Navigating the complexities of Section 111 reporting requires precision, especially when it comes to utilizing the correct diagnosis codes. For Non-Group Health Plans (NGHPs), including liability insurance, no-fault, and workers’ compensation entities, accurate reporting is paramount. To assist Responsible Reporting Entities (RREs) and their agents, updated lists of valid and excluded ICD-9 and ICD-10 diagnosis codes are released annually. These resources are crucial for ensuring compliance and accuracy in your submissions.
These essential diagnosis code lists for Section 111 reporting are conveniently available for download in Excel (.xlsx) format. These lists detail the valid codes that should be used, alongside codes that are specifically excluded to prevent reporting errors. Understanding which codes to use, and importantly, which to avoid, is a fundamental aspect of the Diagnosis Code Look Up process for compliant Section 111 reporting.
The foundation of these lists stems from the ICD-10 diagnosis codes regularly updated and published by the Centers for Medicare & Medicaid Services (CMS). CMS provides these codes to healthcare providers and suppliers for accurate medical claims submission to Medicare. Subsequently, for Section 111 reporting, these codes are carefully reviewed to determine their applicability within liability and workers’ compensation contexts, while also identifying codes unsuitable for no-fault accident or injury scenarios. This review process is integral to refining the diagnosis code look up resources for Section 111 compliance.
Each year, CMS undertakes an annual review of ICD-10 codes. This review is essential to ensure that the diagnosis codes used for Section 111 NGHP Claim Input File Detail Record submissions remain current and relevant. Diagnosis codes that are deemed appropriate for Section 111 reporting are maintained on these lists from year to year. The annual updates involve adding newly validated codes and revising the descriptions of existing codes to reflect the latest medical coding standards. Therefore, regularly checking for the updated diagnosis code list is a critical step in the diagnosis code look up workflow.
It’s important to note that not all code types are included in the valid lists. For instance, ICD-9 codes that begin with the letter “V” and ICD-10 codes that begin with “Z” are systematically removed from the valid lists. ICD-9 “V” codes, which are analogous to ICD-10 “Z” codes and represent factors influencing health status and contact with health services, are therefore excluded from Section 111 claim reports. However, it’s worth mentioning that “V” codes might still be relevant in specific situations, such as when identifying the Alleged Cause of Injury, Incident, or Illness. This nuanced application is why “V” codes are not found on 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 codes are considered incomplete or inadequate for Section 111 Claim Input File submissions. Consequently, these less informative diagnosis codes are added to the excluded lists and will not appear in the valid lists for NGHP plan types. This careful curation ensures that the diagnosis code look up process leads to the selection of codes that are both valid and sufficiently detailed for accurate Section 111 reporting.
