Reason Code Narrative

THE DIAGNOSIS CODE ON THIS CLAIM IS INVALID. PLEASE VERIFY BILLING AND IF APPROPRIATE, CORRECT.

Common Reason Code Errors

• One of diagnosis code listed in UB04 FL 66–69 or electronic equivalent is not valid.
• One of diagnosis code listed in UB04 FL 66–69 or electronic equivalent is not valid for date of service being billed.
• One of diagnosis code listed in UB04 FL 66–69 or electronic equivalent is not left justified.

Common Reason Code Corrections

• Verify that diagnosis codes being billed are valid for date of service. Verify that they are left justified and resubmit claim. Providers with Direct Data Entry (DDE) can PF9 the claim once corrections are made.

Resources

• CMS Definitions of Medicare Code Edits
• CMS Integrated Outpatient Code Editor (IOCE)

View reason code list, return to Reason Code Guidance page.