Q/A: How Many Diagnosis Codes do I use?

April 15th, 2019 - Wyn Staheli, Director of Research
Categories:   Billing   Claims   Diagnosis Coding  
0 Votes - Sign in to vote or comment.

Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that?

Answer: More is not always better. You only need to include the code(s) which most appropriately describe the condition being treated. For example, if the patient has hypertension, but your assessment does not address their hypertension or the management of that condition, then do not include it on your claim. Likewise, if the condition will not alter your treatment/services provided, then do not include it on the claim. This is based on the ICD-10-CM Official Guidelines for Coding and Reporting which states that “all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management” should also be coded.

One more important thing to remember: if they were previously treated for a condition, but that condition no longer exists or affects the management of their CURRENT condition, do not include it. This can be problematic in some patient EHR systems which carry forward previous diagnoses to a new date of service. Be sure that you review the patient list and only include those conditions affecting the current treatment.

As for the question about having more than 12 diagnoses, in a chiropractic office, generally there really would not be a need to document that many diagnoses. However, if they have resolved conditions that were previously treated but that have not been billed, you could split the claim so that those are on a separate claim which would allow you to have space for more diagnosis codes to be reported.

###

Questions, comments?

If you have questions or comments about this article please contact us.  Comments that provide additional related information may be added here by our Editors.


Latest articles:  (any category)

Billing for Telemedicine in Chiropractic
January 14th, 2020 - Evan M. Gwilliam DC MBA BS CPC CCPC QCC CPC-I MCS-P CPMA CMHP
Many large private payers recognize the potential cost savings and improved health outcomes that telemedicine can help achieve, therefore they are often willing to cover it. While there are several considerations, there could be certain circumstances where telemedicine might apply to chiropractic care.
Non-Surgical Periodontal Treatment
January 14th, 2020 - Christine Taxin
AAP treatment guidelines stress that periodontal health should be achieved in the least invasive and most cost-effective manner. This is often accomplished through non-surgical periodontal treatment.Non-surgical periodontal treatment does have its limitations. When it does not achieve periodontal health, surgery may be indicated to restore periodontal health.SCALING AND ROOT PLANINGScaling ...
Q/A: Can Chiropractors Bill 99211?
January 14th, 2020 - Wyn Staheli, Director of Research
Can chiropractic offices bill code 99211? Technically it can be used by chiropractors, but in most instances, it is discouraged. Considering that 99211 is a low complexity examination for an established patient, this code is not really made for the physician to use. In fact, in 2021, changes are coming for this code...
Denials due to MUE Usage - This May be Why!
January 7th, 2020 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
CMS assigns Medically Unlikely Edits (MUE's) for HCPCS/CPT codes, although not every code has an MUE. MUE edits are used to limit tests and treatments provided to a Medicare patient for a single date of service or for a single line item on a claim form. It is important to understand MUE's are ...
CMS Report on QPP Shows Increasing Involvement
January 6th, 2020 - Wyn Staheli, Director of Research
MIPS 2018 participation increased according to the final report issued by CMS on January 6, 2020.
CPT 2020 Changes to Psychiatry Services
January 3rd, 2020 - Namas
As of January 1, 2020, CPT made changes to the health and behavior assessment and intervention codes (96150-96155) and therapeutic interventions that focus on cognitive function (97127). If you code and audit services in this category, you must pay close attention to the changes as they include the removal and ...
Medicare Changes Bilateral Reporting Rules for Certain Supplies
December 30th, 2019 - Wyn Staheli, Director of Research
DME suppliers must bill bilateral supplies with modifiers RT and LT on separate claim lines or they are being rejected.



About Codapedia by innoviHealth Contact Us Terms of Use Privacy Policy Advertise with Us

innoviHealth - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain)

Copyright © 2000-2020 innoviHealth Systems, Inc. - CPT® copyright American Medical Association