New clinical edit: Principal or first-listed diagnosis codes

In accordance with ICD-10 guidelines, we’ll implement a new clinical edit on Oct. 1, 2022.

Principal or first-listed diagnosis codes

ICD-10 coding guidelines require coding to the highest level of specificity. They’ve designated certain diagnosis codes to be principal or first-listed. As the description indicates, these diagnosis codes should be listed first on the claim.

Details are available in the ICD-10-CM Guidelines – April 2022 update.

Example, per ICD-10

A patient is seen solely for the administration of chemotherapy. Assign code Z51.11, Encounter for antineoplastic chemotherapy, as the first-listed or principal diagnosis.

Assign the malignancy for which the therapy is being administered as a secondary diagnosis.

Resubmitting denied claims 

You’ll be able to resubmit denied claims with corrected diagnosis codes to receive payment.