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Diagnosis Codes

An International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) code must be used to identify each patient's diagnosis or nature of illness or injury. A written diagnosis is not required when the code is given. Diagnosis codes are very important in making benefit determinations. They are used to evaluate whether or not services are medically necessary, if a condition is pre-existing, if Worker's Compensation is applicable, and for screening medical emergencies. Providers should use the most recent version of the ICD-9-CM coding book and should code to the highest level of specificity for the diagnosis.

Many offices are putting zeros to the right of the three digit codes to make it five digits. This can make the code invalid or change the intended meaning. Include five digits if the use of the extra digits can more specifically describe the diagnosis. Invalid diagnosis codes will not be accepted.

Last Updated January 2010