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KMAP BULLETIN: Medicare Unacceptable Principal Diagnosis Codes

Date: 10/01/19

KMAP GENERAL BULLETIN 19155 (PDF)

Effective with dates of service on and after October 1, 2019, the Medicare list of unacceptable principal diagnosis codes has been updated. The complete Medicare list of unacceptable principal diagnosis codes can be accessed on the Centers for Medicare & Medicaid Services (CMS) MS-DRG Classifications and Software page. Once the page opens, scroll down to the MS- DRG Definitions Manual and Software heading. Under the 2020 subheading, click the link titled Definition of Medicare Code Edits v37. The groups of codes referenced from the Medicare document are:

  • External causes of morbidity
  • Manifestation codes
  • Unacceptable Principal diagnosis codes

Note: As a reminder, all ICD-10 coding guidelines must be followed.

Note: The effective date of the policy is October 1, 2019.

The implementation of State policy by the KanCare managed care organizations (MCOs) may vary from the date noted in the Kansas Medical Assistance Program (KMAP) bulletins. The KanCare Open Claims Resolution Log on the KMAP Bulletins page documents the MCO system status for policy implementation and any associated reprocessing completion dates, once the policy is implemented.