Non-covered diagnosis codes mapping
Lists diagnosis codes considered non-covered or mapped between 'Commercial' and 'INTEGRITY' code sets for Neighborhood Health Plan of Rhode Island. Intended for use by billing and claims operations to determine non-covered diagnosis coding.
No material clinical or coverage changes in this revision.
Policy Summary
This document lists diagnosis codes that are designated non-covered and shows mappings between the Commercial and INTEGRITY code sets. It is intended for use by billing and claims operations and coding staff at Neighborhood Health Plan of Rhode Island to determine which diagnosis codes should not be used to bill covered services and how those codes are represented across the two code sets.
The policy subject is Non-covered diagnosis codes mapping, and the coverage stance for the listed code groups is not_covered. Billing and claims teams should use the mappings in this document to prevent improper claim adjudication.
Non-covered Diagnosis Mapping
Status: CURRENT. The following diagnosis codes and code-range mappings are designated non-covered and are provided for billing/claims operations and coding staff to apply during claims adjudication. Use the mapping guidance here to map or avoid these diagnosis codes in claims processing to prevent denial or incorrect payment.
| N46.01 to N46.9 | Commercial mapped to L80; INTEGRITY retains N46.01 to N46.9 |
| L80 | Commercial mapping target for N46.01-N46.9 |
| N52.9 | Commercial = N52.9; INTEGRITY = N52.9 |
| N97.0 to N97.9 | Commercial mapped to Z00.8; INTEGRITY retains N97.0 to N97.9 |
| Z00.8 | Commercial mapped to Z01.20; INTEGRITY = Z00.8 |
| Z01.20 | Commercial mapped to Z01.21; INTEGRITY = Z01.20 to Z01.21 |
| Z01.21 | Commercial mapped to Z02.1; INTEGRITY = Z01.3 |
| Z02.1 | Commercial mapped to Z02.3; INTEGRITY = Z02.1 |
| Z02.3 | Commercial mapped to Z02.71 to Z02.81; INTEGRITY = Z02.71 to Z02.79 |
| Z02.71 | Commercial mapped to Z02.83 to Z02.9; INTEGRITY = Z02.89 |
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