DVHA has completed its review of the unspecified diagnosis code list. The original list of unspecified diagnosis codes that DVHA would not accept has been modified.
Some codes are no longer on the list of “not accepted” BUT will not be allowed as a primary diagnosis. Most of the diagnosis codes that are not accepted are due to laterality: these 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.
The claims processing system edit that prevents those “not accepted” diagnosis codes from being on the claim will be effective 4/1/2020.
As of November 2019 there are Two Tabs!
- The updated list of diagnosis codes that are not accepted by VT Medicaid due to a lack of specificity (effective 4/4/2020)
- A list of unspecified diagnosis codes that are not allowed as the primary diagnosis code on the claim by VT Medicaid (effective 1/1/2020)