CMS1500 Form: 12 Dx Codes Per Claim Clarification

We are finding our offices have been getting incorrect information regarding the number of diagnosis codes allowed on the electronic format as well as the paper form.

Rest assured with the implementation of ANSI 5010 electronic format and the revised CMS 1500 (2/12) paper form a few years ago, ChartMaker Medical Suite Practice Manager was updated to allow up to twelve diagnosis codes per claim as required in the X12 Specifications for electronic and paper format. Although twelve diagnosis codes are allowed per claim, only four diagnosis codes are allowed per line item (each individual charge). For more clarification, here are a few examples:

•  If your claim has one charge, then ONLY four diagnosis codes may be reported.

•   If your claim contains more than one charge, then MORE THAN FOUR diagnosis codes may be reported. But only four diagnosis codes will be reported for each charge.

You can see an example when you print a CMS1500 paper form (please see screenshot below). Box 21 can be populated with 12 diagnosis codes. Box 24E will only allow up to four diagnosis pointers. Medicare specs only permit one diagnosis pointer. The NUCC specs outlining the requirement for reporting diagnosis codes for electronic and paper submission is available for your reference HERE.