CORRECT PHYSICIAN APPLICATION OF ICD-9-CM CODES SUBMITTED

Proper Coding Placement on CMS-1500 Claim Form

As a reminder when filing Medicare and other third party payer claims, Item 21 is the appropriate area on the CMS-1500 claim form to provide the ICD-9 codes applicable to the patient's condition. The diagnosis codes should be entered in priority order (primary, secondary condition, etc.). The codes should be provided in the appropriate fields within Item 21. Incorrect placement of these codes may cause rejections due to the claim being processed through the Medicare Optical Character Recognition (OCR) scanner.

Example:
Two diagnoses provided:
Place in fields 1 and 2 within Item 21, which are above and below each other.
Do not place in fields 1 and 3 within Item 21, which are across from each other.

About the Author

Reed Tinsley CPA

This article is written by Reed Tinsley, a Houston, TX-based CPA with over 30 years of experience advising physicians and medical practices across Texas and the United States. Reed holds certifications as a Certified Valuation Analyst (CVA), Certified Healthcare Business Consultant (CHBC), and Certified Financial Planner (CFP), specializing exclusively in the healthcare sector. He is a published author, nationally recognized speaker, and trusted advisor to physicians on accounting & tax, practice management, and financial planning. Schedule a Free Consultation.