principal diagnosis code is missing or invalid.

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nptnhnh
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principal diagnosis code is missing or invalid.

Post by nptnhnh » Mon Oct 05, 2015 8:09 pm

Hi, I am encountering bill submission issues. Rejected. Error messages are written exactly like these: Please help.
1. PRINCIPAL DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE (ICD-9, ICD-10){Z966441D}
2. SUPPLEMENTAl DIAGNOSIS CODE IS MISSING OR INVALID FOR DIAGNOSIS TYPE GIVEN (ICD-9, ICD-10) {R2689}

The codes were entered correctly in the medisoft V20 ; because I was able to use medicare software to send / transmit similar codes with no problems.

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Mon Oct 05, 2015 8:12 pm

Are these UB-04 or Institutional claims? Are these paper claims or electronic claims? How are you submitting them?
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nptnhnh
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Re: principal diagnosis code is missing or invalid.

Post by nptnhnh » Mon Oct 05, 2015 8:15 pm

Thanks for responding. No this is professional out patient cms 1500

nptnhnh
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Re: principal diagnosis code is missing or invalid.

Post by nptnhnh » Mon Oct 05, 2015 8:16 pm

electronic via capario

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Tue Oct 06, 2015 5:36 pm

Either you do not have Medisoft ICD-10 completely setup or you have the wrong iGuide in Revenue Management.
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nptnhnh
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Re: principal diagnosis code is missing or invalid.

Post by nptnhnh » Thu Oct 08, 2015 6:35 pm

Hi,
Thanks again. I had called Emdeon/ capario (the clearinghouse) and I was told that implementation was not properly set up, code list qualifier needs to be changed to icd 10 qualifier. My V20 was purchased from Medtech, I am hoping that I can have it re looked at or be told what needs be done.
I will appreciate your imput.
Thanks.

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Fri Oct 09, 2015 5:00 pm

We still don't know if you didn't set the ICD-10 cut-over date on the insurance (see the link above). If that is not it, I am pretty sure it is the iGuide. You will want to go to RM>Configuration>Receivers. In the transaction set you will want to select the MS19 5010 -Standard.

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Hulty
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Re: principal diagnosis code is missing or invalid.

Post by Hulty » Tue Dec 22, 2015 11:50 am

We had the same error recently.

"Principal diagnosis code is missing or invalid for diagnosis type given (ICD-9, 1CD-10) or cannot be external cause code"

We are using Medisoft Advanced v20 and using 5010 v19 Standard Revenue Management and had no issues after 10-1-2015.

What we discovered by viewing the EDI data is that the principal diagnosis (which was an ICD-10 diagnosis code) was not being label "ABK" but "BK" signifying that was a an ICD-9 diagnosis code.

How the hell did that happen when it's set up as an ICD-10 code in the diagnosis list and we configured only ICD-10 codes to be used the default code set in "Program Options"?

Answer? We added a new insurance company recently and despite the program option setting, ICD-9 format was being sent out in the EDI data for the diagnosis. It appears to be a glitch in v20.

Solution? You have to manually go into Lists>Insurance> Carriers > Options and Codes > and make sure you manually confirm ICD-10 is selected from the drop down as it defaults to ICD-9.
Medisoft Advanced V20

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Tue Dec 22, 2015 3:23 pm

If you have Medisoft Advanced or Network Pro, use the Set Default Option to default all new insurance carriers to ICD-10 with a 10/1/2015 effective date when you create them. On Medisoft Basic, you have to remember to set that each time you create a new insurance carrier.

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Tue Dec 22, 2015 3:26 pm

Whoops, it looks like the effective date won't default. I am putting an enhancement request in to McKesson.

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Hulty
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Re: principal diagnosis code is missing or invalid.

Post by Hulty » Sat Dec 26, 2015 8:42 am

Gavin, as you see, this appears to be a coding error in the program. We had ICD-10 set to 10/1/2015 as default for insurance carriers but it did not work. At least the fix is simple until a bug release comes out.
Medisoft Advanced V20

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Gavin Walker
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Re: principal diagnosis code is missing or invalid.

Post by Gavin Walker » Tue Dec 29, 2015 4:11 pm

I thought you said you had to select ICD-10 and the cut-over date on the insurance. If that is not it, what did you do to fix this? If you have ICD-9 set on the insurance, then the old diagnosis code scheme is used and no mapping is performed. ICD-9 codes will be indicated on the electronic claims.

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