the Diagnosis table with a radio button to
select one diagnosis to move or “attach” to the first position on the claim. The release notes detailing
related billing functionality, along with billing training, will go into detail on how this works if this
functionality is not familiar to you at this time.
Enable Read-Only Copy Functionality – if set to Yes, the option to create a read-only copy of a
previously signed Treatment Diagnosis DSM-5 module is available when creating a new Treatment
Diagnosis. This is a new configuration based on customer requests to prevent changes to the diagnoses
within this module. Attach to Diagnosis functionality is still available in the read-only version. Users will
not be able to create a read-only copy for a consumer if it is their first Treatment Diagnosis.
Show Reconciled Problems – if set to Yes, this field will display in the Treatment Diagnosis DSM-5
module. This field was previously called Show External Problems History.
Organization Configurations
Allow Diagnosis V Codes – if set to Yes, V codes used when adding a Diagnosis will be added to the
claim; V codes added to Psychosocial and Contextual Factors will not pull onto claims.
Enable Relevant Diagnosis – if set to Yes, the Relevant column will be added to the Diagnosis table (can
be checked or unchecked to show the diagnosis is relevant to the claim)
Reporting: No additional Pentaho views will be released with the current functionality Pentaho views
will be updated with all functionality is released.
Troubleshooting: Ensure that all configurations have been turned on or off as desired. A DSM-5 text or
electronic code set is needed to manually enter specifiers and severity for the diagnostic codes that
require them.
Additional Information
Follow up/Next Steps: For additional assistance, please contact your Qualifacts Implementation
Specialist or Qualifacts Support.
Qualifacts Support: (866) 386-6755, option #1
Customer Support Portal: https://support.qualifacts.com/SFSupportPortal
Additional Information:
This release alert was sent to agencies to help prepare for the transition to DSM-5, and includes
information on planning for system setup and staff training.
System Administrator User Guide Part 1
