OhioBWC - Provider:  (ICD-10) - Details

ICD-10 implementation - Latest news

New fact sheet provides post-implementation updates

BWC was ready when the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD)-10-CM implementation began nationally on Oct. 1, 2015. Now we are several months post implementation, and we have five specific coding-efficiency issues to communicate with you. These issues relate to our coding customizations and differences. This post-implementation fact sheet has more details and a spinal/back sprain and strain table.

BWC's grace period to accept ICD-9 codes on bills expires Dec. 31

You must submit bills for dates of service after Dec. 31, 2015, using only ICD-10 codes. As of Jan. 1, BWC's managed care organizations (MCOs) will deny bills not meeting this requirement with EOB 343 - Payment is denied as billed diagnosis code is not valid on the date of service. If this occurs, you must bill again with the appropriate ICD-10 code. Also, remember to code what you are treating and to check your electronic website account for BWC's allowed conditions. For help with BWC specific ICD-10 coding, please visit our ICDs for Ohio workers' comp information section.

Getting down to specifics for claim allowance and billing

As of Nov. 24, this website features a new section for providers that identifies the differences between coding for claims and bills. It also features two new lists to assist providers with validation of ICD-10 codes. The first list highlights codes that are not usually appropriate for claim allowances. The second list highlights the most frequently allowed conditions with ICD-9 codes and their associated ICD-10 codes. Access the new section ICDs for Ohio workers' comp from the left-side menu under Services.

BWC, MCOs now taking ICD-10 codes; specific codes are important

We did it! BWC and our managed care organizations (MCOs) transitioned to ICD-10 on Oct. 1. Thank you for your cooperation during this transition and for using electronic accounts for your claim needs. We continue to work closely with the MCOs to provide the best service possible for you and Ohio's injured workers.

Be specific, complete when coding diagnoses
The new ICD-10 code set allows you to be more specific in how you document the location and severity of the injury and/or occupational disease. Be specific and complete with your ICD-10 coding based on the injury's/occupational disease's narrative description(s), especially when filing the First Report of an Injury, Occupational Disease or Death (FROI). BWC considers certain codes "invalid" for claim-allowance purposes. These codes are typically nonspecific, such as symptom codes.

BWC and MCOs use diagnosis groupings in bill processing
Providers should continue to code bills based on the conditions they are treating. BWC has expanded the clinical diagnosis groups used in bill processing to include ICD-10 codes. BWC and MCOs use these groups as one of the tools that evaluate the relationship between treatment and claim allowances. This approach ensures we can process bills containing ICD-10 codes even if we have not mapped the ICD-9 associated with a claim to ICD-10.

S and T categories
ICD-10 codes from the S and T categories must have seven characters. Assign the seventh character based on the type of encounter. For BWC allowed conditions, we will use the seventh character A (initial encounter) in most cases. Clinical diagnosis groups include initial, subsequent and sequelae codes in the same group so there is no need for additional allowances beyond the initial encounter code.

If you do not have ICD-10 coding resources, you may take advantage of coding services or software that is available online. In addition, please review these sites:

If you have questions, you may ask the injured worker's MCO or email them to BWC provider relations.

BWC, MCOs now taking ICD-10 codes

On Oct. 1, BWC, along with the rest of the nation, implemented the International Classification of Diseases (ICD-10). This means Health Insurance Portability and Accountability Act (HIPAA)-compliant providers do not need to make special accommodations for their patients with a workers' compensation claim resulting in uninterrupted services for your employees.

More specific for injuries
Remember for workers' compensation, claims determinations are based on injury descriptions, not disease codes. The new ICD-10 code set offers the medical community the ability to be more specific in how they document the location and severity of workplace injuries.

Bottom line for employers
Therefore, you may see more (and/or different) codes in existing workers' compensation claims after Oct. 1, but that does not mean there are more allowances in the claims. The bottom line is more (or different) codes do not equal more allowed conditions. The legal narrative descriptions originally allowed in a claim will not change with ICD-10.

For more information, review our ICD-10 Implementation Guiding Principles Fact Sheet or email BWC's provider relations department.

ICD-10 readiness - For the MCOs

On Sept. 8, 2015, staff from all 15 certified managed care organizations (MCOs) received BWC training on ICD-10 implementation. This meeting focused on the agency goal for a seamless transition on Oct 1. Topics included the handling of ICD-10 codes for:

  • Reporting injuries;
  • Processing Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9s);
  • Billing.
The emphasis was on medical necessity and the narrative descriptions allowed in the claim and NOT the codes. We also encouraged MCOs to staff with providers when necessary to recommend ICD-10 codes to BWC for unmapped codes. Documentation for collaboration will be key to making ICD-10 implementation a success.

Q & A: Common questions about ICD-10 and BWC

We're highlighting common questions and answers (Q & A) we've received about our transition to ICD-10 on Oct. 1, 2015, with the rest of the nation. To make this transition as smooth as possible, BWC and our MCOs are implementing measures that allow us to process claims and bills using ICD-9 codes, if necessary, for 90 days past the Oct. 1 effective date.

Here are answers to three commonly asked questions.

1Q: How does ICD-10 implementation affect reporting a claim? - Coding Guidelines for the First Report of an Injury, Occupational Disease of Death (FROI)

1A: Providers should only submit one version of codes on the FROI. For dates of injury prior to Oct. 1, 2015, use ICD-9 codes. For dates of injury on or after Oct. 1, 2015, use ICD-10 codes.

2Q: Are providers testing bill submissions for ICD-10 with MCOs and BWC?

2A: Yes. Testing is in progress right now through BWC's HPP systems support unit and the MCOs' billing contacts. We will complete a final round of testing to confirm everyone is prepared to process bills containing ICD-10 codes.

3Q: How does ICD-10 affect treatment requests in existing claims?

3A: Physician's Request for Medical Service or Recommendation for Additional Conditions for Industrial Injury or Occupational Disease (C-9) - Section III of the C-9 requests a narrative description of requested conditions. The narrative should be as specific as possible so we can ensure we can code the ICD-9 and ICD-10 from the request appropriately.

For answers to your questions about ICD-10 and BWC, please review the ICD-10 Implementation Guiding Principles Fact Sheet. For more information, email BWC's provider relations department.

Injury descriptions
Remember for workers' compensation, claims determinations are based on injury descriptions, not disease codes. Therefore, claims determinations should not be affected by the ICD-10 implementation.

Resources available for general ICD-10 education, information
As providers, you're essential in providing care for Ohio's injured workers. We're implementing and adopting ICD-10 to mitigate any barriers and negative impacts we could face as a payer. In addition, our goal is to continue to provide you the best customer service possible from treatment planning to billing. In this effort, we're sharing some of the resources available from the Centers for Medicare & Medicaid Services (CMS). These may help you with the transition from ICD-9 to ICD-10.

Road to 10
For example, CMS reminds providers that the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services. You also may jump start your ICD-10 transition with Road to 10, an online resource built with input from providers in small practices. This resource includes specialty references and helps providers build ICD-10 action plans tailored for their practice needs.

ICD-10 coding is in full swing at BWC!

We have joined the ICD-10 coding effort, even though we're not mandated to do so.

BWC's commitment
Why, you may ask? The answer is because of YOU. Rather than have providers meet a different coding standard than the rest of the medical world, BWC is making a commitment of service and simplicity to our provider partners. We are now completing the training phase of our ICD-10 implementation plan we designed exclusively for our workers' compensation system. This training will prepare BWC to better support providers in your ICD-10 transition activities.

Provider-treatment plans
One important point to remember, while the codes may change for workers' compensation, the allowed conditions on the claims will not change. Therefore, the change to ICD-10 should not affect your provider-treatment plans. You may review our ICD-10 Implementation Guiding Principles Fact Sheet. For more resources about ICD-10, visit the Centers for Medicare and Medicaid Services website and our sister agency's site, the Ohio Department of Medicaid.

If you have questions, please email BWC's provider relations department.

Oct. 1, 2015: New ICD-10 implementation date nationwide

BWC continues to move forward in meeting the new International Classification of Diseases, tenth revision (ICD-10) code set implementation date of Oct. 1, 2015. The U.S. Department of Health and Human Services (HHS) released a final rule for that date after Congress passed legislation delaying the planned Oct. 1, 2014, transition from ICD-9 to ICD-10.

HHS reports this deadline allows providers, insurance companies and others in the health-care industry time to ramp up their operations to ensure their systems and business processes are ready to go on Oct. 1, 2015.

During this time, BWC is executing our defined project plan and strategy. This helps us successfully prepare our infrastructure and staff members for the health-care system's ICD-10 implementation. Our code-conversion efforts are for the benefit of Ohio's injured workers and employers. For additional updates, you can subscribe to Provider eNews.