What should a diagnosis pointer include?
What are ICD pointers? ICD (Diagnosis code) pointers are used to link the diagnosis code to the appropriate CPT code. The first pointer typically identifies the primary diagnosis in relation to the primary service (CPT) offered, while additional ICD pointers may be added in order of significance.
How do I determine a diagnosis pointer?
The diagnosis pointers are located in box 24E on the paper claim form for each CPT code billed. The line identifiers from Box 21 (A-L) should be related to the lines of service in 24E by the letter of the line.
What is 24E diagnosis pointer?
What is it? Box 24e is used to indicate the line letter from Box 21 that relates to the reason the service(s) was performed. When multiple services are performed, the primary reference letter for each service should be listed first. There can be up to 4 pointers on each service line.
What is an ICD indicator?
A –The ICD indicator is used to indicate to the Payer if the codes entered are ICD-9 or ICD-10 codes. The selected indicator must match the codes that were entered on the claim. Important! Selecting the ICD-10 indicator will not change an ICD-9 code to an ICD-10 code.
How many DX codes are in a claim?
12 diagnosis codes
While you can include up to 12 diagnosis codes on a single claim form, only four of those diagnosis codes can map to a specific CPT code.
What is the diagnosis pointer on the CMS 1500 form?
The diagnosis pointer references the line number from field 21 that relates to the reason the service(s) was performed (ex. 1, 2, 3, or 4, or multiple numbers if the service relates to multiple diagnosis from field 21).
What does diagnosis pointer AB mean?
The “AB” in diagnosis pointer will have no bearing on whether the claim is the result of an accident one way or another. It is common to forget to check the box on whether the claim is the result of an accident as the default is unchecked in most submissions.
How many diagnosis pointers can be used for each CPT code on the CMS-1500?
Up to twelve diagnoses can be reported in the header on the Form CMS-1500 paper claim and up to eight diagnoses can be reported in the header on the electronic claim. However, only one diagnosis can be linked to each line item, whether billing on paper or electronically.
What does ICD indicator 0 mean?
Entering a “0” will indicate the provider intends to submit ICD-10 codes.
What is an ICD-10 qualifier?
The ICD Qualifier designates whether the claim being submitted is for services rendered prior to October 1 (using ICD-9 codes) or on or after October 1 (using ICD-10 codes.) A claim may use ICD-9 codes or ICD-10 codes, but not both. A batch of claims submitted to NCTracks may include both ICD-9 and ICD-10 claims.
What is a diagnosis pointer letter?
Diagnosis code pointers are used to indicate the appropriate order of importance in relation to the service being performed. The first pointer designates the primary diagnosis for the service line. Remaining diagnosis pointers indicate declining level of importance to service line.
What does the diagnosis code on the insurance claim explain?
The diagnosis code supports the medical necessity for the service and tells the payer why the service was performed. It can be the source of denial if it doesn’t show the medical necessity for the service performed.
Can a DX code be primary?
Diagnosis Codes Never to be Used as Primary Diagnosis Claims submitted with these diagnosis codes as primary will deny.
What is diagnosis pointer AB?
What is primary ICD code?
A primary user of ICD codes includes health care personnel, such as physicians and nurses, as well as medical coders, who assign ICD-9-CM codes to verbatim or abstracted diagnosis or procedure information, and thus are originators of the ICD codes.