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Back  RFI # 603: Diagnosis Codes in 837I

Formal vs. Informal Help Informal Formal

Submitter

Joanmarie Cifelli

Description

The paper UB04 claim form can accommodate 1 admit diagnosis code, 3 patient reason for visit diagnosis codes and 3 external cause of injury codes. Can the 837I format accommodate all occurrences of these 3 types of diagnosis codes in loop 2300/HI segment or is the 837I limited to only a total of 3 of they diagnosis code types?

Submitter Assigned Keywords

Diagnosis Codes

Response

Per the 837 institutional version 004010X096, only one admit diagnosis can be reported using a value of BJ in element HI02-1. If a patient reason for visit needs to be reported, a value of ZZ is to be used in element HI02-1. Note that an admit diagnosis and patient reason for visit cannot be reported on the same claim. Value of BN in element HI03-1 is used when reporting an external cause of injury code of which only 1 can be reported. Element HI101-1 is used to report the principal diagnosis which is always required.

Therefore a total of 3 diagnosis can be reported per claim in the PRINCIPAL, ADMITTING, E-CODE AND PATIENT REASON FOR VISIT DIAGNOSIS INFORMATION HI segment - 1 Principal diagnosis, 1 Admitting diagnosis or 1 Patient Reason for Visit, and 1 External Cause of Injury code.

Recommendation

If other diagnoses co-exist with the principal diagnosis, co-exists at the time of admission or develops subsequently during the patient’s treatment, then up to 24 additional diagnoses can be reported with qualifier BF in the Other Diagnosis Information segment.
Submission 9/11/2007
Status Date 10/29/2007
Status F - Final
Primary References
Document 004010X096
Section2300
Page227
Set IDHI