The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) have approved a change in forms to reflect a transition from the ICD-9 system of diagnosis to the ICD-10 system of diagnosis, effective October 1, 2015.

The following forms will be updated:

• Doctor’s First Report of Injury (Form 5021)
• Primary Treating Physician’s Progress Report (Form PR-2)
• Primary Treating Physician’s Permanent and Stationary Report (Forms PR-3, PR-4)

The International Classification of Diseases—10th Revision, Clinical Modification (ICD-10-CM) and the International Classification of Diseases —10th Revision, Procedure Coding System (ICD-10-PCS) have been adopted for workers’ compensation for services rendered and inpatient discharges on or after October 1, 2015, in order to be consistent with the coding system that will be mandatory for most health care providers across the country beginning October 1. ICD-9 codes are not allowed for services rendered, or inpatient discharges, on or after October 1, 2015.

The regulations provide a “grace period” for use of the revised forms. From October 1, 2015 through December 31, 2015, providers may use either the old or new versions of the forms. However, for services rendered on or after October 1, 2015, the ICD-10 code is required, whether the old or new form is used. For services rendered on or after January 1, 2016, the new forms are required.

In order to provide some leeway with the new codes, the DWC has adopted a provision stating that a bill shall not be denied solely due to the level of “specificity” of the ICD-10 code.

The DWC rules requiring use of ICD-10 for medical treatment bills for services on or after October 1, 2015, were adopted last year, and have been updated in the rules posted today. They may be accessed in the DWC Medical Billing and Payment Guide in the provisions relating to “complete bills.”

The Centers for Medicare and Medicaid Services’ website contains useful information and resources relating to preparation for the ICD-10 implementation, including a list of valid ICD-10 codes.

The rulemaking documents, text of the regulations and new forms can be found on the approved regulations page.

What This Means for You:

Be on the look out for revised codes when considering request for payment of provider bills.

– Darlene M. Ball, Esq.