Add and Manage Patient Diagnosis Codes

Before billing a commercial claim, a behavioral diagnosis and a principal diagnosis must be present in the patient's profile. 

• For Institutional claims, the RCM uses the codes in this section for boxes 67, 69, and 70. 
• For professional claims, the diagnosis code used for boxes 21 and 24e is derived from the code selected when recording a standalone service.

User Permissions

Users with admin-level permissions can access and edit this information. For user-level profiles, additional permissions must be configured by an admin before access can be granted. For more information on user profiles and permissions, click here.

Configuration

Available diagnosis codes are managed at the Practice Admin level. For more information on configuring codes, click here.  

Add Diagnosis Codes

Let's review how to set diagnosis codes for the patient!

1. Navigate to the Patient's profile.
   
2. Next, click the quicklink carrot and select Intake.
    
3. Click Behavioral Service Diagnoses.
   
4. Next, in the Admitting row, click Set.
5. Then enter the desired code or a keyword associated with the diagnosis you want to select, and click Search.
   
6. Once you have located the desired code, click the + icon. 
   
7. Confirm the information in the Code field.
   
8. Update the Present on Admission drop-down when applicable. 
   
9. Then click Set Code to complete the process. 
   
10. The system will automatically use the Behavioral Diagnosis Code for the Principal Diagnosis Code. To update the Principal Diagnosis Code, repeat steps 4-9.
11. To add additional codes, click Add ICD10 Behavioral Diagnosis and repeat steps 5-9 until all necessary codes have been added.

Manage Patient Diagnosis Codes

Managing a patient's diagnosis codes for institutional claims uses the same process as setting the codes outlined above. Managing diagnosis codes for standalone services must be done in the Attendance Calendar using the process outlined here. If the existing codes were used to bill claims, the system will attempt to generate corrections based on the new codes.

Note: Deleting a Standalone Service Diagnosis will not remove it from the Behavioral Service Diagnoses tab. However, deleting a Behavioral Service Diagnosis will remove it from the Standalone tab.

Helpful Hints

Some payers will not accept a claim that includes one or more diagnosis codes. Use this Claim Form Rule to omit the diagnosis code from the claim.