Q&A How many ICD-10-CM codes are allowed on a claim form?

[Ruth Sheets]

This was a chat question in the May 2015 Q&A Webinar:
Is it true that ICD10 will only take (most insurance companies) only 4 dx codes?

I've done some research, and this is false.

The National Uniform Claim Committee (NUCC) latest version of the 1500 Health Insurance Claim Form Reference Instruction Manual is for Form Version 02/12 - published in July 2014 and is called Version 2.0 7/14. It can be found here: http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v2.pdf

In this manual, it states:

• You can specify up to 12 diagnosis codes in Item Number 21 (on the form) that relate to the reason the services (CPT codes) were performed.
• If more than 12 diagnoses are required to report the line services, the claim must be split and the service related to the additional diagnoses must be billed as a separate claim.
• In Item 24E (on the form) you can specify up to 4 diagnoses pointers per service. (Each diagnosis pointer points to a diagnosis code given in Item Number 21 on the form).
• These rules apply to either ICD9 or ICD10-CM (when mandated).

So even though it was heard by the webinar attendee that asked this question that ICD10 will only take 4 Dx codes, that is not true. Each CPT code can be linked to up to 4 Dx codes to justify a particular CPT code, and each claim form has available a total of 12 fields for diagnosis codes. If the patient has more than 12 relevant diagnosis codes that need to be reported, you can split the claim into multiple claims.

I've tried to summarize the relevant rules here, but if you are confused, try reading the instruction manual (see link above) because it is quite clear and shows you the form where you would put in the codes, so I think that will help you.

 

[Laureen]

Good sleuthing Ruth - thanks for looking that up for us. I can see now where the confusion came in - 4 dx can be linked per CPT code but we are not limited to 4 total.