Appendix D - MIG Codes - HCAI Info

1 Appendix D MINOR INJURY GUIDELINE (MIG) Codes FOR OCF-23 AND OCF-21C Appendix D Page 1 When managing patients who are eligible for treatment under the MIG, Health Care Facilities must use the OCF-23 Treatment Confirmation form prior to treatment and the OCF-21C to invoice for treatment. There are distinct Codes available for use with patients who will be or have been treated under the MIG. The Codes supplied in this document are separated into two sections: 1. Codes required to complete OCF-23 2. Codes required to complete OCF-21C Part 10 (Guideline Services) of the OCF-23 requires a description of the kind of Guideline that will be delivered to your patient.

2 At the time of publication, the only Guideline in force is the Minor Injury. Radiology Codes If proposing or invoicing for radiology services, specific Codes should be used when completing an OCF-23 or OCF-21. These Codes are used in the following sections: OCF-23 Part 10: Guideline Services OCF-21C Part 6: Goods and Services Rendered When completing Part 10 on an OCF-23 in which x-ray services are proposed or Part 6 on an OCF-21C, facilities must remember to provide the attribute code representing the number of views.

3 The CCI code , attribute Codes and maximum fee payable are shown in the table below: Attribute Codes for X-Ray of Spinal Vertebrae and MIG CCI code Attribute Max Fee Payable (Feb 1, 2014) Cervical Spine 2 or fewer views 3SC10 CXA 3-4 views 3SC10 CXB 5-6 views 3SC10 CXC More than 6 views 3SC10 CXD Thoracic Spine 2 or fewer views 3SC10 THA 3-4 views 3SC10 THB Lumbar Spine 2 or fewer views 3SC10 LBA 3-4 views 3SC10 LBB 5-6 views 3SC10 LBC More than 6 views 3SC10 LBD Appendix D MINOR INJURY GUIDELINE (MIG) Codes FOR OCF-23 AND OCF-21C Appendix D Page 2 CCI code Attribute Max Fee Payable (Feb 1, 2014)

4 Lumbosacral Spine 2 or fewer views 3SC10 LSA 3-4 views 3SC10 LSB 5-6 views 3SC10 LSC More than 6 views 3SC10 LSD Example: OCF-23 Part 10: Guideline Services Example: OCF-21C Part 6: Goods and Services Rendered When invoicing for Goods and Services Rendered, the facility must list all dates of treatment along with the specifics of what kinds of good and/or services were provided on each date of Appendix D MINOR INJURY GUIDELINE (MIG) Codes FOR OCF-23 AND OCF-21C Appendix D Page 3 treatment. In order to complete Part 6 of an OCF-21C, refer to Appendix B (CCI Codes ) and Appendix C (GAP Codes ).

5 NOTE: There are no costs associated with the goods and/or services listed in Part 6. Costs are addressed in the Reimbursable Fees Within the Minor injury Guideline section, using the MIG Block Billing Codes . OCF-21C Reimbursable Fees Within the Minor Injury Guideline Accident Dates On or After September 1, 2010 The following Codes are those that should be used for block billing of MIG services. These Codes should be used on an OCF-21C, NOT in the OCF-23. code Description M Minor Injury Guideline (For accident dates on or after Sept 1 2010) MIG00 Initial visit (1 Session) MIG01 Block 1 (weeks 1 to 4) MIG02 Block 2 (weeks 5 to 8) MIG03 Block 3 (weeks 9 to 12) MIGMO Health practitioner monitoring MIG24 Completion of Guideline Discharge Report (OCF24) MIGSG Supplementary goods and services MIGTR Transfer fee if insured person changes health practitioner MIGXR X-Ray Example: OCF-21C Reimbursable Fees within the Minor Injury Guideline