Provider-Managed Billing Diagnosis Codes Job Aid
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DISCLAIMER |
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This feature is enabled by HHAX System Administration. Please contact HHAX Support Team for details and setup. |
Billing Diagnosis Codes are determined by the Payer and sent in the Authorization at the time of placement. Providers servicing Linked Contracts receive Billing Diagnosis Codes as read-only, unable to edit if/as needed for billing purposes. A Payer-based permission is available to allow Providers to add and manage Billing Diagnosis Codes for any Linked Contract; whether the ones assigned by the Payer or the ones entered/edited by the Provider. This feature applies to all Linked Contracts.
Note: A blank Diagnosis Code may result in an item placed on Billing Hold. Refer to the Resolving Missing Primary Dx Code Exceptions Job Aid to resolve. For specific Contract Setup details and instructions, consult with the respective Linked Payer.
Edit Link in Patient Authorization
Once a Payer enables a Provider to edit or add Billing Diagnosis Codes for an Authorization (located at (Patient > Authorization), an Edit link appears on the applicable row of the Authorization tab, as shown in the following image. The Edit link only appears if the Provider has permission to add Billing Diagnosis Codes.
Edit Link in the Authorization Tab
Providers who are enabled to change Billing Diagnosis Codes are presented with an Add button in the Billing Diagnosis Code(s) section of the Patient Authorization window, as shown in the following image.
Patient Authorization Window
Choosing a Billing Diagnosis Code
On the Authorization Default DX Code window, select the ? (question mark) link to access the ICD-10 Diagnosis search, as seen in the image below. Refer to the section below to select an ICD code.
Once the ICD code is selected, determine if this is an Admitting Diagnosis and/or a Primary Diagnosis by selecting the appropriate checkboxes. Click Save to finalize.
Authorization Default DX Code Window
Use the Diagnosis Search window to search for and select an ICD-10 Code. To add an ICD code, click on the respective link from the ICD-10 column, as shown in the following image.
Diagnosis Search Window
Billing Diagnosis Codes on the Contract Level
For some Linked Contracts, Billing Diagnosis Codes can be added on the Contract level (Admin > Contract Setup > Billing/Collections tab). On the Billing/Collections tab, select the Default Billing Diagnosis Code(s) checkbox. Click on the Add button to open the Contract Default DX Code window. Click on the ? link on the right of the ICD field to search and select the applicable diagnosis Code (as illustrated in the following image).
Billing Diagnosis Codes on the Contract Level
Billing Diagnosis Codes on the Patient Contract Level
Billing Diagnosis Codes can also be added for some Linked Contracts at the Patient Contract level (Patient > Contracts). On the Patient Contract page, click on the Additional Options link for the respective contract. Select Patient Diagnosis Code Override from the menu. On the Patient Diagnosis Code Override window, click the Add button to search and select the applicable Billing Diagnosis Code (as seen in the following image).
Billing Diagnosis Codes on the Patient Contract Level
Billing Diagnosis Code Limit
Up to 26 unique Billing Diagnosis Codes are allowed per Patient, with one defined as Primary. When attempting to add more than 26 codes, the system issues a validation not allowing further entries, as shown in the image below.
Billing DX Code Limit
Billing Diagnosis Codes on the Invoice Details Page
On the Invoice Details page, click on the Billing DX Code link to open the Billing Diagnosis window (as illustrated in the image below). To edit an existing code, click on the Code link and make the changes. To add a Billing Dx Code, click on the Add button and follow the instructions above. Click Save to finalize.
Invoice Details Page: Billing Diagnosis Window
Invalid Billing Diagnosis Codes
At times, a Payer may send an invalid Billing Diagnosis Code. Invalid codes are denoted with an orange exclamation point (!) icon (as seen in the following image) indicating that it must be corrected.
Invalid Billing Diagnosis Codes