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Policy and
Procedure Name:
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Cause
of Injury Codes (Also known as “E-codes”)
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Policy
#:
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CP-05-03
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Code/Rule
Reference:
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None
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Effective
Date:
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12/14/2020
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Approved:
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Ann M. Shannon,
Chief of Claims Policy and Support
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Origin:
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Claims
Policy
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Supersedes:
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All
Injury Management policies, procedures, directives and memos regarding cause
of injury codes or E-codes that predate the effective date of this policy and
procedure.
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History:
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Previous
versions of this policy are available upon request
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I.
POLICY PURPOSE
The
purpose of this policy is to ensure BWC staff properly assigns a code in the
claims management system which identifies the cause of an injury or
occupational disease (OD) incurred by an injured worker (IW).
II. APPLICABILITY
This
policy applies to BWC claims services staff.
III.
DEFINITIONS
Cause
of Injury Codes: Specific
codes available in the BWC claims management system, (originating from the International
Classification of Disease (ICD) code sets), which are assigned to a claim and used
to capture how an injury or OD occurred.
IV.
POLICY
It is the
policy of BWC to identify a cause of injury code in a claim for the purpose of BWC
tracking and reporting.
V.
Procedure
A.
General
Claim Note and Documentation Requirements
1. BWC staff shall refer
to the Standard Claim File
Documentation and Altered Documents policy and procedure for claim note and documentation
requirements; and
2. Shall follow any other
specific instructions for claim notes and documentation included in this
procedure.
B. For every new claim, claims
services staff shall select and enter into the claims management system a cause
of injury code which reflects the illness or injury that caused the initial
diagnosis or condition.
C. If a cause of injury
code has been identified by a managed care organization (MCO) or provider,
claims services staff shall verify the code for appropriateness based on the
accident description.
1. If the cause of injury
code as provided by the MCO or provider is appropriate, claims services staff
shall enter it into the claims management system.
2. If the cause of injury
code is not appropriate, claims services staff shall determine the appropriate code
and enter it into the claims management system.
3. If the cause of injury
category is not populated and is provided by the MCO via the interface, the
data will be systematically updated. If a revised entry is received from the
MCO or provider and is appropriate, claims services staff shall enter it into
the claims management system.
D. In existing claims in
which a cause of injury code has not already been entered, claims services
staff shall determine and enter the code when a subsequent action is taken on
the claim.
E. If multiple events
occurred simultaneously resulting in a claim, claims services staff shall code
the event that caused the most serious diagnosis.
F. Claims services staff
shall not enter cause of injury codes for any intervening causes of an
additional condition subsequent to the initial claim allowance.
G. If claims services staff
is unsure of the appropriate cause of injury code, the claim shall be staffed
with the medical service specialist (MSS) or supervisor.
H. If staffing does not
result in a decision on the appropriate cause of injury code, claims services
staff shall email the claim information to the “BWC Claims Policy Field Techs”
mailbox for direction.