CO-167
This diagnosis is not covered — missing/incomplete/invalid diagnosis
What This Code Means
The diagnosis code submitted is not covered for the billed service, or is missing/invalid.
Common Causes
- ICD-10 code doesn't match payer coverage policy for the CPT
- Diagnosis code truncated or invalid for date of service
- Diagnosis pointer on claim doesn't align with documentation
How to Resolve or Appeal
- Cross-check ICD-10 code validity for the date of service
- Confirm the diagnosis supports medical necessity per payer policy
- Correct and resubmit as a corrected claim
- Query the provider if documentation doesn't support a covered diagnosis
Educational reference only — not medical or legal advice. Always confirm code usage and appeal rights with the specific payer.