OAR 410-146-0040
ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes

(1) The Division requires diagnosis codes on all claims including those submitted by independent laboratories and portable radiology and including nuclear medicine and diagnostic ultrasound providers. A clinic must always provide the client’s diagnosis to ancillary service providers when prescribing services, equipment, and supplies.

(2) The appropriate ICD-10-CM code must be used to identify:

(a) Diagnoses;

(b) Symptoms;

(d) Problems;

(e) Complaints; or

(f) Other reasons for the encounter/visit.

(3) Clinics must list the principal diagnosis in the first position on the claim. Clinics must use the principal diagnosis code for the diagnosis, condition, problem, or other reason for an encounter/visit shown in the medical record to be chiefly responsible for the services provided. Clinics may list up to three additional diagnosis codes on the claim for documented conditions that coexist at the time of the encounter/visit and require or affect client care, treatment, or management.

(4) Clinics must list the diagnosis codes using the highest degree of specificity available in the ICD-10-CM. The Division considers a diagnosis code invalid if it has not been coded to its highest specificity.

(5) The Division requires providers to use the standardized code sets required by the Health Insurance Portability and Accountability Act (HIPAA) and adopted by CMS. Unless otherwise directed in rule, providers must accurately code claims according to the national standards in effect for the date the service was provided:

(a) For dental services, use codes that are in effect for the date the services was provided that are found in Dental Procedures and Nomenclature as maintained and distributed by the American Dental Association;

(b) For health care services, use the combination of Health Care Common Procedure Coding System (HCPCS) and Current Procedural Terminology (CPT) codes in effect for the date the services was provided. These services include, but are not limited to, the following:

(A) Physician services;

(B) Physical and occupational therapy services;

(D) Clinical laboratory tests;

(E) Other medical diagnostic procedures;

(F) Hearing and vision services.

(6) The Division maintains unique coding and claim submission requirements for Administrative Exams and Death with Dignity services. Refer to OAR 410 division 150, Administrative Examination and Billing Services, and OAR 410-130-0670 (Death With Dignity), Death with Dignity Services for specific requirements.

Source: Rule 410-146-0040 — ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes, https://secure.sos.state.or.us/oard/view.action?ruleNumber=410-146-0040.

410‑146‑0000
Foreword 410‑146‑0020
Memorandum of Agreement Reimbursement Methodology 410‑146‑0021
American Indian/Alaska Native (AI/AN) Provider Enrollment 410‑146‑0040
ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes 410‑146‑0060
Prior Authorization 410‑146‑0075
Client Copayments 410‑146‑0080
Professional Ambulatory Services 410‑146‑0085
Encounter and Recognized Practitioners 410‑146‑0086
Multiple Encounters 410‑146‑0100
Vaccines for Children 410‑146‑0120
Maternity Case Management Services 410‑146‑0130
Modifiers 410‑146‑0160
Administrative Medical Examinations and Reports 410‑146‑0200
Pharmacy 410‑146‑0220
Death With Dignity 410‑146‑0240
Transportation 410‑146‑0440
Prepaid Health Plan Supplemental Payments 410‑146‑0460
Compensation for Outstationed Eligibility Workers

California:	Codes
Colorado:	C.R.S.
Nevada:	NRS
New York:	Laws
Oregon:	OAR, ORS
Texas:	Statutes
World:	Rome Statute, International Dictionary

OAR 410-146-0040 ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes

OAR 410-146-0040
ICD-10-CM Diagnosis Codes and CPT/HCPCs Procedure Codes