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  1. CPT code must be used with at least one ICD-10-CM code referenced in the CPT the CPT ICD-10-CM Crosswalk Data Source.
  2. If CPT code has at least one referenced ICD-10-CM code, this edit returns no alert. Otherwise, the below steps are performed.
  3. At this step, we already know that the CPT code has no referenced ICD-10-CM code. Therefore, it will return an error or warning.
  4. If the CPT code belongs to Administration CPT Codes taken from Administration CPT Codes Data Source and the claim has at least one Trade Drug code (refer to the section How to identify Trade Drug Code): Frigg generates one warning for this CPT code. The warning description must refer to all ICD-10-CM codes available in the claim.
  5. Otherwise, Frigg  Greenrain MNC generates one error for this CPT code. The error description must refer to all ICD-10-CM codes available in the claim.

Below examples will help to understand different scenarios better.

Claim details:

  1. The claim has two procedures: C1 and C2.
  2. The claim has four diagnoses: D1, D2, D3 and D4.

Example 1:

  1. C1 is not referenced with any diagnoses.
  2. C2 can be used with D2.
  3. C1 is Administration CPT Codes.
  4. The claim has three drugs.
  5. Results: One warning is generated for C1. The warning message contains a description of D1, D2, D3 and D4.

Example 2:

  1. C1 is not referenced with any diagnosis.
  2. C2 can be used with D4.
  3. Results: One error is generated for C1. The error message contains a description of D1, D2, D3 and D4.

Example 3:

  1. C1 is not referenced with any diagnoses.
  2. C2 is not referenced with any diagnoses.
  3. Results:
    1. One error is generated for C1. The error message contains a description of D1, D2, D3 and D4.
    2. One error is generated for C2. The error message contains a description of D1, D2, D3 and D4.

Example 4:

  1. C1 can be used with D2.
  2. C2 can be used with D4.
  3. Results: No errors and no warnings.

Example 5:

  1. C1 is not referenced with any of the procedures.
  2. C2 is not referenced with any of the procedures.
  3. C1 and C2 are Administration CPT Codes.
  4. The claim has one drug.
  5. Results:
    1. One warning is generated for C1. The warning message contains a description of D1, D2, D3 and D4.
    2. One warning is generated for C2. The warning message contains a description of D1, D2, D3 and D4.

Example 6:

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  1. .

Edit ID: 10002

Error type: ERROR or WARNING

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  1. CPT code = 0110T.
  2. Principal ICD-10-CM code = Z99.81.
  3. The error message may does not refer to Administration CPT Codes.
Warning

CPT code 0110T may not be used with principal diagnosis code Z99.81.

DESCRIPTION

CPT code 0110T = Quantitative Sensory Testing (Qst), Testing And Interpretation Per Extremity; Using Other Stimuli To Assess Sensation

Principal diagnosis code Z99.81 = Dependence On Supplemental Oxygen

Error message example 2:

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  1. CPT code = 00910.
  2. Principal ICD-10-CM code = B95.3.
  3. Secondary ICD-10-CM code = M87.250.Principal diagnosis always goes first in the error message.
  4. The error message may does not refer to Administration CPT Codes.

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  1. CPT code = 9007F.
  2. Principal ICD-10-CM code = A02.22.
  3. Secondary ICD-10-CM codes = K71.51 and Y35.213D.Principal diagnosis always goes first in the error message.
  4. The error message may does not refer to Administration CPT Codes.

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  1. CPT code = 27006.
  2. Principal ICD-10-CM code = I69.969.
  3. Secondary ICD-10-CM codes = G45.9, Z11.4, T50.8X2D, R93.9 and Z85.230.
  4. Principal diagnosis always goes first in the error message.
  5. The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
  6. The last sentence contains a note regarding the 6th ICD-10-CM code.
  7. The error message may does not refer to Administration CPT Codes.

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  1. CPT code = 7010F.
  2. Principal ICD-10-CM code = I77.71.
  3. Secondary ICD-10-CM codes = D3A.010, C92.10, N60.01, R92.2, H02.003, C79.52, E83.59 and G40.009.Principal diagnosis always goes first in the error message.
  4. The error message shows the description of a maximum of 5 ICD-10-CM codes to save the size of the message.
  5. The last sentence contains a note regarding the 6th, 7th, 8th and 9th ICD-10-CM code.
  6. The error message may does not refer to Administration CPT Codes.

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  1. CPT code = 96372.
  2. Principal ICD-10-CM code = J20.9.
  3. Secondary ICD-10-CM codes = R05, J30.9.
  4. Claim also has drug code 0248-122107-1021.
  5. Principal diagnosis always goes first in the error message.
    The warning message may refer only refers to Administration CPT Codes.

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  1. CPT code = 96372.
  2. Principal ICD-10-CM code = J20.9.
  3. Claim also has drug codes 0138-163701-1161, 0070-141901-1171 and 0614-197201-1481.
  4. The warning message may refer only refers to Administration CPT Codes.

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