How do I update a Billing Dx (diagnosis) Code for an internal member?

Billing Dx Codes must be available in the system when you generate an invoice so the system can assign a Billing Dx Code to the invoice based on the code’s priority for the Agency and for the Member (Patient).

If a generated invoice doesn’t have a Billing Dx Code, or if the Billing Dx Code is changed after the invoice is generated, the system holds the invoice in Billing Review with a Missing Primary Diagnosis Code exception. After entering the correct Billing Dx Code, the user must delete and re-generate the invoice.

The Billing Dx Code can be set for a Patient at the Authorization level (highest priority) and at the Contract level (second priority). If no Billing Dx Code is set at either of these Patient levels, the system uses the Billing Dx Code set at the Agency level.

  1. Go to Patient > Authorization to access the Billing Diagnosis Code(s) field.

    Patient Authorization – Billing Diagnosis Code(s) Field

    Dx codes already associated with the Patient from the Agency Contract or from the Patient’s Contract page are displayed and noted in the Billing Diagnosis Code(s) field, as shown in the following image.

    Existing Billing Diagnosis Code

    Information for Billing Dx Codes already associated with the Patient is for reference purposes only. These Codes cannot be edited or deleted. When a new Billing Diagnosis Code is entered, the system removes this information.

  2. Click Add at right to apply a new Billing Diagnosis Code.

  3. On the Authorization Default DX Code page, select the ? link next to the ICD field.

    The system assigns the first Dx Code entered here as Primary. After this, you can add Dx Codes as the Primary or Admitting Diagnosis Code.

    Authorization Default Dx Code page

  4. On the Diagnosis Search page, search for and select ICD 10 Codes. To add an ICD Code, click the Code link at left, as highlighted in the following image.

    Diagnosis Search page

  1. Go to Patient > Contract > Additional Options and select Patient Diagnosis Code Override from the list.

    Patient Diagnosis Code Override

  2. When the Patient Diagnosis Code Override page opens, click Add to apply an ICD code. The system displays a note explaining how the system decides which Diagnosis Code to apply to an invoice.

    Patient Diagnosis Code Override page

  3. On the Contract Default DX Code page, click the ? link to the right of the ICD field.

    Contract Default Dx Code page

  4. On the Diagnosis Search page, search for and select ICD 10 Codes. To add an ICD Code, click the Code link, as highlighted in the following image.

    Diagnosis Search page

    The selected code is displayed.

    Patient Diagnosis Code Override