Question Inappropriate Primary Diagnoses

thomas7331

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Does CMS provide a list of appropriate or inappropriate primary diagnoses?

CMS does publish a list of unacceptable principal diagnosis codes for purposes of inpatient facility DRG claims, which you can find within the 'Definitions of Medicare Code Edits' documents at the link below. I'm not aware of any CMS list of inappropriate primary diagnosis codes for outpatient or professional claims, though there is guidance in ICD-10.

 
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