All PlansBilling CodesHigh impact
Improving Specificity in ICD-10-CM Diagnosis Coding
Healthfirst·Coding
Effective date
Dec 1, 2023
We identified it
Jun 20, 2026
Summary
Healthfirst is ending its grace period for invalid ICD-10-CM diagnosis codes that don't meet CMS specificity requirements. Claims with these invalid codes will be rejected starting December 1, 2023, whereas they were previously approved during the grace period.
Action Required
By December 1, 2023: Billing team must review all 99 pages of invalid ICD-10-CM diagnosis codes listed in this policy and update billing system to flag these codes. Replace invalid codes with more specific alternatives that meet CMS requirements. Update encounter forms and EMR templates to remind providers to document diagnosis codes to the highest level of specificity. Claims using these invalid codes will be rejected after the deadline.