Author Topic: Billing more than 4 diagnosis  (Read 1774 times)


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Billing more than 4 diagnosis
« on: May 09, 2012, 11:24:28 AM »
Hi!! Hoping I can get some clarification. I went to a Ingenix billing and coding class last year and they mentioned that we are now able to bill up to 8 diagnosis on a claim.  Our EMR support team have stated they have no idea what I'm talking about and are aware that only 4 diagnoses can go on a claim. Please anyone, any ideas or suggestions.



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Re: Billing more than 4 diagnosis
« Reply #1 on: May 09, 2012, 12:28:05 PM »
Neither, with the addition of 5010, the field was increased from 8 to 12  allow for up to 12, however only first 4 are pointed/used right now.
So there is  a maximum of 12 dx codes allowed per claim.

From the AMA Fact sheets
The maximum number of diagnosis codes that can be reported on a claim was increased from
eight to twelve. Although twelve diagnosis codes can be reported at the claim level, only four
codes can be pointed to, or linked to, a specific service at the service line level. So if a patient
has twelve diagnoses and you perform a service that relates to five diagnoses, you can only point
to four of them when billing for that service line.
Linda Walker
Practice Managers Resource & Networking Community
One Stop Resources, Education and Networking for Medical Billers