Inappropriate Primary Diagnosis Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans

Overview

The International Classification of Diseases, 10th Revision, Clinical Modification (ICD-10-CM) Official Guidelines for Coding and Reporting, developed through a collaboration of The Centers for Medicare and Medicaid Services (CMS), the National Center for Health Statistics (NCHS) and the Department of Health and Human Services (DHHS), provides clear direction on the coding and sequencing of diagnosis codes. Utilizing the ICD-10-CM Official Guidelines for Coding and Reporting, this policy identifies diagnosis codes, which should never be billed as primary on a CMS-1500 claim form or its electronic equivalent.

Policy Codes

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* COMM-Inappropriate-Primary-Diagnosis-Codes-Policy.pdf
Click to Download: Inappropriate Primary Diagnosis Codes Policy, Professional - Reimbursement Policy - UnitedHealthcare Commercial Plans

Questions and Answers

Q: When an inappropriate diagnosis code is pointed to or linked as primary in box 24E on a CMS-1500 claim form or its electronic equivalent and there is more than one claim line, will the entire claim be denied?

A: No. Only the claim line(s) associated with the diagnosis code inappropriately reported as primary in box 24E will be denied by this policy.