We require providers to use national coding standards when submitting bills to managed care organizations (MCOs), self-insuring employers or BWC. Because of conflicting requirements between our claim and national bill coding standards, we've arranged International Classification of Diseases (ICD) diagnostic codes into groups that facilitate MCO and BWC evaluation of medical bills for relatedness to a specific claim.
An ICD group contains individual codes similar in nature and/or involve the same body part. The groups include codes with varying levels of specificity. Groups are built so codes in that group can be used interchangeably for medical reimbursement. They are, however, not the sole item used in determining the relationship between the treatment or services provided and the claim reimbursement.
MCOs use authorization information and Official Disability Guidelines to determine relatedness as well. The document below is not intended as a coding tool, but rather as a resource for you to understand what MCOs and BWC may consider to be related conditions for bill payment.
If you have questions about whether services are related to a claim, contact the appropriate resource, the MCO for state-fund claims, or the self-insuring employer/their third-party administrator.
If you have any questions about the groups, email BWC Medical Services.