Medicare claim - too many diagnosis codes error

General information about Medisoft
Post Reply
drk
Posts: 155
Joined: Sat Oct 11, 2014 11:40 am
Location: Boston, MA

Medicare claim - too many diagnosis codes error

Post by drk » Tue Oct 06, 2015 8:59 am

We are running Medisoft v20 network pro. I just increased the number of diagnosis codes in global program options to 6 (from 4).

We have a Medicare claim with six diagnosis codes. When I run the claim check in RM, the claim is generating "Too many diagnostic codes" error and it is flagged red.

Anyone else see this behavior? Is there somewhere else I need to indicate that I am using more than 4 diagnosis codes to get past this?

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Medicare claim - too many diagnosis codes error

Post by Gavin Walker » Tue Oct 06, 2015 5:23 pm

You can have up to 12 diagnosis codes on a claim, but only a maximum of 4 pointers ticked on any charge line.
Gavin Walker
Walker Tek Solutions, LLC
417-890-6777 x0
fax: 417-763-6386

drk
Posts: 155
Joined: Sat Oct 11, 2014 11:40 am
Location: Boston, MA

Re: Medicare claim - too many diagnosis codes error

Post by drk » Tue Oct 06, 2015 6:58 pm

Ah that explains it, thanks.

NJMD
Posts: 16
Joined: Sat Oct 17, 2015 9:49 pm

Re: Medicare claim - too many diagnosis codes error

Post by NJMD » Thu Aug 11, 2016 6:49 am

I am running into a similar issue. We use Medisoft 19 Networking. I like to list all 12 diagnosis on most claims. When you create transaction entries, by defaults it checks all 12 diagnosis pointers. The claim would pass the common edits and would go fine with the Emdeon clearing house. Recently however Emdeon changed toa different platform called ChangeHeathcare. On the new platform the claims are rejecting because of too many diagnosis pointers.

How can we retain the 12 diagnosis and prevent 12 diagnosis pointers to be sent out? By default in transaction it checks off all. To manually uncheck 8 is too much work. Can we suppress the checked pointers if over 4 at the medisoft level?

Any other way to deal with issue. Interestingly we didn't have any issue with the older platform on the same clearing house. Thanks
Anil Gupta, MD
Medisoft V22.0.2.35 Networking
Revenue Management 3.1914.16116.394
OS Main: WIN10Pro
OS Clients Win10

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Medicare claim - too many diagnosis codes error

Post by Gavin Walker » Thu Aug 11, 2016 12:19 pm

The ANSI 5010 standard only supports up to 4 diagnosis pointers on any given charge line even though there can be 12 diagnosis codes on a claim. Your previous clearinghouse must have been only checking the first 4 when the claims were submitted to the payers. Now they are flagging this as an error because it is probably incorrect to assume which 4 are intended to go with any charge line and that can affect the payment.

NJMD
Posts: 16
Joined: Sat Oct 17, 2015 9:49 pm

Re: Medicare claim - too many diagnosis codes error

Post by NJMD » Thu Aug 11, 2016 5:20 pm

Gavin Walker wrote:The ANSI 5010 standard only supports up to 4 diagnosis pointers on any given charge line even though there can be 12 diagnosis codes on a claim. Your previous clearinghouse must have been only checking the first 4 when the claims were submitted to the payers. Now they are flagging this as an error because it is probably incorrect to assume which 4 are intended to go with any charge line and that can affect the payment.
Gavin first of all thanks for responding. I believe in their old platform they were either letting all pointers pass through or they had someway of suppressing everything after the first four. Unfortunately the new one doesn't let that happen. So they are asking them to be suppressed from the medisoft generated output file and I don't know how to short of manually deselecting 8 of those from each transaction line and that is lot of clicking. Medisoft by default checks as many pointers as you have diagnosis listed. Don't know if there is anyway to stop this default behavior. Of course I can switch to only 4 diagnosis as in the past and that beats the purpose of achieving more specificity on claims and listing all comorbid conditions.

Any suggestions are appreciated. Thanks again.
Anil Gupta, MD
Medisoft V22.0.2.35 Networking
Revenue Management 3.1914.16116.394
OS Main: WIN10Pro
OS Clients Win10

User avatar
Gavin Walker
Posts: 4625
Joined: Wed Apr 04, 2007 10:11 pm
Location: Springfield, MO
Contact:

Re: Medicare claim - too many diagnosis codes error

Post by Gavin Walker » Fri Aug 12, 2016 11:11 am

Unfortunately, neither your clearinghouse nor Medisoft can write a rule to determine which diagnosis codes should be selected for each charge line. While at first it may seem logical to always pick the first 4, but if that were the case, what are the other 8 diagnosis codes for if they don't apply to any charge line? There is a reason why your clearinghouse is back-tracking on selecting the first 4 diagnosis codes or whatever rule they were using. Someone probably lost a lot of money. At the end of the day, whoever is doing the billing needs to decide which diagnosis code to attach to each line. I have suggest to Medisoft to change the way this works in the past. If you have all 12 diagnosis codes turned on, all 12 diagnosis pointers are ticked on each charge line as a default. That means the biller has to unpick at least 8 of them each time.

Post Reply