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Medical Billing and Coding: Multiple Diagnosis

A medical insurance specialist has a very important job that is essential to any healthcare practice.  One of the important responsibilities of a medical insurance specialist is to apply the correct diagnosis code on the patient’s billing record.  The diagnosis code is reviewed by the medical insurer to ensure that only allowable medical procedures are reimbursed.  An inaccurate diagnosis code can cause the medical insurer to ask the healthcare provider for proof that the procedure was necessary.  Anytime a medical insurer has to request proof from a medical billing and coding specialist the reimbursement process is delayed.

Patients with more than one condition will have multiple diagnosis codes listed on the medical claim form that is submitted to the medical insurer by the healthcare provider.  The first diagnosis code that is listed on the form should be the reason why the patient sought medical care.  Any other conditions that are discovered are listed subsequently.

For example, if a patient seeks medical care for a skin lesion that appears to have pus and necrosis of surrounding tissue on her foot the doctor may diagnose the patient with a chronic skin ulcer.  The initial diagnosis for the skin ulceration will be the first diagnosis code that is entered on the claim form.  If the health care provider determines that the ulcer is due to diabetes and poor circulatory problems then these multiple conditions will be listed after the initial condition that caused her to seek medical attention.  These additional diagnosis codes are not the reasons why the patient sought medical care but are contributing factors.  Up to eight codes can be listed on the HIPAA 837 and four codes can be listed on the CMS 1500.

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