However, for consequential conditions, the eligibility begin date is the filing date for the accepted underlying condition. The medical eligibility begin date is the filing date for most conditions. For all medical conditions with a medical eligibility begin date prior to October 1, 2015, the CE or HR will continue to use ICD-9-CM coding in ECS, development, and decisions. (3) C50.512 Malignant neoplasm of lower-outer quadrant of left female breast (requires a 6 th digit).ġ. (2) C34.11 Malignant neoplasm of upper lobe, right bronchus or lung (requires a 5 th digit). (1) J44.9 chronic obstructive pulmonary disease unspecified (requires 4th digit). Examples of 4, 5, and 6-character ICD-10-CM codes: It is imperative to identify and enter the ICD-10-CM code which most specifically describes the medical condition reported in the medical records.Įxamples of valid 3-character ICD-10-CM codes :ī. The guidance found at this website is intended to supplement the information found in the ICD-10-CM coding books. In addition, claims examiners (CE) may use the coding software found at which will help to identify the appropriate ICD-10-CM code. The CE then verifies that the J40 code corresponds to bronchitis in the Tabular List of the ICD-10-CM coding book. Bronchitis is listed in the alphabetic index as J40. For example, when a physician reports a diagnosis of bronchitis, not specified as acute or chronic, in the claimant’s medical records, the CE first looks up bronchitis in the alphabetic index of the ICD-10-CM coding book. This eligibility file contains, among other items, the accepted condition(s) for which a claimant is entitled to medical treatment along with the corresponding ICD-10-CM code. In order for medical bills to properly process, the Energy Compensation System (ECS) generates an eligibility file which is sent to the bill processing contractor. The CE should read all the instructional notations that appear in both the index and the tabular list of the ICD-10-CM coding books. When a specific condition contains 4 th, 5 th, 6 th, or 7 th place characters the CE enters all available characters associated with that condition, not a partial code set. The CE locates and enters the code that references the disease, illness or medical condition that was reported, and identifies the organ(s) or portion of the body affected by the condition. ICD-10-CM codes are assigned based on the claimant’s medical documentation (records), including, but not limited to physician notes, diagnostic tests, and surgical reports. The ICD-10-CM alphabetic index is divided into sections and is organized under the following main categories: Codes are listed by “Main Term” which describes the disease and or/condition. The alphabetic index is organized in the same manner as ICD-9-CM. ICD-10-CM is divided into an alphabetic index, which is an alphabetic list of terms and their corresponding codes. ICD-10-CM allows for greater specificity and accuracy when reporting diagnoses. The transition to ICD-10-CM is federally mandated for all Health Insurance Portability and Accountability Act ( HIPAA ) covered entities and is occurring because ICD-9-CM reports non-specific data about patient’s medical conditions and hospital inpatient procedures. The ICD-10-CM is a statistical classification and coding system used to assign appropriate codes for signs, symptoms, injuries, diseases, and other medical conditions. On October 1, 2015, the Division of Energy Employees Occupational Illness Compensation (DEEOIC) will transition to the new International Classification of Diseases, Tenth Revision, and Clinical Modification (ICD-10-CM) Coding System. Purpose : To provide guidance on the use of the new ICD-10-CM coding system. Subject : Transition to the ICD-10-CM Coding System. Attention: This bulletin has been superseded and is inactive.
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