Reporting 8 Dx Codes on a Paper Claim Form

Effective July 1, 2007 CMS has mandated that Medicare Part B carrier claims processing systems capture and process up to eight diagnosis codes on all claims (both paper and electronic).

Instructions on how to submit up to eight diagnosis codes on a paper claim submission form are as follows:

• You may place up to eight diagnosis codes on the claim form. The diagnosis that is pointed to in Item 24E must be placed in one of the four diagnoses entry spaces in Item 21. Any indicator other than a 1, 2, 3, or 4 in Item 24E will cause the claim to deny as unprocessable. Place additional diagnosis codes 5-8 (if necessary) in Item 19. Enter only the number (with decimal if needed) and separate each diagnosis in Item 19 with a comma. (For example: 719.41, 719.42, 816.00)
• The diagnosis codes listed in Item 19 should not be codes that are required for payment. If there are more than four diagnosis codes required for payment, submit a second claim form with the additional required codes in Item 21 on the second claim form. (For example: If CPT code “A” requires three diagnosis codes for payment and CPT “B” requires three different codes for payment, these two procedures would need to be billed on two separate claim forms so the processing system could pick up all six of the diagnosis codes as payable.)