Wiki Inappropriate Primary Diagnoses

[mariab_786@hotmail.com]

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

 

[mdeleon]

You can google "unacceptable primary diagnosis". There is a whole list....too many to enter here.

 

[thomas7331]

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.

https://www.cms.gov/Medicare/Medicare-Fee-for-Service-Payment/AcuteInpatientPPS/MS-DRG-Classifications-and-Software

diagnosis codes, diagnosis coding