It will now be necessary for an injured worker’s medical providers to use the correct ICD-10 codes when asking for pre-approval of medical services and payment of medical bills or delays in processing could occur.
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Columbus, OH (PRWEB) September 30, 2015
“The ICD is a coding system intended to bring uniformity to the classification of diagnosable medical conditions for reporting, statistical, insurance and other reasons,” said Zamora. “Injured workers in Ohio may be familiar with the maximum five-digit coding system of the current ICD, Ninth Revision, categorizing for billing purposes the medical condition the BWC has allowed in their injury or occupational disease claims.”
For example, an injury described by a physician as a “lumbar sprain” was coded as “847.2” under the ICD-9, and the managed care organization would address payment of the bill for the lumbar sprain if the medical provider used the proper code. However, under the new ICD-10, a lumbar sprain will be coded “S33.5XXA.”
“The ICD-10 uses an expanded coding system of seven alphanumeric characters, which dramatically increases the level of specificity to describe medical conditions,” said Zamora. “It will now be necessary for an injured worker’s medical providers to use the correct ICD-10 codes when asking for pre-approval of medical services and payment of medical bills or delays in processing could occur.”
Furthermore, the ICD-10 codes will be used on BWC forms in which the injured worker may be asking for compensation. For example, the MEDCO-14 is a form utilized by physicians to obtain payment of temporary total disability compensation when the injured worker is unable to work and the physician must identify the condition which is disabling. The MEDCO-14 form also requires the physician to identify the ICD code for the disabling medical condition. Improper codes may be a basis for temporary total disability compensation to be denied, because it may appear to the BWC that the doctor considers the injured worker to be unable to work due to a non-allowed condition.
According to the Ohio BWC, for injury claims on and after October 1, 2015, physicians should only submit ICD-10 codes on the First Report of Injury. In Ohio workers’ compensation claims, the specific medical conditions that the BWC and the Industrial Commission of Ohio have allowed should always be the controlling factor when the injured worker is asking for medical services and compensation.
“As a practice, however, injured workers should be aware that with the implementation of the ICD-10 coding system, there will be new opportunities for disputes to occur in the approval and payment of medical services and compensation in their BWC claims,” said Zamora.
About Charles Zamora Co., L.P.A.
Attorney Charles Zamora represents injured and disabled workers. Charles was one of the first lawyers to become a certified specialist in the field of workers’ compensation. He has a deep understanding of all the issues at stake as he has gone above and beyond the call of legal duty to become a certified expert in order to better help injured workers and their families. For more information or a free consultation, please call 614-221-1300. The office is located at 447 East Mound St., Columbus, OH 43215.
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