As we continue to transition to our next generation platform, we want to remind you to review the ICD-10-CM guidelines to determine the correct sequencing rules that apply to diagnosis reporting to ensure proper claims processing.
These sequencing rules apply to services reported on both 837I and 837P claim transactions. Claims with inappropriately sequenced diagnosis codes reported at either the header or claim line level will be considered billing errors and these claims may be denied.
Primary-only diagnosis codes
Certain diagnosis codes have been designated as primary-only diagnosis codes, meaning these codes should only ever be reported in the primary or first-listed diagnosis position on the claim. When reported in any other diagnosis field on the claim, the claim may be denied for incorrect billing.
Examples of primary-only diagnosis codes include:
- Encounters for general and administrative examinations
- Encounters for supervision of normal pregnancy
- Liveborn infants according to place of birth and type of delivery
- Encounters for radiation therapy and chemotherapy
- Donors of organs and tissues
Secondary-only diagnosis codes
Other diagnosis codes have been designated as secondary-only diagnosis codes or codes that should never be reported in the first diagnosis position on the claim. When these codes are reported as the primary or first-listed diagnosis on the claim, the claim may be denied for incorrect billing.
Examples of secondary-only diagnosis codes include:
- Manifestation codes
- External causes (i.e., "V – Y" codes)
- Codes from category Z15 Genetic susceptibility to disease
- Sequela (7th character "S") codes
Learn more
Visit our Platform Transition page to stay informed of our ongoing platform transition.