Don't Skimp on CMS 1500 Item 21
Published on Sat Mar 18, 2006
Your carrier's workload will soon get a little heavier
For diagnosis codes, more may be better.
Carriers must review all diagnosis codes you submit to determine coverage, effective for claims processed Oct. 1, 2006, and later, according to CMS Transmittal 735, dated Oct. 31, 2005 (
www.cms.hhs.gov/transmittals/downloads/R735CP.pdf). April 1, 2006, is the effective date for analysis and design
Takeaway: Stop settling for one diagnosis code. Carriers will have to process all the diagnosis codes you report, up to the maximum permitted under the format (paper or electronic). Telling your patient's story with diagnosis codes may increase your coverage chances.
Example: A patient presents complaining of nausea and vomiting two days after chemotherapy and requires 99212 (Office or other outpatient visit for the evaluation and management of an established patient). Report both the nausea and vomiting (787.01, Nausea with vomiting) and the neoplasm she's receiving chemotherapy for (such as 174.1, Malignant neoplasm of female breast; central portion).
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