Client Management›Primary Diagnosis Code

Primary Diagnosis Code

Overview

The primary diagnosis code is commonly required for Medicaid patients, though this may vary depending on the state and program. During typical Medicaid client registration, the primary diagnosis code is entered and this data is automatically provided in data exports. Sometimes this code may need adjustment or double checking, particularly as the code list is typically updated annually around October 1st, and some codes may become outdated and no longer billable.

This article includes:

  • Assigning a Diagnosis Code
  • Confirming a Diagnosis Code
  • Diagnosis Code Rejections

Assigning a Diagnosis Code

New Client - Diagnosis Code Assignment

For new clients, the primary diagnosis code is typically added during the client registration process. Simply add the code in the appropriate field during registration.

Client Registration form showing the Personal Information section with fields for Client ID, Payer Descriptor, First Name, Middle Name, Last Name, Gender, Date of Birth, Client Status, Address, City, Country (set to USA), County, State/Province (set to Missouri), Zip/Postal Code, Phone, Email, and a highlighted red Primary Diagnosis Code field at the bottom.

Existing Client - Diagnosis Code Assignment

To assign a diagnosis code to an existing client, open the client's profile. On the main Information tab, click the Details subtab and enter the primary diagnosis code. Remember, this must be a code (such as I9) for billing purposes.

NOTE: If a text description is entered (such as Hypertension, Lung Cancer, Dementia, etc.), this will usually cause a billing issue.

The Client Detail page for "Test Client" displays contact information including primary phone 217-638-3032 and secondary phone as not set. The page includes tabs for Information, Authorize Units, Care Plans, Calendar, Calendar Pattern, Client Contact, Assigned Caregiver, Skills, Documents, and Notes, with a Client section showing Access/Other and Details sub-tabs and a Patient Details area containing a Primary Diagnosis Code field and Save Client Details button.

Confirming a Diagnosis Code

The code must be a billable code. Typically a billable code will be provided, but to confirm, check a verified list of diagnosis codes, such as https://www.icd10data.com/

It is important to remember that a code may be in the list but may no longer be billable. Be sure to click on the diagnosis code being researched for details. In the example below, one of these diagnosis codes for Parkinson's is billable, but the other is not.

ICD-10-CM diagnosis code G20.C detail page showing code information for "Parkinsonism, unspecified" with billable/specific code status and effective date of October 1, 2023. The page includes a breadcrumb navigation trail and key details about the code's usage for reimbursement purposes.

ICD-10-CM diagnosis code reference page for G20 (Parkinson's disease) showing year tabs from 2016-2024, with the 2024 tab highlighted as "Converted to Parent Code" and a red banner indicating it is a "Non-Billable/Non-Specific Code" with informational notes about reimbursement and code details.

Diagnosis Code Rejections

The first step in managing a diagnosis code rejection is to check whether the code is current and billable as described above.

If the code is billable, one of the following may have occurred:

  • The wrong diagnosis code was provided on the authorization (check in https://www.icd10data.com/ and then reach out to case manager/authorization source)
  • The diagnosis code was mistyped in Ankota (correct and re-send)
  • The diagnosis code was entered after the visit was billed and the rejection was received (re-send)
  • The authorization arrived prior to the state having updated its record with the new authorization (wait 2 weeks after authorization and re-submit)

Review and adjust as needed. If none of the above resolve the issue, reach out to Support for assistance.

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