Diagnosis Code Master File

Diagnosis Code Master File

  1. What they are: ICD-10-CM diagnosis codes (not ICD-10-PCS) that describe why a test is medically necessary.
  2. Primary use: Paired with CPT/HCPCS on claims to support coverage, drive payer edits (NCD/LCD), frequency limits, and whether a test is diagnostic vs. screening.
  3. Who supplies them: The ordering provider. Labs typically transmit the supplied codes and should not change clinical diagnoses; ensure each CPT line is linked to an appropriate ICD-10-CM code.
  4. Common pitfalls: Unspecified/invalid codes, missing code-to-test linkage, using screening codes inappropriately, or codes that don’t match the specimen/clinical context—leading to denials.
  5. Best practices: Capture diagnosis at order entry, maintain diagnosis requirements per test, validate against CMS NCD/LCD and payer policies, educate ordering clients, and keep code sets current.

📘 Instructions

Complete all required fields, if you need to import a csv file with ICD-10 codes, please contact our support team.

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