by Wyn Staheli, Director of Research
April 15th, 2019
Question: My patient has a lot of chronic conditions. Do I need to include all these on the claim? I know that I can have up to 12 diagnoses codes on a single claim. What if I need more than that?
Answer: More is not always better. You only need to include the code(s) which most appropriately describe the condition being treated. For example, if the patient has hypertension, but your assessment does not address their hypertension or the management of that condition, then do not include it on your claim. Likewise, if the condition will not alter your treatment/services provided, then do not include it on the claim. This is based on the ICD-10-CM Official Guidelines for Coding and Reporting which states that “all documented conditions that coexist at the time of the encounter/visit, and require or affect patient care, treatment, or management” should also be coded.
One more important thing to remember: if they were previously treated for a condition, but that condition no longer exists or affects the management of their CURRENT condition, do not include it. This can be problematic in some patient EHR systems which carry forward previous diagnoses to a new date of service. Be sure that you review the patient list and only include those conditions affecting the current treatment.
As for the question about having more than 12 diagnoses, in a chiropractic office, generally there really would not be a need to document that many diagnoses. However, if they have resolved conditions that were previously treated but that have not been billed, you could split the claim so that those are on a separate claim which would allow you to have space for more diagnosis codes to be reported.