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more than 4 diagnosis codes not being sent

Posted: Sat Nov 02, 2019 9:25 am
by RWarsakDC
When submitting claim, only 4 diagnosis codes are being transmitted even though I have 8 slots on my software that I can use. How can I get it to submit all of my diagnosis codes that I have listed.

Re: more than 4 diagnosis codes not being sent

Posted: Mon Nov 04, 2019 8:45 am
by Gavin Walker
The CMS-1500 form only allows 4 diagnosis pointers for each procedure. The entire claim form can have up to 12 diagnosis codes. On each procedure, only check the top 4 most relevant diagnosis for that procedure.

Re: more than 4 diagnosis codes not being sent

Posted: Tue Nov 05, 2019 11:02 am
by RWarsakDC
The CMS 1500 will allow for 12 DX codes. I can add up to 12 slots for diagnosis on my software. But when submitting claims to Medicare, only 4 diagnostic codes are being submitted even though I have 8 diagnostic codes listed for my patient. How can I get it to submit ALL of the DX codes. This is a problem because I need to submit 6 DX codes to Medicare for the claim to be processed and paid properly.

Re: more than 4 diagnosis codes not being sent

Posted: Thu Nov 07, 2019 3:58 am
by mbpros
Gavin is correct. We bill for DCs all the time. You can list up to 12 dx codes on a claim but you can only tie a max of 4 dx codes to one CPT code (the diagnosis pointers). So if you adjust 5 regions (bill a 98942) you will list codes like M99.01, M54.2, M99.02 and M99.03. Even though you only have 4 regions listed, your notes must document the 5 regions you adjusted. Medicare will NOT deny a claim simply because you only have 5 regions listed but only have listed dx code pointers for 3 regions.

AND if you try to have more than 4 diagnosis code pointers for any one procedure code that claim will reject electronically and not make it into the payer's system.

Re: more than 4 diagnosis codes not being sent

Posted: Thu Nov 07, 2019 9:00 am
by Gavin Walker
On each procedure, list all 8 diagnosis in the exact same order. Then tick the pointer boxes for up to 4 diagnosis codes on each procedure. Also, they all default to ticked, so you have to un-tick the ones that don't apply to that line.

Re: more than 4 diagnosis codes not being sent

Posted: Fri Nov 08, 2019 8:00 am
by RWarsakDC
I am trying to submit claims to Medicare for CPT code 98941- chiropractic spinal manipulation 3-4 levels. I need to have 6 diagnoses in box 21. I have 6 diagnoses filled out in my program. When I go to my clearinghouse and view the claim submitted to Medicare, there are only 4 diagnosis codes being transmitted, not the 6 that I want to be sent. I should be able to transmit 12 DX codes but for some reason, only 4 are being sent.

Re: more than 4 diagnosis codes not being sent

Posted: Mon Nov 11, 2019 9:39 am
by Gavin Walker
You'll need to talk to your clearinghouse because all 6 should be transmitting.

Re: more than 4 diagnosis codes not being sent

Posted: Wed Nov 13, 2019 3:02 pm
by RWarsakDC
I contacted my clearing house and they said that there are only 4 DX codes being sent even though I have 6 listed for the patient.
Is this something that you can help me with?

Re: more than 4 diagnosis codes not being sent

Posted: Thu Nov 14, 2019 9:09 am
by Gavin Walker
We would probably troubleshoot by the hour for something like this, but for some clearinghouses, we can troubleshoot for FREE. What clearinghouse are you using?