1. Impact of ICD-10 on Workers’ Compensation The Good, The Bad and The Ugly

2. Objectives Understand the history of the ICD (International Classification of Diseases)Understand the history of the ICD (International Classification of Diseases) Review enhanced diagnostic coding capabilities and advantages of ICD-10 as it relates to clinical documentationReview enhanced diagnostic coding capabilities and advantages of ICD-10 as it relates to clinical documentation Discuss how ICD-10 impacts Workers’ Compensation case managementDiscuss how ICD-10 impacts Workers’ Compensation case management

3. International Classification of Diseases “...diagnostic tool that is used to classify and monitor causes of injury and death and that maintains information for health analyses, such as the study of mortality (death) and morbidity (illness) trends. The ICD is designed to promote international compatibility in health data collecting and reporting.”“...diagnostic tool that is used to classify and monitor causes of injury and death and that maintains information for health analyses, such as the study of mortality (death) and morbidity (illness) trends. The ICD is designed to promote international compatibility in health data collecting and reporting.” SR Raminani, Britannica Online Encyclopedia

4. The History of International Classification of Diseases 1600’s and 1700’s1600’s and 1700’s First attempts to systematically classify diseasesFirst attempts to systematically classify diseases Interest in tracking causes of mortalityInterest in tracking causes of mortality Childhood illnessesChildhood illnesses Communicable diseasesCommunicable diseases Of little benefitOf little benefit Inconsistencies in nomenclatureInconsistencies in nomenclature Poor statistical dataPoor statistical data SR Raminani, Britannica Online Encyclopedia

5. The History of International Classification of Diseases 1800’s1800’s Importance of creating a uniform system was realizedImportance of creating a uniform system was realized International Statistical Congress 1853, ParisInternational Statistical Congress 1853, Paris Organizers request preparation of a uniform classification of causes of deathOrganizers request preparation of a uniform classification of causes of death Introduced principle of categorizing diseases by anatomical siteIntroduced principle of categorizing diseases by anatomical site Never internationally adoptedNever internationally adopted SR Raminani, Britannica Online Encyclopedia 2015 ICD-10-CM Code Set

6. The History of International Classification of Diseases 1800’s1800’s International Statistical Institute 1893International Statistical Institute 1893 Adopted first ICDAdopted first ICD Based on Bertillon’s Classification of Causes of DeathBased on Bertillon’s Classification of Causes of Death Jacques Bertillon was a French statisticianJacques Bertillon was a French statistician SR Raminani, Britannica Online Encyclopedia

7. The History of International Classification of Diseases 1800’s1800’s American Public Health Association 1898American Public Health Association 1898 Recommended Canada, Mexico, and USA all use the new ICD systemRecommended Canada, Mexico, and USA all use the new ICD system Recommended revision every decade to keep ICD up to dateRecommended revision every decade to keep ICD up to date SR Raminani, Britannica Online Encyclopedia

8. The History of International Classification of Diseases 1900’s1900’s The ICD becomes increasingly detailedThe ICD becomes increasingly detailed By 1938 the ICD had undergone 5 revisionsBy 1938 the ICD had undergone 5 revisions World Health OrganizationWorld Health Organization Established April 7, 1948 as specialized agency of United NationsEstablished April 7, 1948 as specialized agency of United Nations Mission is to promote international public healthMission is to promote international public health Assumes responsibility for publishing the ICDAssumes responsibility for publishing the ICD SR Raminani, Britannica Online Encyclopedia Wikipedia

9. The History of International Classification of Diseases 1900’s1900’s World Health OrganizationWorld Health Organization Collects international data for epidemiological surveillance and health management purposesCollects international data for epidemiological surveillance and health management purposes Adopts ICD-9 in 1979 for epidemiological purposesAdopts ICD-9 in 1979 for epidemiological purposes United States adopts ICD-9-CM in 1979United States adopts ICD-9-CM in 1979 Clinical modifications and hospital proceduresClinical modifications and hospital procedures Used for reimbursement based codingUsed for reimbursement based coding ICD-9-CM never used outside of USAICD-9-CM never used outside of USA SR Raminani, Britannica Online Encyclopedia WikipediaOptum 360 Coding

10. The History of International Classification of Diseases 1983: DRGs link ICD-9-CM codes with reimbursement1983: DRGs link ICD-9-CM codes with reimbursement 1988: Medicare Catastrophic Coverage Act requires physicians to report diagnosis codes using ICD-9-CM on Medicare claims1988: Medicare Catastrophic Coverage Act requires physicians to report diagnosis codes using ICD-9-CM on Medicare claims ICD-9 significantly revised in the 1980s and early 1990sICD-9 significantly revised in the 1980s and early 1990s 1994: WHO adopts ICD-101994: WHO adopts ICD-10 SR Raminani, Britannica Online Encyclopedia Optum 360 Coding

11. The History of International Classification of Diseases 1983: DRGs link ICD-9-CM codes with reimbursement 19831983: DRGs link ICD-9-CM codes with reimbursement 1983 1988: Medicare Catastrophic Coverage Act requires physicians to report conditions using ICD-9-CM1988: Medicare Catastrophic Coverage Act requires physicians to report conditions using ICD-9-CM The ICD-9 significantly revised in the 1980s and early 1990sThe ICD-9 significantly revised in the 1980s and early 1990s 1994: WHO adopts ICD-101994: WHO adopts ICD-10 SR Raminani, Britannica Online Encyclopedia Optum 360 Coding

12. The History of International Classification of Diseases 1900’s1900’s 1983: DRGs link ICD-9-CM codes with reimbursement1983: DRGs link ICD-9-CM codes with reimbursement 1988: Medicare Catastrophic Coverage Act requires physicians to report conditions using ICD-9-CM1988: Medicare Catastrophic Coverage Act requires physicians to report conditions using ICD-9-CM The ICD-9 significantly revised in the 1980s and early 1990sThe ICD-9 significantly revised in the 1980s and early 1990s 1994: WHO adopts ICD-101994: WHO adopts ICD-10 SR Raminani, Britannica Online Encyclopedia Optum 360 Coding

13. The History of International Classification of Diseases 19951995 United States draft of ICD-10-CM made availableUnited States draft of ICD-10-CM made available United States poised to adopt ICD-10-CM to align with WHO and other countriesUnited States poised to adopt ICD-10-CM to align with WHO and other countries Optum 360 Coding

14. The History of International Classification of Diseases 1996: HIPAA (Heath Insurance Portability and Accountability Act) enacted1996: HIPAA (Heath Insurance Portability and Accountability Act) enacted Code set standards established under the Administrative Simplification provision of the Social Security ActCode set standards established under the Administrative Simplification provision of the Social Security Act New code set adoption process falls under legislative controlsNew code set adoption process falls under legislative controls 2000’s: Legislative delays stall US adoption of ICD-10-CM2000’s: Legislative delays stall US adoption of ICD-10-CM Optum 360 Coding

15. The History of International Classification of Diseases January 1, 2013: Version 5010 electronic billing process and format compliance required for all health plansJanuary 1, 2013: Version 5010 electronic billing process and format compliance required for all health plans ICD-10 compliance date delaysICD-10 compliance date delays October 1, 2013: DELAYEDOctober 1, 2013: DELAYED October 1, 2014: DELAYEDOctober 1, 2014: DELAYED October 1, 2015 ICD-10 adoptedOctober 1, 2015 ICD-10 adopted ICD-11 targeted for release in 2018ICD-11 targeted for release in 2018 Optum 360 Coding

16. International Classification of Diseases Epidemiologic toolEpidemiologic tool Comprehensive list diseases, disorders and injuriesComprehensive list diseases, disorders and injuries Allows the world to compare and share health information using a common languageAllows the world to compare and share health information using a common language Monitoring of incidence and prevalence of diseasesMonitoring of incidence and prevalence of diseases

17. International Classification of Diseases Clinical toolClinical tool Diagnosis coding for reimbursementDiagnosis coding for reimbursement Analysis of health information for evidenced-based decision-makingAnalysis of health information for evidenced-based decision-making Observing reimbursement trendsObserving reimbursement trends Keeping track of safety and quality guidelinesKeeping track of safety and quality guidelines

18. ICD-10 Code Sets ICD-10-CMICD-10-CM Diagnosis coding for use in all U.S. health care settingsDiagnosis coding for use in all U.S. health care settings ICD­10­PCSICD­10­PCS Inpatient procedure coding for use in U.S. hospital settingsInpatient procedure coding for use in U.S. hospital settings

19. Comparison of ICD-9 to ICD-10 ICD-9-CM Diagnosis CodesICD-10-CM Diagnosis Codes No LateralityLaterality – Right, Left or Bilateral 1)3-5 digits 2)First digit is alpha (E or V) or numeric 3)Digits 2-5 are numeric 4)Decimal is placed after the third character 1)7 digits 2)Digit 1 is alpha; Digit 2 is numeric 3)Digits 3–7 are alpha or numeric 4)Decimal is placed after the third character No placeholder characters“X” placeholders 14,000 codes 69,000 codes to better capture specificity Limited Severity ParametersExtensive Severity Parameters Limited Combination Codes Extensive Combination Codes to better capture complexity

20. ICD-10 Is More Detailed Than ICD-9 ICD-10 Is More Detailed Than ICD-9 Laterality: left, right and for some codes bilateral is specifiedLaterality: left, right and for some codes bilateral is specified Timing of clinical encounterTiming of clinical encounter InitialInitial SubsequentSubsequent SequelaSequela Traumatic vs degenerative conditionsTraumatic vs degenerative conditions More detail captured in unique 7 th character for fracturesMore detail captured in unique 7 th character for fractures

21. ICD-10-CM Code Structure

22. A - initial encounter for closed fracture B - initial encounter for open fracture type I or II C - initial encounter for open fracture type IIIA, IIIB, or IIIC D - subsequent encounter for closed fracture with routine healing E - subsequent encounter for open fracture type I or II with routine healing F - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with routine healing G - subsequent encounter for closed fracture with delayed healing H - subsequent encounter for open fracture type I or II with delayed healing J - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with delayed healing K - subsequent encounter for closed fracture with nonunion M - subsequent encounter for open fracture type I or II with nonunion N - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with nonunion P - subsequent encounter for closed fracture with malunion Q - subsequent encounter for open fracture type I or II with malunion R - subsequent encounter for open fracture type IIIA, IIIB, or IIIC with malunion S - sequela 7 th Character in ICD-10 Fracture Codes

23. Comparisons of ICD-9 to ICD-10 ICD-9ICD-10 3-5 characters in length3-7 characters in length Approximately 13,000 codes Approximately 68,000 codes First digit may be alpha (E or V) or numeric; digits 2-5 are numeric Digit 1 is alpha; digits 2 and 3 are numeric; digits 4-7 are alpha or numeric Limited space for adding new codes Flexible for adding new codes

24. Comparison of ICD-9 to ICD-10 ICD-9 821.11 Open fracture of shaft of femur All codes for femur fracture = 16 ICD-10 S72.352E Displaced oblique fracture of shaft of left femur, subsequent encounter for open fracture type I or II with routine healing All codes for femur fracture = 1530 CMS website: What is different with ICD-10?

25. ICD-10-CM Code Set Organization ChaptersChapters Total of 21 chaptersTotal of 21 chapters Organized mostly by anatomical siteOrganized mostly by anatomical site Chapter 1: Certain infectious and parasitic diseasesChapter 1: Certain infectious and parasitic diseases Chapter 6: Diseases of the nervous systemChapter 6: Diseases of the nervous system Chapter 13: Diseases of the musculoskeletal system and connective tissueChapter 13: Diseases of the musculoskeletal system and connective tissue Chapter 19: Injury, poisoning and certain other consequences of external causesChapter 19: Injury, poisoning and certain other consequences of external causes

26. ICD-10-CM Code Set Organization Subchapters or BlocksSubchapters or Blocks Categories (3 characters)Categories (3 characters) Represents one disease or a group of diseases or related conditionsRepresents one disease or a group of diseases or related conditions Subcategories (4-6 characters)Subcategories (4-6 characters) Greater detail of etiology, anatomical site, and severityGreater detail of etiology, anatomical site, and severity

27. ICD-10-CM Code Set Organization CodesCodes Represents the final level that cannot be further subdividedRepresents the final level that cannot be further subdivided “Highest level of specificity”“Highest level of specificity”

28. ICD-10 Impact on Workers’ Compensation Final rule requires HIPAA covered entities to utilize ICD-10 the code setsFinal rule requires HIPAA covered entities to utilize ICD-10 the code sets Adoption not required for non-covered entitiesAdoption not required for non-covered entities Property and casualty insuranceProperty and casualty insurance Workers' compensation programsWorkers' compensation programs Disability insurance programsDisability insurance programs Most WC insurance carriers are using ICD-10Most WC insurance carriers are using ICD-10

29. ICD-10 Impact on Workers’ Compensation Medicare Secondary Payer ActMedicare Secondary Payer Act WC insurers must notify CMS of any workers' compensation settlement involving Medicare-eligible individualWC insurers must notify CMS of any workers' compensation settlement involving Medicare-eligible individual WC insurers often asked to reimburse Medicare for injuries or illnesses unrelated to a workers’ comp claimWC insurers often asked to reimburse Medicare for injuries or illnesses unrelated to a workers’ comp claim ICD-10 helpful for WC insurers to specify which injuries they accept responsibility and those that should be paid by MedicareICD-10 helpful for WC insurers to specify which injuries they accept responsibility and those that should be paid by Medicare

30. Purported Benefits of ICD-10 Greater clinical detail and specificity Room for adding up-to-date codes More accurate and detailed clinical reporting Improving the accuracy of claims processing Better tracking of patient outcomes

31. Purported Benefits of ICD-10 Better outcome studies Improves monitoring of resources for similar diagnoses Improves tracking risk to employees Detecting and preventing health care fraud and abuse Monitoring resource utilizationMonitoring resource utilization More accurate pattern recognition

32. ICD-10 Benefits for Workers’ Compensation Expanded injury codesExpanded injury codes Better data for:Better data for: Measuring the quality and efficacy of care Measuring the quality and efficacy of care Quicker, more efficient approval of services and proceduresQuicker, more efficient approval of services and procedures Designing payment systems and processing claims for reimbursementDesigning payment systems and processing claims for reimbursement Preventing and detecting healthcare fraud and abusePreventing and detecting healthcare fraud and abuse

33. ICD-10 Impact on Workers’ Compensation Measuring the quality & efficacy of careMeasuring the quality & efficacy of care More visibility into patient conditions and services providedMore visibility into patient conditions and services provided Better analyze healthcare quality at the individual and population levelsBetter analyze healthcare quality at the individual and population levels Better assess the clinical care a patient should receiveBetter assess the clinical care a patient should receive Bowman, Sue E; Leon­Chisen, Nelly. "ICD­10’s Impact on Noncovered Entities: Many Reasons Will Lead to Voluntary Upgrades" Journal of AHIMA 82, no.1 (January 2011): 40­43.

34. ICD-10 Impact on Workers’ Compensation Measuring the quality & efficacy of care (continued)Measuring the quality & efficacy of care (continued) Better assess the quality of care provided by treating physiciansBetter assess the quality of care provided by treating physicians Providing better information for calculating payment ratesProviding better information for calculating payment rates Increase the ability to substantiate the medical necessity of diagnostic and therapeutic servicesIncrease the ability to substantiate the medical necessity of diagnostic and therapeutic services Bowman, Sue E; Leon­Chisen, Nelly. "ICD­10’s Impact on Noncovered Entities: Many Reasons Will Lead to Voluntary Upgrades" Journal of AHIMA 82, no.1 (January 2011): 40­43.

35. ICD-10 Impact on Workers’ Compensation To leverage the advantages of ICD 10 correct diagnostic coding to the highest level of specificity must be performedTo leverage the advantages of ICD 10 correct diagnostic coding to the highest level of specificity must be performed Whose responsibility will this be?Whose responsibility will this be? Treating physicians?Treating physicians? Physicians office staff?Physicians office staff? Case managers?Case managers? Insurance company coders?Insurance company coders?

36. External Causes of Morbidity ICD-10 Codes Found in Chapter 20Found in Chapter 20 Start with the letters V, W, X, and YStart with the letters V, W, X, and Y Used secondary to a code from another chapterUsed secondary to a code from another chapter Primary code indicates nature of conditionPrimary code indicates nature of condition Primary code most often from Chapter 19: Injury, poisoning and certain other consequences of external causesPrimary code most often from Chapter 19: Injury, poisoning and certain other consequences of external causes

37. External Causes of Morbidity ICD-10 Codes Detailed information capturedDetailed information captured Cause: How the injury or health condition happenedCause: How the injury or health condition happened Intent: Accidental or intentionalIntent: Accidental or intentional Place: Where the event occurredPlace: Where the event occurred Activity of the patient at time of the eventActivity of the patient at time of the event Person’s status: paid employment, on-duty military, or leisure activityPerson’s status: paid employment, on-duty military, or leisure activity

38. External Causes of Morbidity ICD-10 Codes Cause of the injury code (examples)Cause of the injury code (examples) UsefulUseful W07 Fall from chairW07 Fall from chair W13.3 Fall through floorW13.3 Fall through floor W17.4 Fall from dockW17.4 Fall from dock HumorousHumorous W55.41 Bitten by pigW55.41 Bitten by pig V96.02 Forced landing of balloon injuring occupantV96.02 Forced landing of balloon injuring occupant

39. External Causes of Morbidity ICD-10 Codes Example WC make upExample WC make up

40. External Causes of Morbidity ICD-10 Codes Intended usesIntended uses Provide data for injury researchProvide data for injury research Evaluation of injury prevention strategiesEvaluation of injury prevention strategies

41. Structure of Chapter 20: ECM’s V00-V99: Transport accidentsV00-V99: Transport accidents V00-V09 Pedestrian injured in transport accidentV00-V09 Pedestrian injured in transport accident V10-V19 Pedal cycle rider injured in transport accidentV10-V19 Pedal cycle rider injured in transport accident V20-V29 Motorcycle rider injured in transport accidentV20-V29 Motorcycle rider injured in transport accident V30-V39 Occupant of three-wheeled motor vehicleV30-V39 Occupant of three-wheeled motor vehicle V40-V49 Car occupant injured in transport accidentV40-V49 Car occupant injured in transport accident V50-V59 Occupant of pick-up truck or vanV50-V59 Occupant of pick-up truck or van V60-V69 Occupant of heavy transport vehicleV60-V69 Occupant of heavy transport vehicle V70-V79 Bus occupant injured in transport accidentV70-V79 Bus occupant injured in transport accident V80-V89 Other land transport accidentsV80-V89 Other land transport accidents V90-V94 Water transport accidentsV90-V94 Water transport accidents V95-V97 Air and space transport accidentsV95-V97 Air and space transport accidents V98-V99 Other and unspecified transport accidentsV98-V99 Other and unspecified transport accidents

42. Granularity of ECM V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle V35.0 Driver of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.0 Driver of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.1 Passenger in three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.1 Passenger in three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.2 Person on outside of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic V35.2 Person on outside of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic

43. Granularity of ECM V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle (cont.) V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle (cont.) V35.3 Unspecified occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.3 Unspecified occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in nontraffic accident V35.4 Person boarding or alighting a three-wheeled motor vehicle injured in collision with railway train or railway vehicle V35.4 Person boarding or alighting a three-wheeled motor vehicle injured in collision with railway train or railway vehicle V35.5 Driver of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.5 Driver of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident

44. Granularity of ECM V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle (cont.) V35 Occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle (cont.) V35.6 Passenger in three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.6 Passenger in three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.7 Person on outside of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.7 Person on outside of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.9 Unspecified occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident V35.9 Unspecified occupant of three-wheeled motor vehicle injured in collision with railway train or railway vehicle in traffic accident

45. Structure of Chapter 20: External Causes of Morbidity W00-X58 Other external causes of accidental injuryW00-X58 Other external causes of accidental injury W00-W19 Slipping, tripping, stumbling and fallsW00-W19 Slipping, tripping, stumbling and falls W20-W49 Exposure to inanimate mechanical forcesW20-W49 Exposure to inanimate mechanical forces W50-W64 Exposure to animate mechanical forceW50-W64 Exposure to animate mechanical force W85-W99 Exposure to electric current, radiation and extreme ambient air temperature and pressureW85-W99 Exposure to electric current, radiation and extreme ambient air temperature and pressure X00-X08 Exposure to smoke, fire and flamesX00-X08 Exposure to smoke, fire and flames …..etc…..etc

46. Structure of Chapter 20: External Causes of Morbidity Y90-Y99: Supplementary factors related to causes of morbidity classified elsewhereY90-Y99: Supplementary factors related to causes of morbidity classified elsewhere Y 92: Place of occurrence of the external causeY 92: Place of occurrence of the external cause Y 93 Activity codesY 93 Activity codes Used to indicate the activity of the person seeking healthcareUsed to indicate the activity of the person seeking healthcare Injury or health condition resulted from, or was contributed to, by the activityInjury or health condition resulted from, or was contributed to, by the activity

47. Structure of Chapter 20: External Causes of Morbidity Y 93 Activity codes (examples)Y 93 Activity codes (examples) Y93.0 Activities involving walking and runningY93.0 Activities involving walking and running Y93.2 Activities involving ice and snowY93.2 Activities involving ice and snow Y93.5 Activities involving other sports and athletics played individuallyY93.5 Activities involving other sports and athletics played individually Y93.C Activities involving computer technology and electronic devicesY93.C Activities involving computer technology and electronic devices Y93.G Activities involving food preparation, cooking and grillingY93.G Activities involving food preparation, cooking and grilling

48. Structure of Chapter 20: External Causes of Morbidity Y99 External cause statusY99 External cause status Used to ndicate the status of the person at the time the event occurredUsed to ndicate the status of the person at the time the event occurred ExamplesExamples Y99.0 Civilian activity done for income or payY99.0 Civilian activity done for income or pay Y99.1 Military activityY99.1 Military activity Y99.8 Other external cause statusY99.8 Other external cause status

49. Useful Detail W50 Accidental hit, strike, kick, twist, bite or scratch by another personW50 Accidental hit, strike, kick, twist, bite or scratch by another person W50.0 Accidental hit or strike by another personW50.0 Accidental hit or strike by another person W50.1 Accidental kick by another personW50.1 Accidental kick by another person W50.2 Accidental twist by another personW50.2 Accidental twist by another person W50.3 Accidental bite by another personW50.3 Accidental bite by another person W50.4 Accidental scratch by another personW50.4 Accidental scratch by another person

50. Not So Useful Detail W56.1 Contact with sea lionW56.1 Contact with sea lion W56.11 Bitten by sea lionW56.11 Bitten by sea lion W56.12 Struck by sea lionW56.12 Struck by sea lion W56.19 Other contact with sea lionW56.19 Other contact with sea lion W56.2 Contact with orca (killer whale)W56.2 Contact with orca (killer whale) W56.21 Bitten by orcaW56.21 Bitten by orca W56.22 Struck by orcaW56.22 Struck by orca W56.29 Other contact with orcaW56.29 Other contact with orca

51. External Causes of Morbidity ICD-10 Codes No national requirement for mandatory external cause code reportingNo national requirement for mandatory external cause code reporting ExceptionsExceptions State-based external cause code reporting mandateState-based external cause code reporting mandate Required by a particular payerRequired by a particular payer Providers encouraged to voluntarily report external cause codesProviders encouraged to voluntarily report external cause codes

52. External Causes of Morbidity ICD-10 Codes Is it obvious why reporting ECM codes is voluntary?Is it obvious why reporting ECM codes is voluntary? Too complicatedToo complicated Difficult to do correctlyDifficult to do correctly Difficult to do completelyDifficult to do completely Too time consumingToo time consuming