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Comment: Examples 8 and 9 are added.

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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 in NCD Crosswalk, this edit returns no alert. Otherwise, the below steps are performed.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.
  3. 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 ICDhas all referenced ICD-10-CM codes available in the claimin LCD Crosswalk only, this edit returns warnings.
  4. 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
titleError Alert Example

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.
Warning
titleError Alert Example

CPT code 00910 may not be used with diagnosis codes B95.3 and M87.250.

DESCRIPTION

CPT code 00910 = Anesthesia For Transurethral Procedures (Including Urethrocystoscopy); Not Otherwise Specified

Principal diagnosis code B95.3 = Streptococcus Pneumoniae As The Cause Of Diseases Classified Elsewhere

Secondary diagnosis code M87.250 = Osteonecrosis Due To Previous Trauma, Pelvis

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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.
Warning
titleError Alert Example

CPT code 9007F may not be used with diagnosis codes A02.22, K71.51 and Y35.213D.

DESCRIPTION

CPT code 9007F = Other Carotid Stenosis: Ipsilateral Tia Or Stroke 120 Days Or Greater Prior To Procedure Or Any Prior Contralateral Carotid Territory Or Vertebrobasilar Tia Or Stroke (Nma-No Measure Associated)

Principal diagnosis code A02.22 = Salmonella Pneumonia

Secondary diagnosis code K71.51 = Toxic Liver Disease With Chronic Active Hepatitis With Ascites

Secondary diagnosis code Y35.213D = Legal Intervention Involving Injury By Tear Gas, Suspect Injured, Subsequent Encounter

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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.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 ICD-10-CM code.
  6. The error message may does not refer to Administration CPT Codes.
Warning
titleError Alert Example

CPT code 27006 may not be used with diagnosis codes I69.969, G45.9, Z11.4, T50.8X2D, R93.9 and Z85.230.

DESCRIPTION

CPT code 27006 = Tenotomy, Abductors And/Or Extensor(S) Of Hip, Open (Separate Procedure)

Principal diagnosis code I69.969 = Other Paralytic Syndrome Following Unspecified Cerebrovascular Disease Affecting Unspecified Side

Secondary diagnosis code G45.9 = Transient Cerebral Ischemic Attack, Unspecified

Secondary diagnosis code Z11.4 = Encounter For Screening For Human Immunodeficiency Virus [Hiv]

Secondary diagnosis code T50.8X2D = Poisoning By Diagnostic Agents, Intentional Self-Harm, Subsequent Encounter

Secondary diagnosis code R93.9 = Diagnostic Imaging Inconclusive Due To Excess Body Fat Of Patient

Note: refer to the coding documentation for a description of secondary diagnosis code Z85.230.

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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.
Warning
titleError Alert Example

CPT code 7010F may not be used with diagnosis codes I77.71, D3A.010, C92.10, N60.01, R92.2, H02.003, C79.52, E83.59 and G40.009.

DESCRIPTION

CPT code 7010F = Patient Information Entered Into A Recall System That Includes: Target Date For The Next Exam Specified And A Process To Follow Up With Patients Regarding Missed Or Unscheduled Appointments (Ml)

Principal diagnosis code I77.71 = Dissection Of Carotid Artery

Secondary diagnosis code D3A.010 = Benign Carcinoid Tumor Of The Duodenum

Secondary diagnosis code C92.10 = Chronic Myeloid Leukemia, Bcr/Abl-Positive, Not Having Achieved Remission

Secondary diagnosis code N60.01 = Solitary Cyst Of Right Breast

Secondary diagnosis code R92.2 = Inconclusive Mammogram

Note: refer to the coding documentation for a description of secondary diagnosis codes H02.003, C79.52, E83.59 and G40.009.

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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.Principal diagnosis always goes first in the error message.
  5. The warning message may refer only refers to Administration CPT Codes.
Info
titleWarning Alert Example

CPT code 96372 may not be used with diagnosis codes J20.9, R05 and J30.9. However, CPT code 96372 is the administration code that might be used for drug code 0248-122107-1021.

DESCRIPTION

CPT code 96372 = Therapeutic, Prophylactic, Or Diagnostic Injection (Specify Substance Or Drug); Subcutaneous Or Intramuscular

Principal diagnosis code J20.9 = Acute Bronchitis, Unspecified

Secondary diagnosis code R05 =Cough

Secondary diagnosis code J30.9 = Allergic Rhinitis, Unspecified

...

  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.
Info
titleError Alert Example

CPT code 96372 may not be used with diagnosis codes J20.9, R05 and J30.9. However, CPT code 96372 is the administration code that might be used for drug codes 0138-163701-1161, 0070-141901-1171 and 0614-197201-1481.

DESCRIPTION

CPT code 96372 = Therapeutic, Prophylactic, Or Diagnostic Injection (Specify Substance Or Drug); Subcutaneous Or Intramuscular

Principal diagnosis code J20.9 = Acute Bronchitis, Unspecified

Example 8:

This example is provided for the following codes:

  1. CPT code = 99244.
  2. Principal ICD-10-CM code = J30.9.

Result: Greenrain MNC does not raise any alert for this example because CPT code 99244 is E&M code.

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Warning message example 9:

This example is provided for the following codes:

  1. CPT code = 0213T.
  2. Principal ICD-10-CM code = M46.81.
  3. The warning message is returned because this combination does not exist in the NCD Crosswalk, but it exists in the LCD Crosswalk.
Info
titleWarning Alert Example

CPT code 0213T may not be used with principal diagnosis code M46.81 because this combination does not exist in the NCD Crosswalk. However, this combination exists in the LCD Crosswalk.

DESCRIPTION

CPT code 0213T = Injection(S), Diagnostic Or Therapeutic Agent, Paravertebral Facet (Zygapophyseal) Joint (Or Nerves Innervating That Joint) With Ultrasound Guidance, Cervical Or Thoracic; Single Level

Principal diagnosis code M46.81 = Other Specified Inflammatory Spondylopathies, Occipito-Atlanto-Axial Region

Owner object: Activity

Owner object property name: Code

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