Diagnosis Code Setup

Diagnosis codes are used to identify what is wrong with the patient. Similar to Procedure Charges, there are specific codes used to identify the conditions to the insurance carriers. The Codes on Disk and Encoder Pro programs can be used to identify and enter these codes into the system. The same advantages apply to each of these programs, as applied with the Procedure Code setup.

In order to enter Diagnosis Codes into your system, click the Lists menu and Diagnosis Codes.


To create a new diagnosis code, click the New button. The following screen will appear.


Code 1:
The code 1 field should be populated with the official ICD-9 code as listed in either Encoder Pro, or in your Diagnosis Code book. This code will be the code entered into the patient’s case or into transaction entry whenever you need to assign someone this diagnosis code.

Tips and Tricks:

Different diagnosis codes have different format requirements. The general format is three numbers followed by a period, and then one or two numbers (Example: 052.9). If the code you are entering requires 5 digits, and you only enter 4 of those digits, claims submitted with that code will be rejected.

 

Description: There are official descriptions available through the Codes on Disk and Encoder Pro Products, as well as the books. Codes that will be sent to insurance carriers should utilize these descriptions, even though the description is not generally sent on electronic claims or printed on paper claims.

Alternate Codes 2 and 3: These are the alternate codes that are available to be sent on claims to certain insurance carriers, as discussed in the Insurance Carrier setup.

Tips and Tricks:

If your insurance carrier has a 1 in the field Diagnosis Code Set, claims sent to that carrier will include the values entered in the Code 1 field of each diagnosis code entered for each transaction included on that claim.

If a 2 or 3 is entered into the Diagnosis Code Set field, claims will include the values in Alternate Code 2 or 3.

 

If you receive reports of diagnosis codes not printing, or incorrect codes printing, this is the first place you should look.

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