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 6 of 27 (2,651 total)
  • T37.2X6SBillable

    Underdosing of antimalarials and drugs acting on other blood protozoa, sequela

  • T37.3X5ABillable

    Adverse effect of other antiprotozoal drugs, initial encounter

  • T37.3X5DBillable

    Adverse effect of other antiprotozoal drugs, subsequent encounter

  • T37.3X5SBillable

    Adverse effect of other antiprotozoal drugs, sequela

  • T37.3X6ABillable

    Underdosing of other antiprotozoal drugs, initial encounter

  • T37.3X6DBillable

    Underdosing of other antiprotozoal drugs, subsequent encounter

  • T37.3X6SBillable

    Underdosing of other antiprotozoal drugs, sequela

  • T37.4X5ABillable

    Adverse effect of anthelminthics, initial encounter

  • T37.4X5DBillable

    Adverse effect of anthelminthics, subsequent encounter

  • T37.4X5SBillable

    Adverse effect of anthelminthics, sequela

  • T37.4X6ABillable

    Underdosing of anthelminthics, initial encounter

  • T37.4X6DBillable

    Underdosing of anthelminthics, subsequent encounter

  • T37.4X6SBillable

    Underdosing of anthelminthics, sequela

  • T37.5X5ABillable

    Adverse effect of antiviral drugs, initial encounter

  • T37.5X5DBillable

    Adverse effect of antiviral drugs, subsequent encounter

  • T37.5X5SBillable

    Adverse effect of antiviral drugs, sequela

  • T37.5X6ABillable

    Underdosing of antiviral drugs, initial encounter

  • T37.5X6DBillable

    Underdosing of antiviral drugs, subsequent encounter

  • T37.5X6SBillable

    Underdosing of antiviral drugs, sequela

  • T37.8X5ABillable

    Adverse effect of other specified systemic anti-infectives and antiparasitics, initial encounter

  • T37.8X5DBillable

    Adverse effect of other specified systemic anti-infectives and antiparasitics, subsequent encounter

  • T37.8X5SBillable

    Adverse effect of other specified systemic anti-infectives and antiparasitics, sequela

  • T37.8X6ABillable

    Underdosing of other specified systemic anti-infectives and antiparasitics, initial encounter

  • T37.8X6DBillable

    Underdosing of other specified systemic anti-infectives and antiparasitics, subsequent encounter

  • T37.8X6SBillable

    Underdosing of other specified systemic anti-infectives and antiparasitics, sequela

  • T37.95XABillable

    Adverse effect of unspecified systemic anti-infective and antiparasitic, initial encounter

  • T37.95XDBillable

    Adverse effect of unspecified systemic anti-infective and antiparasitic, subsequent encounter

  • T37.95XSBillable

    Adverse effect of unspecified systemic anti-infective and antiparasitic, sequela

  • T37.96XABillable

    Underdosing of unspecified systemic anti-infectives and antiparasitics, initial encounter

  • T37.96XDBillable

    Underdosing of unspecified systemic anti-infectives and antiparasitics, subsequent encounter

  • T37.96XSBillable

    Underdosing of unspecified systemic anti-infectives and antiparasitics, sequela

  • T38.0X5ABillable

    Adverse effect of glucocorticoids and synthetic analogues, initial encounter

  • T38.0X5DBillable

    Adverse effect of glucocorticoids and synthetic analogues, subsequent encounter

  • T38.0X5SBillable

    Adverse effect of glucocorticoids and synthetic analogues, sequela

  • T38.0X6ABillable

    Underdosing of glucocorticoids and synthetic analogues, initial encounter

  • T38.0X6DBillable

    Underdosing of glucocorticoids and synthetic analogues, subsequent encounter

  • T38.0X6SBillable

    Underdosing of glucocorticoids and synthetic analogues, sequela

  • T38.1X5ABillable

    Adverse effect of thyroid hormones and substitutes, initial encounter

  • T38.1X5DBillable

    Adverse effect of thyroid hormones and substitutes, subsequent encounter

  • T38.1X5SBillable

    Adverse effect of thyroid hormones and substitutes, sequela

  • T38.1X6ABillable

    Underdosing of thyroid hormones and substitutes, initial encounter

  • T38.1X6DBillable

    Underdosing of thyroid hormones and substitutes, subsequent encounter

  • T38.1X6SBillable

    Underdosing of thyroid hormones and substitutes, sequela

  • T38.2X5ABillable

    Adverse effect of antithyroid drugs, initial encounter

  • T38.2X5DBillable

    Adverse effect of antithyroid drugs, subsequent encounter

  • T38.2X5SBillable

    Adverse effect of antithyroid drugs, sequela

  • T38.2X6ABillable

    Underdosing of antithyroid drugs, initial encounter

  • T38.2X6DBillable

    Underdosing of antithyroid drugs, subsequent encounter

  • T38.2X6SBillable

    Underdosing of antithyroid drugs, sequela

  • T38.3X5ABillable

    Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

  • T38.3X5DBillable

    Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter

  • T38.3X5SBillable

    Adverse effect of insulin and oral hypoglycemic [antidiabetic] drugs, sequela

  • T38.3X6ABillable

    Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, initial encounter

  • T38.3X6DBillable

    Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, subsequent encounter

  • T38.3X6SBillable

    Underdosing of insulin and oral hypoglycemic [antidiabetic] drugs, sequela

  • T38.4X5ABillable

    Adverse effect of oral contraceptives, initial encounter

  • T38.4X5DBillable

    Adverse effect of oral contraceptives, subsequent encounter

  • T38.4X5SBillable

    Adverse effect of oral contraceptives, sequela

  • T38.4X6ABillable

    Underdosing of oral contraceptives, initial encounter

  • T38.4X6DBillable

    Underdosing of oral contraceptives, subsequent encounter

  • T38.4X6SBillable

    Underdosing of oral contraceptives, sequela

  • T38.5X5ABillable

    Adverse effect of other estrogens and progestogens, initial encounter

  • T38.5X5DBillable

    Adverse effect of other estrogens and progestogens, subsequent encounter

  • T38.5X5SBillable

    Adverse effect of other estrogens and progestogens, sequela

  • T38.5X6ABillable

    Underdosing of other estrogens and progestogens, initial encounter

  • T38.5X6DBillable

    Underdosing of other estrogens and progestogens, subsequent encounter

  • T38.5X6SBillable

    Underdosing of other estrogens and progestogens, sequela

  • T38.6X5ABillable

    Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter

  • T38.6X5DBillable

    Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, subsequent encounter

  • T38.6X5SBillable

    Adverse effect of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela

  • T38.6X6ABillable

    Underdosing of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, initial encounter

  • T38.6X6DBillable

    Underdosing of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, subsequent encounter

  • T38.6X6SBillable

    Underdosing of antigonadotrophins, antiestrogens, antiandrogens, not elsewhere classified, sequela

  • T38.7X5ABillable

    Adverse effect of androgens and anabolic congeners, initial encounter

  • T38.7X5DBillable

    Adverse effect of androgens and anabolic congeners, subsequent encounter

  • T38.7X5SBillable

    Adverse effect of androgens and anabolic congeners, sequela

  • T38.7X6ABillable

    Underdosing of androgens and anabolic congeners, initial encounter

  • T38.7X6DBillable

    Underdosing of androgens and anabolic congeners, subsequent encounter

  • T38.7X6SBillable

    Underdosing of androgens and anabolic congeners, sequela

  • T38.805ABillable

    Adverse effect of unspecified hormones and synthetic substitutes, initial encounter

  • T38.805DBillable

    Adverse effect of unspecified hormones and synthetic substitutes, subsequent encounter

  • T38.805SBillable

    Adverse effect of unspecified hormones and synthetic substitutes, sequela

  • T38.806ABillable

    Underdosing of unspecified hormones and synthetic substitutes, initial encounter

  • T38.806DBillable

    Underdosing of unspecified hormones and synthetic substitutes, subsequent encounter

  • T38.806SBillable

    Underdosing of unspecified hormones and synthetic substitutes, sequela

  • T38.815ABillable

    Adverse effect of anterior pituitary [adenohypophyseal] hormones, initial encounter

  • T38.815DBillable

    Adverse effect of anterior pituitary [adenohypophyseal] hormones, subsequent encounter

  • T38.815SBillable

    Adverse effect of anterior pituitary [adenohypophyseal] hormones, sequela

  • T38.816ABillable

    Underdosing of anterior pituitary [adenohypophyseal] hormones, initial encounter

  • T38.816DBillable

    Underdosing of anterior pituitary [adenohypophyseal] hormones, subsequent encounter

  • T38.816SBillable

    Underdosing of anterior pituitary [adenohypophyseal] hormones, sequela

  • T38.895ABillable

    Adverse effect of other hormones and synthetic substitutes, initial encounter

  • T38.895DBillable

    Adverse effect of other hormones and synthetic substitutes, subsequent encounter

  • T38.895SBillable

    Adverse effect of other hormones and synthetic substitutes, sequela

  • T38.896ABillable

    Underdosing of other hormones and synthetic substitutes, initial encounter

  • T38.896DBillable

    Underdosing of other hormones and synthetic substitutes, subsequent encounter

  • T38.896SBillable

    Underdosing of other hormones and synthetic substitutes, sequela

  • T38.905ABillable

    Adverse effect of unspecified hormone antagonists, initial encounter

  • T38.905DBillable

    Adverse effect of unspecified hormone antagonists, subsequent encounter

  • T38.905SBillable

    Adverse effect of unspecified hormone antagonists, sequela