What happens to a claim that lacks an ICD-9 (or ICD-10-CM) code?

A claim that lacks an ICD-9 (or ICD-10-CM) code will be denied by the payer. This is because diagnoses must be accurately documented and coded to justify the medical necessity of the services rendered. The coding system is a critical component of the claim process, as it informs the payer about the reason for the visit and validates the treatment provided.

When a claim is submitted without a proper diagnosis code, it does not meet the necessary requirements for payment processing, leading to its denial. The payer relies on these codes to determine whether the services are covered under the patient's insurance plan. Since the claim lacks the requisite ICD code, it fails to convey the medical context needed for approval and reimbursement.

The other options suggest that the payer would either provide the code, call the practice for clarification, or that none of these actions would occur, but these scenarios are not standard practice within the billing and insurance realm. Instead, the immediate consequence of missing essential coding information is claim denial, emphasizing the importance of complete and accurate coding in the billing process.