Diagnosis codes that are "SDX" only

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Hi,

Has anyone dealt with CMS when it comes to diagnosis codes that are labeled "SDX" in the ICD-9 book and these diagnosis codes just happen to be listed as a acceptable diagnosis code within an LCD policy?

My thought is just because the diagnosis code is listed in the policy doesn't mean it should be placed in the primary position since these diagnosis codes should never be placed in the primary position.

Is there an exception anywhere that states these can be used in the primary position?

Many of the LCD policies have sequencing diagnosis codes that list which codes should be primary, secondary on so on and none of them list any "secondary diagnosis only" in the primary field.

The Official Guidelines for Diagnosis Coding is also in the ICD-9 book and it clearly states these codes are "addl diagnosis only" based on the chart that is listed.

Any thoughts?

thanks
 

abishard

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We just went into effect with WPS Medicare and they have told us that they should pick up any payable diagnosis, whether it is listed as primary, secondary, tertiary, etc. Sometimes I believe there may be processing errors but this is how it should work. I would contact your local Medicare carrier about this issue. Hope this helps!
 
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