Laboratory and Radiological Medicaid Claims Containing General ICD-9 Diagnostic Codes Will Deny

New York State Medicaid

Effective December 1, 2009, all orders for laboratory or radiology procedures must indicate the diagnosis by use of the appropriate ICD-9-CM code. Use of general ICD-9-CM codes such as those listed below or other non-specific codes does not satisfy this requirement. The following ICD-9 diagnosis codes are invalid as primary diagnosis codes for purposes of Medicaid reimbursement:

• V72.5 – Radiological examination, not elsewhere classified
• V72.6 – Laboratory examination

Claims submitted after December 1, 2009, with non-specific diagnoses will be denied.