ICD codes are procedure and diagnosis codes used to identify diseases, symptoms, abnormal findings, complaints, social circumstances and external causes of injury or diseases, as classified by the World Health Organization (WHO).
Health care providers who are subject to the Health Insurance Portability and Accountability Act (HIPAA) must use ICD-10 codes for all professional and facility HIPAA transactions.
- All claims must include valid ICD-10 codes and be coded to the highest level of specificity known at the time of each health care encounter.
- Pre-authorization requests must use valid ICD-10 codes and/or descriptions, as applicable.
- Ensure that the appropriate Present on Admission (POA) indicator is included on the claim. Inpatient claims without the appropriate POA indicator will be denied. The Centers for Medicare & Medicaid Services provides additional coding details.
Steps to take for ICD-10 claims issues
- If the ICD-10 codes are valid, you have checked to make sure codes are mapped correctly, and you still have issues, contact our Provider Contact Center.
- If a claim is rejected by Availity as a non-compliant ICD-10 code, it will not be transmitted to us for processing. Your first point of verification for invalid code submission should be your denial reports from your vendor.