Required when External Codes DC032 is External Source 8 - within the Code ICD Diagnosis Report the ICD Diagnosis Code when DC 62 11/8/12 International varchar[7] ranges of 1% B Code Source Code applicable Classification of 8 - Text Diseases or D9220 or D9221 International Required Lookup Report the value that defines whether the ICD Classification when DC 63 11/8/12 Table - tlkpICDIndicator int[1] diagnoses on claim are ICD9 or ICD10. 100% B Indicator of Diseases is Integer EXAMPLE: 9 = ICD9 version populated Value Description 9 ICD-9 0 ICD-10 Required Lookup Report the value that defines the element. Denied Denied when DC 64 11/8/12 - int[1] EXAMPLE: 1 = Yes, Claim Line was 100% A0 Flag Line Indicator DC031 = Integer denied. 04 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable Carrier Defined External Code Table - Source 16 - Report the code that defines the reason for Required Denial OR - Reason Codes Denial Reason denial of the claim line. Carrier must submit DC 65 11/8/12 varchar[20] when 98% A2 Reason External OR Code denial reason codes in separate table to the – DC063 = 1 Code Carrier Defined APCD. Source Table - 16
DC 62 Code 11/8/12 External Code Source 8 - Text External Codes Source 8 - International Classification of Diseases varchar[7] ICD Diagnosis Code Report the ICD Diagnosis Code when applicable Required when DC032 is within the ranges of or D9220 or D9221 1% B DC 63 ICD Indicator 11/8/12 Lookup Table - Integer tlkpICDIndicator int[1] International Classification of Diseases version Report the value that defines whether the diagnoses on claim are ICD9 or ICD10. EXAMPLE: 9 = ICD9 Required when is populated 100% B Value Description 9 ICD-9 0 ICD-10 DC 64 Denied Flag 11/8/12 Lookup - Integer int[1] Denied Line Indicator Report the value that defines the element. EXAMPLE: 1 = Yes, Claim Line was denied. Required when DC031 = 04 100% A0 Value Description 1 Yes 2 No 3 Unknown 4 Other 5 Not Applicable DC 65 Denial Reason 11/8/12 Carrier Defined Table - OR - External Code Source 16 External Code Source 16 - Reason Codes OR – Carrier Defined Table - varchar[20] Denial Reason Code Report the code that defines the reason for denial of the claim line. Carrier must submit denial reason codes in separate table to the APCD. Required when DC063 = 1 98% A2
v5-apcd-dental-claim-file-submission-guide-REDLINE.docx