NJHA has met with a number of Personal Injury Protection (PIP) carriers as part of the ongoing effort to support the industry’s transition to ICD-10.

Although PIP carriers cover and pay for patient treatment, they are not designated as “covered entities” under the federal HIPAA. As a result, PIP carriers are not required to follow HIPAA transaction and code set rules that require the use of ICD-10 effective Oct.1. Nevertheless, the PIP carriers have indicated to NJHA their desire to transition to ICD-10.

Providers submit an Attending Provider Treatment Plan form (APTP) to PIP carriers to request authorization for care. This form was designed to accept four ICD-9 codes. The N.J. Department of Banking and Insurance has issued an FAQ document that instructs PIP carriers and providers to continue using the existing form until DOBI has updated the APTP form for ICD-10. DOBI offers the following instructions in its FAQ:

• In boxes 36 -39, enter ICD-10 codes for care starting Oct. 1. Note in the box title that this is ICD-10 by crossing out the “9” and writing a “10.”
• A provider is allowed to include more than the four ICD-10 codes if it chooses. DOBI recommends attaching supporting documentation to the APTP form that lists any additional ICD-10 codes. This attached document should be clearly labeled so PIP carriers know these are additional ICD-10 codes.
• As of Oct. 1, providers should be consistent and use ICD-10 on both the APTP form and on the claim to PIP carriers. Providers should not mix ICD-9 and ICD-10 codes between the APTF form and the claims.

DOBI has indicated that the form change for ICD-10 is in process and the new APTP form will allow for more than four ICD-10 codes.

While it is encouraging that DOBI has indicated a way for PIP carriers to accept ICD-10 codes on the APTP form, NJHA encourages members to use caution prior to submitting an APTP form with ICD-10 codes. PIP carriers are not required to accept claim forms with ICD-10 codes and, as the FAQ states, mixing codes on the APTP form and claims forms could lead to administrative delays and denials. NJHA suggests that prior to using the ICD-10 codes on the APTP form, providers should ensure that the PIP carrier will accept them on a claim form as well.

Organizations that receive a request from a PIP carrier for ICD-9 codes for services on or after Oct. 1 are asked to contact NJHA’s Joe Carr, 609-936-2228, jcarr@njha.com, or Colleen Picklo, 609-275-4020, cpicklo@njha.com. This will help NJHA assess and track where ICD-9 codes are still required by PIP carriers.