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 9 of 27 (2,651 total)
  • T42.2X6SBillable

    Underdosing of succinimides and oxazolidinediones, sequela

  • T42.3X5ABillable

    Adverse effect of barbiturates, initial encounter

  • T42.3X5DBillable

    Adverse effect of barbiturates, subsequent encounter

  • T42.3X5SBillable

    Adverse effect of barbiturates, sequela

  • T42.3X6ABillable

    Underdosing of barbiturates, initial encounter

  • T42.3X6DBillable

    Underdosing of barbiturates, subsequent encounter

  • T42.3X6SBillable

    Underdosing of barbiturates, sequela

  • T42.4X5ABillable

    Adverse effect of benzodiazepines, initial encounter

  • T42.4X5DBillable

    Adverse effect of benzodiazepines, subsequent encounter

  • T42.4X5SBillable

    Adverse effect of benzodiazepines, sequela

  • T42.4X6ABillable

    Underdosing of benzodiazepines, initial encounter

  • T42.4X6DBillable

    Underdosing of benzodiazepines, subsequent encounter

  • T42.4X6SBillable

    Underdosing of benzodiazepines, sequela

  • T42.5X5ABillable

    Adverse effect of mixed antiepileptics, initial encounter

  • T42.5X5DBillable

    Adverse effect of mixed antiepileptics, subsequent encounter

  • T42.5X5SBillable

    Adverse effect of mixed antiepileptics, sequela

  • T42.5X6ABillable

    Underdosing of mixed antiepileptics, initial encounter

  • T42.5X6DBillable

    Underdosing of mixed antiepileptics, subsequent encounter

  • T42.5X6SBillable

    Underdosing of mixed antiepileptics, sequela

  • T42.6X5ABillable

    Adverse effect of other antiepileptic and sedative-hypnotic drugs, initial encounter

  • T42.6X5DBillable

    Adverse effect of other antiepileptic and sedative-hypnotic drugs, subsequent encounter

  • T42.6X5SBillable

    Adverse effect of other antiepileptic and sedative-hypnotic drugs, sequela

  • T42.6X6ABillable

    Underdosing of other antiepileptic and sedative-hypnotic drugs, initial encounter

  • T42.6X6DBillable

    Underdosing of other antiepileptic and sedative-hypnotic drugs, subsequent encounter

  • T42.6X6SBillable

    Underdosing of other antiepileptic and sedative-hypnotic drugs, sequela

  • T42.75XABillable

    Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, initial encounter

  • T42.75XDBillable

    Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, subsequent encounter

  • T42.75XSBillable

    Adverse effect of unspecified antiepileptic and sedative-hypnotic drugs, sequela

  • T42.76XABillable

    Underdosing of unspecified antiepileptic and sedative-hypnotic drugs, initial encounter

  • T42.76XDBillable

    Underdosing of unspecified antiepileptic and sedative-hypnotic drugs, subsequent encounter

  • T42.76XSBillable

    Underdosing of unspecified antiepileptic and sedative-hypnotic drugs, sequela

  • T42.8X5ABillable

    Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter

  • T42.8X5DBillable

    Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, subsequent encounter

  • T42.8X5SBillable

    Adverse effect of antiparkinsonism drugs and other central muscle-tone depressants, sequela

  • T42.8X6ABillable

    Underdosing of antiparkinsonism drugs and other central muscle-tone depressants, initial encounter

  • T42.8X6DBillable

    Underdosing of antiparkinsonism drugs and other central muscle-tone depressants, subsequent encounter

  • T42.8X6SBillable

    Underdosing of antiparkinsonism drugs and other central muscle-tone depressants, sequela

  • T43.015ABillable

    Adverse effect of tricyclic antidepressants, initial encounter

  • T43.015DBillable

    Adverse effect of tricyclic antidepressants, subsequent encounter

  • T43.015SBillable

    Adverse effect of tricyclic antidepressants, sequela

  • T43.016ABillable

    Underdosing of tricyclic antidepressants, initial encounter

  • T43.016DBillable

    Underdosing of tricyclic antidepressants, subsequent encounter

  • T43.016SBillable

    Underdosing of tricyclic antidepressants, sequela

  • T43.025ABillable

    Adverse effect of tetracyclic antidepressants, initial encounter

  • T43.025DBillable

    Adverse effect of tetracyclic antidepressants, subsequent encounter

  • T43.025SBillable

    Adverse effect of tetracyclic antidepressants, sequela

  • T43.026ABillable

    Underdosing of tetracyclic antidepressants, initial encounter

  • T43.026DBillable

    Underdosing of tetracyclic antidepressants, subsequent encounter

  • T43.026SBillable

    Underdosing of tetracyclic antidepressants, sequela

  • T43.1X5ABillable

    Adverse effect of monoamine-oxidase-inhibitor antidepressants, initial encounter

  • T43.1X5DBillable

    Adverse effect of monoamine-oxidase-inhibitor antidepressants, subsequent encounter

  • T43.1X5SBillable

    Adverse effect of monoamine-oxidase-inhibitor antidepressants, sequela

  • T43.1X6ABillable

    Underdosing of monoamine-oxidase-inhibitor antidepressants, initial encounter

  • T43.1X6DBillable

    Underdosing of monoamine-oxidase-inhibitor antidepressants, subsequent encounter

  • T43.1X6SBillable

    Underdosing of monoamine-oxidase-inhibitor antidepressants, sequela

  • T43.205ABillable

    Adverse effect of unspecified antidepressants, initial encounter

  • T43.205DBillable

    Adverse effect of unspecified antidepressants, subsequent encounter

  • T43.205SBillable

    Adverse effect of unspecified antidepressants, sequela

  • T43.206ABillable

    Underdosing of unspecified antidepressants, initial encounter

  • T43.206DBillable

    Underdosing of unspecified antidepressants, subsequent encounter

  • T43.206SBillable

    Underdosing of unspecified antidepressants, sequela

  • T43.215ABillable

    Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, initial encounter

  • T43.215DBillable

    Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, subsequent encounter

  • T43.215SBillable

    Adverse effect of selective serotonin and norepinephrine reuptake inhibitors, sequela

  • T43.216ABillable

    Underdosing of selective serotonin and norepinephrine reuptake inhibitors, initial encounter

  • T43.216DBillable

    Underdosing of selective serotonin and norepinephrine reuptake inhibitors, subsequent encounter

  • T43.216SBillable

    Underdosing of selective serotonin and norepinephrine reuptake inhibitors, sequela

  • T43.225ABillable

    Adverse effect of selective serotonin reuptake inhibitors, initial encounter

  • T43.225DBillable

    Adverse effect of selective serotonin reuptake inhibitors, subsequent encounter

  • T43.225SBillable

    Adverse effect of selective serotonin reuptake inhibitors, sequela

  • T43.226ABillable

    Underdosing of selective serotonin reuptake inhibitors, initial encounter

  • T43.226DBillable

    Underdosing of selective serotonin reuptake inhibitors, subsequent encounter

  • T43.226SBillable

    Underdosing of selective serotonin reuptake inhibitors, sequela

  • T43.295ABillable

    Adverse effect of other antidepressants, initial encounter

  • T43.295DBillable

    Adverse effect of other antidepressants, subsequent encounter

  • T43.295SBillable

    Adverse effect of other antidepressants, sequela

  • T43.296ABillable

    Underdosing of other antidepressants, initial encounter

  • T43.296DBillable

    Underdosing of other antidepressants, subsequent encounter

  • T43.296SBillable

    Underdosing of other antidepressants, sequela

  • T43.3X5ABillable

    Adverse effect of phenothiazine antipsychotics and neuroleptics, initial encounter

  • T43.3X5DBillable

    Adverse effect of phenothiazine antipsychotics and neuroleptics, subsequent encounter

  • T43.3X5SBillable

    Adverse effect of phenothiazine antipsychotics and neuroleptics, sequela

  • T43.3X6ABillable

    Underdosing of phenothiazine antipsychotics and neuroleptics, initial encounter

  • T43.3X6DBillable

    Underdosing of phenothiazine antipsychotics and neuroleptics, subsequent encounter

  • T43.3X6SBillable

    Underdosing of phenothiazine antipsychotics and neuroleptics, sequela

  • T43.4X5ABillable

    Adverse effect of butyrophenone and thiothixene neuroleptics, initial encounter

  • T43.4X5DBillable

    Adverse effect of butyrophenone and thiothixene neuroleptics, subsequent encounter

  • T43.4X5SBillable

    Adverse effect of butyrophenone and thiothixene neuroleptics, sequela

  • T43.4X6ABillable

    Underdosing of butyrophenone and thiothixene neuroleptics, initial encounter

  • T43.4X6DBillable

    Underdosing of butyrophenone and thiothixene neuroleptics, subsequent encounter

  • T43.4X6SBillable

    Underdosing of butyrophenone and thiothixene neuroleptics, sequela

  • T43.505ABillable

    Adverse effect of unspecified antipsychotics and neuroleptics, initial encounter

  • T43.505DBillable

    Adverse effect of unspecified antipsychotics and neuroleptics, subsequent encounter

  • T43.505SBillable

    Adverse effect of unspecified antipsychotics and neuroleptics, sequela

  • T43.506ABillable

    Underdosing of unspecified antipsychotics and neuroleptics, initial encounter

  • T43.506DBillable

    Underdosing of unspecified antipsychotics and neuroleptics, subsequent encounter

  • T43.506SBillable

    Underdosing of unspecified antipsychotics and neuroleptics, sequela

  • T43.595ABillable

    Adverse effect of other antipsychotics and neuroleptics, initial encounter

  • T43.595DBillable

    Adverse effect of other antipsychotics and neuroleptics, subsequent encounter

  • T43.595SBillable

    Adverse effect of other antipsychotics and neuroleptics, sequela