I 'o t

,. Rep11blic of the Philippi11es

PHILIPPINE HEALTH INSURANCE CORPORATION
Citystate Centre, 709 Shaw Boulevard, Pasig City
Call Center (02) 441-7442 Trunkline (02) 441-7444
\Vww.ohilhealth.gov.ph

PHILHEALTH CIRCULAR
No. 'Q..0/1~ 0011

ALL PHILHEALTH MEMBERS, ACCREDITED HEALTH

TO CARE PROVIDERS (HCPs), PHILHEALTH REGIONAL
OFFICES (PROs), AND ALL OTHERS CONCERNED

SUBJECT Updated List of ICD-10 codes for Selected Medical Case Rates

I. RATIONALE

In reference to the recent updates by the WHO ICD Update and Revision Committee and
adherence to the Department Circular No. 2016-0363 of the Department of Health that
provides updates to the International Classification of Diseases version 10 (ICD-10),
Phi!Health is mandated to adopt and implement this new information.

As stated "The updated ICD-1 0 codes shall be implemented for statistical purposes starting
on January 1, 2017. Moreover, ICD-10 codes in the Philippine ICD-10 Modifications and the
previous editions of the ICD-10 not affected by the updates remain in effect."

This policy sustained Phi!Health Advisory No. 2017-0008: Clarification on 2016 ICD-10
Updates.

OBJECTIVES

A. To revise Annex 1- List of Medical Case Rates in accordance to the current ICD-10
updates.
B. To provide all accredited health care providers (HCPs), members and all others
concerned the updated ICD-10 codes/ title codes required in the filing of claims.
C. To provide the updated information on claims data presented in ICD-10 codes required
for statistical reporting and research.

III. SCOPE

This policy shall cover claims for All Case Rates of eligible Phi!Health members and their
qualified dependents in all Phi!Health accredited health care institutions.

IV. DEFINITION OF TERMS

0
A. International Classification of Diseases version 10 (ICD-10) -A statistical classification
.~

J'I~
~ that contains a limited number of mutually exclusive code categories which describe all
f disease concepts. The classification is hierarchical in structure with subdivision to identify
broad groups and specific entities.
' 0
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B. List of Medical Case Rates- contained in one of the annexes in PC No. 35 s. 2013
(Annex 1) enumerating the list of medical conditions with corresponding case rate
amount. The amended list is List of Medical Case Rates (updated February 2017).

C. List of Medical Conditions for Primary Care Facilities/Infinnaries/ Dispensaries

(Revised Annex 5 of PC 35 s. 2013) -contained in one of the annexes in PC No. 35 s.
2013 enumerating the list of medical conditions and procedures allowed as second case
rates with corresponding case rate amounts. It was revised under PC No.9 s. 2014.
Currently, the amended list is List of Medical Case Rates for Primary Care Facilities/
Infinnaries/Dispensaries (updated February 2017).

V. GENERAL GUIDELINES

A. The old ICD-10 codes/ category titles in Annex 1, 3 and 5 ofPhilHealth Circular No. 35
s. 2013 and its revisions/amendments stated in this Circular shall no longer be applicable
in filing PhilHealth Claim Form 2.
B. The 2016 ICD-10 updates stated herein shall now be used as reference by all accredited
HCPs in the filing of claims.
C. Claims with incorrect/incomplete/old ICD-10 codes and code title shall be returned to
the sender (RTS).
D. As per Department Circular No. 2016-0020 of the Department of Health, ICD-10 code
U06.9 shall be used for the following code title: Zika virus disease, unspecified; Zika;
Zika virus fever; Zika virus infection. The ICD-10 code entry pointing Zika virus fever
to A92.8 shall be corrected accordingly.

T able 1. Upod ate dL"1St 0 fiCD -10 C 0 d es

Old ICD-10 code I Code title New ICD-10 code I Code title Case Rate
A06.4 A06.4+ K77.0*
Amoebic liver abscess; Hepatic Amoebic liver abscess; Hepatic amoebiasis 10,000
amoebiasis
A08.1 A08.1
Acute gastroenteropathy due to Acute gastroenteropathy due to Norovirus;
6,000

~,....
Norwalk agent; Small round Noroviral enteritis; Small round structured
; structured virus enteritis virus enteritis
09.9 A09.9
ffi>-
t-O..
Cu
"'
Cl
Acute gastroenteritis Gastroenteritis and colitis of unspecified
origin; Neonatal diarrhoea NOS
6,000

~0 ~
93.8 A93.8
~(..)\.~ ' Other specified arthropod- Other specified arthropod-borne viral
home viral fevers; Pity virus fevers; Piry virus disease; Severe fever with
8,100
disease; Vesicular stomatitis thrombocytopenia syndrome [SFTSJ;
u
0
virus disease [Indiana fever] Vesicular stomatitis virus disease [Indiana
fever]
A90 A97.0

~
Dengue without warning sigus;
.:r
' . Dengue without warning sigus Dengue fever (DF) Dengue haemorrhagic 10,000
~~ fever Grades 1 and 2; Dengue haemorrhagic
I-
i,:->:
() fever without warning signs
·I
.,
t:~
A91.1 A97.1
I 0
·~ ., Dengue with warning sigus Dengue with warning sigus; Dengue 10,000
·i.a..,. haemorrhagic fever with warning signs
., A91.3 A97.2
16,000
J__
...
Severe dengue Severe Dengue; Severe Den(!Ue fever; Severe

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Old ICD-10 code I Code tide New ICD-10 code I Code tide Case Rate
Dengue haemorrhagic fever
B05.3+ H67.1* B05.3+ H67.1*
Measles complicated by otitis
7,800
media; Otitis media in viral Otitis media in measles
diseases classified elsewhere
B16.9 B16.9
Acute hepatitis b without delta- Acute hepatitis B without delta-agent and
11,800
agent and without hepatic coma; without hepatic coma; Acute hepatitis B
Hepatitis B(acute)(viral) nos (viral) NOS
B18.1 B18.1
Chronic viral hepatitis b without Chronic viral hepatitis B without delta-agent;
11,800
delta-agent; chronic (viral) Hepatitis B (viral) NOS
hepatitis b
E66.2 E66.2
Extreme obesity with alveolar Extreme obesity with alveolar
13,600
hypoventilation; Pickwickian hypoventilation; Obesity hypoventilation
syndrome syndrome (OHS); Pickwickian syndrome
G23.8 G23.8
Other specified degenerative Other specified degenerative diseases of
diseases of basal ganglia; basal ganglia; Calcification of basal ganglia; 8,300
Calcification of basal ganglia Neurogenic orthostatic hypotension [Shy-
Dragerl
G25.8 G25.8
Other specified extrapyramidal Other specified extrapyramidal and
and movement disorders; movement disorders; Akathisia (drug- 8,300
Restless legs syndrome; Stiff- induced) (treatment-induced) Restless legs
man syndrome svndrome; Stiff-man syndrome
G90.3
Multi-system degeneration;
Neurogenic orthostatic
Deleted code NIA
hypotension fShy-Dragerl
~I45.8 I45.8
~ Other specified Heart Other specified conduction disorder;

~ conduction disorders; Atrioventricular [AV] dissociation;

12,300
Atrioventicular [AV] Interference dissociation
ffi>-
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.,_
CIJ

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0
dissociation; Interference
dissociation
(f)Q 49.8 I49.8
.::( (,) \~ Other specified cardiac Other specified cardiac arrhythmias;
~ -~ arrhythmias; Coronary sinus
rhythm disorder; Ectopic
Brugada syndrome; Long QT syndrome;
coronary sinus rhythm disorder; ectopic
12,200
rhythm disorder; nodal rhythm disorder
u rhythm disorder; nodal rhythm
0 disorder
]09 ]09

m
Influenza A H5N1 (Avian Influenza due to identified zoonotic or
influenza) pandemic influenza virus; Influenza caused 6,600
'
~r
by influenza virus strains of special
flj l epidemiological importance with an animal-
S::
human or inter-human transmission
g ]10.0 ]10.0
g Influenza with pneumonia, seasonal
..
£>.
Influenza with pneumonia,
influenza virus identified; influenza virus identified; Influenza! 6,600

jj Influenza! (broncho)
pneumonia, influenza virus
(broncho)pneumonia, other influenza virus
identified

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Old ICD-10 code I Code title New ICD-10 code I Code title Case Rate
indentified
]10.1 ]10.1
Influenza with other respiratory Influenza with other respiratory
manifestations, influenza virus manifestations, seasonal influenza virus
identified; Influenza, influenza identified; Influenza; Influenzal acute upper
virus identified; Acute upper respiratory infection, seasonal influenza
respiratory influenzal infection, virus identified; Influenza! laryngitis, 6,600
influenza virus identified; seasonal influenza virus identified;
Influenza! laryngitis, influenza Influenza! pharyngitis, seasonal influenza
virus identified; Influenzal virus identified; Influenzal pleural effusion,
pharyngitis; Influenzal pleural seasonal influenza virus identified
effusion
]10.8 ]10.8
Influenza with other Influenza with other manifestations,
manifestations, influenza virus seasonal influenza virus identified;
identified; Encephalopathy due Encephalopathy due to influenza, seasonal
to influenza, influenza virus influenza virus identified; Influenzal
6,600
identified; Influenzal gastroenteritis, seasonal influenza virus
gastroenteritis, influenza virus identified; Influenza! myocarditis (acute),
identified; Acute influenzal seasonal influenza virus identified
myocarditis, influenza virus
identified
]11.8+ I41.1* ]11.8+ I41.1 *
Acute influenzal myocarditis, Influenza! myocarditis (acute), virus not 6,600
virus not identified identified
]95.4 ]95.4
Mendelson's syndrome Mendelson syndrome;
10,300
Chemical pneumonitis due to aspiration
durin~ anaesthesia
•
~ 'K22.2 K22.2
~I Oesophageal obstruction; Oesophageal obstruction; Oesophageal web
I ' Compression of oesophagus; (acquired); Compression of oesophagus;
8,300
.,...
0., Constriction of oesophagus; Stenosis of
ffi>-
t-0.. 0
O'J
Constriction of oesophagus;
Stenosis of oesophagus;
Stricture of oesophagus
oesophagus; Stricture of oesophagus

~8<~
K55.2 K55.2
Angiodysplasia of colon Angiodysplasia of colon; Angiodysplasia of 9,500
intestine NOS
M31.2
u
0 Lethal midline ~anuloma
Deleted code N/A
M86.9 M86.9
Osteomyelitis, unspecified; Osteomyelitis, unspecified; Infection of
Infection of bone NOS; bone NOS; Periostitis NOS 13,000

VI
.,. I Periostitis without mention of
osteomyelitis

II;
N80.8 N80.8
Other endometriosis Other endometriosis; Endometriosis of 7,700
thorax
089.0 089.0
.i Pulmonary complications of Pulmonary complications of anaesthesia
1l during the puerperium; Aspiration
anaesthesia during the
~t puerperium; Aspiration pneumonitis due to anaesthesia during the 10,600
pneumonitis due to anaesthesia puerperium; Chemical pneumonitis due to
during the puerperium; aspiration, due to anaesthesia during the

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Old ICD-10 code I Code title
Inhalation of stomach contents
or secretions NOS due to
anaesthesia during the
puerperiumMendelson's
syndrome due to anaesthesia
P78.3
N oninfective neonatal
diarrhoea; Neonatal diarrhoea
NOS
T60.2
Toxic effect of Other
insecticides
New ICD-10 code I Code title Case Rate
puerperium; Inhalation of stomach contents
or secretions NOS due to anaesthesia during
the puerperium; Mendelson syndrome due
to anaesthesia during the puerperium;
Pressure collapse oflung due to anaesthesia
during the puerperium
P78.3
11,700
Noninfective neonatal diarrhoea
T60.2
Other and unspecified insecticides 6,400

VI. PENALTY CLAUSE

The health care provider shall be subject to the rules on monitoring and evaluation of
performance as stipulated in Phi!Health Circular No. 54, s-2012: Provider Engagement
through Accreditation and Contracting for Health Services (PEACHeS) and Phi!Health
Circular No. 2016-0026 re: Health Care Provider Performance Assessment System Revision
1 (HCPPAS).

VII. SEPARABILITY CLAUSE

In the event that a part or provision of this Circular is declared unauthorized or rendered
invalid by any Court of Law or competent authority, those provisions not affected by such
declaration shall remain valid and effective.

VIII. REPEALING CLAUSE

All provisions of previous issuances, circulars, and directives that are inconsistent with any of
the provisions of this Circular for this particular circumstance wherein the same is exclusively
applicable, are hereby amended, modified or repealed accordingly.

IX. DATE OF EFFECTIVITY

This Circular shall take effect on claims with admission date starting September 1, 2017. It
shall be published in any newspaper of general circulation and shall be deposited thereafter
with the National Administrative Register at the University of the Philippines Law Center.
·1':•. ::.. •• _
fit ;.: i.
·,! '
X. ANNEXES
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!(

A. Annex A- List of Medical Case Rates (updated February 2017)

/1 , , ;; ~ \-\ B. Annex B- List of Medical Case Rates for Primary Care Facilities/ Infirmaries/
i ~ ~ ~ Dispensaries (updated February 2017)
1I
q'~.,i ~
a,
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 The updated annexes listed herein shall be available at www.philhealth.gov.ph as pdf file and
may be searched online through "Search Case Rates" or may be downloaded as Phi!Health
ACR mobile application through Play Store for Android platforms.

~J!~)fnE
Interim/OIC President and CEO

Date signed: Iq
<t

SUBJECT Updated List of ICD-10 codes for Selected Medical Case Rates

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