November 2009
Helpful claim filing reminders
Using diagnosis reference numbers
On a CMS-1500 claim form, one to four diagnosis codes can be entered in Field 21 Diagnosis or Nature of Illness or Injury. Field 24E Diagnosis Pointer is populated to link the procedure to the diagnosis. Only one diagnosis reference number (e.g., 1, 2, 3 or 4) should be populated per procedure line item.
If a situation occurs where two or more diagnoses are required for a procedure code (e.g., Pap smear), please choose only one of the diagnoses to populate Field 24E per procedure line item.
Review additional CMS-1500 claim form instructions.
Submitting corrected claims
Correct charges, procedure or diagnostic codes, or other information on claims as soon as possible. If submitting corrected claims electronically on the American National Standards Institute (ANSI) 837, please include:
- Code source "235" Claim Frequency Type Code
- In loop 2300, CLM05-03 "Claim Frequency Type Code," the Frequency type code specifies the frequency of the claim. The third position should be "6" CORRECTED Adjustment of Prior Claim.
Hospital claims should use Type of Bill code XX7 Replacement of prior claim and indicate all changes in the remarks field.
Mailing a corrected paper claim? Attach a Corrected Claim Cover Sheet.