​​Enhanced Claim Editor Program: Secondary diagnosis codes​

May 8, 2023

​AmeriHealth HMO, Inc.  and AmeriHealth Insurance Company of New Jersey (AmeriHealth) follow ICD-10-CM guidelines to identify certain diagnosis codes that cannot be reported as the first-listed or primary diagnosis. In other words, they are secondary-only diagnosis codes.

Secondary diagnosis codes are intended to be used as a supplement to the primary ones to indicate additional information such as a manifestation of an underlying condition or an external cause of morbidity.

Some examples of secondary-only codes are:

  • Manifestation codes
  • External causes (i.e., "V – Y" codes) 
  • Codes from category Z15 Genetic susceptibility to disease
  • Sequela (7th character "S") codes

Because they are only used as additional codes, any claim received with a secondary diagnosis code as the first-listed or primary diagnosis will be denied as incorrectly coded.

The AmeriHealth Enhanced Claim Editing Program supports our commitment to ensure compliance with reporting requirements and guidelines endorsed by national and regional industry sources.

We continue to evaluate and review our claim payment policies, industry standard sources, and specialty societies to identify additional claim edits and make changes where necessary.​


For questions about the enhanced claim editing process, review our Enhanced Claim Editor Program: Frequently asked questions (FAQ). If you still have questions after reviewing these resources, please send an email to ahclaimeditquestions@amerihealth.com.