Ambulatory CDI (PCP Practice) Claims Issue

ABWhiteRNABWhiteRN
in CDI Expansion

Hello - for those outpatient CDI programs that have some experience, have you run into having a limited number of diagnoses on the claim that are allowed to be submitted? We use EPIC and found out recently that only four diagnosis codes are getting dropped into the claim. Do you have a solution to this and are willing to share what it is? Thanks so much. Alison.White@cvmc.org

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Comments

  • deannewilkdeannewilk

    Hi Alison,

    You are correct. This is often a discussion point in OP Coding and CDI. You can actually report up to 12 diagnoses per CMS1500 claim electronically. Per highmark and what we had done in the past is the following:

    "If there are more than 12 diagnoses, submit a second claim using CPT code 99499 with modifier 25 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."

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