International Classification of Diseases, 10th Revision (ICD-10), is the national standard for diagnostic coding. ICD-10 is a morbidity classification published in the United States for classifying diagnosis and the reason for visits in healthcare settings. The ICD-10 code selected should justify the medical necessity of the service or procedure the provider performed for the injured worker.
Successful code selection helps avoid bill denials and allows bills to be processed faster.
The Colorado Division of Workers’ Compensation (DOWC) Rule 16 requires providers to use current, accurate and specific diagnosis codes for each billed patient encounter. While the DOWC is one year behind with CPT codes, ICD-10 codes are current and updated annually in October.
Avoid potential denials with these tips for successful ICD-10 coding:
- Use the most specific code available.
- Avoid signs and symptoms codes.
- Submit confirmed diagnosis codes.
- Indicate the reason for the visit is the primary diagnosis code.
- Include signs and symptoms in the diagnosis code.
- Remember M54.5 is no longer a valid code as of October 2021.
- Use external cause code(s).
See the examples below for specific ICD-10 coding:
If you have questions about billing or coding, please contact the Medical Payments and Quality Assurance team at 303.361.4940 or billingsuccess@pinnacol.com.
