ICD-9 Codes are three, four or five-digit numeric codes that represents
a uniform, international classification system of coding disease and injury
diagnoses and are used to report allowed, non-allowed or disallowed/denied
conditions. ICD-9 is an acronym for International Classification of Diseases,
9th Revision. ICD-9 coding is a statistical classification system that arranges
diseases and injuries into code categories according to established criteria.
For example, an injury such as a broken arm could be classified and coded as follows:
fractured radius, 813.81 Using the broken arm example; the left, right, or
bilateral (both) arms would be identified. In addition, an injury site may also be
listed if necessary. Site locations apply to injuries to the fingers, teeth, and toes.
How does BWC use ICD-9 codes?
Since ICD-9 codes identify the type and nature of the injury sustained, they are also used to determine what medical treatment is appropriate for an injured worker. For example, if a claim were allowed for a torn medial meniscus, a serious knee injury, surgery would likely be an appropriate type of treatment. However, if the claim were allowed for a sprained knee, a less serious injury, surgical intervention would not be appropriate and authorization would not be granted.
In addition, when medical providers bill BWC for services,
the ICD-9 code is listed on the billing forms. All bills that
are submitted are reviewed to determine if the medical provider
is treating the allowed injuries in the claim. If bills are submitted
for injuries that are allowed within the claim they will be paid. If bills
are submitted for injuries that are not allowed within the claim the bill will
What is an invalid ICD-9 code?
BWC has defined the following information as an invalid ICD-9 code:
- A code for an injury/condition that is not causally related to an industrial injury or occupational disease;
- The proper application of coding principles (Code assignment requires the highest level of specificity, i.e., must assign the maximum number of digits for a code.) BWC has identified all three and four digit codes that require a fourth and fifth digits respectively;
- An unspecified injury/condition or site code therefore a more specific code exists;
- A symptom code;
- A multiple injury/site code. Reported injury/condition with more than one injury/site are assigned individual codes for each.
If you know your claim number, click here to look up the ICD-9 codes for your claim.