tci ED Coding & Reimbursement Alert - 2019 Issue Q3

You Be the Coder: Manage Multiple Diagnoses

Question: We saw a patient who ended up having more than 12 diagnoses. Is there a way to report them all on a claim? The clearinghouse we use splits claims with multiple diagnoses and often duplicates procedure and office codes, which causes issues with payers. Tennessee Subscriber Answer: CMS modified form 1500 to support up to 12 diagnosis codes per claim to reduce paper and electronic claims from the splitting you describe. Twelve diagnosis codes are allowed per claim; however, only four diagnosis codes are allowed per line item for each individual procedure code. That means only four diagnosis...

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