New Rules For Personal Injury Claims

4345044321_4270159f6b_zOn October 1, 2015, the Centers for Medicare and Medicaid Services (CMS) adopted the 10th Revision of the International Classification of Diseases (ICD-10) for diagnostic coding. ICD-10 is a medical coding system.

Medical coding systems assign a standardized numerical code to thousands of patient complaints, symptoms, and diagnoses. For example, the ICD-9 code for a broken arm is 829. The code is universally accepted by healthcare providers and health insurance companies, which allows the healthcare industry to record and bill for patient visits digitally.

The former ICD-9 was adopted in 1975 and has been criticized for its lack of specificity.  ICD-9 contained approximately 14,000 diagnostic and 4,000 procedural codes. The new ICD-10 contains more than 68,000 diagnostic and 72,000 procedural codes. The increase in coding options will add accuracy to the billing and reporting process.

ICD-10 will help attorneys precisely identify accident related treatment and dispute unrelated charges. For instance, imagine Paul Plaintiff suffered a left shoulder injury in 2014. Thereafter, in 2015, Paul sustains a right shoulder injury in a motor vehicle collision with David Defendant. The former ICD-9 system did not differentiate right and left. Therefore, when reviewing Paul’s medical history, David Defendant’s insurance adjuster would incorrectly label Paul’s injury as pre-existing. ICD-10 will resolve similar issues caused by imprecise coding.

The date of injury (DOI) designates which coding version is used. ICD-10 is mandatory for all CMS cases with a DOI after October 1, 2015.  However, parties can continue to use ICD-9 codes on cases that arose before the adoption date.


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