ICD-10-CM coding rules: Medicare Code Edits

The sex conflict edit was deactivated 10/01/2024 and no longer ships code lists.

• Perinatal/Newborn diagnoses (42 codes): Age conflict edit. These diagnoses occur only during the perinatal or newborn period, so the Medicare Code Editor flags them on any record where the patient is not age 0.
• Pediatric diagnoses (age 0 through 17) (125 codes): Age conflict edit. These diagnoses are clinically expected only in patients age 0 through 17.
• Maternity diagnoses (age 9 through 64) (2,543 codes): Age conflict edit. These diagnoses are clinically expected only in patients age 9 through 64.
• Adult diagnoses (age 15 through 124) (856 codes): Age conflict edit. These diagnoses are clinically expected only in patients age 15 through 124.
• Manifestation codes as principal diagnosis (422 codes): Manifestation codes describe the manifestation of an underlying disease, not the disease itself, and are not allowed as principal diagnosis.
• Questionable admission (30 codes): Some diagnoses are not usually sufficient justification for admission to an acute care hospital when reported as principal diagnosis.
• Unacceptable principal diagnosis (2,651 codes): These codes describe a circumstance which influences care but is not a current illness or injury, or capture only an underlying condition, and are unacceptable as principal diagnosis.
• Unspecified code (laterality) (3,465 codes): Unspecified codes for which a more specific code identifying laterality (right, left, bilateral) exists within the same code family.