Common Rejections - Missing/Invalid Diagnosis Code

Missing/Invalid Diagnosis

Rejection Messages include, but are not limited to the following:

Diagnosis code rejections are usually flagged because the claim contains an invalid Diagnosis code for the Date of Service. This could be because the diagnosis code used was not a billable code for the submitted date of service, or the wrong diagnosis code qualifier (ICD-9 or ICD-10) was used. The clearinghouse rejection message contains the rejected code in parenthesis next to Bad Data.

Example: Emdeon Reject PRINCIPAL DIAGNOSIS CODE IS MISSING OR INVALID (Bad Data: 3627 )

• This rejection is stating that the diagnosis code 362.7 is an invalid code and should be reviewed.

First verify that the code in question was a billable code for the Date of Service in question; please consult an ICD-9 or ICD-10 codebook or other online source. It is important that Diagnosis codes may be updated at various points during the year. Claims submitted for dates of service before October 1, 2015 should be sent with a valid ICD-9 code. Claims submitted for dates of service on October 1, 2015 and later should utilize ICD-10.

Once the correct code has been located, it will need to be altered in the charge window. After selecting the valid code the claim can be rebuilt and resent.

Diagnosis (ICD-10) codes, along with procedure (CPT and HCPCS) codes, are typically updated every year. The user will want to be certain that they are not using an outdated code.