La. Admin. Code tit. 40 § I-5113

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

Section I-5113 - Coding System

A. Diagnosis Coding. The International Classification of Diseases, Tenth Revision (ICD-10-CM) is the basis of diagnosis coding. These are the disease codes in the international classification, tenth revision, clinical modifications published by the U.S. Department of Health and Human Resources.

B. Helpful Hints for Diagnosis Coding

1. To ensure accurate payment, always report the primary diagnosis code on the claim form.

2. Each diagnosis code should be reported when services for multiple diagnosis are filed on the same claim form.

3. All digits of the appropriate ICD-10-CM code(s) should be reported.

4. The date of accident should always be reported if the ICD-10-CM code is for an accident diagnosis.

5. It is important to provide a complete description of the diagnosis if an appropriate ICD-10-CM code cannot be located.

C. Procedure Codes. HCPCS (pronounced "hick picks") is the acronym for the HCFA (Health Care Financing Administration) common coding system. This system is a uniform method for health care providers and medical suppliers to code professional services, procedures and supplies. HCPCS contains three unique coding systems, each called a level and numbered I, II and III respectively.

1. Level I. Level I is the American Medical Association's CPT (Physicians' Current Procedural Terminology) which is developed and maintained by the AMA. The CPT is a listing of descriptive terms and identifying codes for reporting medical services and procedures performed by physicians and are used for processing claims. Each procedure or service is identified with a five digit code.

2. Level II. HCPCS National Level II codes are alphanumeric codes which start with a letter followed by four numbers. These codes can be used in addition to CPT codes when services are provided at the same time or during the same visit. All services, procedures, supplies, materials and injections should be properly documented in the medical record.

3. Level III. This level is often used to describe new services, supplies or materials or to report procedures and services which have been deleted from CPT. These level III codes are not to be used for Workers' Compensation claims.

NOTE: The following Sections are to be used for Chapter 51 only.

La. Admin. Code tit. 40, § I-5113

Promulgated by the Department of Labor, Office of Workers' Compensation, LR 19:54 (January 1993), repromulgated LR 19:212 (February 1993), amended LR 20:1299 (November 1994), Amended by the Workforce Commission, Office of Workers' Compensation Administration, LR 42288 (2/1/2016).

AUTHORITY NOTE: Promulgated in accordance with R.S. 23:1034.2.