A patient's diagnosis is defined as the condition of the patient at the time a charge is recorded. Diagnosis codes are almost always required on any mailed or electronicaly transmittted insurance claims so it is important that you understand how to add them to the patient's file.
Diagnoses are caregorized according to the International Statistical Classification of Diseases system (most commonly referred to by the abbraviation ICD) compiled by the U.S. Department of Health and Human Services. These codes are used to classify a wide array of deseases, complaints, causes of injury etc.
As part of creating a
patient's file, you need to enter the diagnosis/condition using the ICD-9
code number.** There is space for up to four (4) diagnoses in
priority order (primary, secondary condition, etc.) per patient on the
CMS-1500 claim form, although you can enter as many as you wish. To
add/edit/delete diagnoses to the patient's information, follow the
step's below. To add a
diagnosis: 1.
From the patient's
file, click on the DIAGNOSIS tab. 2.
Click the ADD
button. 3.
The Diagnosis list will appear. Highlight the desired diagnosis
and double click to add it to the patient's file.
4.
IIf you do not see
the desired diagnosis in the list, click the "ADD" button inside the
diagnosis codes list. You may either manually type in the ICD-9
code and description, or chose one from the master list if you are using
the deluxe or professional version (standard version does not
include a master list). For more information on adding items into
your diagnosis codes list, click here. To delete a
diagnosis: 1. From the
DIAGNOSIS tab, highlight the erronious diagnosis and click "DELETE". If a
diagnosis is already linked to a charge, you must delete the charge before
you can delete the diagnosis To edit a
diagnosis: 1. From the
DIAGNOSIS tab, highlight the diagnosis and click "EDIT".
**Note: Remember,
that you can also add diagnosis from the charge entry screen. Diagnosis
that you use when posting charges will automatically appear on the
diagnosis tab. Important: If you have your charge entry
preferences configured to "always assign the patient's current
diagnosises to each service", it is important that you use the checkbox
to dismiss all diagnosis besides the most
current four. If you do not, the software will simply link the patient's
top four diagnosis to the charges that you post.