Section 2908.50  Billing Code Sets

All billing codes and modifier systems used for electronic billing shall be in accordance with 50 Ill. Adm. Code 9110.90 (Illinois Workers' Compensation Commission Medical Fee Schedule). Billing codes and modifier systems identified in this Section are valid codes for the specified workers' compensation transactions, in addition to any code sets defined by the standards adopted in the Workers' Compensation Act [820 ILCS 305] and 50 Ill. Adm. Code 9110.90.

a)         "CDT-4 Codes" − codes and nomenclature prescribed by the American Dental Association, as published in CDT 2015: Dental Procedure Codes, September 2014, American Dental Association, 211 East Chicago Ave., Chicago IL 60611-2678, website http://www.ada.org/en/ (no later amendments or editions).

b)         "CPT-4 Codes" − the procedural terminology and codes contained in the "Current Procedural Terminology, Fourth Edition", as published by the American Medical Association (AMA) and as adopted in the appropriate fee schedule contained in 50 Ill. Adm. Code 9110.90.

c)         "Diagnosis Related Group" or "DRG" − the inpatient classification scheme used by CMMS for hospital inpatient reimbursement. The DRG system classifies patients based on principal diagnosis, surgical procedure, age, presence of co-morbidities and complications, and other pertinent data.  (See 42 CFR 412.)

d)         "HCPCS" − CMMS' Healthcare Common Procedure Coding System, a coding system that describes products, supplies, procedures and health professional services and that includes AMA's CPT-4 codes, alphanumeric codes, and related modifiers.

e)         "ICD-9-CM Codes" − diagnosis and procedure codes in the International Classification of Diseases, 9^th Revision, Clinical Modification, published by HHS.

f)         "ICD-10-CM/PCS Codes" − diagnosis and procedure codes in the International Classification of Diseases, 10^th Edition, Clinical Modification/Procedure Coding System, maintained and published by HHS.

g)         "NDC" − National Drug Codes of the United States Food and Drug Administration. (See Section 510 of the Federal Food, Drug, and Cosmetic Act (21 USC 360).)

h)         "Revenue Codes" − the 4-digit coding system developed and maintained by the National Uniform Billing Committee (NUBC) for billing inpatient and outpatient hospital services, home health services, and hospice services.  The revenue codes are contained in the Official UB-04 Data Specifications Manual 2016 (Manual 2016), July 2015, National Uniform Billing Committee, website http://www.nubc.org/ (no later amendments or editions).

i)          "National Uniform Billing Committee Codes" − code structure and instructions established for use by NUBC, such as occurrence codes, condition codes, or prospective payment indicator codes.  These are known as UB-04 codes and are contained in Manual 2016.