Diagnosis Code Lookup

The Diagnosis Code Lookup dialog allows you to search for diagnosis codes and then select and add a code as an alleged cause of injury, or to select other diagnosis codes (up to 19) and then add them on the Injury Information page.

The results that are returned depend on the value you selected in the ICD Indicator field in combination with the Diagnosis Code field that the search was initiated from. For example, if you selected ICD-9 as the ICD Indicator and you were looking up an alleged cause of injury code, the results will only show codes prefixed with “E.” If you selected ICD-10 as the ICD Indicator and you were looking up an alleged cause of injury code, the results will only show codes prefixed with “V,” “W,” “X,” and “Y.”

Alleged Cause of Injury (COI)

You may only select one alleged cause of injury code at a time. Follow these steps in the lookup tool:

1.   Make sure you have selected a Diagnosis Code Indicator (ICD-9 or ICD-10).

2.   Click Add to open the Cause of Injury Diagnosis Code Lookup dialog.

3.   If you are replacing a code, click Add and select a different code. The new code will replace the existing code. Only one COI diagnosis code can be entered.

4.    If you know the code, enter it in the Apply Code field and click Apply Code.

5.    To conduct searches, enter a full or partial code number in the Diagnosis Code field or keywords in the Diagnosis Keywords field; then click Search.

The results will appear below the fields.

6.   From the results list, select a radio button for a code and click Continue.

The dialog closes and the diagnosis code appears on the Claim Information page.

Other Diagnosis Codes

Follow these steps to select up to 19 other diagnosis codes:

1.   Make sure you have selected a Diagnosis Code Indicator (ICD-9 or ICD-10).

2.   Click Add to open the Diagnosis Code Indicator [ICD-X] dialog.

3.   If you know the codes you want, enter them one at a time in the Add Diagnosis field and click Add Diagnosis.

4.   To conduct searches, enter a full or partial code number in the Diagnosis Code field or keywords in the Diagnosis Keywords field; then click Search.

The results will appear below the fields.

5.   Click to check one or more code check boxes; then click Continue.

The dialog closes and the diagnosis codes appear on the Claim Information page. To remove a code, click the delete icon (X) under the Remove column.

If the result set does not contain the code(s) you are looking for, you can perform another search from this page either with a different partial code or text, or by changing the code or text to refine or expand your search. The code and text searches work independently, so you will only be executing the search for the partial code or only the text depending on which search icon you click.

Up to 100 matches can be returned. If more than 100 matches are found on the database, the total found will be shown but only the first 100 will be listed. The application will allow you to select more than 19 codes on the Diagnosis Lookup page, but it will cause an error if you attempt to go to the next page from the Injury Information page. The extra codes must be deleted before continuing.

Under special circumstances some liability and workers’ compensation claims do not have an injury associated with them. If a claim is required to be reported where this is the case, the code NOINJ may be entered in both the Alleged Cause of Injury Diagnosis Code field and the regular Diagnosis Code field. This code may not be used in combination with any other diagnosis code. See the CMS website for more guidance on this topic.

Note: See the valid and excluded code lists on CMS.gov, at https://www.cms.gov/medicare/coordination-benefits-recovery/overview/icd-code-lists. This link is also available through the Reference Materials section of the navigation bar.

Click Continue on the dialog to return the selected codes to the Claim Information page.

Click Cancel to return to the Claim Information page without selecting any codes.

September 2024