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Section 111 Mandatory Reporting Application (MRA)

Section 111 Valid ICD-10 Diagnosis Codes for NGHP RREs


This page describes the purpose and layout of the file of valid ICD-10 diagnosis codes made available to responsible reporting entities (RREs) and agents for Section 111 Liability Insurance (Including Self-Insurance), No-Fault, and Workers' Compensation Mandatory Reporting (Non-GHP or NGHP). Please see Chapter IV in the Section 111 NGHP User Guide for more information on the use of these codes for Section 111 reporting.

The list of valid codes for Section 111 reporting was derived from files of valid ICD-10 diagnosis codes posted each year by CMS to https://www.cms.gov/Medicare/Coding/ICD10/2017-ICD-10-CM-and-GEMs.html for providers and suppliers to use when submitting medical claims to Medicare. CMS started with these codes when defining those that may be used on Section 111 NGHP Claim Input Files.

The COB&R uses the version posted on the CMS.gov website. The text files with valid ICD-10 diagnosis codes and descriptions are downloaded from the CMS web site. Codes beginning with the letter "Z" and codes on the list of exclusions in Appendix I of the Section 111 NGHP User Guide Appendices Chapter are dropped. Codes invalid for NGHP No-Fault MSP records only (Plan Insurance Type is equal to "D" in Field 51) are listed here, with an indicator to show that they are not valid for No-Fault cases. These codes are also listed in Appendix J of the NGHP User Guide, referred to as the list of "No-Fault Excluded ICD-9/ICD-10 Diagnosis Codes."

The most recent descriptions associated to codes found on multiple versions are retained. No codes previously considered valid are dropped from year to year.

To download the Section 111 valid ICD-10 diagnosis codes, click on a link below. To save a copy to your workstation, right-click a link and select Save Target As. The data is provided in two formats, in a Microsoft Office Excel 2003 file (.xls) and in a MS-DOS text file (.txt). The file names are:

Purpose

RREs may use this list to validate ICD-10 diagnosis codes submitted in the Claim Input File Detail Record Alleged Cause of Injury, Incident or Illness (Field 15) and ICD-10 Diagnosis Codes 1-19 beginning in Field 18. Note that there are additional requirements related to these fields. For example, ICD-10 diagnosis codes submitted in Field 15 must begin with the letters "V," W," "X," or "Y". See Chapter IV of the Section 111 NGHP User Guide for the complete set of requirements related to these fields.

The downloadable files provided here reflect the valid ICD-10 diagnosis codes as defined in the Section 111 NGHP User Guide and are provided to make it easier for RREs and agents to incorporate these codes into their Section 111 reporting process. RREs must submit codes considered valid for Section 111 reporting but use of these downloadable files to accomplish that is optional.

File Format

The Excel file contains four columns. The first column contains the 5 character valid ICD-10 diagnosis codes. The second column contains a short description. The third column contains the long description. The fourth column contains the No-Fault excluded indicator.

The text file is a standard MS-DOS text file formed from lines terminated with carriage return line feed (CRLF). Records are of variable length and fields begin at fixed character positions 1, 9, 71, and 219.