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Diagnosis Code Requirements


Provider Administrative Policy

Section
Hospital
Policy Date
November 2007
Status/Date
Revised/March 2009
Provider Type(s)
Hospitals  

Disclaimer

Our provider administrative policies contain information regarding claims submission, reimbursement, and other information in order to achieve an efficient relationship with our providers. These policies are not an authorization or explanation of benefits. Blue Cross of Idaho retains the right to add to, delete from and otherwise modify this policy in accordance with our provider contracts.

Policy

Diagnosis Code Requirements

Blue Cross of Idaho requires that hospitals provide a full accounting of all patient diagnoses codes present at the time of discharge. Specify ICD-9-CM diagnosis codes to the fourth and fifth digits, as applicable, to provide the most comprehensive description of the patient’s condition.

For outpatient procedure or inpatient claims, please use field 67 (Principal Diagnosis Code) of the UB-04 to report the condition chiefly responsible for causing the hospitalization or use of other hospital services.

For outpatient testing claims, please use field 67 to report the diagnosis based on the test results. Code the signs or symptoms that prompted the ordering of the test as additional diagnosis in fields 67A through 67Q.  Present on Admission (POA) indicators should be reported in the 8th digit place.

Use Field 69 (Admitting Diagnosis) to report the ICD-9-CM diagnosis code present at the time of admission. This usually represents a significant or abnormal finding during an exam.


Policy History

Date Action Reason
March 2009 Revised POA indicator reporting

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