Wednesday, 1 August 2012

EDI 5010 Documentation 837 Professional - Loop 2300 Health care Diagnosis Code

2300 Health care diagnosis code

        

One of the main purposes of 5010 is to support the upcoming change to ICD-10 diagnosis and procedure codes – a change providers must make by October 1, 2013. To help prepare for ICD-10, 5010 now requires a Diagnosis Code on all claims, and the maximum number of Diagnosis Codes was increased from eight in 4010 to 12 in 5010. Although you can report 12 diagnosis codes at the claim level, you can only point or link four codes to a specific service at the service line level.

Loop Seg ID Segment Name Format Length Ref# Req Value
2300 HI Health care Diagnosis code ID 2 R HI
Element Separator AN 1 *
HI01-1 Code List Qualifier Code ID 1/3 1270 R BK = Principal Diagnosis
    Component Element separator   1     :
HI01-2 Industry Code AN 1/30 1271 R Print Primary Diagnosis code
Element Separator AN 1 *
HI02-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis Code
    Component Element separator   1     :
HI02-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI03-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis Code
    Component Element separator   1     :
HI03-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI04-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis Code
    Component Element separator   1     :
HI04-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI05-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis Code
    Component Element separator   1     :
HI05-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI06-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI06-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI07-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI07-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI08-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI08-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI09-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI09-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI10-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI10-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI11-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI11-2 Industry Code AN 1/30 1271 R Print Diagnosis code
Element Separator AN 1 *
HI12-1 Code List Qualifier Code ID 1/3 1270 R BF = Diagnosis
    Component Element separator   1     :
HI12-2 Industry Code AN 1/30 1271 R Print Diagnosis code
  Segment Terminator ~
               
 
Example
Claim Setup

Field

Value

Claim No

252

Claim Location

NY Office

Place of Service

11 - Office

Rendering Provider

David Mark

ICD Code

410,415, 368.34, 522.3

Line items

Procedure Code

Mod1

Mod2

Mod3

Mod4

ICD

FromDOS

ToDOS

Units

Unit Charges

99214

1,2,3,4

01/09/2012

01/09/2012

1

40

92570

1

01/09/2012

01/09/2012

1

180.04

90371

3,4

01/09/2012

01/09/2012

1

83


HI*BK:410*BF:415*BF:36834*BF:5223~

image

By Loop
2300 - Claim Information CLM CLM*252*303.04***11:B:1*Y*A*Y*Y~
2300 - Claim Information - Clia Number REF REF*X4*CL324234~
2300 - Claim Information - ICDs HI HI*BK:410*BF:415*BF:36834*BF:5223~
2310B - Rendering Provider Name NM1 NM1*82*1*Mark*David****XX*1111111111~
2310D - Service Facility Location NM1 NM1*77*2*NY Office*****XX*1336177328~
2310D - Service Facility Location N3 N3*5081 Tellus. Avenue*668-2204 Non Rd.~
2310D - Service Facility Location N4 N4*White Plains*NY*809051232~
2310D - Service Facility Location REF REF*LU*484345~
2400 - Service Line LX LX*1~
2400 - Service Line SV1 SV1*HC:99214*40*UN*1*11**1:2:3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1140~
2400 - Service Line LX LX*2~
2400 - Service Line SV1 SV1*HC:92570*180.04*UN*1*11**1~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1141~
2400 - Service Line LX LX*3~
2400 - Service Line SV1 SV1*HC:90371*83*UN*1*11**3:4~
2400 - Service Line DTP DTP*472*RD8*20120109-20120109~
2400 - Service Line REF REF*6R*1142~

 

 

ICD 10 Changes :
To convert ICD-9 to ICD-10 claim files, all the segments are remain same except the HI segement.

Example
ICD-9 claim HI segment with diagnosis code ( 0340 -shore throat) with Secondary diagnosis code -V202 for - child well visit.

HI*BK:0340*BF:V202~

After changing to ICD 10 :

HI*ABK:J020*ABF:Z00129~

To get ICD 10 Code by ICD 9, use the AMA online tool to convert


        

Questions or feedback are always welcome. You can email me at vbsenthilinnet@gmail.com.
 

6 comments:

  1. This comment has been removed by the author.

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  2. Hi. Question: if only 4 dx can be linked per service line, then how can I submit required HCC data that occur after 4 dx?

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