ICD-9

ICD-10

Principal Diagnosis Code

BK

ABK

Other Diagnosis Code

BF

ABF

If 2300.HI01-1 is not equal to "BK" or "ABK", the claim is rejected.

Receive 999R with:
IK403 = 7: "Invalid Code Value"

When there is more than one iteration of 2300.HI with HI01-1 = "BK" or "ABK" the claim is rejected.

Receive 999R with:
IK304 = 5: "Segment Exceeds Maximum Use"

If 2300 HI01-1 = "BK", then 2300.HI02-1 must be "BF"; otherwise the claim is rejected.

Note: this applies to occurrences HI02-1 thru HI12-1

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 255: "Diagnosis code"

If 2300 HI01-1 = "ABK", then 2300.HI02-1 must be "ABF"; otherwise the claim is rejected.

Note: this applies to occurrences HI02-1 thru HI12-1

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 255: "Diagnosis code"

When ISA15 = "P" and HI01-1 is not equal to "BK", the claim rejects.

Receive 999E with:
IK403 = I12: "Implementation Pattern Match Failure"

Receive 277CA with:
CSCC A7: "Acknowledgement /Rejected for Invalid Information…"
CSC 732: "Information submitted inconsistent with billing guidelines."
CSC 255: "Diagnosis Code"

If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "1" and 2300.HI01-1 is "BK" then 2300.HI01-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate; otherwise claim is rejected.

Note: code validation in CEMB regardless of pointer definition in SV107.

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 254: "Principal diagnosis code

If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "1" and 2300.HI01-1 is "ABK" then 2300.HI01-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If DTP02=RD8, use the "from" date to validate; otherwise claim is rejected.

Note: code validation in CEMB regardless of pointer definition in SV107.

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 254: "Principal diagnosis code"

If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "2" and 2300.HI02-1 is "BF" then 2300.HI02-2 must be a valid ICD-9-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-9-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate; otherwise claim is rejected.

Note: code validation in the CEMB and applies to occurrences HI02-2 thru HI12-2 regardless of the pointer definitions in SV107.

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 255: "Diagnosis code"

If 2400.SV107-1, SV107-2, SV107-3, or SV107-4 is "2" and 2300.HI02-1 is "ABF" then 2300.HI02-2 must be a valid ICD-10-CM Diagnosis code on the date in 2400.DTP03 when DTP01 = "472", based on the ICD-10-CM Diagnosis Code list table. If 2400.DTP02=RD8, use the "from" date to validate; otherwise claim is rejected.

Note: code validation in the CEMB and applies to occurrences HI02-2 thru HI12-2 regardless of the pointer definitions in SV107.

Receive 999A and 277CA with:
CSCC A7: "Acknowledgement/Rejected for Invalid Information…"
CSC 255: "Diagnosis code"