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ICD-10 Coding for COVID-19 and Section 111 Reporting
Workers’ compensation COVID-19 exposure claims involving Medicare beneficiaries may need to be reported to the Benefits Coordination and Recovery Center under Section 111 mandatory reporting. Given the various types of illnesses that may stem from a COVID-19 infection, the Centers for Disease Control and Prevention (CDC) issued official diagnosis coding guidance on February 20, 2020. On March 18, 2020, the CDC announced the new International Classification of Diseases, Tenth Revision (ICD-10) diagnosis code of U07.1, COVID-19. This code became effective on April 1, 2020. https://www.cdc.gov/nchs/data/icd/COVID-19-guidelines-final.pdf
Since employees may test positive for COVID-19 and not become ill, the Section 111 Workers’ Compensation Ongoing Responsibility for Medical (ORM) reporting exclusion may apply. The exclusion applies when all of the following conditions are met: the claim is for “medical” only, lost time is less than 7 days, all payments have been made directly to the medical provider, and total payment for medical does not exceed $750.00. Once all the exclusion criteria are no longer met, the claim should be reported.
We will continue to keep you advised of developments in this area.