Wiki MORE THAN 12 DX BILL SECOND CLAIM

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LMOuellette

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Hello,
I am inquiring when a provider is capturing more than 12 dx in note, and we bill a second claim, what code would you use? This is just to capture dx. We were advised to use 99499 and of course denied for medicare records then advised to use 1160F. Denied again. I cannot find any information regarding this so looking for an expert to assist. Thank you in advance.
 
Hello, I am currently researching this same issue with 99499. So far what I have found is only guidance from Highmark Blue Cross.

Instructions for Submitting
  1. Submit the first claim using an applicable visit CPT code(s).
    • NOTE: A claim only requires one line with an eligible procedure code for the entire claim and all its diagnosis codes to be deemed eligible for risk adjustment.

  3. If there are more than 12 diagnoses, submit a second claim using CPT code 99499 and bill a $0 charge on the additional claim. Include the additional diagnosis codes that went beyond the maximum codes allowed from original claim on this new claim.
    • IMPORTANT: 99499 must be the only CPT code on this claim.

  5. If appropriate, submit remaining diagnoses using CPT code 99499 with modifier 25 and bill a $0 on an additional claim.
CPT code 99499 will show as denied/rejected for payment on the Explanation of Benefits (EOB); however, Highmark will still capture the diagnosis codes affiliated with this procedure code.
 
Check with each payer about the CPT code. Most of them want 99499 but I remember one payer wanted a totally different code (it's been a while since I've done MA.)
 
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