La. Admin. Code tit. 40 § I-307

Current through Register Vol. 50, No. 11, November 20, 2024

Section I-307 - Billing Code Sets

A. Billing codes and modifier systems identified below are valid codes for these workers' compensation transactions, in addition to any code sets defined by the standards adopted in Section 305

1. "CDT-4 Codes"-codes and nomenclature prescribed by the American Dental Association.

2. "CPT-4 Codes"-the procedural terminology and codes contained in the "Current Procedural Terminology, Fourth Edition," as published by the American Medical Association and as adopted in the appropriate fee schedule contained in Title 40 of the Louisiana Administrative Code.

3. "Diagnosis Related Group (DRG)"-the inpatient classification scheme used by CMS for hospital inpatient reimbursement. The DRG system classifies patients based on principal diagnosis, surgical procedure, age, presence of co-morbidities and complications, and other pertinent data.

4. "HCPCS"-CMS' Healthcare Common Procedure Coding System, a coding system which describes products, supplies, procedures, and health professional services and which includes the American Medical Association's (AMA's) Physician "Current Procedural Terminology, Fourth Edition," (CPT-4) codes, alphanumeric codes, and related modifiers.

5. "ICD-9-CM Codes"-diagnosis and procedure codes in the International Classification of Diseases, Ninth Revision, Clinical Modification published by the United States Department of Health and Human Services.

6. "ICD-10-CM/PCS Codes"-diagnosis and procedure codes in the International Classification of Diseases, Tenth Edition, Clinical Modification/Procedure Coding System maintained and published by the United States Department of Health and Human Services.

7. "NDC"-National Drug Codes of the Food and Drug Administration.

8. "Physical Therapy"/"Occupational Therapy Codes: Codes specified in Title 40 of the LAC covering physical therapy and occupational therapy services.

9. "Revenue Codes"-the four digit coding system developed and maintained by the National Uniform Billing Committee for billing inpatient and outpatient hospital services, home health services, and hospice services.

10. "National Uniform Billing Committee codes"-code structure and instructions established for use by the National Uniform Billing Committee (NUBC), such as occurrence codes, condition codes, or prospective payment indicator codes. These are known as UB 04 Codes.

La. Admin. Code tit. 40, § I-307

Promulgated by the Louisiana Workforce Commission, Office of Workers' Compensation, LR 37:3544 (December 2011), amended LR 40:375 (February 2014).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1203.2.