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)

RT and LT Modifier Usage Change (effective 2019-03-01)
May 21st, 2019 - Chris Woolstenhulme, QCC, CMCS, CPC, CMRS
According to Noridian Medicare, there are new changes required when reporting the RT and LT modifier(s). In the past, it was appropriate to bill the RT and LT modifier on the same line when it was required for certain HCPCS codes. Noridian released a publication stating claims reported with RT/LT on the same ...
Do You Understand Medicare
May 21st, 2019 - Christine Taxin
Even though we may think we truly understand what it means to be a participating provider, Medicare doesn’t quite work the way that other insurance plans do. Far too many providers do not understand the difference and get into hot water. To further complicate matters, the rules are different for ...
An Update on the DHS OIG's Effort to Combat Fraud & Abuse
May 17th, 2019 - Namas
An Update on the DHS OIG's Effort to Combat Fraud & Abuse Every year, the Department of Health and Human Services (DHS) Office of Inspector General (OIG) is required by law to release a report detailing the amounts deposited and appropriated to the Medicare Trust Fund, and the source of such ...
Prioritize Your Patient's Financial Experience
May 13th, 2019 - Wyn Staheli, Director of Research
For many years, the ChiroCode DeskBook has emphasized the need for providers to firmly establish the patient’s financial responsibility through clear communication. We even created a “Patient Financial Responsibility Acknowledgment Form” to help providers with this process. Lately, the lack of pricing transparency has been in the news and even ...
Q/A: Two Payers Both Paid the Claim. Who Gets the Refund?
May 13th, 2019 - Wyn Staheli, Director of Research
Question We have a personal injury situation where we submitted a claim was sent to the patient's auto policy carrier who refused payment. We then submitted it to her other insurance. Eventually, both companies paid her claims. Her auto paid at full value, and her secondary paid at a reduced rate ...
HIPAA Violation Penalties Revised
May 6th, 2019 - Wyn Staheli, Director of Research
On April 30, 2019 The Department of Health and Human Services (HHS) announced that “HHS will apply a different cumulative annual CMP limit for each of the four penalties tiers in the HITECH Act.” Unlike other notices which require a proposed rule with a comment period, this notice will take ...
Q/A: If Orthopedic Tests are Negative, do You List Them in Your Treatment Notes?
May 6th, 2019 - Wyn Staheli, Director of Research
Question: If orthopedic tests are negative, do you need to still list them in your treatment notes? Answer: Yes. Any tests which are performed by a healthcare provider, regardless of the result, should be documented in the patient record. This record is the only way that a reviewer or another provider ...



About Codapedia & Find-A-Code Contact Us Terms of Use Privacy Policy Advertise with Us

Codapedia™/Find-A-Code™ - 62 E 300 North, Spanish Fork, UT 84660 - Phone 801-770-4203 (9-5 Mountain) - Fax (801) 770-4428

Copyright © 2009-2019 Find A Code, LLC - CPT® copyright American Medical Association