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Edit 00146
Primary/Principal Diagnosis Not on File
HIPAA Claim Adjustment Reason Code: 16
Remark Code: MA63
HIPAA Healthcare Claim Status Code: 254
Entity Identifier Code: N/A
Potential Causes:
Medicaid only accepts valid ICD-9-CM diagnosis codes. The 4th and 5th digit sub-classifications are required when indicated by the ICD-9-CM.
Solution:
Ensure the diagnosis entered is a valid diagnosis code and includes the 4th or 5th digit if required. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300 HI (Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = ICD-9-CM or 7999 |
| 837 Professional |
Loop 2300 HI (Health Care Diagnosis Code)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = Principal Diagnosis
And
Loop 2400 SV1 (Professional Service)
SV107-1 = Primary Diagnosis Code Pointer |
Note: Diagnosis Code: NYSDOH expects to receive the Primary Diagnosis Code pointer in Loop 2400, SV2, and SV107-1. NYSDOH will be unable to determine the appropriate Diagnosis Code without this pointer.
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