On August 16, 2020, the MO HealthNet Division (MHD) began accepting ICD10 diagnosis codes on pharmacy claims. To ensure data integrity claims may be denied if the diagnosis is not coded to the highest level of specificity. When including the ICD-10 code on the pharmacy claim, the pharmacy should verify the code is billable. As an example, the code F20 Schizophrenia is a non-billable code. It lacks the full specificity needed to be billable. The list of billable ICD-10 codes for Schizophrenia is below and the exact diagnosis code should come from the prescriber of the medication. When submitting the diagnosis code in the pharmacies point of sale software the diagnosis code should be entered without the period. For the diagnosis of paranoid schizophrenia the diagnosis code should be submitted as F200.
F20.0 Paranoid schizophrenia
F20.1 Disorganized schizophrenia
F20.2 Catatonic schizophrenia
F20.3 Undifferentiated schizophrenia
F20.5 Residual schizophrenia
F20.81 Schizophreniform disorder
F20.89 Other schizophrenia
F20.9 Schizophrenia, unspecified
The submitted diagnosis code must be from the prescriber and will be subject to audit. In Missouri, pharmacists are currently not allowed to diagnose based on current rules and regulations.