Wiki Hello Billers!! Quick question

[KKIRKCRC]

So, if there is a second claim that needs to be submitted due to more dx codes on the encounter than each claim can hold, what is the CPT code that is to be used on the second claim? So if the first claim can only hold 12 dx codes and there are 15 and there needs to be a second claim submitted is it still the same CPT such as a 99214?

Thank you in advance!

Kat

 

[csperoni]

While I can't answer your question, my curiosity needs to know why there would possibly be 15 diagnoses on a claim for 99214.

 

[taysin93]

Hello , you can use 99499 CPT to report more Dx codes. yes ! why there would possibly be 15 diagnoses on a claim for 99214.

 

[thomas7331]

While I can't answer your question, my curiosity needs to know why there would possibly be 15 diagnoses on a claim for 99214.

I agree, I can't imagine a situation in which there would be a necessity or value in reporting that many codes for a single office encounter. I would report the most important and relevant codes and leave it at that.

 

[trarut]

Odds are the payer is only going to pick up the first 1-4 listed ICD codes anyway. Just prioritize the diagnoses and release the claim for billing.

 

[KKIRKCRC]

While I can't answer your question, my curiosity needs to know why there would possibly be 15 diagnoses on a claim for 99214.

Lol! I feel you! This came from our billing department.

 

[KKIRKCRC]

Thank you all! My doctors don't generally do that. We have 40 or so PCP's in our large group plus four specialties. That is why I reached out. My four generally so not go over 5-6 codes, but I guess some one in the group does. I'm a CRC not a biller but they knew I was a member and asked me to ask the forum for help. I appreciate it!

 

[Katiemiles1]

In our practice, It's common to have this many codes. (Orthopedics) We prioritize the dx and only bill one claim. Remember with many conditions, ICD-10 does not require extraneous pain codes to be included. Especially for sprains. For example, S338XA is a lumbar strain. So low back pain M545 is not necessary to be included. I would advise ensuring that the DX's are not redundant. Also worth mentioning, remember bilateral codes should be combined when possible, instead of broken up into separate codes. This also helps avoid denials. For example, Carpal tunnel bilateral is G5603. So these codes (G5600, G5601, and G5602) are redundant, And only G5603 should be on the claim if documentation supports Bilateral condition. Lastly, encounters that have multiple 7th character ICD-10 codes can be narrowed down by looking at the encounter. For example, S338XA and S338XD are for initial and subsequent lumbar strain encounters. Only use the appropriate one and remove the extraneous/less accurate one. Hope this helps!

 

[franchesca.feliciano@optum.com]

HI I know is string is really old, but fast forward and I have the same dilemma. I am billing penny claims to report additional codes for risk adjustment. Its the only way to report all the codes for the shared savings program. When my analytics team is reconciling to verify that all dx on a claim are represented on the CCLF file with CMS we are finding that some of the codes are not represented. I'm curious if anyone is submitting penny claims successfully for risk adjustment.

 

[bcoburn@coviewconsulting.com]

HI I know is string is really old, but fast forward and I have the same dilemma. I am billing penny claims to report additional codes for risk adjustment. Its the only way to report all the codes for the shared savings program. When my analytics team is reconciling to verify that all dx on a claim are represented on the CCLF file with CMS we are finding that some of the codes are not represented. I'm curious if anyone is submitting penny claims successfully for risk adjustment.

I know this is old, but wondering if you ever got a response? Or if you are doing this? I've read some things that say it's not a good practice or a red flag? But other things say it's common?

 

[Heatherc7]

The claim only holds 12 Dx's, and you can only assign 4 per line. There wouldn't be a need to add the other 3.