Clinical Guidance Category

Unacceptable Principal Diagnosis Codes

ICD-10-CM codes identified as unacceptable when used as principal diagnosis by MCE edit logic.

Source: Definitions of Medicare Code Edits v43.1, edit 9.
Linked Diagnostic CodesPage 12 of 27 (2,651 total)
  • T45.96XSBillable

    Underdosing of unspecified primarily systemic and hematological agent, sequela

  • T46.0X5ABillable

    Adverse effect of cardiac-stimulant glycosides and drugs of similar action, initial encounter

  • T46.0X5DBillable

    Adverse effect of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter

  • T46.0X5SBillable

    Adverse effect of cardiac-stimulant glycosides and drugs of similar action, sequela

  • T46.0X6ABillable

    Underdosing of cardiac-stimulant glycosides and drugs of similar action, initial encounter

  • T46.0X6DBillable

    Underdosing of cardiac-stimulant glycosides and drugs of similar action, subsequent encounter

  • T46.0X6SBillable

    Underdosing of cardiac-stimulant glycosides and drugs of similar action, sequela

  • T46.1X5ABillable

    Adverse effect of calcium-channel blockers, initial encounter

  • T46.1X5DBillable

    Adverse effect of calcium-channel blockers, subsequent encounter

  • T46.1X5SBillable

    Adverse effect of calcium-channel blockers, sequela

  • T46.1X6ABillable

    Underdosing of calcium-channel blockers, initial encounter

  • T46.1X6DBillable

    Underdosing of calcium-channel blockers, subsequent encounter

  • T46.1X6SBillable

    Underdosing of calcium-channel blockers, sequela

  • T46.2X5ABillable

    Adverse effect of other antidysrhythmic drugs, initial encounter

  • T46.2X5DBillable

    Adverse effect of other antidysrhythmic drugs, subsequent encounter

  • T46.2X5SBillable

    Adverse effect of other antidysrhythmic drugs, sequela

  • T46.2X6ABillable

    Underdosing of other antidysrhythmic drugs, initial encounter

  • T46.2X6DBillable

    Underdosing of other antidysrhythmic drugs, subsequent encounter

  • T46.2X6SBillable

    Underdosing of other antidysrhythmic drugs, sequela

  • T46.3X5ABillable

    Adverse effect of coronary vasodilators, initial encounter

  • T46.3X5DBillable

    Adverse effect of coronary vasodilators, subsequent encounter

  • T46.3X5SBillable

    Adverse effect of coronary vasodilators, sequela

  • T46.3X6ABillable

    Underdosing of coronary vasodilators, initial encounter

  • T46.3X6DBillable

    Underdosing of coronary vasodilators, subsequent encounter

  • T46.3X6SBillable

    Underdosing of coronary vasodilators, sequela

  • T46.4X5ABillable

    Adverse effect of angiotensin-converting-enzyme inhibitors, initial encounter

  • T46.4X5DBillable

    Adverse effect of angiotensin-converting-enzyme inhibitors, subsequent encounter

  • T46.4X5SBillable

    Adverse effect of angiotensin-converting-enzyme inhibitors, sequela

  • T46.4X6ABillable

    Underdosing of angiotensin-converting-enzyme inhibitors, initial encounter

  • T46.4X6DBillable

    Underdosing of angiotensin-converting-enzyme inhibitors, subsequent encounter

  • T46.4X6SBillable

    Underdosing of angiotensin-converting-enzyme inhibitors, sequela

  • T46.5X5ABillable

    Adverse effect of other antihypertensive drugs, initial encounter

  • T46.5X5DBillable

    Adverse effect of other antihypertensive drugs, subsequent encounter

  • T46.5X5SBillable

    Adverse effect of other antihypertensive drugs, sequela

  • T46.5X6ABillable

    Underdosing of other antihypertensive drugs, initial encounter

  • T46.5X6DBillable

    Underdosing of other antihypertensive drugs, subsequent encounter

  • T46.5X6SBillable

    Underdosing of other antihypertensive drugs, sequela

  • T46.6X5ABillable

    Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter

  • T46.6X5DBillable

    Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter

  • T46.6X5SBillable

    Adverse effect of antihyperlipidemic and antiarteriosclerotic drugs, sequela

  • T46.6X6ABillable

    Underdosing of antihyperlipidemic and antiarteriosclerotic drugs, initial encounter

  • T46.6X6DBillable

    Underdosing of antihyperlipidemic and antiarteriosclerotic drugs, subsequent encounter

  • T46.6X6SBillable

    Underdosing of antihyperlipidemic and antiarteriosclerotic drugs, sequela

  • T46.7X5ABillable

    Adverse effect of peripheral vasodilators, initial encounter

  • T46.7X5DBillable

    Adverse effect of peripheral vasodilators, subsequent encounter

  • T46.7X5SBillable

    Adverse effect of peripheral vasodilators, sequela

  • T46.7X6ABillable

    Underdosing of peripheral vasodilators, initial encounter

  • T46.7X6DBillable

    Underdosing of peripheral vasodilators, subsequent encounter

  • T46.7X6SBillable

    Underdosing of peripheral vasodilators, sequela

  • T46.8X5ABillable

    Adverse effect of antivaricose drugs, including sclerosing agents, initial encounter

  • T46.8X5DBillable

    Adverse effect of antivaricose drugs, including sclerosing agents, subsequent encounter

  • T46.8X5SBillable

    Adverse effect of antivaricose drugs, including sclerosing agents, sequela

  • T46.8X6ABillable

    Underdosing of antivaricose drugs, including sclerosing agents, initial encounter

  • T46.8X6DBillable

    Underdosing of antivaricose drugs, including sclerosing agents, subsequent encounter

  • T46.8X6SBillable

    Underdosing of antivaricose drugs, including sclerosing agents, sequela

  • T46.905ABillable

    Adverse effect of unspecified agents primarily affecting the cardiovascular system, initial encounter

  • T46.905DBillable

    Adverse effect of unspecified agents primarily affecting the cardiovascular system, subsequent encounter

  • T46.905SBillable

    Adverse effect of unspecified agents primarily affecting the cardiovascular system, sequela

  • T46.906ABillable

    Underdosing of unspecified agents primarily affecting the cardiovascular system, initial encounter

  • T46.906DBillable

    Underdosing of unspecified agents primarily affecting the cardiovascular system, subsequent encounter

  • T46.906SBillable

    Underdosing of unspecified agents primarily affecting the cardiovascular system, sequela

  • T46.995ABillable

    Adverse effect of other agents primarily affecting the cardiovascular system, initial encounter

  • T46.995DBillable

    Adverse effect of other agents primarily affecting the cardiovascular system, subsequent encounter

  • T46.995SBillable

    Adverse effect of other agents primarily affecting the cardiovascular system, sequela

  • T46.996ABillable

    Underdosing of other agents primarily affecting the cardiovascular system, initial encounter

  • T46.996DBillable

    Underdosing of other agents primarily affecting the cardiovascular system, subsequent encounter

  • T46.996SBillable

    Underdosing of other agents primarily affecting the cardiovascular system, sequela

  • T47.0X5ABillable

    Adverse effect of histamine H2-receptor blockers, initial encounter

  • T47.0X5DBillable

    Adverse effect of histamine H2-receptor blockers, subsequent encounter

  • T47.0X5SBillable

    Adverse effect of histamine H2-receptor blockers, sequela

  • T47.0X6ABillable

    Underdosing of histamine H2-receptor blockers, initial encounter

  • T47.0X6DBillable

    Underdosing of histamine H2-receptor blockers, subsequent encounter

  • T47.0X6SBillable

    Underdosing of histamine H2-receptor blockers, sequela

  • T47.1X5ABillable

    Adverse effect of other antacids and anti-gastric-secretion drugs, initial encounter

  • T47.1X5DBillable

    Adverse effect of other antacids and anti-gastric-secretion drugs, subsequent encounter

  • T47.1X5SBillable

    Adverse effect of other antacids and anti-gastric-secretion drugs, sequela

  • T47.1X6ABillable

    Underdosing of other antacids and anti-gastric-secretion drugs, initial encounter

  • T47.1X6DBillable

    Underdosing of other antacids and anti-gastric-secretion drugs, subsequent encounter

  • T47.1X6SBillable

    Underdosing of other antacids and anti-gastric-secretion drugs, sequela

  • T47.2X5ABillable

    Adverse effect of stimulant laxatives, initial encounter

  • T47.2X5DBillable

    Adverse effect of stimulant laxatives, subsequent encounter

  • T47.2X5SBillable

    Adverse effect of stimulant laxatives, sequela

  • T47.2X6ABillable

    Underdosing of stimulant laxatives, initial encounter

  • T47.2X6DBillable

    Underdosing of stimulant laxatives, subsequent encounter

  • T47.2X6SBillable

    Underdosing of stimulant laxatives, sequela

  • T47.3X5ABillable

    Adverse effect of saline and osmotic laxatives, initial encounter

  • T47.3X5DBillable

    Adverse effect of saline and osmotic laxatives, subsequent encounter

  • T47.3X5SBillable

    Adverse effect of saline and osmotic laxatives, sequela

  • T47.3X6ABillable

    Underdosing of saline and osmotic laxatives, initial encounter

  • T47.3X6DBillable

    Underdosing of saline and osmotic laxatives, subsequent encounter

  • T47.3X6SBillable

    Underdosing of saline and osmotic laxatives, sequela

  • T47.4X5ABillable

    Adverse effect of other laxatives, initial encounter

  • T47.4X5DBillable

    Adverse effect of other laxatives, subsequent encounter

  • T47.4X5SBillable

    Adverse effect of other laxatives, sequela

  • T47.4X6ABillable

    Underdosing of other laxatives, initial encounter

  • T47.4X6DBillable

    Underdosing of other laxatives, subsequent encounter

  • T47.4X6SBillable

    Underdosing of other laxatives, sequela

  • T47.5X5ABillable

    Adverse effect of digestants, initial encounter

  • T47.5X5DBillable

    Adverse effect of digestants, subsequent encounter

  • T47.5X5SBillable

    Adverse effect of digestants, sequela