ICD-10-CM coding rules
Code lists from the Medicare Code Editor and the CMS POA exempt list. Each one flags codes that get an extra claim check: patient age, use as principal diagnosis, or POA reporting. Open a list to see every code it covers.
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- Newborn Codes42 codes
ICD-10-CM diagnoses designated by MCE age-conflict logic for perinatal/newborn patients (age 0 years only).
Source: Definitions of Medicare Code Edits v44.0, Age conflict section A.
- Pediatric Codes126 codes
ICD-10-CM diagnoses designated by MCE age-conflict logic for pediatric patients (age 0 through 17).
Source: Definitions of Medicare Code Edits v44.0, Age conflict section B.
- Maternity Codes2,587 codes
ICD-10-CM diagnoses designated by MCE age-conflict logic for maternity patients (age 9 through 64).
Source: Definitions of Medicare Code Edits v44.0, Age conflict section C.
- Adult Codes857 codes
ICD-10-CM diagnoses designated by MCE age-conflict logic for adult patients (age 15 through 124).
Source: Definitions of Medicare Code Edits v44.0, Age conflict section D.
- Manifestation Codes422 codes
ICD-10-CM manifestation diagnoses not allowed as principal diagnosis per MCE edit logic.
Source: Definitions of Medicare Code Edits v44.0, edit 6.
- Questionable Admission Codes30 codes
ICD-10-CM principal diagnoses considered questionable for acute-care admission by MCE edit logic.
Source: Definitions of Medicare Code Edits v44.0, edit 8A.
- Questionable Obstetric Outcome Codes19 codes
ICD-10-CM outcome-of-delivery diagnosis codes used in MCE questionable obstetric admission logic.
Source: Definitions of Medicare Code Edits v44.0, edit 8B section 3.
- Unacceptable Principal Diagnosis Codes2,666 codes
ICD-10-CM codes identified as unacceptable when used as principal diagnosis by MCE edit logic.
Source: Definitions of Medicare Code Edits v44.0, edit 9.
- Present On Admission Exempt Codes38,399 codes
ICD-10-CM diagnosis codes exempt from POA reporting based on the official FY2027 CMS POA exempt list.