OP, adhering to CMS guidelines, allows up to 12 diagnosis codes per claim with a max of 4 per CPT code. Previously, only the diagnosis codes that were attached to a CPT code would be transmitted on a claim. With the current development of OP, the inclusion of the 12 codes has been expanded so that they are now all generated on the claim regardless of whether or not they are attached to a CPT code.
Additionally, users now have the ability to auto-include BMI and Problem List diagnosis codes. This means that Providers should carefully consider the order in which the diagnosis codes appear in the Assessment section of their visit notes to ensure that the most relevant codes are being passed to the claim.
How do diagnosis codes get to claims?
- As templates are applied
- As vaccines are administered
- As in-house labs are completed
- As surveys are completed
- If the Auto-calculate BMI code checkbox is checked in the Assessment section of the note and vitals are entered during the visit
- If the Auto-copy problems to encounter diagnosis list checkbox is check in the Problem List section of the note and problems are marked reviewed (either individually with the paper clip or by clicking Mark Reviewed).
|Note: With the exception of Labs and Surveys, all diagnosis codes show in the Assessment section of the note.|
How do I make sure my most important codes are included in the 12 spots on a claim?
OP first includes diagnoses that are attached to CPT codes. The remaining order is up to the provider coding the visit.
Remember, if you chose to Auto-copy problems to encounter diagnosis list for a patient with a number of problems, each diagnosis code will be added to the claim.
To sort the diagnosis codes, simply click in the Sort field of the Assessment section of the note and change the number to be higher or lower depending on where you want the code to appear in the list of importance.
|Example: Patient, Mariah Brown is seen for a Well Visit. |
There were a total of 14 diagnosis codes added to the visit.
We know that:
That means that 8 of the 14 diagnosis codes will automatically hit the superbill.
Now, with 4 spots left and 6 more diagnosis codes, the Provider has a decision to make. What 2 codes are the least important to include on the claim? It may not always be very obvious what diagnosis codes are going to land on the superbill. For that reason it is recommended to always order the most important diagnosis codes at the top of the sort (or with the lowest sort number). The sort should be changed to the highest value for the 2 that are decided to be left off the claim.