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Scheduled Outage: The HCAI system will be unavailable from 5:00 p.m. (ET) Friday, November 15 to 8:00 a.m. (ET) Monday, November 18
Health Care Facility | Insurers | Related Initiatives  

Coding


HCAI uses standard coding on OCFs for injuries (ICD), interventions (CCI), good/supplies (GAP), 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.

Coding


Which Codes does HCAI Use?

An Overview of Injury and Intervention Coding

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).

Intervention codes briefly describe what interventions, products, and/or services are being proposed or were provided to address the problem.

GAP codes: Goods, Supplies, 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

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 (Kilometer) 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.

Coding


View Code Lists (PDFs)

GAP Codes
Provider Type Codes
Unit Measures
Minor Injury Guideline Codes for OCF-23 and OCF-21C

Partial lists of Injury/Sequelae (ICD-10-Ca) and Intervention/Treatment (CCI) codes used in HCAI are viewable in the HCAI application by pressing the <...> button in the applicable section of the OCF.

If your facility uses a Practice Management System (PMS) to submit OCFs and you need help navigating your software’s coding functionality, please contact your PMS Vendor for help.

If you need help determining which code is most appropriate for your OCF, please contact your Professional Association or Regulatory College. HCAI cannot advise facilities about code selection.

If you would like to download the full list of ICD-10-Ca or CCI codes, more information can be found on the Canadian Institute for Health Information’s website.

Coding


Injury Coding Basics

HCAI 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 Main problem
Home is not WC accessible Home accessibility assessment Z59.1 Inadequate housing
Diagnosed with depression Assessment and treatment by psychologist F32 Depressive episode
Chronic pain Physiotherapy treatment 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)

Bilateral Injuries

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”

Coding


Intervention Coding Basics

HCAI Treatment 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.

Coding


How to Indicate Remote/Virtual Services in HCAI

Click on the image to download as PDF

  • Coding


    Submitting Virtual Services: A Guide For Health Care Facilities

    Click on the image to download as PDF

  • Coding


    Signaling of Virtual Services in HCAI

    Click on the image to download as PDF

  • Coding


    Virtual Assessment GAP Codes

    The blue text indicates new GAP codes. These will become available to use for assessments provided on or after June 29, 2020.

    Click on the image to download as PDF

  • Coding


    Viewing Attribute Codes on an OCF

    Click on the image to download as PDF

  • Coding


    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.

    Coding


    HCAI uses standard coding on OCFs for injuries (ICD), interventions (CCI), good/supplies (GAP), 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.

    Jump to:

    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).

    Intervention codes briefly describe what interventions, products, and/or services are being proposed or were provided to address the problem.

    GAP codes: Goods, Supplies, 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

    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 (Kilometer) 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)

    GAP Codes
    Provider Type Codes
    Unit Measures
    Minor Injury Guideline Codes for OCF-23 and OCF-21C

    Partial lists of Injury/Sequelae (ICD-10-Ca) and Intervention/Treatment (CCI) codes used in HCAI are viewable in the HCAI application by pressing the <...> button in the applicable section of the OCF.

    If your facility uses a Practice Management System (PMS) to submit OCFs and you need help navigating your software’s coding functionality, please contact your PMS Vendor for help.

    If you need help determining which code is most appropriate for your OCF, please contact your Professional Association or Regulatory College. HCAI cannot advise facilities about code selection.

    If you would like to download the full list of ICD-10-Ca or CCI codes, more information can be found on the Canadian Institute for Health Information’s website.

    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 Main problem
    Home is not WC accessible Home accessibility assessment Z59.1 Inadequate housing
    Diagnosed with depression Assessment and treatment by psychologist F32 Depressive episode
    Chronic pain Physiotherapy treatment 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)

    Bilateral Injuries

    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.

    How to Indicate Remote/Virtual Services in HCAI

  • Submitting Virtual Services: A Guide For Health Care Facilities

  • Signaling of Virtual Services in HCAI

  • Virtual Assessment GAP Codes

    The blue text indicates new GAP codes. These will become available to use for assessments provided on or after June 29, 2020.

  • Viewing Attribute Codes on an OCF

  • 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.

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