[Virginia] Ensure inpatient facility claims have the correct primary diagnosis: non-reimbursable claims for unacceptable primary diagnosis (PDX) may require resubmission

By July 31, 2026: Billing team must implement a pre-submission review process for all inpatient facility claims to verify that the primary diagnosis code (PDX) is appropriate and reflects the primary reason for admission, not a secondary diagnosis. Review CMS ICD-10-CM coding and reporting guidelines to identify unacceptable PDX codes in your practice's common diagnoses. Configure billing system alerts to flag claims with potentially unacceptable PDX selections before submission. Train providers and coders on proper primary diagnosis sequencing. Educate providers to document the primary reason for admission clearly on encounter forms. After August 1, 2026, any inpatient claims denied for unacceptable PDX must be corrected using Availity.com (Help & Training → Find Help → search 'correct a claim') and resubmitted. Failure to correct PDX coding will result in claim denials with no reimbursement.