International Classification of Diseases (ICD-10) coding is a statistical
classification system that arranges diseases and injuries into groups
according to established criteria. ICD-10 codes are alphanumeric and consist of three to seven alphanumeric characters
and a description.
Example: An ICD-10 code for a right Colles' fracture is S52.531_. The seventh character will indicate the episode of care,
which will generally be indicated as 'initial' for BWC purposes. Therefore, the code would be S52.531A, Colles' fracture
of the right arm, initial episode of care.
How does BWC use ICD codes?
Since ICD codes identify the type, episode of care and nature of the injury, we use them to
determine appropriate medical treatment. For example, for a torn medial meniscus,
a serious knee injury, surgery would likely be an appropriate type of treatment.
However, if the allowed condition in the claim is a sprained knee,
surgery would not be appropriate, nor approved.
In addition, when medical providers bill BWC for services, they list the ICD code
on the billing forms. BWC and the managed care organizations review all bills
to make sure medical providers treat only allowed conditions in the claim.
If bills are submitted for injuries that are allowed within the claim, we will
pay. If bills are submitted for injuries that are not allowed within the claim,
we will not pay.
What is an invalid ICD code?
BWC has defined the following information as an invalid ICD-9 code:
- A code for an injury/condition that is not causally related to an industrial injury or occupational disease;
- The proper application of coding principles (Code assignment requires the highest level of specificity, i.e., must assign the maximum number of digits for a code.) BWC has identified all three and four digit codes that require a fourth and fifth digits respectively;
- An unspecified injury/condition or site code therefore a more specific code exists;
- A symptom code;
- A multiple injury/site code. Reported injury/condition with more than one injury/site are assigned individual codes
If you know your claim number, click here to look up the ICD codes for your claim.