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KMAP BULLETIN: 2024 Updates to the Medicare Guidelines for Unacceptable Principal Diagnosis Codes

Date: 10/31/23

KMAP GENERAL BULLETIN 23270 (PDF)

Kansas Medicaid adheres to the Medicare Guidelines for Acceptable Diagnosis Codes. Effective with dates of service on and after October 1, 2023, the Medicare list of unacceptable diagnosis codes has been updated, and Kansas Medicaid will adopt these same guidelines. The complete Medicare list of unacceptable codes can be accessed here or on the Centers for Medicare and Medicaid Services (CMS) website here. Scroll down under the FY 2024 heading and open the link ‘Definition of Medicare Code Edits v41’.

The groups of codes referenced from the Medicare document are:

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

Note: As a reminder, all ICD-10 Coding Guidelines must be followed.

Note: The effective date of the policy is October 1, 2023. 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.