Knowledgebase: Claim Rejections
Common ICD-9/ICD-10 Rejections
Posted by Will Morrow, Last modified by Will Morrow on 09 December 2015 01:52 PM

Below are the most common ICD-9 and ICD-10 Office Ally claim rejections.

Instructions for using the Office Ally code search: Practice Mate or Service Center


Rejection: Date of Service FROM and TO dates cannot span 10/1/2015. Before 10/1 must be ICD9 on or after 10/1 must be ICD10 (FE562)

What Happened: One of the line items in box 24a has a “FROM” date that is before 10/1/15 and a “TO” date after 10/1/15.

Resolution: ICD-9 codes are required for dates of service on or before 9/30/15 and ICD-10 codes are required for dates of service on or after 10/1/15. Because of this, a single line cannot span these dates. This will need to be split into 2 claims.



Rejection: Payer does not Accept ICD-10 Diagnosis Codes for this DOS (LC1760)

What Happened: The ICD Indicator in the upper right corner of box 21 is selected as “0” but the date of service on at least 1 line item is before 10/1/15.

Resolution: Change the ICD Indicator to 9. Also be sure to verify the diagnosis codes are ICD-9 codes.



Rejection: Payer does not Accept ICD-9 Diagnosis Codes for this DOS (LC1761)

What Happened: The ICD Indicator in the upper right corner of box 21 is selected as “9” but the date of service on at least 1 line item is after 10/1/15.

Resolution: Change the ICD Indicator to 0. Also be sure to verify the diagnosis codes are ICD-10 codes.



Rejection: Diagnosis Code ICD-9 AND ICD-10 On Same Claim not Supported (LC1759)

What Happened: Claim contains at least 1 ICD-9 code and 1 ICD-10 code in box 21.

Resolution: ICD-9 codes are required for dates of service on or before 9/30/15 and ICD-10 codes are required for dates of service on or after 10/1/15. This will need to be split into 2 claims.



Rejection: Admitting Diagnosis Code is Invalid (LC1776)

What Happened: The diagnosis code in box 69 is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: Admitting Diagnosis Code is not billable (further specification required) (LC1805)

What Happened: The diagnosis code in box 69 is no longer billable.

Resolution: Utilize the code search to find a billable code. Also verify the indicator being sent in box 66.



Rejection: Claim has additional Diagnosis code errors. Please check the ICD9/10 indicator and all formatting is correct (LC1908)

What Happened: A code in boxes 67A-Q is not correct.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: Diagnosis Code 1(A) is Invalid (LC1701)

What Happened: Diagnosis code 1 in box 21 is invalid

Resolution: Verify diagnosis code 1 in box 21 as well as the indicator being sent in the upper right corner of box 21.



Rejection: Diagnosis code 1(A) is not billable (further specification required) (LC1696)

What Happened: The diagnosis code in box 69 is no longer billable.

Resolution: Utilize the code search to find a billable code. Also verify the indicator being sent in the upper right corner of box 21.



Rejection: Diagnosis code 1(A) not effective for this DOS (LC1711)

What Happened: Diagnosis code 1 in box 21 cannot be billed for the date of service in box 24

Resolution: Verify diagnosis code 1 in box 21 as well as the indicator being sent in the upper right corner of box 21.



Rejection: Diagnosis code 1(A) not valid for patient gender (LC1719)

What Happened: Diagnosis code 1 in box 21 is not valid for the patient gender selected in box 3.

Resolution: Verify diagnosis code 1 in box 21 as well as the indicator being sent in the upper right corner of box 21.



Rejection: External Cause of Injury 1(a) Diagnosis Code is Invalid (LC1780)

What Happened: The diagnosis code in box 72 is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: External Cause of Injury 1(a) Diagnosis Code is not billable (further specification required) (LC1809)

What Happened: The diagnosis code in box 72 is no longer billable.

Resolution: Utilize the code search to find a billable code. Also verify the indicator being sent in box 66.



Rejection: Other Procedure Code 1(a) is invalid (LC1912)

What Happened: The diagnosis code in box 74a is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: Primary Diagnosis Code is Invalid (LC1775)

What Happened: The diagnosis code in box 67 is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: Primary Diagnosis Code is not billable (further specification required) (LC1804)

What Happened: The diagnosis code in box 67 is no longer billable.

Resolution: Utilize the code search to find a billable code. Also verify the indicator being sent in box 66.



Rejection: Principle Procedure Code is invalid (LC1709)

What Happened: The diagnosis code in box 74 is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.



Rejection: Reason for Visit 1(a) Diagnosis Code is not billable (further specification required) (LC1806)

What Happened: The diagnosis code in box 70 is no longer billable.

Resolution: Utilize the code search to find a billable code. Also verify the indicator being sent in box 66.




Rejection: Reason for Visit 1(a) Diagnosis Code is Invalid (LC1777)

What Happened: The diagnosis code in box 70 is not valid.

Resolution: Verify the code being sent as well as the ICD Indicator being used in box 66.