# Diagnosis code linking



## cheermom68 (Mar 17, 2009)

We have a billing software vendor for one of our physician practices who will only allow the primary diagnosis to be linked to each E/M code.  They state that this is how Medicare wants it, that they have written proof and will not change the software until written proof can be provided to the contrary.  In the directions for filling out the 1500, on the website, it says to only link the primary dx for PROCEDURES.  We have always linked all appropriate dx for medical necessity.  I have "proof"  from various seminars, but nothing officially from Medicare.  Does anyone know of a link that has this, or can offer any help.
Thanks


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## Lisa Bledsoe (Mar 17, 2009)

I also have issues with our practice management system software/vendor, but of a somewhat different nature.  This software will change the order of the dx codes in box 21 depending on how the codes are linked in 24E.  For example, I might have 2 dx codes but I want them linked in a specific order on the line item.  So the software just flips them so it is always 1,2 rather than the appropriate 2,1.  I'd love to hear what other issues are out there...  The system we have is McKesson.  Any comments?


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## RebeccaWoodward* (Mar 17, 2009)

Item 21 - Enter the patient's diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) use an ICD-9-CM code number and code to the highest level of specificity for the date of service. Enter up to four diagnoses in priority order. All narrative diagnoses for nonphysician specialties shall be submitted on an attachment.

Item 24E - Enter the diagnosis code reference number as shown in item 21 to relate the date of service and the procedures performed to the primary diagnosis. Enter only one reference number per line item. When multiple services are performed, enter the primary reference number for each service, either a 1, or a 2, or a 3, or a 4. This is a required field. *If a situation arises where two or more diagnoses are required for a procedure code (e.g., pap smears), the provider shall reference only one of the diagnoses in item 21*.

Pg-15

http://www.cms.hhs.gov/manuals/downloads/clm104c26.pdf


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## Lisa Bledsoe (Mar 17, 2009)

Rebecca - this vendor has created a way for us to "work around" the Medicare requirements (i.e. screening colonscopy becomes colonsocopy with polypectomy - so our data entry people have to take extra steps to have V76.51 show as dx 1 in box 21 but only link 211.3.  Why?  because if we only link 211.3 then V76.51 simply disappears from the claim!).  So I'm trying to convince them that their software logic is erroneous.  Logically, the way the dx codes are listed in box 21 they should remain that way regardless of what code I link a procedure to...does that make sense?  Or am I making a mountain out of a mole hill?


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## RebeccaWoodward* (Mar 17, 2009)

No...I see your point of view. Our vendor has done the same for us.  As a whole, I'm not a very big fan of vendors.  Just from personal experience, many take the short road to avoid any effort on their part.


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## Lisa Bledsoe (Mar 17, 2009)

So true!  And the only way to "fix" it is if I give them proof that what their software is doing is inappropriate (changing the order of the codes).  I guess at the end of the day if I know that the codes are entered correctly, then what the software does with them from there is beyond my control.   Except it then becomes my problem when the patient calls because their insurance didn't process the claim right because the diagnosis codes aren't in the order that they were entered into the system  (aka "you didn't code it right")   and that irritates the heck out of me!


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