Edit 02106

Primary Diagnosis Cannot be Billed

HIPAA Claim Adjustment Reason Code: 167
            Remark Code: M81
HIPAA Healthcare Claim Status Code: 254
            Entity Identifier Code: 85

Potential Causes:
The Primary Diagnosis code on the claim is flagged by the NYS Department of Health as a diagnosis that cannot be used as a primary diagnosis code.

Solution:
Check to ensure the diagnosis code entered on the claim as primary is correct. If the code is correct then an alternate code must be used. If an incorrect code was entered, correct the diagnosis code and re submit the claim.

837 Institutional

Loop 2300, HI (PRINCIPAL, ADMITTING, E-CODE AND PATIENT REASON FOR VISIT DIAGNOSIS INFORMATION) HI01-1 = BK (Qualifier for Principal Diagnosis) HI01 – 2 = Principal Diagnosis

837 Professional

Loop 2300, HI (HEALTH CARE DIAGNOSIS CODE) HI01-1 = BK (Qualifier for Principal Diagnosis) HI01 – 2 = Principal Diagnosis