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 13 of 27 (2,651 total)
  • T47.5X6ABillable

    Underdosing of digestants, initial encounter

  • T47.5X6DBillable

    Underdosing of digestants, subsequent encounter

  • T47.5X6SBillable

    Underdosing of digestants, sequela

  • T47.6X5ABillable

    Adverse effect of antidiarrheal drugs, initial encounter

  • T47.6X5DBillable

    Adverse effect of antidiarrheal drugs, subsequent encounter

  • T47.6X5SBillable

    Adverse effect of antidiarrheal drugs, sequela

  • T47.6X6ABillable

    Underdosing of antidiarrheal drugs, initial encounter

  • T47.6X6DBillable

    Underdosing of antidiarrheal drugs, subsequent encounter

  • T47.6X6SBillable

    Underdosing of antidiarrheal drugs, sequela

  • T47.7X5ABillable

    Adverse effect of emetics, initial encounter

  • T47.7X5DBillable

    Adverse effect of emetics, subsequent encounter

  • T47.7X5SBillable

    Adverse effect of emetics, sequela

  • T47.7X6ABillable

    Underdosing of emetics, initial encounter

  • T47.7X6DBillable

    Underdosing of emetics, subsequent encounter

  • T47.7X6SBillable

    Underdosing of emetics, sequela

  • T47.8X5ABillable

    Adverse effect of other agents primarily affecting gastrointestinal system, initial encounter

  • T47.8X5DBillable

    Adverse effect of other agents primarily affecting gastrointestinal system, subsequent encounter

  • T47.8X5SBillable

    Adverse effect of other agents primarily affecting gastrointestinal system, sequela

  • T47.8X6ABillable

    Underdosing of other agents primarily affecting gastrointestinal system, initial encounter

  • T47.8X6DBillable

    Underdosing of other agents primarily affecting gastrointestinal system, subsequent encounter

  • T47.8X6SBillable

    Underdosing of other agents primarily affecting gastrointestinal system, sequela

  • T47.95XABillable

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

  • T47.95XDBillable

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

  • T47.95XSBillable

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

  • T47.96XABillable

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

  • T47.96XDBillable

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

  • T47.96XSBillable

    Underdosing of unspecified agents primarily affecting the gastrointestinal system, sequela

  • T48.0X5ABillable

    Adverse effect of oxytocic drugs, initial encounter

  • T48.0X5DBillable

    Adverse effect of oxytocic drugs, subsequent encounter

  • T48.0X5SBillable

    Adverse effect of oxytocic drugs, sequela

  • T48.0X6ABillable

    Underdosing of oxytocic drugs, initial encounter

  • T48.0X6DBillable

    Underdosing of oxytocic drugs, subsequent encounter

  • T48.0X6SBillable

    Underdosing of oxytocic drugs, sequela

  • T48.1X5ABillable

    Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter

  • T48.1X5DBillable

    Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], subsequent encounter

  • T48.1X5SBillable

    Adverse effect of skeletal muscle relaxants [neuromuscular blocking agents], sequela

  • T48.1X6ABillable

    Underdosing of skeletal muscle relaxants [neuromuscular blocking agents], initial encounter

  • T48.1X6DBillable

    Underdosing of skeletal muscle relaxants [neuromuscular blocking agents], subsequent encounter

  • T48.1X6SBillable

    Underdosing of skeletal muscle relaxants [neuromuscular blocking agents], sequela

  • T48.205ABillable

    Adverse effect of unspecified drugs acting on muscles, initial encounter

  • T48.205DBillable

    Adverse effect of unspecified drugs acting on muscles, subsequent encounter

  • T48.205SBillable

    Adverse effect of unspecified drugs acting on muscles, sequela

  • T48.206ABillable

    Underdosing of unspecified drugs acting on muscles, initial encounter

  • T48.206DBillable

    Underdosing of unspecified drugs acting on muscles, subsequent encounter

  • T48.206SBillable

    Underdosing of unspecified drugs acting on muscles, sequela

  • T48.295ABillable

    Adverse effect of other drugs acting on muscles, initial encounter

  • T48.295DBillable

    Adverse effect of other drugs acting on muscles, subsequent encounter

  • T48.295SBillable

    Adverse effect of other drugs acting on muscles, sequela

  • T48.296ABillable

    Underdosing of other drugs acting on muscles, initial encounter

  • T48.296DBillable

    Underdosing of other drugs acting on muscles, subsequent encounter

  • T48.296SBillable

    Underdosing of other drugs acting on muscles, sequela

  • T48.3X5ABillable

    Adverse effect of antitussives, initial encounter

  • T48.3X5DBillable

    Adverse effect of antitussives, subsequent encounter

  • T48.3X5SBillable

    Adverse effect of antitussives, sequela

  • T48.3X6ABillable

    Underdosing of antitussives, initial encounter

  • T48.3X6DBillable

    Underdosing of antitussives, subsequent encounter

  • T48.3X6SBillable

    Underdosing of antitussives, sequela

  • T48.4X5ABillable

    Adverse effect of expectorants, initial encounter

  • T48.4X5DBillable

    Adverse effect of expectorants, subsequent encounter

  • T48.4X5SBillable

    Adverse effect of expectorants, sequela

  • T48.4X6ABillable

    Underdosing of expectorants, initial encounter

  • T48.4X6DBillable

    Underdosing of expectorants, subsequent encounter

  • T48.4X6SBillable

    Underdosing of expectorants, sequela

  • T48.5X5ABillable

    Adverse effect of other anti-common-cold drugs, initial encounter

  • T48.5X5DBillable

    Adverse effect of other anti-common-cold drugs, subsequent encounter

  • T48.5X5SBillable

    Adverse effect of other anti-common-cold drugs, sequela

  • T48.5X6ABillable

    Underdosing of other anti-common-cold drugs, initial encounter

  • T48.5X6DBillable

    Underdosing of other anti-common-cold drugs, subsequent encounter

  • T48.5X6SBillable

    Underdosing of other anti-common-cold drugs, sequela

  • T48.6X5ABillable

    Adverse effect of antiasthmatics, initial encounter

  • T48.6X5DBillable

    Adverse effect of antiasthmatics, subsequent encounter

  • T48.6X5SBillable

    Adverse effect of antiasthmatics, sequela

  • T48.6X6ABillable

    Underdosing of antiasthmatics, initial encounter

  • T48.6X6DBillable

    Underdosing of antiasthmatics, subsequent encounter

  • T48.6X6SBillable

    Underdosing of antiasthmatics, sequela

  • T48.905ABillable

    Adverse effect of unspecified agents primarily acting on the respiratory system, initial encounter

  • T48.905DBillable

    Adverse effect of unspecified agents primarily acting on the respiratory system, subsequent encounter

  • T48.905SBillable

    Adverse effect of unspecified agents primarily acting on the respiratory system, sequela

  • T48.906ABillable

    Underdosing of unspecified agents primarily acting on the respiratory system, initial encounter

  • T48.906DBillable

    Underdosing of unspecified agents primarily acting on the respiratory system, subsequent encounter

  • T48.906SBillable

    Underdosing of unspecified agents primarily acting on the respiratory system, sequela

  • T48.995ABillable

    Adverse effect of other agents primarily acting on the respiratory system, initial encounter

  • T48.995DBillable

    Adverse effect of other agents primarily acting on the respiratory system, subsequent encounter

  • T48.995SBillable

    Adverse effect of other agents primarily acting on the respiratory system, sequela

  • T48.996ABillable

    Underdosing of other agents primarily acting on the respiratory system, initial encounter

  • T48.996DBillable

    Underdosing of other agents primarily acting on the respiratory system, subsequent encounter

  • T48.996SBillable

    Underdosing of other agents primarily acting on the respiratory system, sequela

  • T49.0X5ABillable

    Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter

  • T49.0X5DBillable

    Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, subsequent encounter

  • T49.0X5SBillable

    Adverse effect of local antifungal, anti-infective and anti-inflammatory drugs, sequela

  • T49.0X6ABillable

    Underdosing of local antifungal, anti-infective and anti-inflammatory drugs, initial encounter

  • T49.0X6DBillable

    Underdosing of local antifungal, anti-infective and anti-inflammatory drugs, subsequent encounter

  • T49.0X6SBillable

    Underdosing of local antifungal, anti-infective and anti-inflammatory drugs, sequela

  • T49.1X5ABillable

    Adverse effect of antipruritics, initial encounter

  • T49.1X5DBillable

    Adverse effect of antipruritics, subsequent encounter

  • T49.1X5SBillable

    Adverse effect of antipruritics, sequela

  • T49.1X6ABillable

    Underdosing of antipruritics, initial encounter

  • T49.1X6DBillable

    Underdosing of antipruritics, subsequent encounter

  • T49.1X6SBillable

    Underdosing of antipruritics, sequela

  • T49.2X5ABillable

    Adverse effect of local astringents and local detergents, initial encounter