Duplicate diagnosis codes

[muraiken]

Is there a billing/coding rule for CMS 1500 claims that you cannot have duplicate diagnosis codes listed?   I know that for UB claims, duplicate diagnosis codes cannot be used because it can cause a change in DRG values.   Can anyone cite a Medicare billing rule that prohibits duplicate diagnosis codes for 1500 forms? 

[Michele]

Not sure what you mean by "duplicate diagnosis codes".  Not sure why you would have duplicates on a CMS form.

[muraiken]

I am talking about a situation where a provider puts two of the same diagnosis codes in box 21.  250.00 as the primary and also 250.00 as secondary and 2 other different diagnosis codes.  So there are duplicate diagnosis codes on the claim.  Probably a provider error.  So would this be a claim that would be rejected by Medicare?  Or would it just be paid since it really doesn't affect payment in any way.   

[supertaz93]

You would not put a duplicate diagnosis on a claim.  I would think that your software would red flag this.

[PMRNC]

Yeah, I've had this flagged by the PM system and even if not, it should be caught in edits.

[muraiken]

I am working for a health plan so am looking at things from the payor side and I do see claims coming in with duplicate diagnosis codes.
My question is if Medicare has some specific rule that it will reject claims with duplicate diagnosis codes......

[DMK]

I have accidentally input the same dx twice on a Medicare claim and it was not rejected.  I felt stupid though! 

[PMRNC]

I am working for a health plan so am looking at things from the payor side and I do see claims coming in with duplicate diagnosis codes.
My question is if Medicare has some specific rule that it will reject claims with duplicate diagnosis codes......

That really wouldn't matter because every insurer has a diff payor program, I worked at 3 of the top 5 and we always had these edits in place to flag duplicate info of any kind on a claim form. It also depends on the procedure for that flag.. with billing you mostly have to go by Medicare guidelines for clean claims. 

I have accidentally input the same dx twice on a Medicare claim and it was not rejected.  I felt stupid though! 

I would THINK you should have this edit on clearinghouse side if it's not in your PM setup