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Back  RFI # 237: Max use of other dx codes

Formal vs. Informal Help Informal Formal

Submitter

ruth french

Description

Can you clarify the rules from the implementation guide in the 2300 loop for Other Diagnosis Information in the HI segment for V4010 837 Institutional Claims.

My interpretation is that for each HI segment with a BF qualifier Code there may be up to 8 diagnosis codes in that segment. Such as below, and the file could have up to 25 of these loops thus giving the potential to send up to 200 other diagnosis codes.

HI*BF:dx1*BF:dx2*BF:dx3*BF:dx4*BF:dx5*BF:dx6*BF:dx7*BF:dx8
HI*BF:dx9*BF:dx10*BF:dx11*BF:dx12*BF:dx13*BF:dx14*BF:dx15*BF:dx16

However, some of our payors are interpreting each BF loop to contain only 1 other diagnosis code each creating a new segment. Such as below. The problem is that in this format below you can only submit 25 other codes, the file will hit a HIPAA error if you exceed 25 other codes in the format below.

HI*BF:DX1
HI*BF:DX2
HI*BF:DX3

Response

This issue is explicitly addressed in guide 004010X096A1. The Other Diagnosis Information HI segment in the 2300 loop supports up to 12 iterations of the composite element per segment. That allows 12 other diagnosis codes per segment iteration. The segment usage only permits two iterations of the HI segment containing other diagnisis information (Qualifier BF in the first element of the composite). That gives a capacity of 24 additional diagnosis codes per claim.

Restricting the HI segment to only contain one diagnosis code per segment or using more than two HI segments to convey other diagnosis codes is not consistant with the guide.
Submission 4/8/2005
Status Date 4/13/2005
Status F - Final
Primary References
Document 004010X096A1
Section2300
Page232
Set IDHI