Question

In Block 33 (Billing Provider Info & PH # ) , enter the addres and phone number of the provider asking to be paid on this claim In Block 33a, enter the same NPI number listed in Block 24J. Procedure 17-3 shows how to complete a health insurance claim form using the information from an insurance card and an encounter form. CRITICAL THINKING APPLICATION 17-3 Ann is reviewing an encounter form that has one CPT code and two HCPCS codes with one diagnosis code for the same office visit. How many lines in Box 24 of the CMS-1500 will she need to Use? Will all three CPT/HCPCS codes point to the same diagnosis? Why or why not? the CMS-1500 Health Insurance Claim Form BLOCK INFORMATION NEEDED If patient's condition or illness is related to employment, auto accident, or some other type of accident, make sure information is obtained as outlined in Block 10a-c Claim codes as designated by NUCC 10d Insured's policy, group, or FECA number (primary insurance) 11 Primary insured's date of birth and gender 11a Other claim ID designated by NUCC 11b Brimary insured's insurance plan or program name J bu a

Answer 1

Critical Thinking 17-3

Ann should use only one line in the Box 24 of CMS 1500 claim form because it has the same office visit with one diagnosis. In the claim form has 24A to 24I that has to be entered with required details from date of service to the end. In 24A should enter the date of service. 24B should be entered with the place of service and 24C if any emergency schedules take place. In 24D, CPT/HCPCS code should be entered and it allowed for entering four modifiers. 24E indicates the diagnosis, 24F the charged amount to be entered. 24G indicates the total charges, 24H specifies any special services provided under the insurance plan.

As the CPT, two HCPCS code indicate the same diagnosis in a single office visit.  So it can be entered in a single line.

For e.g, if the patient has the unspecified lump in the breast, then the diagnosis code is N63. If the patient has undergone a biopsy of the breast, then the CPT code is 19100. If the biopsy was done on both breast then HCPCS code should be mentioned with Modifier-50. So the single line is enough if all the codes are determined with the same diagnosis.