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Why Can't 12 Diagnosis Codes be Billed for One Procedure

Q. Why Can't 12 Diagnosis Codes be Billed for One Procedure?


A. According to 5010 HIPAA Standards for Professional Claims, a claim can have 12 diagnosis codes, but a service line or a procedure code can only have four diagnosis codes. In order for a claim to have 12 diagnosis codes, at least three procedure codes must be listed with four different diagnosis codes.
 
If the insurance company requires additional information, they will correspond directly with you, requesting documentation.
 
If you have additional questions, it is important that you speak with your certified coder that will properly advise you regarding your coding questions.

 

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