AUG 12, 2024
Linking Appropriate Number of ICD-10 to Claim
My practice often submits one diagnosis code on a claim when the encounter addresses several diagnoses. Is it more appropriate to submit every applicable diagnosis code? Are there advantages to listing more than one diagnosis?Answer:
For each claim submission, up to four ICD-10 codes can be linked per CPT, but one may support medical necessity per the payer policy. However, submit all diagnoses that are addressed during the encounter to the office visit code. The number of diagnoses assessed during the encounter impacts medical decision-making criteria when using evaluation and management (E/M) codes. For testing services and procedures, link only the ICD-10 code(s) that support medical necessity.
Appropriate linking of ICD-10 to procedure codes is addressed in Fundamentals of Ophthalmic Coding. Here is one example:
Example: What should you submit on the exam if the patient has a different type of glaucoma in each eye and blepharitis on all four lids? That equals six ICD-10 codes, but you can’t link six diagnosis codes to one service.
Solution: Submit the two types of glaucoma and at least one of the lids for blepharitis. The claim should still be processed correctly.