Common ICD-9/ICD-10 Rejections
Below are the most common ICD-9 and ICD-10 Office Ally claimrejections. Instructions for using the Office Ally code search: Practice Mate [1] or Service Center [2]
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 before9/30/15 and ICD-10 codes are required for dates of service on or after10/1/15. 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 21is 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 21is 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.