The International Classification of Diseases (ICD) is a system used to code and classify morbidity data from physician offices and hospitals.

The federal and provincial governments rely on this data to calculate and report morbidity statistics for their populations. Accordingly, provincial governments have mandated that physicians provide an ICD code as a component of each billing claim.

As with any required claim information, it is critical to ensure ICD information is present and correct (e.g., an ICD code that coincides with the service rendered). A claim returned to the physician for correction or additional information will result in a delay of payment.

Billing Advice:

• Selecting the appropriate ICD reduces the potential of rejected claims. After Hours Premiums are one example of a service where the ICD code helps Manitoba Health staff determine if the service is premium eligible. 
  
• Similarly, if two separate services are claimed in the same visit, e.g. hypertension and anxiety, the ICD helps differentiate each unique service which in turn, aides Manitoba Health staff.
• Looking for an ICD code? Click HERE to review the database.

Manitoba Health now requires four digit ICD codes. If a claim has an ICD code without 4 digits it will be returned with an appropriate Explanation of Benefit code (e.g., H0 — This service was refused as the ICD9 submitted does not coincide with the benefit catalogue item submitted, or L1. This ICD9 indicates an unspecified disorder or condition. Please change the ICD9 to a more specific code or provide supportive information to assist us in assessing your claim.)

There are certain tariffs that do not require ICD codes, such as billing for indirect care. In these limited cases, an ICD code is not required.

Unsure which ICD code applies? Contact Manitoba Health at (204) 786‑7361.