Wiki Too many DX Codes for Medicare?

[kkornkven167]

I have a physical therapist wanting to submit a claim to Medicare with 6 DX codes for their evaluation (97163 GP & 97110 GP). Their primary diagnosis is G35 (MS) but the provider has also added M21.372, M54.6, M54.59, M25.552, M25.562. I am worried this will lead to a denial. Thoughts?

 

[Troykall1]

ICD Diagnosis Code Requirements Introduction -Here is a link to CMS FAQ on ICD. Electronic claim submission you can have up to 19 ICD codes per claim.

 

[TThivierge]

I have a physical therapist wanting to submit a claim to Medicare with 6 DX codes for their evaluation (97163 GP & 97110 GP). Their primary diagnosis is G35 (MS) but the provider has also added M21.372, M54.6, M54.59, M25.552, M25.562. I am worried this will lead to a denial. Thoughts?

Hi KKorn
This looks like clean claim none of the Dx.codes are in conflict to because Excludes Rule 1 if occurred. Each area of body mentioned above hip, stiff elbow, foot drop can be affected by dx G35. All dx. are permissible as long as document in medical record for day of treatment. Ah does the payer want modifier of 96 or 97 with the phys. therapy? And does the payer want an attend or referring doc on claim plus one date before the date of treatment listed in comments section on the claim? This maybe something to think about but payers can demand different data to process the claim for payment. Good Luck!
I hope I helped you a little bit more.
Lady T

 

[trarut]

If it takes 6 diagnosis codes to tell the "story" of the patient's visit that day, you should report those 6 codes. As long as your system and clearinghouse can process those 6 lines, the number of diagnosis codes should not result in a denial. I'd venture to say the majority of PM systems these days can handle a minimum of 12.