Insurance News:

Workers Compensation Updates

by NYSCA Workers' Compensation Committee | 10/7/2015 10:20:48 AM

USE OF ICD-10 CODES

As you are all aware, October 1st represents the transition date from ICD-9 to ICD-10 diagnosis codes. The WCB Chair has published several announcements over the years expressing their intent to adopt the use of ICD-10 consistent with Medicare and Medicaid's timetable. As we're all aware, that time has finally arrived!

The rules adopted by the WCB are significantly more liberal and provider friendly than those enacted by CMS and commercial carriers. The NYSCA appreciates the WCB's understanding that a claim for medical benefits should not be unduly delayed or denied based solely upon ICD code use during this transition. In summary:

  • Do not submit ICD-9 codes and ICD-10 codes on the same claim / C4 form.  Separate bills must be submitted for dates of service on or before September 30, 2015 and on or after October 1, 2015.
  • Carriers CANNOT deny or reduce your medical bill based solely upon your failure to convert to ICD-10 codes.  Carriers must accept both ICD-9 codes and ICD-10 codes effective October 1, 2015.
  • You may choose to submit a CMS-1500 with a detailed narrative report or office note in lieu of C-4 or C-4.2 forms. HOWEVER, the failure to include a detailed narrative report consistent with the published requirements is not considered a valid submission.

What does the NYSCA Workers' Compensation Committee recommend?

Make the transition to ICD-10 coding for your workers' compensation patients consistent with the rest of your patient population. Unless you are familiar with the EC-4NARR reporting requirements, avoid submitting a CMS-1500 and continue with the applicable C4 form.

We do not know when the WCB will require health care providers and claims examiners to require the use of ICD-10 codes. In the interim, if a claim is denied based upon your continued use of ICD-9 coding, or your conversion to the appropriate ICD-10 code contact the carrier, print and share Subject No. 046-785 with the claims examiner, and send a blinded/santitized copy of your denial to NYSCA so we may monitor trends and contact the WCB for corrective action.

NEW C4 FORMS

The WCB has produced a new set of C4 forms. The new forms (C4, C4.2 and C4.3) are essentially the same as the current versions with the exception of the ICD title (ICD-9 updated to ICD-10). We have reached out to the Medical Director's Office to discuss a few formatting issues and discuss the timeframe for implementation.

We have reached out to some software vendors to alert them to this update. You may wish to contact your software vendor to ensure the most recent form is incorporated into your office software.

DURABLE MEDICAL EQUIPMENT (DME) FEE SCHEDULE

The WCB adopted the NYS Medicaid durable DME fee schedule. Note that any durable medical equipment provided to your patient must also be recommended within the applicable medical treatment guideline or a Variance is required. The most recent DME fee schedule can be found on the WCB web site.

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