Unacceptable Principal Diagnosis - apply to Inpatient coding? or both IP coding and OP
We recently began getting edits for Unacceptable Principal diagnoses lately on Outpatient claims; however, I thought this edit was only a MCE for Inpatient claims. The additional annotations section of my 2018 ICD10CM Expert“Unacceptable PDx/Questionable Admission Dx” section states “Unacceptable principal diagnoses will appear with a gray color bar over the code title. These codes do not describe a current illness or injury, but a circumstance which influences a patient’s health status. They are considered an unacceptable principal diagnosis for inpatient admission”.
I have tried to find where this has changed and applies to coding of both Inpatient and Outpatient scenarios in our acute care facility, or if we are getting edited inappropriately.
Pamela Riddle, RHIT, CCS
Coding Compliance Coordinator
Iredell Memorial Hospital
I have tried to find where this has changed and applies to coding of both Inpatient and Outpatient scenarios in our acute care facility, or if we are getting edited inappropriately.
Pamela Riddle, RHIT, CCS
Coding Compliance Coordinator
Iredell Memorial Hospital
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Comments
I have not seen anything about any changes to the edits for principal diagnoses related to outpatient claims. There are a couple of questions that come to mind. Is this an internal edit or a CMS Claims Processing edit? Is there a pattern with either the code(s) or the circumstances of the encounter, like a admission status change (for example)? Is the edit related to one or two codes? If not, it could be that an edit flag is set incorrectly.