using 99080 more than 12 diagnosis codes to report submit 2 claims (split)

kschoon

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I am looking for advice for when a provider wants to submit more than the 12 diagnosis codes from an annual wellness exam for the sole purpose of Risk Adjustment. Let's say the provider has 15 in total to submit.
Wouldn't the provider split the claim? Submitting the first claim with the CPE 99397, then CPT code such as 99080 for the 11 remaining codes (B-L) of course 99080 only allows the 4 codes on each charge line (total of 3 99080 lines on the first claim), then the second claim only has 99080 with the additional 3 diagnosis codes?
This is a new process to me that providers are wanting to take on. So I'm looking for advice, since there seems to be very little information out there on this subject.
Thank you
 

mitchellde

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There is no way to submit more than 12 diagnosis for a single encounter. you cannot have a page 2 for additional diagnosis, the second claim will be rejected as a duplicate. in addition when you do this you are overwriting the "a" diagnosis with a second "a" diagnosis. you can have only 1 "a-L" for a total of 12.
In addition, do you have documentation to support multiple line items of the 99080? I believe you are allowed only one line with one unit for this service. as stated above you do not need to link all dx codes on the claim.
You should select the most pertinent 12 diagnosis and list those.
 
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pscanlan

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Where can I find this in writing to present to my providers?
It's just the way a claim is set up. The 1500 form has 12 spaces for diagnosis codes, with pointers A through L. If you put a Dx in each space, you'll end up with 12 on a claim. You max out at 4 pointers per service line, but if all you need is for the Dx to be on the claim, it hardly matters whether they are pointed towards a specific service. Be prepared, most clearinghouses will hold or reject a claim where there are diagnoses that do not point to a service line, so you may have to force the release of the claim, or force it to paper to get it to print correctly.
 

Jsmith56

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For proper HCC coding the provider should submit all DX pertinent for patient care, however many have more than 12 diagnosis. Is there a CPT or CPT II tracking code that can be used on the second page with .01 charge to tie the remaining DX to the patient? It is not recommended to have patient come for a second visit to report DX codes that couldn't be reported. So, what is the solution? Any ideas?
 

mitchellde

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Think of it as each en punter gets one A diagnosis , one B diagnosis and so on to L.. you cannot have a second claim for the same encounter because you would have two A diagnosis codes and a duplicate encounter. There is a claim form instruction manual you can pull up at nucc.org which may help.
 
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