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ICD-10 Information

The department has recently received a number of inquiries regarding the Center for Medicare Services' (CMS) upcoming implementation of ICD-10. Please note that the Pennsylvania Workers' Compensation Act's (act) Medical Fee Schedule does not rely on ICD-9 or ICD-10 codes to determine appropriate fees for treatment. Instead, the Fee Schedule relies upon HCPCS, CPT, DRG and service/revenue codes to determine that applicable reimbursement rate. Notably, the Center For Medicare Services has reminded providers and payors that "the change to ICD-10 does not affect CPT coding for outpatient procedures and physician services." See, https://www.cms.gov/Medicare/Coding/ICD10/index.html?redirect=/ICD10.
 
Providers and payors should refer to guidance issued by CMS to determine when the use of ICD-10 is appropriate or required.
 
Furthermore, while ICD-10 PCS may result in changes to providers' inpatient billing practices, inpatient acute care providers reimbursed by DRGs must continue to "cross-walk" DRGs to the Frozen Grouper, as set forth in 34 Pa. Code §§ 127.110-.116, 127.154.
 
Of course, implementation of ICD-10, and the additional information it is expected to provide, may also cause payors to alter the means by which they adjust and pay medical bills; however, the department's review of such bills will continue to take place as described in the act and regulations promulgated thereunder.