This week the New York Workers’ Compensation Board released new versions of several of its health provider forms. These updated forms are available for download on the Board’s website, and include the following:

  • C-4 (10/15) – Doctor’s Initial Report
  • C-4.2 (10/15) – Doctor’s Progress Report
  • C-4.3 (10/15) – Doctor’s Report of MMI/Permanent Impairment
  • C-4 AMR (10/15) – Ancillary Medical Report

The primary change to these forms is that while the old forms required ICD-9 diagnosis codes, the new forms require ICD-10 diagnosis codes. Effective October 1, 2015, the New York Workers’ Compensation Board adopted the use ICD-10 in tandem with CMS’s adoption of ICD-10.

When submitting paper claims to Atlantic Imaging Group (AIG) via mail, fax, or email, AIG prefers that providers submit a current CMS-1500 (or HCFA-1500) form with a detailed diagnostic medical reports. The New York Workers’ Compensation Board will also accept this combination of documents in lieu of C-4 forms in order to ease the transition to ICD-10.