The Centers for Medicare & Medicaid Services (CMS) provides updated ICD-9 and ICD-10 diagnosis code lists annually. These lists are crucial for Non-Group Health Plan (NGHP) Responsible Reporting Entities (RREs) and their agents involved in Section 111 mandatory reporting, covering liability insurance, no-fault, and workers’ compensation claims. Accessing the most current diagnosis code ICD-10 lookup is essential for accurate claim submissions.
These diagnosis code lists are derived from the ICD-10 codes that CMS utilizes for Medicare medical claims. While many of these codes are applicable across different claim types, some are specifically relevant to liability and workers’ compensation scenarios but not to no-fault accidents. CMS conducts an annual review of ICD-10 codes to pinpoint those suitable for Section 111 NGHP Claim Input File Detail Record submissions.
Once a diagnosis code is approved for Section 111 reporting, it remains on the valid list in subsequent years. Each year, the lists are updated with newly valid codes, and descriptions of existing codes may be revised to reflect the most current medical terminology and reporting requirements. This annual update process ensures that the diagnosis code ICD-10 lookup resources remain accurate and aligned with healthcare standards.
However, not all code types are included in the valid lists. For instance, ICD-9 codes starting with “V” and ICD-10 codes beginning with “Z,” which denote factors influencing health status and contact with health services, are generally excluded. These “Z” codes, equivalent to the older “V” codes, are therefore omitted from Section 111 claim reports. Despite this general exclusion, “V” codes might be used in specific situations, such as identifying the Alleged Cause of Injury, Incident, or Illness. This specific use case explains why “V” codes are not included in the excluded ICD-10 code list. Furthermore, CMS has identified certain valid diagnosis codes that lack sufficient detail regarding the cause and nature of an illness, incident, or injury. These less informative codes are added to the excluded lists, ensuring they do not appear in the valid lists for NGHP plan types, thus maintaining the integrity and specificity of Section 111 Claim Input File submissions.
For those involved in Section 111 reporting, regularly consulting the updated diagnosis code ICD-10 lookup lists provided by CMS is a critical step in ensuring compliance and accuracy in claim reporting. These resources are vital for navigating the complexities of medical coding in the context of insurance liability and compensation claims.
