A Patient Reason For Visit Code is an ICD-10 code that codes the patient's stated reason for seeking outpatient care and may differ from the principal or admitting diagnosis code. Up to 3 codes can be submitted on an outpatient claim.
The Patient Reason for Visit Code will print to the claim form as the first diagnosis code from Intake > Standalone Service Diagnoses. In order to include the Patient Reason for Visit Code, a claim form rule will be required. Perform the following steps to create this rule:
- From the Main Menu, navigate to Management Center > Claim Rules and select Create Claim Form Rule.
- Select the practice that requires the claim rule.
- Select the conditions that will require the patient reason for visit code. Generally, we will see the Current Sequence Behavioral Payer should be set to a specific payer and the Bill Type Prefix is set to 13, 78, or 85.
- Select the Behavior to "Diagnosis - Patient Reason for Visit Code".
- When creating new claims, confirm the claim rule is working by clicking the View link next to the claim. Users should see Box 70a for Patient Reason for Visit 1 and the code.
- Users can also look at the PDF by clicking the Preview link next to the claim to see Box 70 include in the Patient Reason DX.
Loop 2300, Segment HI