How many ICD-10-CM codes are allowed on a claim form?

[RinshidaK_89540]

Question:

Ruth Sheets
This was a chat question in the May 2015 Q&A Webinar:
Is it true that ICD10 will only take (most insurance companies) only 4 dx codes?

I've done some research, and this is false.

The National Uniform Claim Committee (NUCC) latest version of the 1500 Health Insurance Claim Form Reference Instruction Manual is for Form Version 02/12 - published in July 2014 and is called Version 2.0 7/14. It can be found here: http://www.nucc.org/images/stories/PDF/1500_claim_form_instruction_manual_2012_02-v2.pdf

In this manual, it states:

• You can specify up to 12 diagnosis codes in Item Number 21 (on the form) that relate to the reason the services (CPT codes) were performed.
• If more than 12 diagnoses are required to report the line services, the claim must be split and the service related to the additional diagnoses must be billed as a separate claim.
• In Item 24E (on the form) you can specify up to 4 diagnoses pointers per service. (Each diagnosis pointer points to a diagnosis code given in Item Number 21 on the form).
• These rules apply to either ICD9 or ICD10-CM (when mandated).

So even though it was heard by the webinar attendee that asked this question that ICD10 will only take 4 Dx codes, that is not true. Each CPT code can be linked to up to 4 Dx codes to justify a particular CPT code, and each claim form has available a total of 12 fields for diagnosis codes. If the patient has more than 12 relevant diagnosis codes that need to be reported, you can split the claim into multiple claims.

I've tried to summarize the relevant rules here, but if you are confused, try reading the instruction manual (see link above) because it is quite clear and shows you the form where you would put in the codes, so I think that will help you.

Answer Thread:

Laureen​

Good sleuthing Ruth - thanks for looking that up for us. I can see now where the confusion came in - 4 dx can be linked per CPT code but we are not limited to 4 total.

 

[AnneB_81435]

I'm trying to work on Practicode cases and barely recall diagnosis pointing as part of my training for the CPC exam. Where would I have found instruction for this? I just took the AAPC course end of 2024. Seems like the focus was on A&P background, and the codes. Didn't really practice completing the 1500 forms. Barely did when I attended a different school previously.
Feeling lost.

 

[Laureen Jandroep]

How Diagnosis Pointing Works

• Diagnosis codes are listed in Box 21 on the CMS-1500 form.
• Diagnosis pointers in Box 24E (for each line item) indicate which diagnosis code(s) justify the medical necessity for each procedure billed.
• Each CPT code must be linked to at least one diagnosis code, and you can link up to four diagnosis codes per CPT code using pointers (e.g., A, B, C, D)

Where to Review This Concept

• CMS-1500 Claim Form Instructions: Review the instructions for Box 21 and Box 24E
• Online Videos and Courses: Search for “diagnosis pointer CMS-1500” or “how to use diagnosis pointers” for practical demonstrations

If you feel you missed this topic, it is usually covered in practical billing modules or claim form training rather than in the main coding guidelines of the CPC exam. However, it is a crucial skill for working coders and is well explained in billing-focused resources.