Sunday, September 26, 2010

CMS 1500 BOX #21 - Diagnosis Codes - Filling instruction

Are we required to complete the ICD Indicator field in Item 21 of the CMS-1500 (02/12) claim form?

Yes, the ICD indicator field, which is in the top right corner of item 21, must be completed to identify the ICD-CM code set being reported. Enter either:

9 - to indicate the ICD-9 CM diagnosis code set
0 -  to indicate the ICD-10 CM diagnosis code set
Enter the indicator as a single digit between the vertical, dotted lines.  Failure to complete this field or incorrectly completing this field will result in claim rejection.

Example for dates of service prior to October 1, 2015 billed with ICD-9 CM codes:

The Medicare Claims Processing manual states:

“Enter the patient’s diagnosis/condition. With the exception of claims submitted by ambulance suppliers
(specialty 59), all physician and non-physician specialties (i.e., PA, NP, CNS, CRNA) must use an ICD-9-CM code number and code to the highest level of specificity. Enter up to four codes in priority order (primary, secondary condition).”

When more than four codes or code descriptions are entered in Item 21 Optical Character Recognition (OCR) equipment will read extra information, not necessary for claim processing. For quicker and more accurate processing, use the proper format when reporting diagnosis codes in Item 21.

All narrative diagnosis for non-physician specialties must be submitted on an attachment or in Item 19. In
addition, codes should be submitted within the outline for the four items.


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