Skip to main content
  • Exams ICD-10 Ask the Expert Coding Competency

    Appropriate Number of ICD-10 to Link on Claim


    Add to My Bookmarks
    In my practice I often see just one diagnosis code submitted to an insurance company when the patient’s visit addresses several problems. Although I imagine insurers may pay with just one ICD-10 code, is it more appropriate to submit every applicable diagnosis code?

    Answer:
    You can submit up to four diagnosis codes per CPT, but one may be sufficient. You should submit all applicable diagnoses that are addressed at the encounter. The number of diagnoses addressed can impact the level of medical decision-making (MDM) when using evaluation and management (E/M) codes.

    Example:
    What should you submit on the exam if the patient has a different type of glaucoma in each eye and blepharitis on all four lids? That equals six ICD-10 codes, but you cannot link six diagnosis codes to one service.
    Solution:
    Submit the two types of glaucoma and at least one of the lids for blepharitis. The claim should be processed correctly.

    This information is covered in the Academy’s Fundamentals of Ophthalmic Coding. Additional information on E/M MDM can be found at EM Documentation.