TMPPM 2010 > Volume 1, General Information > Section 6: Claims Filing > Coding > Diagnosis Coding

   
 

6.3.1 Diagnosis Coding

Texas Medicaid requires providers to provide International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) diagnosis codes on their claims. The only diagnosis coding structure accepted by Texas Medicaid is the ICD-9-CM. Diagnosis codes must be to the highest level of specificity available. In most cases a written description of the diagnosis is not required. ICD-9-CM evaluation and management codes are not payable as a primary diagnosis.

All V-codes are acceptable as diagnoses except the following nonspecific codes:

D037
Diagnosis Codes

V0381

V0382

V0389

V039

V040

V041

V042

V043

V044

V045

V046

V047

V048

V0481

V0482

V0489

V050

V051

V052

V053

V054

V058

V059

V060

V061

V062

V063

V064

V065

V066

V068

V069

V070

V071

V078

V079

V1200

V1201

V1202

V1203

V1209

V121

V122

V1260

V1261

V1269

V1270

V1271

V1272

V1279

V1300

V1321

V1329

V133

V134

V1361

V1369

V137

V138

V139

V140

V141

V142

V143

V144

V145

V146

V147

V148

V149

V1501

V1502

V1503

V1504

V1505

V1506

V1507

V1508

V1509

V1541

V1542

V156

V157

V1581

V1582

V1584

V1585

V1586

V1587

V1588

V1589

V159

V160

V161

V162

V1640

V1641

V1642

V1643

V1649

V1651

V1659

V166

V167

V168

V169

V171

V172

V173

V174

V175

V176

V177

V1781

V1789

V1859

V200

V201

V202

V210

V211

V212

V2130

V2131

V2132

V2133

V2134

V2135

V218

V219

V260

V261

V2621

V2622

V2629

V2631

V2632

V2633

V2634

V2635

V2639

V264

V2641

V2649

V2651

V2652

V268

V2681

V2689

V269

V289

V426

V4281

V4282

V4283

V4284

V4289

V4574

V4575

V4576

V4577

V4578

V4579

V4586

V460

V4611

V4612

V4613

V4614

V462

V468

V469

V4981

V4982

V4983

V4984

V4985

V4989

V499

V500

V501

V503

V5041

V5042

V5049

V508

V509

V520

V521

V522

V523

V524

V528

V529

V534

V538

V539

V570

V5721

V5722

V574

V5781

V5789

V579

V582

V5830

V5831

V5832

V585

V589

V5901

V5902

V5909

V591

V592

V593

V594

V595

V596

V5970

V5971

V5972

V5973

V5974

V598

V599

V600

V601

V602

V603

V604

V605

V606

V609

V6110

V6111

V6112

V6120

V6129

V613

V6141

V6149

V616

V617

V618

V619

V620

V621

V623

V624

V625

V626

V6281

V6282

V6283

V6284

V6289

V629

V630

V631

V632

V638

V639

V650

V651

V6511

V6519

V652

V653

V6540

V658

V659

V665

V666

V667

V669

V680

V6801

V6809

V681

V682

V6881

V6889

V689

V690

V691

V692

V693

V694

V695

V698

V699

V700

V702

V703

V704

V706

V707

V708

V709

V7211

V7212

V7219

V729

V730

V731

V732

V733

V734

V735

V736

V7388

V7389

V7398

V7399

V740

V741

V742

V743

V744

V745

V746

V748

V749

V750

V751

V752

V753

V754

V755

V756

V757

V758

V759

V762

V763

V7641

V7642

V7643

V7644

V7645

V7646

V7647

V7649

V7650

V770

V771

V772

V773

V774

V775

V776

V777

V778

V780

V781

V782

V783

V788

V789

V801

V802

V803

V810

V811

V812

V813

V814

V815

V816

V8271

V8279

V8489

V8551

V8552

V8553

V8554

V860

V861

These nonspecific codes can be used for a general description but may not be referenced to a specific procedure code. Generally, V-codes are supplementary and are used only when the client's condition cannot be classified to categories 001 through 999. The use of observation diagnosis code V717 results in claim denial with explanation of benefits (EOB) 00543, "Documentation insufficient to verify medical necessity. Resubmit the claim with signed claim copy, R&S Report copy, and complete documentation of medical necessity."

Independent laboratories, pathologists, and radiologists are not required to provide diagnosis codes unless otherwise stated in other sections of this manual.


Texas Medicaid & Healthcare Partnership
CPT only copyright 2009 American Medical Association. All rights reserved.
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