Code to the highest level of specificity
A diagnosis code on the claim is a category code that needs more characters to be complete.
Usual causes
- Three- or four-character ICD-10 code used where a longer code exists.
- Unspecified code when the record documents the detail.
The fix
Code to the full number of characters from the documentation and resubmit.
Appeal or corrected claim?
Corrected claim.
Deadline to watch
Timely filing limit.
Exact limits are in your payer contract or provider manual. When in doubt, send the correction or appeal this week.
M81 in short
What does M81 mean?
A diagnosis code on the claim is a category code that needs more characters to be complete. The official X12 text reads: "You are required to code to the highest level of specificity."
What usually causes a M81 denial?
Three- or four-character ICD-10 code used where a longer code exists. Unspecified code when the record documents the detail.
How do I fix M81?
Code to the full number of characters from the documentation and resubmit.
Should I appeal M81 or send a corrected claim?
Corrected claim. Corrected claim.
What deadline applies to M81?
Timely filing limit.