HCAI uses standard coding on OCFs for injuries, interventions, unit measures, and provider types. Explore the side menu to learn more about the standard codes HCAI uses, and the basics of injury and intervention coding.
Why Use Standard Coding?
Standard coding is beneficial because it
- Standardizes how injuries and treatments are communicated by health providers to Insurers
- Provides valuable data to inform and improve management and treatment of claimants
- Identifies resource and service needs of claimants
- Informs stakeholders and policymakers about the system
Coding was not designed for adjudication purposes, and does not replace effective communication between health care providers and insurers.
Which Codes does HCAI Use?
Injury and sequelae codes
IDC-10-CA codes: International Statistical Classifications of Disease and Related Health Problems, Tenth Revision, Canadian version. Developed by the World Health Organization (WHO) and the Canadian Institute for Health Information (CIHI).
These codes inform us why the claimant is seeking care. A code briefly describes the problem that drives health expenditures. In HCAI, the problem must directly relate to the motor vehicle collision.
Intervention (treatment) codes
CCI codes: Canadian Classification of Health Interventions. Developed by the Canadian Institute for Health Information (CIHI).
GAP codes: Goods, Administration, and Other codes. The CCI did not address certain services specific to the Ontario auto insurance health system. GAP codes were created only for use in the Ontario auto insurance system
Intervention codes briefly describe what interventions, products, and/or services are being proposed or were provided to address the problem.
Unit measure codes
These codes indicate how certain services are measured when filling out the Reimbursable Goods and Services on an invoice, or Part 12 of an OCF-18. For example, HR (hour) and KM (Kilometre) are unit measure codes.
Health Professional References Codes (Provider Type codes)
Provider Type codes represent a profession or specialty. For example, the profession code for a chiropractor is DC.
Quick tip: Additional details about injuries or interventions may be provided in narrative form in the OCF’s “Additional comments” section.
View Code Lists (PDFs)
ICD-10-CA (Injury and Sequelae) Information and Partial Pick List
ICD-10-CA Complete Alphabetical Index
ICD-10-CA Tabular List
CCI (Intervention/treatment) Information and Partial Pick List
CCI Complete Alphabetical Index
CCI Tabular List
Provider Type Codes
Minor Injury Guideline Codes for OCF-23 and OCF-21C
Injury Coding Basics
The ICD-10-CA codes indicate why a patient is seeking treatment. It is not necessarily a diagnosis, although it can be. It can be a problem, diagnosis, condition, or circumstance.
The main problem is:
- The problem most responsible for the goods and services proposed in a treatment plan or billed for in an invoice
- The most clinically significant reason for a patient’s visit to a particular health professional
- Requires evaluation, treatment, or management
The main problem varies depending on which health professional the patient sees. For example, a patient sustained a complete spinal cord injury (C5-6 SCI). As a result:
|Resulting injury, problem, or circumstance
||Health good and/or service required
|Home is not WC accessible
||Home accessibility assessment
||Z59.1 Inadequate housing
|Diagnosed with depression
||Assessment and treatment by psychologist
||F32 Depressive episode
||R52.1 Chronic intractable pain
Each situation has a different main problem, which requires a different professional to fill out the OCF.
Other problems: Patients often have more than one problem, secondary to the main problem. These result from the collision and influence their need for care. For example:
- A patient could have a main problem: Fractured clavicle
- And an other problem: Post-traumatic headache
In HCAI, list the main problem first, and other problems afterward.
Only code problems that are a direct result of the automobile collision.
Prior health conditions should be addressed in Part 7 of the OCF-18 and Part 6 of OCF-23.
Common Categories (Series) of Injury Codes
Most physical injuries, consequences, or circumstances fall into the S or T series of codes.
- S (S00-S99) series: Single injury and certain other consequences of external causes (e.g. S034 – Sprain and strain of jaw)
- T (T00-T98) series: Multiple injuries involving multiple body regions (e.g. T025 – Fractures involving multiple regions of both lower limbs)
There are also non-physical injuries, consequences, or circumstances which would fall under the other sets of codes, such as the F or Z series of codes.
- F (F00-F99) series: Mental and behavioral disorders (e.g. F32.1 - Moderate depressive episode)
- Z (Z00-Z99) series: Factors influencing health status and contact with health services (e.g. Z59.1 - Inadequate housing)
Do not code bilateral injuries twice unless they are distinct and very different injuries. Instead, use T series: ‘Injury… and other consequences of external causes (multiple)”. An example would be “T025 – fractures involving multiple regions of both lower limbs”
Intervention Coding Basics
Intervention or Treatment coding is done using CCI codes or GAP codes. GAP codes were created because the CCI did not address certain services specific to the Ontario auto insurance health system. GAP codes cover goods as well as administrative services.
When filling out a form, regardless of whether you select CCI codes or GAP codes, you should use the narrative section of the form to offer further explanation and details. You can find narrative sections in the Additional Comments section of all OCFs, as well as in Part 12 of the OCF-18 and in the Additional Information section of the OCF-21B.
Assessment codes are intended to include all activities required to produce the assessment report. The assessment code includes time for booking, file review, administration, photocopying, report preparation, report review, etc. The only additional lines should be disbursements such as parking, translation services, or travel time.
Further Questions about Coding?
If you want to know more about coding, or need help determining which code is most appropriate for your form, please contact your Health Professional Association. HCAI cannot advise Facilities about code selection.