Smart Edit Tip: NPD Flag

The NPD system rule identifies claim lines that contain a diagnosis code that has been identified as not appropriate as a primary diagnosis. The purpose of this article is to assist Medicare Part B providers in understanding NDP ‘Smart Edit’ flag verbiage. If you receive this edit, you should review the ICD-9-CM Official Guidelines for Coding and Reporting to ensure proper sequencing of diagnosis codes. ICD-9-CM codes that are secondary diagnosis codes only should not be submitted as a primary diagnosis code at the detail level. The primary diagnosis code for the service should be reported at the detail level. When using the CMS 1500 form, the diagnosis pointer dictates the primary code for a particular line.