TEST YOUR SKILLS

How many diagnosis codes are necessary per CPT code?

Answer: b

Insurance claims allow space for 4 (four) diagnosis codes. Any diagnosis that affects the treatment of the patient can be listed. Some insurance carriers only read the first diagnosis code listed per CPT. Therefore, it is very important that the primary diagnosis for each service be "linked" to the corresponding CPT reported. In many cases, the primary diagnosis is not the same for all services reported on a given date. For example, a patient may be seen for a sinus infection and also have urinary frequency. The physician bills an E&M service and a urinalysis to rule-out a urinary tract infection. The diagnoses for the E&M visit code would be both the sinus infection and the urinary frequency. The primary diagnosis (and only one necessary) for the urinalysis that was billed would be the one for the urinary frequency, not the sinus infection as it would appear for the E&M visit. A diagnosis of sinus infection would not be compatible or acceptable for ordering and billing a urinalysis. Make sure that every CPT has the correct, compatible primary diagnosis linked with it on the insurance claim.

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