Perhaps something in their logic that was updated for ICD-10 has broken this as well. If it is a claim that is only the four immunizations, then you should always have a pointer of “1”.The clearinghouse is incorrectly rejecting the claim. Sorry about the delay.Insurers should ignore the pointers for risk adjustment purposes and consider all claim level diagnosis apply to every line when submitting for risk adjustment – not just those that have been pointed to.The (up to) four pointers at any line level simply represent the TOP four diagnosis for any given treatment. Just wanted to see if there was away to get all of the dx codes for each Service Line.Thank you, Lee. But my question is when we are instructing the providers to bill ALL diagnosis codes which will impact the Risk Adjustment Program (RAPs) and HEDIS for the provider and insurance company – how can a provider bill the pointers for 12 diagnosis codes if they only have say two Service Lines (i.e., 992xx and 364xx)? Some documentation states “the top 4 dx codes” but most provider office personnel will pick the first 4 dx codes which may not include the most important ones. I am inquiring about Diagnosis code Pointers – I understand that up to 12 diagnosis codes can be accepted via paper or EDI along with the corresponding diagnosis code pointer on each Service Line. If there are five diagnosis listed on the bill / claim and all are related, you would have four pointers – 1,3,4, 5 for example – and pick the four diagnosis that were the most important / relevant to the procedure.Let me know if this helps.

Use the pointers to indicate what diagnosis are most related to why the procedure is being done. You MAO plan will be very happy with the properly coded claim if done this way. You note all of the things wrong with the person – especially if they were evaluated in any way. Rhonda,You are correct that you would note all 10 diagnosis codes and then only send pointers to the 4 that are most relevant to the visit.If an office visit takes place where someone came in because they had a cold, but they have lots of other things going on like diabetes, a previous lower leg amputation, a history of AMI, etc. In other words, will the Medicare Administrative Contractors penalize for submission of (and account for) multiple same-line diagnosis pointers submitted in an ASC X12 V5010 837P transaction?. Otherwise, the instructions above apply.“If a situation arises where two or more diagnoses are required for a procedure code (e.g., pap smears), THE PROVIDER SHALL REFERENCE ONLY ONE OF THE DIAGNOSES IN ITEM 21.”My question is whether this instruction applies ONLY to CMS-1500 claims, or if it applies to CMS-1500 claims and “electronic equivalent”.

Adcd 1.12