The ICD-9 and ICD-10 valid and excluded diagnosis codes for the latest fiscal year are made available to non-group health plan (NGHP) responsible reporting entities (RREs) and agents for Section 111 liability insurance (including self-insurance), no-fault, and workers’ compensation mandatory reporting.
ICD-9 and ICD-10 Codes for Section 111 Reporting
Click the links below to download the valid and excluded ICD diagnosis code lists in Excel (.xlsx). The valid lists also include the No-Fault Plan Type D exclusion indicators.
The diagnosis code lists are derived from ICD-10 diagnosis codes that CMS posts each year so that providers and suppliers utilize the applicable diagnosis codes when submitting medical claims to Medicare. There are diagnosis codes that are applicable to liability and workers’ compensation situations but are not applicable to no-fault accidents or injuries. CMS reviews ICD 10 codes annually to identify the codes that may be used for Section 111 NGHP Claim Input File Detail Record submissions.
Once identified for Section 111 reporting, diagnosis codes are retained on the lists from year to year. New valid codes are added and descriptions of existing codes are revised annually.
Not all code types are added to the valid lists. For example, ICD-9 codes beginning with the letter “V” and ICD-10 codes beginning with the letter “Z” are removed from the valid lists. ICD-9 “V” codes are equivalent to ICD-10 “Z” codes (e.g., factors influencing health status and contact with health services). These “Z” codes, therefore, are also excluded from Section 111 claim reports. However, a “V” code may be used in certain circumstances, such as to identify the Alleged Cause of Injury, Incident, or Illness, which is the reason why “V” codes will not appear on the list of excluded ICD-10 codes. Additionally, CMS has also determined that certain valid diagnosis codes do not provide enough information related to the cause and nature of an illness, incident, or injury to be complete, useful, or adequate for Section 111 Claim Input File submissions. Therefore, these diagnosis codes are added to the excluded lists and will not be found on the valid lists for NGHP plan types.