Add or Remove Patient Reason for Visit Code

This rule is used to add or remove the patient's reason for visit code.

Workflow

Let's review how to create a claim rule to add or remove the patient's reason for visit code!

• 1. 1. Navigate to Management Center > Claim Rules.
        
        
     2. Click Create Claim Form  Rule.
        
     3. Select the Practice.
        
     4. Next, give the rule a name.
     5. Update the Claim Type to Institutional.
        
     6. Select Conditions to create criteria a claim should meet before the rule will apply.
        
     7. Next, click on the Behaviors dropdown.
     8. Select Diagnoses - Patient Reason for Visit.
        
     9. Next, click Add.
        
     10. Update the dropdown to one of the following:
         1. Omit to remove the Patient Reason for Visit code from the claim.
         2. Require and Write to Claim to include the Patient Reason for Visit code in the claim
     11. To create multiple behaviors, repeat steps 7-10.
     12. Click Save to complete the process.
          

Box Number(s)

• UB-04: Box 70a-c - Patient Reason DX
• CMS-1500: N/A

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.