Reporting manifestation diagnosis codes

The January Integrated Outpatient Code Editor (IOCE) expands editing related to manifestation diagnosis codes and reporting them in the principal diagnosis code position to all outpatient prospective payment system (OPPS) and non-OPPS claims. 

A diagnosis code that is considered a manifestation code from the Medicare Code Editor (MCE) that is reported as the principal diagnosis code, (DIAG CODES 01) field, will be returned to provider with reason code W7A86. 

• Reason code narrative for W7A86:
  • A diagnosis code that is considered a manifestation code from the MCE is reported as the principal diagnosis code, DIAG CODE 01. Claims will be returned to provider. Diagnosis codes identified as manifestations, are conditions that describe the symptoms of an underlying disease and not the disease itself. These codes are typically identified with "in diseases classified elsewhere" in the code description. Refer to the Definition of MCE on the CMS website for complete listing of manifestation codes: MS-Diagnosis Related Group (DRG) Definitions Manual and Software page.       

Diagnosis codes identified as manifestations, are conditions that describe the symptoms of an underlying disease and not the disease itself. These codes are typically identified with "in diseases classified elsewhere" in the code description.  

Resolution

• Verify principal diagnosis code:
  • Refer to the appropriate version “Definition of MCE” on the CMS website for a complete listing of diagnosis codes that are considered manifestation codes in the MS-DRG classifications and software
• Move the manifestation diagnosis code to a different diagnosis position on the claim.    

Please correct and resubmit claims returned with reason code W7A86.