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 1 of 27 (2,651 total)
  • B95.0Billable

    Streptococcus, group A, as the cause of diseases classified elsewhere

  • B95.1Billable

    Streptococcus, group B, as the cause of diseases classified elsewhere

  • B95.2Billable

    Enterococcus as the cause of diseases classified elsewhere

  • B95.3Billable

    Streptococcus pneumoniae as the cause of diseases classified elsewhere

  • B95.4Billable

    Other streptococcus as the cause of diseases classified elsewhere

  • B95.5Billable

    Unspecified streptococcus as the cause of diseases classified elsewhere

  • B95.61Billable

    Methicillin susceptible Staphylococcus aureus infection as the cause of diseases classified elsewhere

  • B95.62Billable

    Methicillin resistant Staphylococcus aureus infection as the cause of diseases classified elsewhere

  • B95.7Billable

    Other staphylococcus as the cause of diseases classified elsewhere

  • B95.8Billable

    Unspecified staphylococcus as the cause of diseases classified elsewhere

  • B96.0Billable

    Mycoplasma pneumoniae [M. pneumoniae] as the cause of diseases classified elsewhere

  • B96.1Billable

    Klebsiella pneumoniae [K. pneumoniae] as the cause of diseases classified elsewhere

  • B96.20Billable

    Unspecified Escherichia coli [E. coli] as the cause of diseases classified elsewhere

  • B96.21Billable

    Shiga toxin-producing Escherichia coli [E. coli] [STEC] O157 as the cause of diseases classified elsewhere

  • B96.22Billable

    Other specified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere

  • B96.23Billable

    Unspecified Shiga toxin-producing Escherichia coli [E. coli] [STEC] as the cause of diseases classified elsewhere

  • B96.29Billable

    Other Escherichia coli [E. coli] as the cause of diseases classified elsewhere

  • B96.3Billable

    Hemophilus influenzae [H. influenzae] as the cause of diseases classified elsewhere

  • B96.4Billable

    Proteus (mirabilis) (morganii) as the cause of diseases classified elsewhere

  • B96.5Billable

    Pseudomonas (aeruginosa) (mallei) (pseudomallei) as the cause of diseases classified elsewhere

  • B96.6Billable

    Bacteroides fragilis [B. fragilis] as the cause of diseases classified elsewhere

  • B96.7Billable

    Clostridium perfringens [C. perfringens] as the cause of diseases classified elsewhere

  • B96.81Billable

    Helicobacter pylori [H. pylori] as the cause of diseases classified elsewhere

  • B96.82Billable

    Vibrio vulnificus as the cause of diseases classified elsewhere

  • B96.83Billable

    Acinetobacter baumannii as the cause of diseases classified elsewhere

  • B96.89Billable

    Other specified bacterial agents as the cause of diseases classified elsewhere

  • B97.0Billable

    Adenovirus as the cause of diseases classified elsewhere

  • B97.10Billable

    Unspecified enterovirus as the cause of diseases classified elsewhere

  • B97.11Billable

    Coxsackievirus as the cause of diseases classified elsewhere

  • B97.12Billable

    Echovirus as the cause of diseases classified elsewhere

  • B97.19Billable

    Other enterovirus as the cause of diseases classified elsewhere

  • B97.21Billable

    SARS-associated coronavirus as the cause of diseases classified elsewhere

  • B97.29Billable

    Other coronavirus as the cause of diseases classified elsewhere

  • B97.30Billable

    Unspecified retrovirus as the cause of diseases classified elsewhere

  • B97.31Billable

    Lentivirus as the cause of diseases classified elsewhere

  • B97.32Billable

    Oncovirus as the cause of diseases classified elsewhere

  • B97.33Billable

    Human T-cell lymphotrophic virus, type I [HTLV-I] as the cause of diseases classified elsewhere

  • B97.34Billable

    Human T-cell lymphotrophic virus, type II [HTLV-II] as the cause of diseases classified elsewhere

  • B97.35Billable

    Human immunodeficiency virus, type 2 [HIV 2] as the cause of diseases classified elsewhere

  • B97.39Billable

    Other retrovirus as the cause of diseases classified elsewhere

  • B97.4Billable

    Respiratory syncytial virus as the cause of diseases classified elsewhere

  • B97.5Billable

    Reovirus as the cause of diseases classified elsewhere

  • B97.6Billable

    Parvovirus as the cause of diseases classified elsewhere

  • B97.7Billable

    Papillomavirus as the cause of diseases classified elsewhere

  • B97.81Billable

    Human metapneumovirus as the cause of diseases classified elsewhere

  • B97.89Billable

    Other viral agents as the cause of diseases classified elsewhere

  • C80.2Billable

    Malignant neoplasm associated with transplanted organ

  • D47.Z1Billable

    Post-transplant lymphoproliferative disorder (PTLD)

  • D89.810Billable

    Acute graft-versus-host disease

  • D89.811Billable

    Chronic graft-versus-host disease

  • D89.812Billable

    Acute on chronic graft-versus-host disease

  • D89.813Billable

    Graft-versus-host disease, unspecified

  • D89.831Billable

    Cytokine release syndrome, grade 1

  • D89.832Billable

    Cytokine release syndrome, grade 2

  • D89.833Billable

    Cytokine release syndrome, grade 3

  • D89.834Billable

    Cytokine release syndrome, grade 4

  • D89.835Billable

    Cytokine release syndrome, grade 5

  • D89.839Billable

    Cytokine release syndrome, grade unspecified

  • E88.ABillable

    Wasting disease (syndrome) due to underlying condition

  • F05Billable

    Delirium due to known physiological condition

  • F06.70Billable

    Mild neurocognitive disorder due to known physiological condition without behavioral disturbance

  • F06.71Billable

    Mild neurocognitive disorder due to known physiological condition with behavioral disturbance

  • F07.0Billable

    Personality change due to known physiological condition

  • F07.89Billable

    Other personality and behavioral disorders due to known physiological condition

  • F17.200Billable

    Nicotine dependence, unspecified, uncomplicated

  • F17.201Billable

    Nicotine dependence, unspecified, in remission

  • F17.210Billable

    Nicotine dependence, cigarettes, uncomplicated

  • F17.211Billable

    Nicotine dependence, cigarettes, in remission

  • F17.220Billable

    Nicotine dependence, chewing tobacco, uncomplicated

  • F17.221Billable

    Nicotine dependence, chewing tobacco, in remission

  • F17.290Billable

    Nicotine dependence, other tobacco product, uncomplicated

  • F17.291Billable

    Nicotine dependence, other tobacco product, in remission

  • F52.9Billable

    Unspecified sexual dysfunction not due to a substance or known physiological condition

  • F81.9Billable

    Developmental disorder of scholastic skills, unspecified

  • G73.1Billable

    Lambert-Eaton syndrome in neoplastic disease

  • G92.00Billable

    Immune effector cell-associated neurotoxicity syndrome, grade unspecified

  • G92.01Billable

    Immune effector cell-associated neurotoxicity syndrome, grade 1

  • G92.02Billable

    Immune effector cell-associated neurotoxicity syndrome, grade 2

  • G92.03Billable

    Immune effector cell-associated neurotoxicity syndrome, grade 3

  • G92.04Billable

    Immune effector cell-associated neurotoxicity syndrome, grade 4

  • G92.05Billable

    Immune effector cell-associated neurotoxicity syndrome, grade 5

  • H16.9Billable

    Unspecified keratitis

  • H36.811Billable

    Nonproliferative sickle-cell retinopathy, right eye

  • H36.812Billable

    Nonproliferative sickle-cell retinopathy, left eye

  • H36.813Billable

    Nonproliferative sickle-cell retinopathy, bilateral

  • H36.819Billable

    Nonproliferative sickle-cell retinopathy, unspecified eye

  • H36.821Billable

    Proliferative sickle-cell retinopathy, right eye

  • H36.822Billable

    Proliferative sickle-cell retinopathy, left eye

  • H36.823Billable

    Proliferative sickle-cell retinopathy, bilateral

  • H36.829Billable

    Proliferative sickle-cell retinopathy, unspecified eye

  • H40.1210Billable

    Low-tension glaucoma, right eye, stage unspecified

  • H40.1211Billable

    Low-tension glaucoma, right eye, mild stage

  • H40.1212Billable

    Low-tension glaucoma, right eye, moderate stage

  • H40.1213Billable

    Low-tension glaucoma, right eye, severe stage

  • H40.1214Billable

    Low-tension glaucoma, right eye, indeterminate stage

  • H40.1220Billable

    Low-tension glaucoma, left eye, stage unspecified

  • H40.1221Billable

    Low-tension glaucoma, left eye, mild stage

  • H40.1222Billable

    Low-tension glaucoma, left eye, moderate stage

  • H40.1223Billable

    Low-tension glaucoma, left eye, severe stage

  • H40.1224Billable

    Low-tension glaucoma, left eye, indeterminate stage