Wiki CMS 1500 claim form

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angnel1

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I work in obstetrics and have taken an ICD10 course. When you add the weeks of gestation to an obesity complication and advanced maternal age (for example) there are more than 4 diagnosis codes to map to the e/m. Does the new CMS 1500 form allow for this. I pulled an example and it reads that it can but our system is only allowing us to map 4 diagnosis codes even for ICD 10. Is this a glitch with our system or are we still supposed to only code 4 diagnosis codes to the CPT. Hope this makes sense....need help!
 
The CMS 1500 (02-12) has enough room on the claim for 12 diagnoses. If your software is only allowing 4 then it will be an issue with them. Hopefully they will have an update really soon, like 3 months ago = /
 
angnel1 said:
I work in obstetrics and have taken an ICD10 course. When you add the weeks of gestation to an obesity complication and advanced maternal age (for example) there are more than 4 diagnosis codes to map to the e/m. Does the new CMS 1500 form allow for this. I pulled an example and it reads that it can but our system is only allowing us to map 4 diagnosis codes even for ICD 10. Is this a glitch with our system or are we still supposed to only code 4 diagnosis codes to the CPT. Hope this makes sense....need help!
Click to expand...

You can list a maximum of 12 diagnosis per claim, however you are allowed to link only 4 per line item. There is no way around this, so the instructions state to link only the pertinent 4 for any given service (line item ) performed.
 
Mapping

Thank you for your help with this. Are there certain codes that are required for ICD 10 that need to be mappled when it comes to obstetrics? I know the weeks of gestation needs to be on the claim but if a patient is high risk and the codes out number the CPT allowance of 4 how do we know it won't get rejected by the insurance company. I guess I was under the impression with ICD 10 we would be able to map more to the CPT code. I know the form can hold 12 but if you don't map it how does it get on the claim form??
 
Billing manager, CPC

After speaking with my tech support people today (because I had the same concern), I found a way for all dx to appear on the claims, but they will be unmapped. I don't know if this will be sufficient specificity to satisfy payers. Does anyone know if it will be enough that they are on the claim?
 
so stupid

We have been researching this today as well because we thought with ICD-10 we would be able to link more DX's per line. Whats the point to all of this if only 4 DX's are still going to go. you still can't give a complete picture of what the physician is doing...
 
Cms 02/12

You have to submit ANSI 5010 or CMS version 02/12 as of 10-1-15 this will allow up to 12 dx, each service line can point up to 4 of those (does not have to be the same 4 on each line) dx . hope this helps
 
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