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 16 of 27 (2,651 total)
  • Z02.2Billable

    Encounter for examination for admission to residential institution

  • Z02.4Billable

    Encounter for examination for driving license

  • Z02.5Billable

    Encounter for examination for participation in sport

  • Z02.6Billable

    Encounter for examination for insurance purposes

  • Z02.71Billable

    Encounter for disability determination

  • Z02.79Billable

    Encounter for issue of other medical certificate

  • Z02.82Billable

    Encounter for adoption services

  • Z02.84Billable

    Encounter for child welfare exam

  • Z02.89Billable

    Encounter for other administrative examinations

  • Z02.9Billable

    Encounter for administrative examinations, unspecified

  • Z03.71Billable

    Encounter for suspected problem with amniotic cavity and membrane ruled out

  • Z03.72Billable

    Encounter for suspected placental problem ruled out

  • Z03.73Billable

    Encounter for suspected fetal anomaly ruled out

  • Z03.74Billable

    Encounter for suspected problem with fetal growth ruled out

  • Z03.75Billable

    Encounter for suspected cervical shortening ruled out

  • Z03.79Billable

    Encounter for other suspected maternal and fetal conditions ruled out

  • Z03.821Billable

    Encounter for observation for suspected ingested foreign body ruled out

  • Z03.822Billable

    Encounter for observation for suspected aspirated (inhaled) foreign body ruled out

  • Z03.823Billable

    Encounter for observation for suspected inserted (injected) foreign body ruled out

  • Z03.83Billable

    Encounter for observation for suspected conditions related to home physiologic monitoring device ruled out

  • Z04.9Billable

    Encounter for examination and observation for unspecified reason

  • Z08Billable

    Encounter for follow-up examination after completed treatment for malignant neoplasm

  • Z09Billable

    Encounter for follow-up examination after completed treatment for conditions other than malignant neoplasm

  • Z11.0Billable

    Encounter for screening for intestinal infectious diseases

  • Z11.1Billable

    Encounter for screening for respiratory tuberculosis

  • Z11.2Billable

    Encounter for screening for other bacterial diseases

  • Z11.3Billable

    Encounter for screening for infections with a predominantly sexual mode of transmission

  • Z11.4Billable

    Encounter for screening for human immunodeficiency virus [HIV]

  • Z11.51Billable

    Encounter for screening for human papillomavirus (HPV)

  • Z11.52Billable

    Encounter for screening for COVID-19

  • Z11.59Billable

    Encounter for screening for other viral diseases

  • Z11.6Billable

    Encounter for screening for other protozoal diseases and helminthiases

  • Z11.7Billable

    Encounter for testing for latent tuberculosis infection

  • Z11.8Billable

    Encounter for screening for other infectious and parasitic diseases

  • Z11.9Billable

    Encounter for screening for infectious and parasitic diseases, unspecified

  • Z12.0Billable

    Encounter for screening for malignant neoplasm of stomach

  • Z12.10Billable

    Encounter for screening for malignant neoplasm of intestinal tract, unspecified

  • Z12.11Billable

    Encounter for screening for malignant neoplasm of colon

  • Z12.12Billable

    Encounter for screening for malignant neoplasm of rectum

  • Z12.13Billable

    Encounter for screening for malignant neoplasm of small intestine

  • Z12.2Billable

    Encounter for screening for malignant neoplasm of respiratory organs

  • Z12.31Billable

    Encounter for screening mammogram for malignant neoplasm of breast

  • Z12.39Billable

    Encounter for other screening for malignant neoplasm of breast

  • Z12.4Billable

    Encounter for screening for malignant neoplasm of cervix

  • Z12.6Billable

    Encounter for screening for malignant neoplasm of bladder

  • Z12.71Billable

    Encounter for screening for malignant neoplasm of testis

  • Z12.72Billable

    Encounter for screening for malignant neoplasm of vagina

  • Z12.73Billable

    Encounter for screening for malignant neoplasm of ovary

  • Z12.79Billable

    Encounter for screening for malignant neoplasm of other genitourinary organs

  • Z12.81Billable

    Encounter for screening for malignant neoplasm of oral cavity

  • Z12.82Billable

    Encounter for screening for malignant neoplasm of nervous system

  • Z12.83Billable

    Encounter for screening for malignant neoplasm of skin

  • Z12.89Billable

    Encounter for screening for malignant neoplasm of other sites

  • Z12.9Billable

    Encounter for screening for malignant neoplasm, site unspecified

  • Z13.0Billable

    Encounter for screening for diseases of the blood and blood-forming organs and certain disorders involving the immune mechanism

  • Z13.1Billable

    Encounter for screening for diabetes mellitus

  • Z13.21Billable

    Encounter for screening for nutritional disorder

  • Z13.220Billable

    Encounter for screening for lipoid disorders

  • Z13.228Billable

    Encounter for screening for other metabolic disorders

  • Z13.29Billable

    Encounter for screening for other suspected endocrine disorder

  • Z13.30Billable

    Encounter for screening examination for mental health and behavioral disorders, unspecified

  • Z13.31Billable

    Encounter for screening for depression

  • Z13.32Billable

    Encounter for screening for maternal depression

  • Z13.39Billable

    Encounter for screening examination for other mental health and behavioral disorders

  • Z13.40Billable

    Encounter for screening for unspecified developmental delays

  • Z13.41Billable

    Encounter for autism screening

  • Z13.42Billable

    Encounter for screening for global developmental delays (milestones)

  • Z13.49Billable

    Encounter for screening for other developmental delays

  • Z13.5Billable

    Encounter for screening for eye and ear disorders

  • Z13.6Billable

    Encounter for screening for cardiovascular disorders

  • Z13.71Billable

    Encounter for nonprocreative screening for genetic disease carrier status

  • Z13.79Billable

    Encounter for other screening for genetic and chromosomal anomalies

  • Z13.810Billable

    Encounter for screening for upper gastrointestinal disorder

  • Z13.811Billable

    Encounter for screening for lower gastrointestinal disorder

  • Z13.818Billable

    Encounter for screening for other digestive system disorders

  • Z13.820Billable

    Encounter for screening for osteoporosis

  • Z13.828Billable

    Encounter for screening for other musculoskeletal disorder

  • Z13.83Billable

    Encounter for screening for respiratory disorder NEC

  • Z13.84Billable

    Encounter for screening for dental disorders

  • Z13.850Billable

    Encounter for screening for traumatic brain injury

  • Z13.858Billable

    Encounter for screening for other nervous system disorders

  • Z13.88Billable

    Encounter for screening for disorder due to exposure to contaminants

  • Z13.89Billable

    Encounter for screening for other disorder

  • Z13.9Billable

    Encounter for screening, unspecified

  • Z14.01Billable

    Asymptomatic hemophilia A carrier

  • Z14.02Billable

    Symptomatic hemophilia A carrier

  • Z14.1Billable

    Cystic fibrosis carrier

  • Z14.8Billable

    Genetic carrier of other disease

  • Z15.01Billable

    Genetic susceptibility to malignant neoplasm of breast

  • Z15.02Billable

    Genetic susceptibility to malignant neoplasm of ovary

  • Z15.03Billable

    Genetic susceptibility to malignant neoplasm of prostate

  • Z15.04Billable

    Genetic susceptibility to malignant neoplasm of endometrium

  • Z15.05Billable

    Genetic susceptibility to malignant neoplasm of fallopian tube(s)

  • Z15.060Billable

    Genetic susceptibility to colorectal cancer

  • Z15.068Billable

    Genetic susceptibility to other malignant neoplasm of digestive system

  • Z15.07Billable

    Genetic susceptibility to malignant neoplasm of urinary tract

  • Z15.09Billable

    Genetic susceptibility to other malignant neoplasm

  • Z15.1Billable

    Genetic susceptibility to epilepsy and neurodevelopmental disorders

  • Z15.2Billable

    Genetic susceptibility to obesity

  • Z15.3Billable

    Genetic susceptibility to kidney disease