Diagnosis to Modifier Mismatch - Policy Update
Policy Update : POLDIMO060125
Effective Date: June 1, 2025
Current State: N/A
Future State: According to the ICD-10-CM manual guidelines, some diagnosis codes indicate laterality, specifying whether the condition occurs on the left or right, or is bilateral. The diagnosis-to-modifier comparison assesses the lateral diagnosis associated with the claim line to determine if the procedure modifier matches the lateral diagnosis.
Applicable Plan(s): Medicaid and Medicare
Applicable Policy: Policy Number: 3812
Business Owner: Cost of Care