ICD-10 and Workers’ Comp

Medicare Set-Aside Blog on September 26, 2011 | Posted by

With the uncertainty of MMSEA reporting penalties looming in the hearts and minds of insurance carriers when trying to decide what ICD-9 codes to report as related to their claims, I can’t help but wonder if they have an idea what happens on October 1, 2013. For those unfamiliar, ICD-9 codes identify the injury being reported; however there are only 18,000 codes total so as you can imagine, they do not get very specific to the circumstances of every injury. The other issue is that several different codes many be used to code similar conditions. While an individual may have suffered a lumbar sprain work injury, he may have been treating for a previous displacement in the same region but different level and they all get associated as related by CMS. If you over report, you may unintentionally take responsibility for more than your covered injury.

Well no more. When CMS officially switches to ICD-10 in 2013, it will have 140,000 codes to select from. We will now know exactly which level was involved, and unfortunately the location in which the injury occurred. Perhaps this will indirectly make great strides in combating WC fraud because we will be able to tell that a railroad worker’s injury was unlikely to have occurred during the course and scope when incurred on a squash court or in a hen house. When we question the compensibility of a water skiing professionals burn injuries, we will know that it happened while jumping through flaming hoops and most certainly related. If an animal bite is reported, we will know if it occurred at the hands of a turtle or any one of 72 types of birds.

Oh what fun this will be…

For more entertainment, see the following Wall Street Journal article: