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- If the claim has a CPT code related to maternity, then it must have at least one diagnosis related to maternity too. It can be either the principal or a secondary diagnosis. Otherwise, this edit raises an error for every maternity CPT code.
- If the claim has an ICD-10-CM related to maternity, then we expect it also has must have at least one CPT code related to maternity too. However, the hospital can report maternity for reporting purposes only. Therefore, if the claim has no CPT related to maternity, this Edit edit raises a warning for every maternity ICD-10-CM code.
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- CPT code = 89290.
- Principal ICD-10-CM code = C50.119.
- Secondary ICD-10-CM code = E28.1.
- Secondary ICD-10-CM code = Q51.11.
- Principal diagnosis always goes first in the error message.
| Warning |
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CPT code 89290 is related to maternity. Therefore, the claim would have at least one diagnosis related to maternity too. DESCRIPTION CPT code 89290 = Biopsy, Oocyte Polar Body Or Embryo Blastomere, Microtechnique (For Pre-Implantation Genetic Diagnosis); Less Than Or Equal To 5 Embryos Principal diagnosis code C50.119 = Malignant neoplasm of central portion of unspecified female breast Secondary diagnosis code E28.1 = Androgen excess Secondary diagnosis code Q51.11 = Doubling of uterus with doubling of cervix and vagina with obstruction |
Warning message example 2:
This example is provided for the following scenario:
- Secondary ICD-10-CM code = O00.2.
- CPT code = 57505.
- CPT code = 81215.
- CPT code = 84830.
- CPT code = 00950.
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- CPT code = 81512.
- Principal ICD-10-CM code = A18.18.
- Secondary ICD-10-CM code = C50.111, D07.30, E28.310, G43.821 and N77.1.Principal diagnosis always goes first in the error message.
- The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
- The last sentence contains a note regarding the 6th ICD-10-CM code.
| Warning |
|---|
CPT code 81512 is related to maternity. Therefore, the claim would have at least one diagnosis related to maternity too. DESCRIPTION CPT code 81512 = Fetal Congenital Abnormalities, Biochemical Assays Of Five Analytes (Afp, Ue3, Total Hcg, Hyperglycosylated Hcg, Dia) Utilizing Maternal Serum, Algorithm Reported As A Risk Score Principal diagnosis code A18.18 = Tuberculosis of other female genital organs Secondary diagnosis code C50.111 = Malignant neoplasm of central portion of right female breast Secondary diagnosis code D07.30 = Carcinoma in situ of unspecified female genital organs Secondary diagnosis code E28.310 = Symptomatic premature menopause Secondary diagnosis code G43.821 = Menstrual migraine, not intractable, with status migrainosus Note: refer to the coding documentation for a description of secondary diagnosis code N77.1. |
Owner object: Diagnosis / Activity
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