more than 4 diagnosis codes not being sent

Technical problems with Medisoft.
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RWarsakDC
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more than 4 diagnosis codes not being sent

Post by RWarsakDC » Sat Nov 02, 2019 9:25 am

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.

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Gavin Walker
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Re: more than 4 diagnosis codes not being sent

Post by Gavin Walker » Mon Nov 04, 2019 8:45 am

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.
Gavin Walker
Walker Tek Solutions, LLC
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RWarsakDC
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Re: more than 4 diagnosis codes not being sent

Post by RWarsakDC » Tue Nov 05, 2019 11:02 am

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.

mbpros
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Re: more than 4 diagnosis codes not being sent

Post by mbpros » Thu Nov 07, 2019 3:58 am

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.
Steven Zats
Medical Billing Professionals

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Gavin Walker
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Re: more than 4 diagnosis codes not being sent

Post by Gavin Walker » Thu Nov 07, 2019 9:00 am

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.

RWarsakDC
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Re: more than 4 diagnosis codes not being sent

Post by RWarsakDC » Fri Nov 08, 2019 8:00 am

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.

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Gavin Walker
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Re: more than 4 diagnosis codes not being sent

Post by Gavin Walker » Mon Nov 11, 2019 9:39 am

You'll need to talk to your clearinghouse because all 6 should be transmitting.

RWarsakDC
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Re: more than 4 diagnosis codes not being sent

Post by RWarsakDC » Wed Nov 13, 2019 3:02 pm

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?

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Gavin Walker
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Re: more than 4 diagnosis codes not being sent

Post by Gavin Walker » Thu Nov 14, 2019 9:09 am

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?
Gavin Walker
Walker Tek Solutions, LLC
866-890-6777
417-890-6777

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