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December 2016 Texas Medicaid Provider Procedures Manual

Section 6: Claims Filing : 6.3 Coding : 6.3.1 Diagnosis Coding

Texas Medicaid requires providers to provide International Classification of Diseases, Tenth Revision, Clinical Modification (ICD‑10‑CM) diagnosis codes on their claims. The only diagnosis coding structure accepted by Texas Medicaid is the ICD‑10‑CM. Diagnosis codes must be to the highest level of specificity available. In most cases a written description of the diagnosis is not required.
All diagnosis codes that are submitted on a claim must be appropriate for the age of the client as identified in the ICD‑10‑CM description of the diagnosis code. Claims that are denied because one or more of the diagnosis codes submitted on the claim are not appropriate for the age of the client may be appealed with the correct diagnosis code or documentation of medical necessity to justify the use of the diagnosis code.
Diagnosis codes in the following categories are not valid as primary or referenced diagnosis:

Texas Medicaid & Healthcare Partnership
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