ICD-10-CM
Coding rules & edit lists
Code lists from the Medicare Code Editor, MS-DRG definitions and the official code set. These are the edits that make inpatient claims reject or pend.
- Billable / specific codes74,879Codes specific enough to report on a claim.
- Non-billable / header codes23,524Category and subcategory headers that need more characters before they can be reported.
- MCC codes (major complication or comorbidity)3,356Secondary diagnoses that raise an inpatient stay to the highest-severity MS-DRG in a family, unless excluded for the principal diagnosis.
- CC codes (complication or comorbidity)15,083Secondary diagnoses that raise an inpatient stay to the middle-severity MS-DRG in a family, unless excluded for the principal diagnosis.
- Newborn (perinatal) codes42Diagnoses the Medicare Code Editor expects only for patients age 0.
- Pediatric codes126Diagnoses the Medicare Code Editor expects only for patients age 0 through 17.
- Maternity codes2,587Diagnoses the Medicare Code Editor expects only for patients age 9 through 64.
- Adult codes857Diagnoses the Medicare Code Editor expects only for patients age 15 through 124.
- Female-only diagnosis codes3,431Diagnoses consistent only with female patients.
- Male-only diagnosis codes529Diagnoses consistent only with male patients.
- Manifestation codes422Codes that describe a manifestation of an underlying disease. They can't be reported as the principal diagnosis; code the underlying condition first.
- Questionable admission codes30Diagnoses not usually sufficient to justify an inpatient admission when reported as the principal diagnosis.
- Unacceptable principal diagnosis codes2,667Codes that describe a circumstance influencing health status rather than a current illness, so they are unacceptable as the principal diagnosis for an inpatient stay.
- Unspecified codes with more specific options3,476Unspecified codes (usually laterality) for which a more specific code exists. The MCE flags these for review on inpatient claims.
- POA exempt codes38,399Diagnoses exempt from present-on-admission (POA) indicator reporting.