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2020 ICD-10-CM (Diagnosis) Codes

DVHA’s Coding Team and Clinical Operations Unit has performed a review of the ICD-10-CM diagnosis code restrictions in the claims adjudication system.

Your use of ICD-10-CM Diagnosis Codes could cause your claims to deny due to two primary reasons:

1. The ICD-10-CM Diagnosis Code is not allowed as the Primary Diagnosis on the claim.

These diagnosis codes are often unspecified and will not be accepted on claims in the primary diagnosis position, but may be appropriate to report in a secondary position.
This list was updated on the website on July 31, 2020.

2. The ICD-10-CM Diagnosis Code is not allowed to be reported to Vermont Medicaid due to a lack of specificity related to laterality.

These diagnosis codes have a choice for left, right, bilateral, and unspecified… but the unspecified code will not be accepted on claims in any diagnosis position.  You should choose the most specific code outlined in the medical record. If the provider did not specify in the medical record, please reach out to the provider to specify and amend the record.

Questions?  Please contact your DXC Provider Representative.


ICD-10-CM Diagnosis Code Restrictions
Please note that there are two tabs on the spreadsheet.

December 2020

November 2020

October 2020

September 2020

August 2020

July 2020 (updated 7/31/20)

June 2020

May 2020

April 2020

March 2020

February 2020

January 2020