Coding

Overview

HCAI has adopted use of standardized coding for injuries and interventions. By implementing standard data collection strategies, the ability of stakeholders and researchers to conduct meaningful data analysis is enhanced. The following code lists may be downloaded:

Appendix A: ICD-10-Ca (Injury and Sequelae) Partial Pick List (PDF)
Appendix B: CCI (Intervention/treatment) Partial Pick List (PDF)
Appendix C: GAP (PDF)
Appendix D: PAF (PDF)
Appendix E: Provider Type Codes (PDF)

In addition to injury and intervention coding, HCAI requires health care facilities to also select the correct codes for attributes and unit measures. You may download a document on Unit Measures:

Appendix F: Unit Measures (PDF)

Ontario Claim Forms (OCF) and Coding

OCFs require health facilities to provide the following coded information on claim forms:

1. Injury and Sequelae codes
• When completing forms, the most important code to include is the injury, problem or circumstance that is responsible for your involvement in management of the patient.
• Since different health professionals may manage different problems that result from the motor vehicle collision, it is acceptable for variations to exist on OCFs created for the same patient
2. Intervention (treatment) Codes
1. CCI codes
2. GAP codes
3. PAF codes
3. Unit measure codes
4. Health Professional Reference codes

Injury and Sequelae Codes

Access a partial pick list of commonly used injury/sequelae codes (ICD10-Ca) (PDF)

ICD10-Ca - which code is the right one?

• Single Injuries
• Most single physical injuries will fall under Chapter XIX of the ICD 10-Ca: Injury, poisoning and certain other consequences of external causes
• Why? Generally, injuries from auto collision are not diseases or illnesses that originate from internal or systemic origins
• However, in some circumstances, there are sequelae from the physical injury that result in the patient’s need for health services and other types of codes may be required

• Multiple physical injuries
• Can be captured using a sub-section of Chapter XIX of the ICD10-Ca: Injuries involving multiple body regions
• Do not enter bilateral injuries twice. Use a T code instead.
• Example: Bilateral fractures lower limb = T02.5 (fractures involving multiple regions of both lower limbs)

Example 1: Spinal cord injury and home accessibility assessment

Example 2: Same client with SCI being treated by psychologist for depression

Patient's injury/problem/circumstances	Claimant sustained complete paraplegis following collision Reports lowering of mood, reduction of energy, and decrease in activity. Capacity for enjoyment, interest, and concentration is reduced, and marked tiredness after even minimum Referred by GP to psychologist for assessment and treatment OCF 18 being prepared by psychological practice
Primary problem responsible for health goods &/or services	Moderate depressive episode
Locate appropriate code	F32 - Depressive episode
Coding Breakdown Chapter Block Category	Chapter F - Mental and behavioural disorders Block 32 - Depressive episode Optional - may also code category .1 (e.g. F32.1) to express moderate depressive episode

Intervention (Treatment) Coding Pick Lists

CCI Codes

The Canadian Classification of Interventions (CCI) reflect interventions of a medical/rehabilitative nature. Typically these codes are 5-digits long. The exceptions are:

7.SE.02.AB: Assessment of environment (private living space, includes: Home assessment)
7.SE.02.AW: Assessment of environment (workplace, includes: Ergonomic and Workplace assessments)
7.SJ.30.LB: Documentation, support activity (for claim form)

Access a partial pick list of commonly used treatment (intervention) codes (CCI) (PDF)

CCI – which one is the right one?
Intervention coding is usually expressed using 5-digit codes. The description of treatment is usually at a high level, which means that one intervention code may reflect several different treatments in the same category.

Example:

Stimulation
The codes for “stimulation” are used when delivering all forms of electro stimulation (e.g. FES, TENS, interferential) as well as ultrasound treatment. There are no distinct 5-digit codes that specify which form of stimulation energy is used.

Note: When coding for assessments, where possible, a GAP assessment code should be chosen.

GAP Codes

GAP codes are also intervention codes. These are codes that do not exist in the CCI because they are specific to Ontario’s auto insurance health system. In some cases, GAP codes reflect administrative services and/or goods that have been provided to patients.

Access the current list of GAP codes here (PDF)

Coding for Assessments
Where possible, assessments should be coded using the GAP assessment codes. In this way, it is possible to more specifically identify the type of assessment that is being proposed or invoiced for.

Examples (NB - this is not a complete list of GAP assessment codes)

What is included in the GAP assessment codes?

The Superintendent’s Guideline (PDF) specifies on page 3 that insurers are not required to pay for administrative costs, overhead and related fees. As a result, assessment codes are inclusive of administrative activities and charges that were incurred as a result of completing the assessment. This includes contacting the patient for the purpose of booking the appointment, photocopying charges, report preparation time, etc.

Activities such as mileage, travel time or expenses related to parking should be invoiced separately.

Goods
The use of the code to specify “Other” Goods & Supplies is discouraged. If there is no code suitable to describe the good or supplies that are being provided, be sure to provide a description in the space available in each OCF form.

PAF Codes

Appendix D (PDF) provides the CURRENT codes for the WAD I and WAD II pre-approved framework.

Appendix G (PDF) PAF Barriers to Recovery

Using OCF Forms

Web Users
Need to learn how to complete OCF forms? Click Here.

DEC Users
Need to learn how to complete OCF forms? Click Here.