Wiki Billing with only 4 diagnosis

TKoehn

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Our software currently has a glitch were only 4 dx can be entered for claims. Sometimes the Doc has 5 or 6 dx documented in the chart, but we cannot input those for billing the claim. Only the top four. Is this a big problem? Is it considered fraudulant to not report the other codes? I know only 4 codes appear on a claim anyway, but I am getting mixed answers.

I just want to know that if an audit happens, I would be penalized for not have the 5th or 6th code on the billing side of things.

Please help!
 
the 5010 allows for 12 and the payer does see all 12. The only problem will be if you need to link a procedure to dx 5,6,7,8,9,10,11,or 12.
 
I have the opposite problem with my software--it still allows me to enter up to 12 dx per CPT code even though only the first 4 will be transmitted on the claim! The 5010 standards do allow 12 diagnoses to be submitted with each claim, but only a maximum of 4 diagnoses can point to any given CPT code. Under the 4010 standards, we could send up to 8 dx per CPT code, and when I asked a coder at our software vendor why there was a reduction in 5010, I was told it was in preparation for ICD-10 where greater specificity within each dx code will mean a case can be described in fewer diagnoses. That may be true for some specialties, but I think there will still be plenty of cases where the doctors will document more than 4 codes.
 
You have always been limited to linking only 4 dc codes per line item hcpcs/cot code. You can list 12 and link 4 any 4. You use to be able to list 8 but still only link 4.
 
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