Author Topic: Secondary diagnosis codes on CMS1500  (Read 10098 times)

davhafstehow

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Secondary diagnosis codes on CMS1500
« on: April 01, 2011, 02:49:36 PM »
When I need to use a secondary diagnosis code for a CPT Code, do I list the primary diagnosis code first with the diagnosis pointer "1" and then do not use a diagnosis pointer of "2"?  Therefore, in box 21 of the CMS 1500 form it would show an extra diagnosis code, but no diagnosis pointer identifying it.  Is this correct?  I am having a hard time finding any information telling me as to how this is done.  Am I correct that the insurance company will see that the diagnosis pointer "1" is the primary and any additional codes in either 2, 3, or 4 would be secondary, third or fourth diagnoses?  Can someone please help?

Thanks,

Tanya

Michele

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Re: Secondary diagnosis codes on CMS1500
« Reply #1 on: April 01, 2011, 03:40:03 PM »
1.  401.1         3.  496
2.  250.00

dx pointers   123

This indicates that 401.1 is the primary reason for the service, 250.00 is the secondary, and 496 is the third.  If there are more than one service you may do the following:

99213    231
93000    1

Does this help??  You must point the dx to the service if you want the insurance carrier to recognize it.

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davhafstehow

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Re: Secondary diagnosis codes on CMS1500
« Reply #2 on: April 02, 2011, 10:36:07 AM »
So does this mean that the primary diagnosis code for 99213 would be 250.00 as primary, followed by 496 as secondary and 401.1 would be third?  And, the only diagnosis code for 93000 would be 401.1?

Am I correct to assume that for each procedure code, whichever order you put the diagnosis pointers indicates to the ins. co. which diagnosis code is 1, 2, 3 or 4th and so on?  And, it's not necessarily the number of the diagnosis pointer, but rather the order in which they are listed in the diagnosis pointer column?

Tanya

medauthor

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Re: Secondary diagnosis codes on CMS1500
« Reply #3 on: April 03, 2011, 08:54:04 AM »
Tanya,

It doesn't have to do with the 'order' they are listed in: you have to make sure to LINK the procedure to the correct dx code---see the example below:


1.) 380.4(impacted cerumen)    3.) 034.0 (strep throat)

2.) 599.0 (urinary tract infec)    4.) 250.00

You can link all your dx to the OV--but you must make sure that ONLY your dx that are related to the procedures are linked to that procedure!

99213    1,2,3,4
87070 (strep test)   3
81002 (urinalysis)     2
69210 (cerumen removal)    1


If you were to put pointer 2 for the last procedure---that would be incorrect, as a urinary tract infection would NOT justify the cerumen removal procedure...............  :)
Michelle Rimmer, CHI, CPMB
President-Professional Medical Billers Association
Owner-ABA Therapy Billing Services
Author, 'Medical Billing 101' and 'Coding Basics: Understanding Medical Collections

davhafstehow

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Re: Secondary diagnosis codes on CMS1500
« Reply #4 on: April 03, 2011, 05:04:57 PM »
Ok...thanks.  I'm beginning to understand a little better.  Here is an example.  Can you tell me if this seems correct? 
(The ICD-9 says I must first code 250.51 before using 362.01 on the fundus photography). 

1. 250.51 (Diabetes w/ Complications)

2. 362.01 (Diabetic Retinopathy)

92014 (Comprehensive Exam)  1 2
92250 (Fundus Photography)  1 2

I pointed the dx pointer of 1 & 2 to the exam because they are both related to the exam and the dx pointer of 1 & 2 to the photo (92250) because the code book said I must first use the 250.51 code, then the 362.01.  Correct?

Michele

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Re: Secondary diagnosis codes on CMS1500
« Reply #5 on: April 06, 2011, 10:21:26 AM »
Yes, you have it correct. 
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davhafstehow

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Re: Secondary diagnosis codes on CMS1500
« Reply #6 on: April 06, 2011, 07:56:13 PM »
Thanks, Michele!  This is an awesome forum that has helped me tremendously!  Thanks again!