Billing > Billing
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.
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