Noridian has observed an increase in claims submitted with unspecified diagnosis codes when more specific diagnosis information may be available.

Providers, coders, and billing staff are reminded that ICD-10-CM coding conventions require reporting diagnoses to the highest level of specificity supported by the medical record. When clinical documentation identifies a more specific condition, including laterality (right, left, or bilateral) or other available diagnostic detail, the corresponding specific diagnosis code should be reported on the claim.

While there are circumstances in which a definitive diagnosis cannot be determined, unspecified diagnosis codes should be used only when the medical record does not support a more specific code assignment.

Submitting diagnosis codes that accurately and specifically reflect the patient's condition helps support efficient claims processing and accurate payment. Use of unspecified diagnosis codes when more specific information is available may result in claim processing delays, requests for additional information, or potential impacts to claim adjudication.

Noridian encourages providers to review their documentation, coding, and billing practices to help ensure that diagnosis codes are reported at the highest level of specificity supported by the medical record.

Thank you for your attention to this reminder and for your continued efforts to submit complete and accurate claims.

Contractor Medical Directors

Noridian Healthcare Solutions