OhioBWC - Provider - Service:  (ICDs for Ohio workers' comp) - Claim conditions

ICDs for claim conditions

BWC and self-insuring employers rely on provider diagnoses to determine what conditions to allow in industrial claims. They need specific diagnoses, including site and location, to understand the severity and nature of an injury. The conditions reported on our First Report of Injury (FROI) should include the cause of the injured worker's symptoms and not just the symptoms themselves. We cannot allow claims with only symptom codes.

With the implementation of ICD-10, selecting codes to report in claims has become more difficult. So, we've developed documents to provide guidance for reporting injuries and requesting additional conditions.

  1. ICD-10 codes inappropriate for claim allowances - These are primarily symptom codes, unspecified codes and incomplete (ICD chapter heading) codes. Providers who report codes from this list on FROIs may receive follow-up communication from managed care organizations or BWC requesting diagnosis clarification. Reporting injuries with inappropriate diagnoses delays claim allowance, treatment authorizations and provider reimbursement.
  2. Most frequently allowed diagnosis codes - This document includes ICD-9 codes and the alternatives that can be used in reporting with ICD-10. This is NOT a substitute for ICD-10 coding education and use of professional coding resources, but an illustration of conditions commonly seen in workers' compensation. Providers can use the narrative descriptions to determine the best code for reporting injuries and requesting additional conditions.