How to find out a disease by code on a sick leave certificate?

What are disability codes on sick leave?

This is the reason for the absence of a subordinate from the enterprise for a certain time. Each disease has a code indicated on the sick leave certificate. This type of encryption is required for many reasons.

Important: the employer does not have the right to ask a subordinate for a decoding of the disease codes indicated on the sick leave certificate, or for detailed explanations from him.

The diagnosis is displayed on the sick leave certificate using a code - to maintain medical confidentiality and unification

Codes can be two-digit - indicating the main cause of the ailment - and three-digit. The latter establish the employee’s need for special treatment/rehabilitation conditions, so they are used only when necessary.

The procedure for filling out and applying disease codes on sick leave is based on Order of the Ministry of Health of the Russian Federation No. 624n of 2011.

Decoding disease codes and other codes on the certificate of incapacity for work

Code 11 on sick leave: employer's responsibilities

Other responsibilities may arise for the employer if the disease code on the sick leave certificate is 11. It reflects the fact that the employee suffered the disease specified in clause 1 of the list of socially significant ones, approved. by Decree of the Government of the Russian Federation dated December 1, 2003 No. 715, - tuberculosis.

In this case, the duration of treatment can be up to 12 months (Clause 4, Article 59 of the Law “On the Fundamentals of Health Protection...” dated November 21, 2011 No. 323-FZ), and the employer must be prepared to compensate for it. The maximum duration of treatment in the general case is 10 months (clause 13 of the procedure approved by order of the Ministry of Health and Social Development of the Russian Federation dated June 29, 2011 No. 624n).

In addition, if an employee, along with a sick leave certificate, brings a medical order according to which he will need to be transferred to another position for health reasons, the employer will be obliged to provide such a position or remove the employee from work and pay him temporary disability benefits (Article 73 of the Labor Code of the Russian Federation , paragraph 3 of article 14 of the law “On preventing the spread of tuberculosis” dated June 18, 2001 No. 77-FZ).

Functions of disability codes

Codes have several functions, and protecting medical confidentiality is only one of them:

• optimization of accounting work - payments are calculated based on the numbers entered on the sheet;
• economical filling out of the form, without specifying long medical terms;
• filling out the sheet in accordance with international standards.

So, if the sickness form was opened abroad, the code indicated in it will be the carrier of one information in the territory of any country participating in international legal relations.

Decoding the main disability codes

Two-digit coding is the basic information about the reason for the employee’s absence; payments will be calculated for them and entries will be made in personnel documents. The breakdown of the diseases indicated on the sick leave is as follows.

Important: the last two points from the table are indicated only with the consent of the employee. If he does not want to provide the employer with information regarding the child’s special condition, no one has the right to insist.

Codes

Special digital codes are used to record information describing the nature (diagnosis, disease, cause) and duration of disability. Codes can be two-digit or three-digit (starting from zero). Using such a flexible system, all reasons for incapacity/sick leave are coded. There are 15 main causes of disability (illness), let's figure out what the codes on the sick leave mean, what disease and diagnosis is hidden behind it, and let's decipher them:

• “01” - disease, the most common case, especially during influenza epidemics;
• “02” - domestic injury, that is, damage to the body received outside of work/workplace;
• “03” - quarantine, indicates the need for quarantine, typical for infectious diseases, for example, tuberculosis;
• “04” is a work injury, but the correct name would be “work accident”;
• “05” - the onset of disability due to pregnancy and childbirth;
• “06” - prosthetics, which (for medical reasons) can only be performed in a hospital;
• "07" - prof. disease, as well as exacerbation of prof. diseases, especially typical for industries with hazardous conditions;
• “08” - medical procedures in hospitals and sanatoriums;
• “09” - disability due to the need to care for a sick family member (for example, a disabled person);
• “10” - poisoning, as well as other conditions;
• “11” is a disease from the list of social services. significant diseases, the list is approved by Government Decree N715. These include, in particular, tuberculosis, hepatitis, HIV, diabetes, oncology;
• “12” - the reason is the illness of a child under 7 years old, the need for additional care;
• “13” - caring for a disabled child;
• “14” - cancer in a child or a post-vaccination complication;
• “15” – HIV infection in a child.

You will find more detailed information on filling out a certificate of incapacity for work due to a child’s illness in the article “Issuing sick leave for child care.” In addition, you may be interested in the article “Sick leave to care for a relative.”

Points “14” and “15” are noted on the form only with the consent of the insured person (employee).

After the code “15”, three-digit designations begin (the first is “017”), they are indicated next to the above two-digit ones. They are incremental in nature, giving more detail if needed, and they start with the number “0.” There are five such designations in total:

• “017” - indicate if the treatment took place in a special facility. sanatoriums;
• “018” - undergoing sanatorium-resort treatment due to an industrial injury;
• “019” – treatment in a clinic at a university/institute;
• "020" - additional holiday for labor and finance;
• “021” - noted if the disease/injury was caused by alcohol and drug use.

Thus, correlating the reason with the established list, the doctor enters the reason on the form. For example, if a woman is on sick leave due to BiR and has received additional leave for this reason, the form will indicate the codes “05” and “017”.

Then, in the lines “Other” and “Violation of the regime”, the code again becomes two-digit. Let's figure out what some of the codes in the "Other" section mean:

• “31” - noted if the employee continues to be sick;
• “32” - the employee was assigned a disability;
• “34” — death (in this case: the reason for the end of sick leave);
• “36” - the patient arrived (at the appointment) healthy and able to work.

In addition to codes for causes of disability, there are so-called ICD (International Classification of Diseases) codes. The latest version is ICD-10, the tenth edition of this classification. The doctor on sick leave also notes the disease according to the ICD system. There are 22 classes of diseases in total. They are designated from "A00" to "Z100". The ICD is already completely medical information.

If the doctor made a mistake when filling out the codes, then he must take a new, blank form. He is not allowed to cross out, sign or make changes.

Decoding additional disability codes

Additional ones include three-digit codes that are used to convey to the employer a more complete picture of the employee’s problems. They also play a significant role for the Social Insurance Fund.

Important: the role of additional codes is significant; thanks to their indication, the employer has a full picture of the employee’s problem, which can significantly increase payments. For example, the reason for disability code 05 020 indicates a complication during childbirth and provides a legally mandated increase in vacation pay.

If hospital code 05 is supplemented with code 020, this means that the established 70 days for pregnancy have increased:

• for 14 days in case of multiple pregnancy;
• for 16 days in case of complications during childbirth;
• for 40 days after birth for the birth of 2 or more children.

Cause of disability code 05 020 means complicated childbirth requiring longer recovery

There are two-digit codes indicating family ties. They are needed to identify the caregiver.

The “Other” category is supplemented with the following codes:

All stated disease codes and additions to them on sick leave are indicated by the attending physician. He must take responsibility for entering them, since not only he, but also the management of the medical institution will be responsible for incorrect information.

Disease codes in the document are filled out by a physician

Decoding the causes of disability

The procedure and rules for filling out documents on temporary disability are approved by Order of the Ministry of Health and Social Development of Russia No. 347n dated April 26, 2011.
The same document provides information about disease codes. The reasons for exemption from work are indicated on the form with a two- or three-digit code. This information is entered in a special field consisting of seven cells. It's called "Cause of Disability." Each cell is intended for one number.

The first two cells are called “code”, in which the doctor indicates the reason why he gave his patient an exemption from work on the first visit. Nearby there are three cells labeled “additional code”.

They contain information in cases where it is necessary to clarify the cause of disability. To the right there are two more cells. They are called "ism code". They are filled out only when the diagnosis has changed during the examination. Where exactly the cipher is indicated can be seen in the image below.

The main cause of the disease is written with a code whose value ranges from 01 to 15. Clarification of the cause of disability is encrypted with three numbers: from 017 to 021. What this or that code means is given in the table below.

Most often, the code “01” is entered on the sick leave certificate. These numbers indicate the most common pathologies: seasonal colds, ARVI, influenza. The explanation of all codes is given on the back of the disability form. This greatly simplifies the procedure for filling out the document.

The “Other” field may contain the code “31”. It means that the employee is still sick. The doctor sets such a code if he believes that the certificate of incapacity for work needs to be extended. Also, “36” is sometimes written in this field. Doctors indicate this code if the patient showed up for an appointment without signs of pathology.

Expert opinion

Irina Vasilyeva

Civil law expert

Only the attending physician has the right to enter the code for the cause of disability. At the same time, codes 14 and 15 are written on the form only with the written permission of the patient.

How to pay for two sick days if the first is closed and the second is a continuation of the first?

There are situations when one sick leave has already been closed and the “Get to work” column is filled in, but the employee brings a new open sick leave, which is a continuation of the first one.

For example, if a woman spent 140 days at home during pregnancy and childbirth and closed her sick leave, but then brought a sheet with disability code 05 020, open for 16 days due to complications during childbirth.

In this case, the manager must be guided by Art. 255 of the Labor Code of the Russian Federation and calculate benefits according to the established social amounts.

In the example given, the medical institution initially prepared a sheet on pregnancy and childbirth. If complications occurred during labor, an additional sheet for 16 days was issued for the same insured event. The employer is obliged to pay these two sheets in total, taking as a basis the employee’s average daily earnings in the amount that existed before maternity leave.

Payment for sick leave when indicating code “01” in the sick note

In this situation, sick leave is paid according to the general scheme. The employer pays for the first three days of illness from his own funds, and for the remaining days - the Social Insurance Fund of the Russian Federation. This procedure was established by Federal Law of the Russian Federation No. 255 dated December 29, 2006. To receive the required social benefits, an ill employee:

1. Must belong to the insured persons in the FSS system of the Russian Federation (i.e. be an insured person).
2. Must present the sick leave certificate at work to an authorized employee (accounting or human resources department).

Next, the necessary actions are carried out sequentially by the designated responsible person. As established, the section of the ballot intended for the employer is completed first. Finally, the benefit for sick days is calculated and paid.

The formula for calculating the total amount to be paid is: daily social benefits * number of sick days.

Calculation of sick leave payment by codes

After completing the work sheet, the employee must submit it to the accounting department for calculation of payments.

Important: a payment will be made on the sheet if it is presented within 6 months from its closure. If you present the sheet even a day later, there will be no payment for sick days.

Management has 10 days to review it and calculate payments. The employee will receive the money on the next payday. The amount of payments will depend on the adopted system for calculating them and the codes indicated by the doctor in them.

In 2021, when making calculations, the accountant will take into account the following changes:

• The minimum wage for an insurance period of up to 6 months is set at 12,130 rubles;
• the calculation period will be 2021 and 2021;
• in 2021, the maximum base for calculating benefits has been increased to 1,680,000 rubles.

In addition, the number of days allocated by law for resolving health issues and recovery will be taken into account. For this purpose, the codes entered on sick leave certificates and their decoding are taken into account.

For example, for child care, code 12 is entered if the problem is from the special list, the child is under 7 years old, and the sick leave lasts no more than 90 days. But if he gets better at a dispensary, the doctor can indicate code 017, and the mother’s paid sick leave will be extended.

Calculation of sick leave payment by codes

After establishing the picture of the illness and studying the doctor’s records, the employer must indicate a code that is the basis for payments and indicating the features of their accrual.

What does code 09 mean on sick leave: legal consequences for the employer

If an employee’s sick leave is coded 09, this means that he was absent from work due to caring for a child who was sick. Indication of this code in the document implies payment of sick leave in an amount determined in the general manner, as if code 01 or 02 were on the sick leave. As for the number of paid days an employee is on sick leave, it is established taking into account certain provisions of the law.

The duration of paid sick leave for an employee who was absent from work to care for a child is (Article 6 of Law No. 255-FZ):

1. If the child is under 7 years old:

• 90 days a year if the child’s illness is reflected in the list approved by order of the Ministry of Health and Social Development of the Russian Federation dated February 20, 2008 No. 84n;
• 60 days in other cases.

2. If the child is from 7 to 15 years old - up to 45 days a year for all cases of illness (no more than 15 days for each individual case).

3. If the child is under 18 years old:

• up to 120 days if the parent is caring for a child with disabilities;
• without restrictions, if a parent is caring for a child with HIV;
• without restrictions, if a parent is caring for a child who has suffered from vaccination complications or is undergoing treatment for malignant neoplasms.

These rules are the same for employees, regardless of whether their child is a son or daughter, grandson or granddaughter.

IMPORTANT! The specified time restrictions relate specifically to the payment of sick leave, and not to the duration of stay. Read more here.

Reasons for refusal to pay for sick leave

The main reason for refusal is the lack of a certificate of incapacity for work. In addition, there are several more justified reasons for completely refusing to pay for the period of illness:

• the employee took leave at his own expense, during which he fell ill;
• during the regular vacation period, the employee’s child fell ill;
• removal of an employee from performing duties without maintaining his salary;
• imprisonment of the employee, sickness benefits are not paid during this period;
• if the employee fell ill during the period of administrative arrest;
• if a forensic medical examination is carried out regarding the employee;
• when the illness occurred after the start of the plant’s downtime. If an employee has previously fallen ill and his illness continues during the period of inactivity, his sick leave is paid in full;
• Also, sick pay for caring for a relative may be denied if the employee has used more time than required by law.

In addition, the legislation identifies several points when an employee, in principle, cannot count on sick leave:

• when the employee intentionally committed a crime that resulted in illness;
• the employee deliberately inflicted serious injuries on himself.

Important: to justify the refusal to accrue benefits, a court decision is required, which will indicate the harmful intent of the subordinate.

Specialists working under a civil contract or without official registration are also deprived of payments.

Also, refusal to issue money will follow if:

• the employer will discover that the document is fake, is an old-style form, bears a fake seal and signature. For such fraud, the employer has the right to hold the employee accountable;
• the employer identified errors in filling out the sheet made by the doctor, for example, the name of the enterprise was incorrectly indicated or the diagnosis codes entered on the sick leave sheet diverged from the real picture. Errors must be corrected at the medical institution and until they are corrected, payments are not accrued.

If the employer made errors in filling out the form, the Social Insurance Fund may refuse payment.

What should an employee do if the doctor wrote down the code incorrectly on sick leave?

Errors found in a completed ballot cannot be ignored. The Federal Social Insurance Fund of the Russian Federation may not accept such a document and may not pay social benefits to the employee based on it. The consequences of errors are discussed in more detail in paragraph 4 of paragraph 1 of Art. 4. 2 Federal Law of the Russian Federation No. 255 of December 29, 2006, as well as clause 18 of Resolution No. 101 of February 12, 1994. Based on this, the following legal provisions should be taken into account.

First. The ballot form consists of two sections: one of them is filled out by the doctor, the second by the employer. The filling out requirements are common for everyone - in accordance with Part 9 of Order of the Ministry of Health and Social Development of the Russian Federation No. 624n dated June 29, 2011.

Second. If the employer made a mistake when filling out his section, then he corrects it, following a strictly established procedure. This rule also applies to incorrect indication of codes by the employer.

Nevertheless, the FSS of the Russian Federation draws attention to the following (letter of the FSS of the Russian Federation No. 14-03-18/15-12956 dated October 28, 2011). Minor errors (such as spaces when writing the doctor’s initials), permitted shortcomings are not grounds for reissuing the ballot or refusing to assign social benefits. The key point here is the readability of the text and the absence of distortions in content.

A. P. Kaminsky.

Third. If a mistake is made by a doctor, then the ballot is considered invalid and must be replaced (in relation to clause 56 of Order of the Ministry of Health and Social Development No. 624n dated June 29, 2011). The doctor does not have the right to make changes to the ballot form.

This legal norm fully applies to erroneous writing of codes. That is, if a doctor made a mistake when writing the code, and it was discovered at the patient’s work, then you should go to your doctor and reissue the bulletin.

Reasons for reducing the amount of payment for sick leave

The manager has the right to reduce the amount of payments or pay only part of the period of illness. There are the following reasons for this:

• violation by the patient of the treatment period without good reason;
• the illness or injury was caused by alcohol or intoxication;
• the patient did not appear during the period of illness for medical procedures prescribed by the doctor or for an appointment with him.

These cases of violation of the treatment regimen lead to a reduction in payments. The employee will receive no more than the minimum monthly wage established by federal law. If the minimum wage is adjusted by local regulations, the payment will correspond to its size.

If the patient maliciously ignored the doctor’s orders, this may be indicated with the corresponding code on the sick leave, which will lead to a reduction in payments

Payment reductions will be made for certain periods of incapacity:

• if the patient violates the regime established by the doctor, the payment will be reduced by the number of days of violation;
• when the illness is a consequence of the employee’s improper condition, the payment can be canceled for the entire period of illness.

The following category of codes indicates a violation of the treatment prescribed by the doctor:

Codes that are recorded in the hospital bulletin

On sick leave, codes are indicated in lines and cells specially designated for this purpose. There are several of them on the form. The main ones are disease codes.

The values ​​of the codes, depending on their purpose, fluctuate and are used in numerical terms from “1” to “51”. So, in the hospital bulletin the following is used and written:

1. For the line “reason of disability” - one of the two-digit codes (range from “01” to “15”).

It is noteworthy that codes meaning “post-vaccination complication and malignant neoplasm in a child” and “HIV-infected child” are recorded exclusively with the permission of the insured employee.

1. On the same line, if necessary, indicate an additional three-digit code (values ​​from “017” to “021”). For example, if the patient was undergoing treatment in a specialized sanatorium.
2. In the line “violation of the regime”, the doctor indicates the corresponding code value from “23” to “28”, if the patient did not comply with the regimen prescribed to him, did not show up to the doctor on time, and in other similar cases.
3. In the “other” line, the doctor, using the code, “makes his verdict” about what the patient should do after undergoing the prescribed treatment (go to work, receive further treatment, etc.). The values ​​set for the codes are from “31” to “37”.
4. “Relationship” is indicated on the corresponding line using code values ​​from “38” to “42”.
5. Finally, in the line “calculation conditions”, the employer indicates, using one or more codes (range from “43” to “51”), information that affects the amount of social benefits.

Important! Code “01” is indicated by the attending physician in the hospital bulletin once and only under the line “reason of disability.”