Technical ALERT: Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation-Excluded Diagnosis Codes

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1 Department of Health & Human Services Centers for Medicare & Medicaid Services 7500 Security Boulevard Baltimore, Maryland Financial Services Group July 11, 2013 Implementation of Medicare Secondary Payer Mandatory Reporting Provisions in Section 111 of the Medicare, Medicaid, and SCHIP Extension Act (MMSEA) of 2007 (See 42 U.S.C. 1395y(b)(7) & (8)) Technical ALERT: Liability Insurance (Including Self-Insurance), No-Fault Insurance, and Workers Compensation-Excluded Diagnosis Codes New Excluded ICD-9-CM Diagnosis Codes Two new ICD-9-CM Diagnosis Codes have been added to the list of excluded ICD-9-CM diagnosis codes: (Other specified sites, including multiple injury) and (Unspecified site injury). As of October 1, 2013, these codes will not be accepted in the Alleged Cause of Injury, Incident or Illness (Field 15) or in any ICD Diagnosis Code field. Transition from ICD-9-CM to ICD-10-CM Diagnosis Codes Beginning October 1, 2014, CMS will adopt the International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) for diagnosis coding in accordance with mandatory Health Insurance Portability and Accountability Act (HIPAA) administrative simplification requirements. More specific requirements for Section 111 MMSEA responsible reporting entities (RREs) may be referenced in the June 11, 2013 Alert titled, Transition from ICD-9-CM to ICD-10- CM diagnosis codes. Excluded Diagnosis Codes CMS previously determined that certain ICD-9-CM diagnosis codes did not provide enough information related to the and nature of an illness, incident or injury. These codes have been excluded from use in Section 111 reporting. The list of excluded ICD-9-CM codes is available in the NGHP User Guide Appendices Chapter (Appendix I). With the impending transition to ICD-10-CM, CMS has identified the ICD-10-CM diagnosis codes that correspond to each excluded ICD-9-CM diagnosis code. The combined list of excluded ICD-9-CM diagnosis codes and corresponding excluded ICD-10-CM codes is provided below. Note: None of these codes will be accepted in the Alleged Cause of Injury, Incident or Illness (Field 15) or in the ICD Diagnosis Codes beginning in Field 18 as of October 1, 2013 (in test), and October 1, 2014 (in production). Excluded ICD-9-CM Diagnosis Corresponding Excluded ICD-10-CM Diagnosis Other general symptoms R41.9 Unspecified symptoms and signs involving cognitive functions and awareness R45.84 Anhedonia R68.89 Other general symptoms and signs

2 Corresponding Excluded ICD-10-CM Diagnosis Other abnormal clinical findings R68.89 Other general symptoms and signs Other nonspecific abnormal R68.89 Other general symptoms and signs findings Instantaneous death R99 Ill-defined and unknown of mortality Death occurring in less than R99 Ill-defined and unknown of mortality 24 hours from onset of symptoms, not otherwise explained Unattended death R99 Ill-defined and unknown of mortality Other ill-defined conditions R44.8 Other symptoms and signs involving general sensations and perceptions R44.9 Unspecified symptoms and signs involving general sensations and perceptions R46.0 Very low level of personal hygiene R46.1 Bizarre personal appearance R46.2 Strange and inexplicable behavior R46.3 Overactivity R46.4 Slowness and poor responsiveness R46.5 Suspiciousness and marked evasiveness R46.6 Undue concern and preoccupation with stressful events R46.7 Verbosity and circumstantial detail obscuring reason for contact R46.81 Obsessive-compulsive behavior R46.89 Other symptoms and signs involving appearance and behavior R68.19 Other nonspecific symptoms peculiar to infancy R69 Illness, unspecified Other unknown and R69 Illness, unspecified unspecified of R99 Ill-defined and unknown of mortality morbidity and mortality Other specified sites, T07 Unspecified multiple injuries including multiple injury Unspecified site injury T14.8 Other injury of unspecified body region T14.90 Injury, unspecified T14.91 Suicide attempt E849.0 Home accidents Y Kitchen of unspecified non-institutional (private) residence as the place of occurrence of the external Y Dining room of unspecified non-institutional (private) residence as the place of occurrence of the external Y Bathroom of unspecified non-institutional private) residence singlefamily (private) house as the place of occurrence of the external Y Bedroom of unspecified non-institutional (private) residence as the place of occurrence of the external Y Garden or yard of unspecified non-institutional (private) residence as the place of occurrence of the external Y Other place in unspecified non-institutional (private) residence as the place of occurrence of the external Y Unspecified place in unspecified non-institutional (private) residence as the place of occurrence of the external Y Kitchen of single-family (private) house as the place of occurrence of the external Y Dining room of single-family (private) house as the place of occurrence of the external Y Bathroom of single-family (private) house as the place of occurrence of the external

3 E849.0 Home accidents (continued from previous page) Corresponding Excluded ICD-10-CM Diagnosis Y Bedroom of single-family (private) house as the place of occurrence of the external Y Private driveway to single-family (private) house as the place of occurrence of the external Y Private garage of single-family (private) house as the place of occurrence of the external Y Swimming-pool in single-family (private) house or garden as the place of occurrence of the external Y Garden or yard in single-family (private) house as the place of occurrence of the external Y Other place in single-family (private) house as the place of occurrence of the external Y Unspecified place in single-family (private) house as the place of occurrence of the external Y Kitchen in mobile home as the place of occurrence of the external Y Dining room in mobile home as the place of occurrence of the external Y Bathroom in mobile home as the place of occurrence of the external Y Bedroom in mobile home as the place of occurrence of the external Y Driveway of mobile home as the place of occurrence of the external Y Garage of mobile home as the place of occurrence of the external Y Swimming-pool of mobile home as the place of occurrence of the external Y Garden or yard of mobile home as the place of occurrence of the external Y Other place in mobile home as the place of occurrence of the external Y Unspecified place in mobile home as the place of occurrence of the external Y Kitchen in apartment as the place of occurrence of the external Y Bathroom in apartment as the place of occurrence of the external Y Bedroom in apartment as the place of occurrence of the external Y Other place in apartment as the place of occurrence of the external Y Unspecified place in apartment as the place of occurrence of the external Y Kitchen in boarding-house as the place of occurrence of the external Y Bathroom in boarding-house as the place of occurrence of the external Y Bedroom in boarding-house as the place of occurrence of the external Y Driveway of boarding-house as the place of occurrence of the external Y Garage of boarding-house as the place of occurrence of the external Y Swimming-pool of boarding-house as the place of occurrence of the external Y Garden or yard of boarding-house as the place of occurrence of the external Y Other place in boarding-house as the place of occurrence of the external Y Unspecified place in boarding-house as the place of occurrence of the external Y Kitchen in other non-institutional residence as the place of occurrence of the external

4 E849.0 Home accidents (continued from previous page) Corresponding Excluded ICD-10-CM Diagnosis Y Bathroom in other non-institutional residence as the place of occurrence of the external Y Bedroom in other non-institutional residence as the place of occurrence of the external Y Driveway of other non-institutional residence as the place of occurrence of the external Y Garage of other non-institutional residence as the place of occurrence of the external Y Swimming-pool of other non-institutional residence as the place of occurrence of the external Y Garden or yard of other non-institutional residence as the place of occurrence of the external Y Other place in other non-institutional residence as the place of occurrence of the external Y Unspecified place in other non-institutional residence as the place of occurrence of the external Y92.10 Unspecified residential institution as the place of occurrence of the external E849.1 Farm accidents Y92.71 Barn as the place of occurrence of the external Y92.72 Chicken coop as the place of occurrence of the external Y92.73 Farm field as the place of occurrence of the external Y92.74 Orchard as the place of occurrence of the external Y92.79 Other farm location as the place of occurrence of the external E849.2 Mine and quarry accidents Y92.64 Mine or pit as the place of occurrence of the external E849.3 Accidents occurring in industrial places and premises E849.4 Accidents occurring in place for recreation and sport Y92.61 Building [any] under construction as the place of occurrence of the external Y92.62 Dock or shipyard as the place of occurrence of the external Y92.63 Factory as the place of occurrence of the external Y92.65 Oil rig as the place of occurrence of the external Y92.69 Other specified industrial and construction area as the place of occurrence of the external Y Basketball court as the place of occurrence of the external Y Squash court as the place of occurrence of the external Y Tennis court as the place of occurrence of the external Y Other athletic court as the place of occurrence of the external Y Baseball field as the place of occurrence of the external Y Football field as the place of occurrence of the external Y Soccer field as the place of occurrence of the external Y Other athletic field as the place of occurrence of the external Y Ice skating rink (indoor) (outdoor) as the place of occurrence of the external Y Roller skating rink as the place of occurrence of the external Y92.34 Swimming pool (public) as the place of occurrence of the external Y92.39 Other specified sports and athletic area as the place of occurrence of the external Y Public park as the place of occurrence of the external Y Amusement park as the place of occurrence of the external Y Beach as the place of occurrence of the external Y Campsite as the place of occurrence of the external Y Zoological garden (Zoo) as the place of occurrence of the external Y Other recreation area as the place of occurrence of the external

5 E849.5 Street and highway accidents E849.6 Accidents occurring in public building Corresponding Excluded ICD-10-CM Diagnosis Y Unspecified street and highway as the place of occurrence of the external Y Interstate highway as the place of occurrence of the external Y Parkway as the place of occurrence of the external Y State road as the place of occurrence of the external Y Local residential or business street as the place of occurrence of the external Y Exit ramp or entrance ramp of street or highway as the place of occurrence of the external Y Sidewalk as the place of occurrence of the external Y Parking lot as the place of occurrence of the external Y Bike path as the place of occurrence of the external Y Other paved roadways as the place of occurrence of the external Y Daycare center as the place of occurrence of the external Y Elementary school as the place of occurrence of the external Y Middle school as the place of occurrence of the external Y High school as the place of occurrence of the external Y College as the place of occurrence of the external Y Trade school as the place of occurrence of the external Y Other school as the place of occurrence of the external Y Unspecified school as the place of occurrence of the external Y92.22 Religious institution as the place of occurrence of the external Y Courthouse as the place of occurrence of the external Y Library as the place of occurrence of the external Y Post office as the place of occurrence of the external Y City hall as the place of occurrence of the external Y Other public administrative building as the place of occurrence of the external Y Art Gallery as the place of occurrence of the external Y Museum as the place of occurrence of the external Y Music hall as the place of occurrence of the external Y Opera house as the place of occurrence of the external Y Theater (live) as the place of occurrence of the external Y Other cultural public building as the place of occurrence of the external Y92.26 Movie house or cinema as the place of occurrence of the external Y92.29 Other specified public building as the place of occurrence of the external Y Bank as the place of occurrence of the external Y Restaurant or café as the place of occurrence of the external Y Supermarket, store or market as the place of occurrence of the external Y Shop (commercial) as the place of occurrence of the external Y Airport as the place of occurrence of the external Y Bus station as the place of occurrence of the external Y Railway station as the place of occurrence of the external Y Highway rest stop as the place of occurrence of the external Y Gas station as the place of occurrence of the external Y Ambulatory surgery center as the place of occurrence of the external Y Health care provider office as the place of occurrence of the external Y Urgent care center as the place of occurrence of the external Y Other ambulatory health services establishments as the place of occurrence of the external Y92.59 Other trade areas as the place of occurrence of the external

6 E849.7 Accidents occurring in residential institution Corresponding Excluded ICD-10-CM Diagnosis Y Kitchen in children's home and orphanage as the place of occurrence of the external Y Bathroom in children's home and orphanage as the place of occurrence of the external Y Bedroom in children's home and orphanage as the place of occurrence of the external Y Driveway of children's home and orphanage as the place of occurrence of the external Y Garage of children's home and orphanage as the place of occurrence of the external Y Swimming-pool of children's home and orphanage as the place of occurrence of the external Y Garden or yard of children's home and orphanage as the place of occurrence of the external Y Other place in children's home and orphanage as the place of occurrence of the external Y Unspecified place in children's home and orphanage as the place of occurrence of the external Y Kitchen in nursing home as the place of occurrence of the external Y Bathroom in nursing home as the place of occurrence of the external Y Bedroom in nursing home as the place of occurrence of the external Y Driveway of nursing home as the place of occurrence of the external Y Garage of nursing home as the place of occurrence of the external Y Swimming-pool of nursing home as the place of occurrence of the external Y Garden or yard of nursing home as the place of occurrence of the external Y Other place in nursing home as the place of occurrence of the external Y Unspecified place in nursing home as the place of occurrence of the external Y Kitchen in prison as the place of occurrence of the external Y Dining room in prison as the place of occurrence of the external Y Bathroom in prison as the place of occurrence of the external Y Cell of prison as the place of occurrence of the external Y Swimming-pool of prison as the place of occurrence of the external Y Courtyard of prison as the place of occurrence of the external Y Other place in prison as the place of occurrence of the external Y Unspecified place in prison as the place of occurrence of the external Y Kitchen in reform school as the place of occurrence of the external Y Dining room in reform school as the place of occurrence of the external Y Bathroom in reform school as the place of occurrence of the external Y Bedroom in reform school as the place of occurrence of the external Y Driveway of reform school as the place of occurrence of the external Y Garage of reform school as the place of occurrence of the external Y Swimming-pool of reform school as the place of occurrence of the external Y Garden or yard of reform school as the place of occurrence of the external

7 E849.7 Accidents occurring in residential institution (continued from previous page) Corresponding Excluded ICD-10-CM Diagnosis Y Other place in reform school as the place of occurrence of the external Y Unspecified place in reform school as the place of occurrence of the external Y Kitchen in school dormitory as the place of occurrence of the external Y Dining room in school dormitory as the place of occurrence of the external Y Bathroom in school dormitory as the place of occurrence of the external Y Bedroom in school dormitory as the place of occurrence of the external Y Other place in school dormitory as the place of occurrence of the external Y Unspecified place in school dormitory as the place of occurrence of the external Y Kitchen in other specified residential institution as the place of occurrence of the external Y Dining room in other specified residential institution as the place of occurrence of the external Y Bathroom in other specified residential institution as the place of occurrence of the external Y Bedroom in other specified residential institution as the place of occurrence of the external Y Driveway of other specified residential institution as the place of occurrence of the external Y Garage of other specified residential institution as the place of occurrence of the external Y Pool of other specified residential institution as the place of occurrence of the external Y Garden or yard of other specified residential institution as the place of occurrence of the external Y Other place in other specified residential institution as the place of occurrence of the external Y Unspecified place in other specified residential institution as the place of occurrence of the external Y Patient room in hospital as the place of occurrence of the external Y Patient bathroom in hospital as the place of occurrence of the external Y Corridor of hospital as the place of occurrence of the external Y Cafeteria of hospital as the place of occurrence of the external Y Operating room of hospital as the place of occurrence of the external Y Other place in hospital as the place of occurrence of the external Y Unspecified place in hospital as the place of occurrence of the external

8 E849.8 Accidents occurring in other specified places E849.9 Accidents occurring in unspecified place Corresponding Excluded ICD-10-CM Diagnosis Y Kitchen on military base as the place of occurrence of the external Y Mess hall on military base as the place of occurrence of the external Y Barracks on military base as the place of occurrence of the external Y Garage on military base as the place of occurrence of the external Y Swimming-pool on military base as the place of occurrence of the external Y Garden or yard on military base as the place of occurrence of the external Y Other place on military base as the place of occurrence of the external Y Unspecified place military base as the place of occurrence of the external Y Car as the place of occurrence of the external Y Bus as the place of occurrence of the external Y Truck as the place of occurrence of the external Y Airplane as the place of occurrence of the external Y Boat as the place of occurrence of the external Y Train as the place of occurrence of the external Y Subway car as the place of occurrence of the external Y Other transport vehicle as the place of occurrence of the external Y Desert as the place of occurrence of the external Y Forest as the place of occurrence of the external Y Other wilderness area as the place of occurrence of the external Y92.84 Military training ground as the place of occurrence of the external Y92.85 Railroad track as the place of occurrence of the external Y92.86 Slaughter house as the place of occurrence of the external Y92.89 Other specified places as the place of occurrence of the external Y92.9 Unspecified place or not applicable