March 20, 2018

CA DIR, DWC Post Final, Approved Regulations Regarding Transition to ICD-10

San Francisco, CA – The Department of Industrial Relations (DIR) and its Division of Workers’ Compensation (DWC) recently posted the final approved regulations regarding transitioning the California workers’ compensation system from the ICD-9 system of diagnosis to the ICD-10 system of diagnosis, effective October 1, 2015.

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 that have been approved by the Office of Administrative Law include updates to the following forms and related regulations:

  • 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 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 recognition of the challenges involved in transitioning to the new coding system, the regulations provide some leeway in relation to the accuracy of the ICD-10 code used.

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. This is similar to the guidance (PDF) provided by the Centers for Medicare and Medicaid Services, allowing some flexibility in the selection of the ICD-10 code, as long as the diagnosis code used is a valid 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. 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.

Source: CA DIR

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