Chapter IV: Inquiries Submenu (01)
DX Proc Codes ICD-10 (1B)
Purpose
The purpose of the DX/PROC CODES ICD-10 option is to provide a reference of ICD-10 code(s) used to identify a specific or various diagnosis codes or inpatient surgical procedure codes relating to the bill. These codes may be used to calculate payment (e.g., DRG) or make medical determinations relating to the claim.
Note: Claims submitted via DDE must contain ICD-10 codes for dates of discharge/through dates on or after 10/1/2015. Claims submitted containing ICD-9-CM codes for dates of discharge/through dates on or after 10/1/2015, will be RTPd.
Note: This option is for inquiry purposes only. Reporting of any ICD-10 diagnosis or procedure code listed in this option does not guarantee the code will be accepted/reimbursed by Medicare.
Note: For more information about ICD-10, refer to the CMS website.
To access the DX/PROC CODES ICD-10 option from the FISS Online Inquires submenu, type ‘1B’ at the Enter Menu Selection: prompt and press the <Enter> key.
Upon selecting the DX/PROC CODES ICD-10 option, the ICD-10-CM Code Inquiry Screen is available:
Press the <Enter> key to display a complete list of ICD-10 diagnosis and procedure codes available in the system, starting with procedure code BB0DZZZ.
To research a specific ICD-10-CM diagnosis code, type ‘D’ in the DIAG/PROC: field, and type the diagnosis code in the STARTING ICD 10 CODE: field, then press the <Enter> key. The ICD-10-CM CODE INQUIRY screen will refresh to provide details for diagnosis codes (listed in increasing alphanumeric order, starting with the diagnosis code being researched).
In the example included below, ICD-10-CM diagnosis code N17.0 is displayed.
| Field | Description |
|---|---|
| DIAG/PROC: | Allows the user to designate whether you are researching an ICD-10 diagnosis or procedure code (one-position alphabetic field) Valid Values: D ‑ Diagnosis code being researched P ‑ Procedure code being researched |
| STARTING ICD 10 CODE: | Starting ICD-10 Code ‑ Allows the user to research a specific ICD-10 code (seven-position alphanumeric field) |
| D/P | Identifies whether or not an ICD-10 diagnosis or procedure code is shown (one-position alphabetic field) Valid Values: D ‑ Diagnosis code shown P ‑ Procedure code shown |
| ICD 10 CODE | Identifies the ICD-10 Code (seven-position alphanumeric field) |
| SEQ CODE | Identifies the Number Of Times CMS Has Terminated And Then Reactivated A Given ICD-10 Code with a different meaning (two-position numeric field) |
| DESCRIPTION | Identifies the Description for the ICD-10 code (60-position alphanumeric field) |
| EFFECTIVE DATE | Identifies the Effective Date of the Medicare Code Editor program (six-position numeric field in MMDDYY format) |
| TERM DATE | Identifies the Termination Date, in which Medicare Code Editor was no longer in effect (six-position numeric field in MMDDYY format) |
To research a specific ICD-10-CM procedure code, type ‘P’ in the DIAG/PROC: field, and type the procedure code in the STARTING ICD 10 CODE: field, then press the <Enter> key. The ICD-10-CM CODE INQUIRY screen will refresh to provide details for procedure codes (listed in increasing alphanumeric order, starting with the procedure code being researched).
In the example included below, ICD-10-CM procedure code BD24YZZ is displayed:
| Field | Description |
|---|---|
| DIAG/PROC: | Allows the user to designate whether you are researching an ICD-10 diagnosis or procedure code (one-position alphabetic field) Valid Values: D - Diagnosis code being researched P ‑ Procedure code being researched |
| STARTING ICD 10 CODE: | Starting ICD-10 Code - Allows the user to research a specific ICD-10 code (seven-position alphanumeric field) |
| D/P | Identifies whether or not an ICD-10 diagnosis or procedure code is shown (one-position alphabetic field) Valid Values: D ‑ Diagnosis code shown P ‑ Procedure code shown |
| ICD 10 | Identifies the ICD-10 Code (seven-position alphanumeric field) |
| SEQ CODE | Identifies the Number Of Times CMS Has Terminated And Then Reactivated A Given ICD-10 Code with a different meaning (two-position numeric field) |
| DESCRIPTION | Identifies the Description for the ICD-10 code (60-position alphanumeric field) |
| EFFECTIVE DATE | Identifies the Effective Date of the Medicare Code Editor program (six-position numeric field in MMDDYY format) |
| TERM DATE/td> | Identifies the Termination Date, in which Medicare Code Editor was no longer in effect (six-position numeric field in MMDDYY format) |
Revised 8/16/2023