Section title: Requests for Interpretation
RFI #
2109
837P 12 DX codes 4 DX pointers
Description

If 12 diagnostic codes are used, should there be a diagnostic code pointer for each code on a service line? For example, you have DX codes 1 through 12 you have 12 service lines. Service line 1 points to DX code 1, service line 2 points to DX code 2, service line 3 points to DX code 3, service line 4 points to DX code 4, service line 5 points to DX code 5, service line 6 points to DX code 6, service line 7 points to DX code 7, service line 8 points to DX code 8, service line 9 points to DX code 9, service line 10 points to DX code 10, service line 11 points to DX code 11 and service line 12 points to DX code 12.

Is it incorrect to use 12 diagnostic codes and some DX codes do not have a service line that points to the DX code?

RFI Response

The guide is silent on this question. Since there is no requirement, a diagnosis code does not need to be linked to a service line. These additional diagnosis codes are considered to be additional information.

It should be noted there is also no restriction preventing a submitter from linking multiple line items to a single diagnosis code.

DOCUMENT ID
005010X222