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More than 4 Diagnosis Codes for Superbills and Claims

1500 form allows you to enter 9 Dx codes at a time. But the superbill allows only 4 Dx codes at a time. If we create two superbills for the same patient who has more than 4 Dx. there will be an issue with the insurance companies processing the claim. Please give option to enter more Dx codes while we create a superbill.

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Acknowledged  ·  Matthew Douglass responded  · 

After consulting with our billing partners, we wanted to provide some additional context for why we are limiting each CPT line to 4 diagnosis codes:


You may associate up to 4 diagnoses per CPT code in the Practice Fusion superbill. While the official CMS 1500 claim form that your biller creates allows for 12 diagnoses to be documented per claim, only 4 diagnosis pointers can be associated per CPT code. To simplify and standardize the superbill process in Practice Fusion, we are limiting each CPT line to 4 diagnosis codes. Please note that the Practice Fusion superbill is not used as an electronic claim and can be adjusted to include diagnosis pointers and additional diagnoses after it has been submitted to your billing system for review.

You can read more about superbills here: http://knowledgebase.practicefusion.com/knowledgebase/articles/483043-how-do-i-create-a-superbill


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41 comments

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  • PEDRO P CARBALLO MD commented  · 

    ACO's are asking us to document 12 diagnosis codes to accurately be able to get ACC SCORES which impact the shared savings and 'degree of sickness of the patient". WHY DOES PRACTICE FUSION CONTINUE TO DENY THIS FEATURE?

  • Dr RONALD FISCELLA commented  · 

    For multiple insurance incentive programs, we are needing to be able to have up to 12 dx codes added per CPT used.
    We have tried the suggestion stating previously, but this did not work out as all claims were rejected that we did this for.
    At this point we are having to bring the patient back in order to comply with requirements for the insurance companies and yearly treatments/documentation for patients with multiple chronic conditions.

  • Anonymous commented  · 

    It would be great to be able to enter more than 4 diagnosis codes under Superbill. It would help if facility/billing provider number is automatically uploaded so Dr doesn't need to enter it for every patient.

  • Ms Jessica Stroup commented  · 

    Would like to recommend add the capability to add more then 4 ICD 10 codes on a pts superbill. As in our practice we see many pts that have more then 4 diagnosis for the issue we are treating.

  • Dr Joni Ashcroft commented  · 

    In order to justify various levels of procedures it can be necessary to utilize several diagnosis codes not just 4. For example a 98942 codes must show diagnosis for 5 plus regions to be justified. It could take 10 or more diagnosis codes in order to justify that level of care. By only allowing 4 codes we are unable to accurately bill for procedures.

  • Anonymous commented  · 

    Need to add more then 4 diagnosis on a procedure.

  • becky commented  · 

    It is just additional work to adjust the diagnosis with the billing system. It makes no sense to have to go back to Practice Fusion and review the chart to add additional diagnoses to the billing system that are needed for most patients especially patients with chronic conditions.

  • Mrs Annette Leno commented  · 

    We need the ability to add up to 12 dx on the superbill. insurances are requiring.

  • Mrs Evelyn Pridgen commented  · 

    I was only asking because when the insurance companies audit us they always want to know why all issues are not put on the claim.

  • Ms Sandee Pulford commented  · 

    INSURANCE COMPANY'S REQUIRE MORE THAN FOUR ICD-10 CODE ON VISIT FOR P4P

  • David R. commented  · 

    This needs to be looked at again. Medicare, in particular, refuses to accept any of the claims sent by my billing service that use superbills created by PracticeFusion.

  • Anonymous commented  · 

    With the changes in requirements for insurance reporting, it is necessary that we are allowed up to 12 diagnosis codes, just as medicare allows. If the billing process becomes to cumbersome, people are going to have to start looking elsewhere for software.

  • Kristen commented  · 

    Medicare ACO's are actually requiring this for CY2017 for practices to meet shared savings benchmarks.
    It doesn't seem right for the individual practice to have to enter additional data after pushing through to the billing software - that is a lot of extra work and effort when the change could be made at the iniitial end of the process.

  • Linn commented  · 

    Medicare allows up to 12 DX's on a claim, and is using the information for QIP and other initiatives. We need to be able to add more DX codes to give a clear picture of our chronic patients

  • Anonymous commented  · 

    Many times, having the ability to add more than 4 diagnoses on the super bill will decrease the number of claims rejected by the insurance companies.
    Particularly with the E&M procedure codes (99203, 99213, etc.).... when the complexity becomes more involved, and multiple systems are involved.
    Please, please look into this.

  • Anonymous commented  · 

    This makes good sense to me as I have sent more than 4 codes in only to have it rejected by certain insurance companies. Explanation is no dx pointer to the cpt code. Thank you for you input. To add to the comments below. We have a practice that is driven by medicare advantage plans run by IPA groups and they insist of all codes being used and in fact I have had to bill as many as 20 dx codes for one patient but for commercial plans they will reject more than 4 codes as it actually creates more than one superbill. Some of the fee for service medicare advantage plans have attestation forms that will be filled out by physician or nurse practitioner. As long as the billing note in the patient's chart has all codes listed when they come in to audit.

  • Dr. Abusuwa commented  · 

    I think practice fusion should increase the diagnosis codes to 6-8 per CPT due to insurance demand for that, I am having the same issue, Humana keep asking me that I should include all the diagnosis codes in the claim.
    Usually Doctors send the claim to billing system & does not have the time to go to billing system and start adding more diagnosis.
    This an Urgent request for Practice Fusion to solve this problem.
    Thanks.

  • Mrs Monica Spielman commented  · 

    I believe you should be able to add up to 12 dx codes for 1 proc code. As it effects the drs RAF score and may limit their reimbursements or future bargaining with ins companies. Putting the proc in a couple times with 4 dx's each is not efficient as you have to go in to billing software and take the codes out, which is a waste of time.

  • Hello Mary,

    In this scenario, we suggest you create an additional procedure line with the same CPT code on that superbill. This will allow you to communicate additional diagnoses to the biller, once the superbill lands in the claim.

    We understand this is not the most ideal method of communication with your biller at this time, but after checking with our integrated billing systems, this should work just fine.

  • Anonymous commented  · 

    While I appreciate your reasoning, it still does not help me from a practice and time management standpoint. I have to spend the time looking at each bill and manually adding ICD10 codes. Also, please see the following about submitting more than 4 codes per CPT and reconsider allowing the practices to do so.

    While you can include up to 12 diagnosis codes on a single claim form, only four of those diagnosis codes can map to a specific CPT code. That’s because the current 1500 form allows space for up to four diagnosis pointers per line, and that won’t change with the transition to ICD-10. So, why even list diagnosis codes that you’re not going to link to any of your service lines? This article answers that question using the following example: “For a service that is somewhat generic like an office visit, the patient may have come in because they had the flu, but ended up getting a full evaluation that showed a previous lower leg amputation and perhaps diabetes management. While the office visit did not address the leg specifically, capturing the diagnosis is still very important.” Furthermore, even though you can only officially point four diagnoses to any one service, if the other diagnoses “are relevant to the treatment, they are still available to the examiner at the insurance company who is doing the adjudication—they just are not specifically pointed to.”

    https://www.webpt.com/blog/post/icd-10-and-your-claims-7-essential-must-knows

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