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Thread: Diagnosis pointers

  1. #1

    Default Diagnosis pointers

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    Has anyone found any documentation of heard anything from Medicare and Medicaid in regards to not being able to use diagnosis pointers anymore?

    Patient was seen in our office for a physical. The claim is billed as followed:

    99204 25 463, 380.4, 477.0
    99386 V70.0
    93000 V70.0
    81000 V70.0

    We are using Medisoft V17, and with the knowledge that I have about Medisoft (not sure about any other program), if each line of the claim is submitted with different diagnosis, it creates a new claim for each line and they are submitted separately. I was told that the guidelines have changed and that the claims are no longer being accepted with the diagnosis pointers reflecting the applicable diagnosis.

    Can anyone shed some light on this subject for me, please?

    Thanks!

  2. #2
    Join Date
    Apr 2007
    Location
    Lubbock, TX
    Posts
    1,505

    Default

    Quote Originally Posted by pumpkin1279 View Post
    Has anyone found any documentation of heard anything from Medicare and Medicaid in regards to not being able to use diagnosis pointers anymore?

    Patient was seen in our office for a physical. The claim is billed as followed:

    99204 25 463, 380.4, 477.0
    99386 V70.0
    93000 V70.0
    81000 V70.0

    We are using Medisoft V17, and with the knowledge that I have about Medisoft (not sure about any other program), if each line of the claim is submitted with different diagnosis, it creates a new claim for each line and they are submitted separately. I was told that the guidelines have changed and that the claims are no longer being accepted with the diagnosis pointers reflecting the applicable diagnosis.

    Can anyone shed some light on this subject for me, please?

    Thanks!
    Our system does that too, but it only goes off of the primary Dx. It does it, because if you have more than 4 unique diagnosis codes on the same claim, they won't all fit on the form; so codes with the same primary Dx are lumped together, to ensure that their PDx will show up on the claim. (P.S. - if you have more than 4 Dx codes, your pointer may print as '0', instead of 1, 2, 3, or 4)

    As for guideline changes - I haven't heard that, for Medicare; and I don't know what state you're in, but our Medicaid (TX) hasn't changed anything about it, to my knowledge.

  3. #3

    Default

    Thank you for replying.

    I know that only 4 diagnosis will fit on the form, but I'm so accustomed to entering all 4 dx codes and then using the diagnosis pointers when necessary. I was just a little confused when I heard that the guidelines don't allow the pointers to be used anymore. I'm just afraid of over/under payments if there are multiple procedures in place.

  4. #4
    Join Date
    Apr 2007
    Location
    Columbia, MO
    Posts
    12,085

    Default

    If you are submitting electronic then you have the ability for 12 dx codes on the claim, but you can only link 4 dx codes per line item , but you can link any 4 of the 12 listed as number 1 thru 12.

    I am curious though if the patient was there for a physical then why did you bill an office visit also? A split encounter is to be used when a patient has a symptomatic complaint in addition to having the annual.
    Also did you know that with ICD-10 CM you cannot use other dx codes on the same claim with the preventive annual dx code? Just something to look at.

    Debra A. Mitchell, MSPH, CPC-H

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