PRINCIPAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10) OR CANNOT BE EXTERNAL CAUSE CODE

Rejection Message

PRINCIPAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10) OR CANNOT BE EXTERNAL CAUSE CODE

Rejection Details

This rejection indicates the claim was submitted with an invalid diagnosis (ICD-10) code.

The principal diagnosis cannot be an external cause. New edits had been placed for ICD-10 codes on 10/1/2016.

Resolution

1. Check the date of service.
2. Check an up to date ICD Code Book (or online code resource) to make sure ALL diagnosis codes submitted on the claim are valid for the date of service being billed.

Follow the instructions below to edit a diagnosis code:

1. Click Encounters > Track Claim Status. The Find Claim window opens.
2. Look for and double-click on the encounter that needs correcting. The Edit Claim window opens.
3. Double-click on the Encounter number. The Edit Encounter window opens.
4. Click the Diag cell with the invalid code and replace the diagnosis with a valid code.
   • To delete a diagnosis, select the diagnosis and click Delete on your keyboard.
5. Click Save & Rebill.

Then, resubmit all affected claims.

Tip: Most subscription levels include access to a free code scrubbing tool on the Encounter. Utilizing this feature for all encounters can help prevent code rejections.

Note: Kareo Support cannot provide coding assistance. Please contact your biller/coder with any CPT or ICD code questions.