This is to amend the implementing guidelines for ICD-10 system and incorporation of the Philippine Modification into the ICD-10 coding system or the PhilHealth Circular 43, s. 2002.

All claims with no ICD codes, incorrect ICD-10 codes and/or ambiguous ICD-10 codes shall NO LONGER BE DENIED but shall be returned to the accredited health care provider (RTH) on the ground of non-compliance with the correct ICD-10 codes.

To further ensure faithful compliance by all accredited healthcare providers, all RTH claims for the hereinabove ground shall be duly recorded and those found to be habitual violators shall be appropriately dealth with during the renewal of accreditation period. A provider shall be deemed a habitual violator if it is found to have an RTH claim for non-compliance with the correct ICD-10 codes in every month of the duration of its accreditation.

This Circular shall take effect immediately upon all pending and incoming claims at all PhilHealth Regional Offices and the Central Office.

All other provisions of PhilHealth Circular No. 43, s. 2002 not inconsistent with this circular shall remain in full force effect.

Adopted: 11 Aug. 2003

(SGD.) FRANCISCO T. DUQUE III, MD, MSc
President and CEO