Due to 5010 ANSI standardization and NUCC (National Uniform Claim Committee) requirements, there can be a maximum of 12 diagnosis codes on an eClaim or CMS 1500 (02/12) form. However, standardization still only allows for 4 diagnosis pointers. Because of this there can be up to 8 "floating" codes on the claim that will not be directly pointed to the charges.
The NUCC claim requirements can be viewed Here.
- Page 39 refers to Diagnosis codes.
Adding Primary Diagnosis Codes
Open the new charge window, and after selecting a procedure the diagnosis code fields will become available. Up to 4 diagnosis codes can be entered in this window.
Note: If the patient has a problem list that is greater than 4 diagnosis, more than four may be viewable from this window. Only the first 4 that are checked will make their way to the claim.
From here the charge window can be saved, and the claim can be created from the patient's ledger or New Claims Manager.
Since Electronic and Paper claims work separately from one another in MacPractice, there will be steps (shown below) of how to add additional (up to 8) diagnosis to a claim.
In MacPractice Build 7.3, you can configure the software to accept adding 12 Diagnosis Codes to a Charge, which will pull successfully to the CMS 1500 (02/12) form.
In order to activate this feature, navigate to the MacPractice Menu > Preferences > Claims, and check "Allow Up to 12 Diagnoses Per Charge".
Once enabled, log out and back in to MacPractice. When entering a charge, you should now be able to enter more than 4 diagnosis codes on a Charge.
Note: If you enable this preference, we recommend you keep it enabled. Disabling this preference after adding more than 4 diagnosis codes to a charge may cause some issues with generating claims.
Once the eClaim has been generated and is in the 'Ready' bin, go to the Claim Details window in the bottom left corner of the eClaims ability.
Expand the 'Claim' header and notice the list of diagnosis code slots.
From here, click the empty space in the 'Value' column for Diagnosis 5 - 12 and manually type any additional ICD-9 / ICD-10 codes needed.
Next, set the Diagnosis Qualifier via the dropdown 5 - 12 to ICD-9 / ICD-10 Diagnosis as needed.
Once the additional codes have been added to the Claim Details, save the claim. It is now ready to send.
CMS 1500 (02/12)
The CMS 1500 form that allows for 12 diagnosis codes is a custom form that will need to be requested from MacPractice.
Note: This form is best utilized when a single procedure needs more than 4 diagnosis codes.
MacPractice Technical Support can be reached at 877-220-8418 and a support representative will be able to install the "CMS 1500 (02/12) Only NPI - 12 Dx Codes" form.
Once the form has been transferred and the claim has been created, box 21 E-L will prompt the user for manual entry of the additional diagnosis codes.
Add any additional ICD-9 / ICD-10 codes needed into these fields and click the 'Done' button in the top left corner of the window. It will prompt to print the form as normal.