Conversion to ICD-10
On Oct. 1, 2015, ICD-10 coding—based on the 10th revision of the International Classification of Diseases—became the national standard for providers and payers to use in transactions for services provided on or after that date. To ensure Sedgwick’s compliance with the requirements of the U.S. Department of Health and Human Services (HHS), we updated our claims systems with more than 90,000 ICD-10 diagnosis codes and delivered training to our claims colleagues in advance of the Oct. 1 compliance date on the proper use of ICD-10 codes with the Official Disability Guidelines (ODG). For more information on the U.S. government’s implementation of ICD-10 coding, please refer to www.cms.gov/ICD10. If you have additional questions for Sedgwick that are not answered below, please contact us at ICD10@sedgwick.com.
Frequently asked questions
- Did Sedgwick adopt the ICD-10 diagnosis codes for professional claims for workers’ compensation?
Yes. Professional claims were included in our transition on Oct. 1, 2015.
- Will Sedgwick accept test files directly from a physician’s office to ensure the ICD-10 codes are accepted and approved?
A. To ensure our readiness for the transition, we are currently executing internal integration testing, user acceptance testing and direct vendor testing (where applicable). However, our plan does not include direct testing with medical providers.
- Does Sedgwick support dual claim processing? If so, when?
A. Yes. Professional claims will be included in our transition on Oct. 1, 2015.
- Will Sedgwick be able to process ICD-9 codes for rebills and appeals after Oct. 1 conversion date?
A. As a general rule, claims with a date of injury (DOI) before Oct. 1, 2015, should use ICD-9 codes, and claims with a DOI on or after Oct. 1, 2015, should use ICD-10 codes.
However, there are instances where a claim with a DOI prior to Oct. 1, 2015, may include ICD-10 codes. A claim can include a combination of ICD-9 and ICD-10 codes, except when involving Medicare beneficiaries; Medicare claims must use only ICD-9 or only ICD-10 codes. Claims examiners are responsible for selecting the appropriate ICD-codes during the administration process.
In reporting states, including California, Florida, North Carolina and Oregon, claims with DOIs prior to Oct. 1, 2015, must use ICD-9 codes, and claims with DOIs on or after Oct. 1, 2015, must use ICD-10 codes.
July 1, 2015: Preparedness for Oct. 1 ICD-10 compliance date
Sept. 4, 2014: HHS establishes Oct. 1, 2015, ICD-10 compliance date
April 4, 2014: Government delays ICD-10 implementation
March 22, 2013: Sedgwick committed to meeting deadline for ICD-10 code compliance
to watch CMS' "Countdown to ICD-10" video