Home Forums Medisoft and 8 diagnoses?????

We have used Medisoft with electronic billing for many, many years and have never been able to figure out how to put more than 4 diagnosis on a charge - does anyone know how to do this? I see other PM vendors make it difficult to do also - also have seen that I get faxes from insurance vendors (mostly about meds) who complain that I have not sent every diagnosis I treat a patient for but with Heart disease, HTN, Diabetes with neuropathy I have run out of places to put gout, disc disease, etc.

Steven,
Are they not paying or just complaining? We use a round file for insurance complaints. (Acommpanied by the world's smallest violin).

Dave
FP
Your northern neighbor.

I have never understood this either. So far as I know, we rarely use more than a couple of diagnosis codes per claim. The purpose of the coding is to get paid, and they don't pay more for 10 codes than for 2, do they? So if they deny payment, I can understand that you might want to submit more codes to justify the complexity of the service, but short of that, who cares if the company complains?
Maybe it is different for primary care providers as opposed to specialists in this regard.

Status of 3 stable conditions warrants a 99214. No need for more than 4 diagnosis codes.
Dave

I agree but when other offices told me they could do 8 diagnosis I thought I would do a few - would allow you to do 3 or 4 diagnosis and some v codes.......

For FFS you don't need more than 4 diagnoses
But in SoCal with our managed care (and soon with ACO's) you will benefit from coding all of the applicable diagnoses with HCC codes as reimbursement will increase if you document the medical conditions a patient has.
Simple diabetes 250.00 is not as complex as diabetes with renal impairment-250.40, 583.81, Old MI- 412, depression 296.20, etc.
Many elderly have several of these HCC conditions that impact reimbursement and need to be billed annually so having room for 8 is an advantage.

Greg

This has actually come up for us in a big way recently - we're a small practice and the largest Medicare Advantage player in our area (Humana) just terminated our contract with them with no notice and no explanation to our patients, all of whom are elderly and many of whom have been with us for years. They left our commercial Humana contract intact, cancelled only the Medicare HMO one. We were pretty stunned. They sent our patients letters saying we were no longer in network and even sent them new Humana cards with the name of a new doctor on them... down at the local Jencare clinic.

We called, rather irate. Turns out the reason we were termed is that based on our coding (we had never used more than 4 codes before, either) our patients were "not as complex as they should be" and Medicare is apparently reimbursing Medicare HMO's at least partially based on the number of and complexity of the codes submitted. They didn't want us to undercode because it was costing them money. We could have waved goodbye to Humana but didn't for 2 reasons: 1. we like these 300 or so old folks and it's not their fault and 2. Medicare is going to start paying everyone this way before too long and we may as well get with the program.

So, we are not in the process of finding a new claims solution that allows us to submit 8 codes.

So, in short, being able to submit 8 Dx codes is not a big issue - yet - unless you see a lot of Medicare patients. But I anticipate commercial payors to follow suit before too long.

This is setup in Program Options -> Data Entry tab -> Number of Diagnosis field. Medisoft currently supports up to 12 diagnosis codes per charge. CMS-1500 paper forms and print image claims will only include the first 4 diagnosis codes. ANSI 5010 professional claims can support 8 diagnosis codes, but the standard only allows 4 diagnosis pointers per charge.