Increased diagnosis codes with 5010 ?

alincoln

Networker
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Midlothian, VA
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I understand that we can now report more diagnoses codes in total but I'm look for some guidance or ideas on where to find these answers:

1. Are there any guidelines on how/when to increase your number of diagnoses? I understand the concept of reporting what is most relevant to the service provided, but just wondering why/when we should increase?

2. All sources I can find relating to the number of diagnoses codes are from 2011 - is it still true that the total was increased to 12 but still only 4 diagnoses per CPT code? I thought I heard something about 25 CPT and 25 ICD9 codes being accepted? (That seems huge to me..)

3. If number 2 is true, that only 4 per CPT code still, that could be why I can't find anything on when you should adding more diagnoses codes to your claim... Because while we can now report more total dx codes, we are still only reporting 4 per CPT code?

Thanks!
 

mitchellde

True Blue
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Columbia, MO
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It is a total of 12 dx codes on the claim but you may link only 4 of the 12 to a single line item CPT/HCPC II code. There are times when having more than 4 dx codes on the claim is beneficial, such as a multi trauma case where you can have 6 or 7 injury codes plus your e-codes and you have a different procedure for each injury. So while you will not always need access to 12 diagnosis code slots it is nice to know they are there. ICD-10 Cm is going to need more dx codes for certain condition such as injuries, I have one scenario for an auto accident with 2 injuries that takes 6 codes to get it done.
 

alincoln

Networker
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Midlothian, VA
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Thank you sooo much!

I was over thinking it and then got myself confused.. thanks for making it clearer for me :D

I'm excited to be able to report more than 4-8 individual codes now also! Will come in super handy with our Sepsis coding and ODs/poisonings

Thanks again!
 

KKMeeks

Contributor
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Question about more than 4 codes.

If I understand this right, you may list up to 12 dx codes on a claim, but can only use a dx pointer for the first 4? I have a doc that likes to use up to 8 and wants to be able to use the dx code pointer for all eight. Is there somewhere I can show him that this is not the case?
 

mitchellde

True Blue
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It is not that you point to the first 4 it is that you can point only 4 dx codes. You may point any 4 of the 12 allowed.. for instance you may point 1234, or 1589, or 19101112. Any 4 of the 12 allowed. The 5010 transaction instructions state that you can link only 4 dx codes per line item.
 
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