Billing Diagnosis Codes

There are two Diagnosis Codes categories: Billing Dx Codes and Clinical Dx Codes.

Billing Dx Codes	Diagnosis Codes are assigned by the HHAeXchange system when the Invoice is generated; if the contract is configured to require a Primary Dx Code for billing. Billing Dx Codes can be entered in one of three places to include: Patient Authorization page, Patient Contract page, and in the Billing/Collections tab under the Contract Setup page.
Clinical Dx Codes	Diagnoses Codes entered on the Patient Clinical Info page, which appear on the Patient MD Orders.

Billing Dx Codes must be entered into the HHAeXchange system prior to generating an invoice. The system assigns a Billing Dx Code at the time of Invoice generation. The Billing Dx Code can be set in the sections highlighted below, with the system determining which Dx code to assign for billing based on the priority level.

Priority	Page	Description
Highest	Patient Authorization	If provided, then the system uses the Billing Diagnosis Code(s) set on the Patient’s Authorization Page for billing purposes.
Secondary	Patient Contract	If no Dx code is set on the Patient’s Authorization page, the system searches for a Patient Diagnosis Code Override on the Patient’s Contract page.
Default	Agency Contract Level	If no Dx codes are set at the Patient level (Patient Authorization page or Patient Contract page), then the system defaults to values set at the Agency Contract level (Default Billing DX Code).

The following sections provide step-by-step instructions on how to set the Billing Dx Code in each area of the HHAeXchange system.

If the Billing Dx Code is not set before generating an invoice, or is changed after invoice generation, then the invoice is held in Billing Review with a Missing Primary Diagnosis Code exception. In this case, the invoice must be deleted and re-generated after the Billing Dx Code is entered.

Set up a Default Billing DX Code at the Agency Contract Level Closed

Agencies may set a contract-level billing DX code using the Default Billing DX Code(s) field. The system assigns this the default code unless there is a higher priority DX code assigned at the patient level. 

Go to Admin > Contract Setup > Search Contract.
Enter search parameters and then select Search. Open the contract from the search results.
Select the Billing/Collections tab.
Select the Default Billing DX Code(s) check box.
Select Add to apply a default DX billing code on the diagnosis code table.
In the Contract Default DX Code window, select the question mark ? link to the right of the ICD field.
Search for the ICD 10 code in the Diagnosis Search window, select the code and then select Save.

By default, the system assigns the first DX code entered as the primary code. Users may manually designate the primary or admitting diagnosis code in the Contract Default DX Code window.

Set up Billing DX Codes at the Patient Contract Level Closed

DX codes entered on the Patient Contract page are second priority. If no DX code is set on the Patient Authorization page, the system searches for a Patient Diagnosis Code Override on the Patient Contract page.

Go to Patient > Search Patient. Enter search parameters and then select Search. Open the patient from the search results.
Select Contract from the left menu and then select Additional Options. Select Patient Diagnosis Code Override from the dropdown.
Select the Add button to apply an ICD code on the Patient Diagnosis Code Override window.
In the Contract Default DX Code window, select the question mark (?) link to the right of the ICD field.
Search for the ICD 10 code in the Diagnosis Search window, select the code and then select Save.
The selected code appears on the Patient Diagnosis Code Override window. Select Close.

Set up Billing DX Codes at the Patient’s Authorization Level Closed

DX codes entered on the Patient Authorization page receive the highest priority. This means the system assigns the DX code on this page for billing purposes even if the patient has one set on the Patient Contract page or at the agency contract level.

Go to Patient > Search Patient. Enter search parameters and then select Search. Open the patient from the search results.
Select Authorization/Orders from the left menu and then select the contract listed under the Authorizations tab.  
Select the Add button beside the Billing Diagnosis Code(s) field.

The system removes notes and codes when a user enters a new billing diagnosis code.
In the Authorization Default DX Code window, click the question mark (?) link to the right of the ICD field, search for, and select ICD 10 codes.
- By default, the system assigns the first DX code entered here as the Primary code. From here, a user can set DX codes as the primary or admitting diagnosis code.  
Select Save.