BWC now requires ICD-10 codes for Ohio workers' compensation claims
The Ohio Bureau of Workers’ Compensation’s (BWC’s) grace period to accept ICD-9 codes from providers and vocational rehabilitation vendors for Ohio workers’ compensation bills expired on December 31, 2015.
Provider and vocational rehabilitation vendors must bill ICD-10 codes for dates of service starting January 1, 2016, and going forward. As of January 1, 2016, BWC's managed care organizations (MCOs) will deny bills not meeting this requirement with EOB 343 - Payment is denied as billed diagnosis code is not valid on the date of service.
The bills will be rejected back to the provider with a request to re-bill with an updated ICD-10 code. Providers are reminded they should bill with the condition they are treating, including the appropriate ICD-10 code and to check their electronic website account for BWC's allowed conditions. For help with BWC-specific ICD-10 coding, please visit BWC’s ICD-10 section for more information.
The new ICD-10 code set allows providers to be more specific in how they document the location and severity of an injury and/or occupational disease. Providers are asked to be specific and complete with their ICD-10 coding based on an injury/occupational disease's narrative description(s), especially when completing a BWC First Report of an Injury, Occupational Disease or Death (FROI) form. BWC considers certain codes "invalid" for claim-allowance purposes. These codes are typically nonspecific, such as symptom codes.
Providers should continue to code bills based on the conditions they are treating. BWC has expanded the clinical diagnosis groups used in bill processing to include ICD-10 codes. BWC and MCOs use these groups as one of the tools to evaluate the relationship between treatment and claim allowances. This approach ensures we can process bills containing ICD-10 codes even if BWC has not mapped the ICD-9 associated with a claim to ICD-10.