Pain Management Coding Alert

Published on Wed Feb 03, 2016 PDF

Question: I have been told we shouldn’t use ICD-10 for workers’ compensation related claims. Is that true?

Vermont Subscriber

Answer: Workers’ compensation (WC) payers were not required to make the switch to ICD-10. That means you might need to use both ICD-9 as well as ICD-10 codes in specific cases.

Many of the states are at different stages of ICD-10 readiness, according to information from the Workgroup for Electronic Data Interchange (WEDI).  Plus, some states may have created an alternate solution for their workers’ comp programs.

For instance: Wyoming said it would accept both ICD-9 and ICD-10 codes effective Oct. 1, allowing workers’ compensation providers a full year to transition from the current system to the new one, WEDI says. Hawaii, on the other hand, does not use ICD coding as part of its workers’ compensation system, and does not plan on doing so in the near future, WEDI notes.

Best advice: Although HIPAA-covered entities such as Medicare, Medicaid, and most private health plans are now required to use ICD-10 codes, keep in mind that “non-covered entities” are not subject to that rule. Non-covered entities include workers’ compensation, auto, property, and casualty insurers. To find out your state’s specific workers’ compensation coding requirements, contact your state office directly, because these payers fall into a loophole in which they aren’t required to transition to ICD-10.

Medicaid difference: Even though Medicaid is also run by the states, your Medicaid insurers were required to accept ICD-10 codes effective Oct. 1, 2015. And although CMS has stated that Medicare Administrative Contractors (MACs) will actually allow non-specified codes as long as you assign a code from the correct code family, this is for Medicare only. No other payers — not even Medicaid — have announced a grace period for assigning the right code, so make sure you get specific. This is very important for your providers to know now. More documentation detail should be the slogan in all offices in order to get the most appropriate ICD-10 code the first time out of the gate.

Resource: To review WEDI’s list of the states and their current ICD-10 readiness level, visit http://wedi.org/knowledge-center/resource-view/resources/2014/11/05/property-and-casualty-icd-10-state-readiness-resource-center.