PIP Update for ICD-10December 10, 2015

On October 1, 2015, the ICD-10 conversions began for medical providers, but it only applies to PIP in limited circumstances.

In summary providers should know:

• The ICD-10 conversion only applies to providers subject to Health Insurance Portability Accountability Act (HIPAA).

• Generally, PIP medical expense benefits are not subject to HIPAA.

• For the purposes of PIP medical expense reimbursement ICD-9 is still accepted unless the patient has elected for health insurance primary under his/her automobile policy.

• If the patient is health insurance primary, ICD-10 codes will need to first be billed to the employee health coverage, Medicaid or Medicare.

• Auto insurers accept either ICD-9 or ICD-10 billing

• DOBI will not be changing the Attending Provider Treatment Plan (APTP) to include ICD-10.

The DOBI post concerning ICD-10 is located at:

Contact Keith J. Roberts, Esq for additional information.

Attorney: Keith Roberts

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