Principal diagnosis codes are required for completion of the Health Care Finance Administration HCFA-1450 billing form for outpatient claims. Report the full ICD-9-CM code for the diagnosis shown to be chiefly responsible for the outpatient services in Form Locator (FL) 67 of the HCFA-1450 form. Report the diagnosis to the highest degree of certainty. For instance, if a patient is seen on an outpatient basis for an evaluation of a symptom (e.g., cough) for which a definitive diagnosis is not made, the symptom must be reported (786.2). If during the course of the outpatient evaluation and treatment a definitive diagnosis is made (e.g., acute bronchitis), report the definitive diagnosis (466.0). Secondary diagnoses should include any symptoms that brought the patient to the hospital along with other medical problems that would affect the patient's care. Use FL 68-75 for these secondary diagnoses.
When a patient arrives at the hospital for examination or testing without a referring diagnosis and cannot provide a complaint, symptom, or diagnosis, report an ICD-9-CM code for Persons Without Reported Diagnosis Encountered During Examination and Investigation of Individuals and Populations (V70-V82).
Note: |
Diagnosis codes are not required on nonpatient claims for laboratory services where you function as an independent laboratory, however, ICD-9-CM diagnosis codes may be required by a Local Medical Review Policy to document medical necessity for a specific test. |
Refer to the Hospital Manual section 460 for specifics.