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Back  RFI # 433: Diagnosis Code Pointers

Formal vs. Informal Help Informal Formal

Submitter

Joanmarie Cifelli

Description

In the 4010 version of the Professional 837, the Diagnosis Pointers in 2400/SV107 are defined as max 2 positions and acceptable values are 1 through 8 inclusive. Please confirm whether the maximum number of pointers received could be 4 or 8.

Submitter Assigned Keywords

Diagnosis Code Pointers

Response

The 837 Professional Claim Transaction allows up to eight diagnosis codes per claim in the Loop ID-2300 HI Health Care Diagnosis Code segment. Each service line (Loop ID-2400) points back to at least one, and a maximum of four, of the diagnosis codes in the claim level HI segment. The pointer value, reported in SV107, corresponds to the diagnosis code's position in the HI segment, which can be 1 through 8. Therefore, a claim can contain up to 8 diagnosis codes, but a specific service line can only point to a maximum of 4 of those 8 codes.
Submission 7/25/2006
Status Date 9/8/2006
Status F - Final
Primary References
Document 004010x091a1
SectionService
Page405
Set ID837
Loop2400
Segment Position370
Segment IDSV1