Diagnosis/Procedure
Diagnosis/ProcedureDiagnosis and Procedure information must be entered on the claim to inform the payer of why the claim is being submitted. This information is entered in the form of standard ICD-9-CM codes.
ICD-9/ICD-10: Currently, only ICD-9 codes can be used.
Principal Diagnosis : A principal diagnosis is required for all institutional claims.
Admitting Diagnosis: The Admitting Diagnosis is required on inpatient claims only. Cannot be entered in combination with Reason for Visit.
Reason for Visit Diagnosis: If applicable, enter the diagnosis code that is being used for the reason for the visit.
Other Diagnosis: Other Diagnosis codes may be entered when other condition(s) co-exist with the principal diagnosis, co-exist at the time of admission, or develop subsequently during the patient's treatment. Up to 24 Other Diagnosis codes may be entered on a single claim and may not be duplicated.
POA: Present on Admission code is required for all inpatient claims. It is used to indicate whether a Principal/Other Diagnosis code was present at the time of admission, to distinguish it from a diagnosis that occurred after the admission but during the stay. Select the appropriate Present on Admission code.
Code: This field is used when an external Cause of Injury is needed to describe an injury, poisoning, or adverse effect.
Principal Procedure : A Principal Procedure must be entered on inpatient claims where a procedure was performed.
Principal Procedure Date: Required if a Principal Procedure is entered. The date may not be greater than the current date. The format is: MM/DD/YYYY and may either be entered in the field or selected from the calendar available by pressing the button to the right of the field.
Code: Only Inpatient claims use ICD-9 procedure codes for the Other Procedure Code field. NO other claims use this entry. If a procedure code is entered, the date the procedure was performed must also be entered.
Date: Enter a date only if an Other Procedure Code field has an entry.
Click here for the controls located at the bottom of the page or continue to the Other Payers tab.
