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 15 of 27 (2,651 total)
  • T50.8X6SBillable

    Underdosing of diagnostic agents, sequela

  • T50.915ABillable

    Adverse effect of multiple unspecified drugs, medicaments and biological substances, initial encounter

  • T50.915DBillable

    Adverse effect of multiple unspecified drugs, medicaments and biological substances, subsequent encounter

  • T50.915SBillable

    Adverse effect of multiple unspecified drugs, medicaments and biological substances, sequela

  • T50.916ABillable

    Underdosing of multiple unspecified drugs, medicaments and biological substances, initial encounter

  • T50.916DBillable

    Underdosing of multiple unspecified drugs, medicaments and biological substances, subsequent encounter

  • T50.916SBillable

    Underdosing of multiple unspecified drugs, medicaments and biological substances, sequela

  • T50.A15ABillable

    Adverse effect of pertussis vaccine, including combinations with a pertussis component, initial encounter

  • T50.A15DBillable

    Adverse effect of pertussis vaccine, including combinations with a pertussis component, subsequent encounter

  • T50.A15SBillable

    Adverse effect of pertussis vaccine, including combinations with a pertussis component, sequela

  • T50.A16ABillable

    Underdosing of pertussis vaccine, including combinations with a pertussis component, initial encounter

  • T50.A16DBillable

    Underdosing of pertussis vaccine, including combinations with a pertussis component, subsequent encounter

  • T50.A16SBillable

    Underdosing of pertussis vaccine, including combinations with a pertussis component, sequela

  • T50.A25ABillable

    Adverse effect of mixed bacterial vaccines without a pertussis component, initial encounter

  • T50.A25DBillable

    Adverse effect of mixed bacterial vaccines without a pertussis component, subsequent encounter

  • T50.A25SBillable

    Adverse effect of mixed bacterial vaccines without a pertussis component, sequela

  • T50.A26ABillable

    Underdosing of mixed bacterial vaccines without a pertussis component, initial encounter

  • T50.A26DBillable

    Underdosing of mixed bacterial vaccines without a pertussis component, subsequent encounter

  • T50.A26SBillable

    Underdosing of mixed bacterial vaccines without a pertussis component, sequela

  • T50.A95ABillable

    Adverse effect of other bacterial vaccines, initial encounter

  • T50.A95DBillable

    Adverse effect of other bacterial vaccines, subsequent encounter

  • T50.A95SBillable

    Adverse effect of other bacterial vaccines, sequela

  • T50.A96ABillable

    Underdosing of other bacterial vaccines, initial encounter

  • T50.A96DBillable

    Underdosing of other bacterial vaccines, subsequent encounter

  • T50.A96SBillable

    Underdosing of other bacterial vaccines, sequela

  • T50.B15ABillable

    Adverse effect of smallpox vaccines, initial encounter

  • T50.B15DBillable

    Adverse effect of smallpox vaccines, subsequent encounter

  • T50.B15SBillable

    Adverse effect of smallpox vaccines, sequela

  • T50.B16ABillable

    Underdosing of smallpox vaccines, initial encounter

  • T50.B16DBillable

    Underdosing of smallpox vaccines, subsequent encounter

  • T50.B16SBillable

    Underdosing of smallpox vaccines, sequela

  • T50.B95ABillable

    Adverse effect of other viral vaccines, initial encounter

  • T50.B95DBillable

    Adverse effect of other viral vaccines, subsequent encounter

  • T50.B95SBillable

    Adverse effect of other viral vaccines, sequela

  • T50.B96ABillable

    Underdosing of other viral vaccines, initial encounter

  • T50.B96DBillable

    Underdosing of other viral vaccines, subsequent encounter

  • T50.B96SBillable

    Underdosing of other viral vaccines, sequela

  • T50.Z15ABillable

    Adverse effect of immunoglobulin, initial encounter

  • T50.Z15DBillable

    Adverse effect of immunoglobulin, subsequent encounter

  • T50.Z15SBillable

    Adverse effect of immunoglobulin, sequela

  • T50.Z16ABillable

    Underdosing of immunoglobulin, initial encounter

  • T50.Z16DBillable

    Underdosing of immunoglobulin, subsequent encounter

  • T50.Z16SBillable

    Underdosing of immunoglobulin, sequela

  • T50.Z95ABillable

    Adverse effect of other vaccines and biological substances, initial encounter

  • T50.Z95DBillable

    Adverse effect of other vaccines and biological substances, subsequent encounter

  • T50.Z95SBillable

    Adverse effect of other vaccines and biological substances, sequela

  • T50.Z96ABillable

    Underdosing of other vaccines and biological substances, initial encounter

  • T50.Z96DBillable

    Underdosing of other vaccines and biological substances, subsequent encounter

  • T50.Z96SBillable

    Underdosing of other vaccines and biological substances, sequela

  • T78.110ABillable

    Other adverse food reactions due to milk and dairy products with tolerance to baked milk, initial encounter

  • T78.110DBillable

    Other adverse food reactions due to milk and dairy products with tolerance to baked milk, subsequent encounter

  • T78.110SBillable

    Other adverse food reactions due to milk and dairy products with tolerance to baked milk, sequela

  • T78.111ABillable

    Other adverse food reaction due to milk and dairy products with reactivity to baked milk, initial encounter

  • T78.111DBillable

    Other adverse food reaction due to milk and dairy products with reactivity to baked milk, subsequent encounter

  • T78.111SBillable

    Other adverse food reaction due to milk and dairy products with reactivity to baked milk, sequela

  • T78.119ABillable

    Other adverse food reaction due to milk and dairy products with baked milk tolerance/reactivity, unspecified, initial encounter

  • T78.119DBillable

    Other adverse food reaction due to milk and dairy products with baked milk tolerance/reactivity, unspecified, subsequent encounter

  • T78.119SBillable

    Other adverse food reaction due to milk and dairy products with baked milk tolerance/reactivity, unspecified, sequela

  • T78.120ABillable

    Other adverse food reaction due to egg with tolerance to baked egg, initial encounter

  • T78.120DBillable

    Other adverse food reaction due to egg with tolerance to baked egg, subsequent encounter

  • T78.120SBillable

    Other adverse food reaction due to egg with tolerance to baked egg, sequela

  • T78.121ABillable

    Other adverse food reaction due to egg with reactivity to baked egg, initial encounter

  • T78.121DBillable

    Other adverse food reaction due to egg with reactivity to baked egg, subsequent encounter

  • T78.121SBillable

    Other adverse food reaction due to egg with reactivity to baked egg, sequela

  • T78.129ABillable

    Other adverse food reaction due to egg with baked egg tolerance/reactivity, unspecified, initial encounter

  • T78.129DBillable

    Other adverse food reaction due to egg with baked egg tolerance/reactivity, unspecified, subsequent encounter

  • T78.129SBillable

    Other adverse food reaction due to egg with baked egg tolerance/reactivity, unspecified, sequela

  • T78.19XABillable

    Other adverse food reactions, not elsewhere classified, initial encounter

  • T78.19XDBillable

    Other adverse food reactions, not elsewhere classified, subsequent encounter

  • T78.19XSBillable

    Other adverse food reactions, not elsewhere classified, sequela

  • T81.12XABillable

    Postprocedural septic shock, initial encounter

  • T81.12XDBillable

    Postprocedural septic shock, subsequent encounter

  • T81.12XSBillable

    Postprocedural septic shock, sequela

  • Z00.00Billable

    Encounter for general adult medical examination without abnormal findings

  • Z00.01Billable

    Encounter for general adult medical examination with abnormal findings

  • Z00.110Billable

    Health examination for newborn under 8 days old

  • Z00.111Billable

    Health examination for newborn 8 to 28 days old

  • Z00.121Billable

    Encounter for routine child health examination with abnormal findings

  • Z00.129Billable

    Encounter for routine child health examination without abnormal findings

  • Z00.2Billable

    Encounter for examination for period of rapid growth in childhood

  • Z00.3Billable

    Encounter for examination for adolescent development state

  • Z00.5Billable

    Encounter for examination of potential donor of organ and tissue

  • Z00.70Billable

    Encounter for examination for period of delayed growth in childhood without abnormal findings

  • Z00.71Billable

    Encounter for examination for period of delayed growth in childhood with abnormal findings

  • Z00.8Billable

    Encounter for other general examination

  • Z01.10Billable

    Encounter for examination of ears and hearing without abnormal findings

  • Z01.110Billable

    Encounter for hearing examination following failed hearing screening

  • Z01.118Billable

    Encounter for examination of ears and hearing with other abnormal findings

  • Z01.12Billable

    Encounter for hearing conservation and treatment

  • Z01.20Billable

    Encounter for dental examination and cleaning without abnormal findings

  • Z01.21Billable

    Encounter for dental examination and cleaning with abnormal findings

  • Z01.30Billable

    Encounter for examination of blood pressure without abnormal findings

  • Z01.31Billable

    Encounter for examination of blood pressure with abnormal findings

  • Z01.812Billable

    Encounter for preprocedural laboratory examination

  • Z01.818Billable

    Encounter for other preprocedural examination

  • Z01.82Billable

    Encounter for allergy testing

  • Z01.83Billable

    Encounter for blood typing

  • Z01.84Billable

    Encounter for antibody response examination

  • Z01.89Billable

    Encounter for other specified special examinations

  • Z02.0Billable

    Encounter for examination for admission to educational institution