Guidelines › Code assignment and clinical criteria

Code assignment and clinical criteria

Official text from the FY2027 ICD-10-CM Official Guidelines for Coding and Reporting. The wording is quoted exactly.

Guidelines I.A.19

“The provider's statement that the patient has a particular condition is sufficient. Code assignment is not based on clinical criteria used by the provider to establish the diagnosis. If there is conflicting medical record documentation, query the provider.”

Where this applies

This is a general rule. It applies to code assignment everywhere, not to one code or group of codes.

Source: FY 2027 ICD-10-CM Official Guidelines for Coding and Reporting, effective October 1, 2026. Full Guidelines (PDF, CMS)