How does BWC use ICD-9 codes?
Since ICD-9 codes identify the type and nature of the injury, they also are used to determine what medical treatment is appropriate. 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. What is an invalid ICD-9 code”? BWC has defined the following information as a invalid ICD-9 codes: • 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
