About Diagnosis Review

For outpatient services, the diagnosis must be present for the 837P file to compile. For inpatient services, the Admission diagnosis must be present for the 837I, and depending on the payor’s companion guide, the Discharge diagnosis may be required when a discharge date is included in the file.

In most cases the clinician completes the Diagnosis form. myAvatar populates the Bill Order based on the order the clinician enters the diagnoses. Billers need to be familiar with the form to troubleshoot billing errors. The Type Of Diagnosis is integral in billing.

• Admission – pulls in the Admission Date. If the form Change Program/Admission Date is used to change the admission date, the diagnosis date updates to the new Date of Admission.
• Update – for professional services, the system uses the most recent update for populating the primary, secondary, and so on diagnoses on the 837P. If all diagnoses in a record are voided, the system uses the next most recent diagnosis for populating the diagnoses on the 837P.
• Discharge – pulls in the Discharge Date. The workflow should be to complete the discharge, then complete the discharge diagnosis

If the Bill Order is inaccurate, it can be modified. If the registry setting has been set to limit the edits to the diagnosis author, then the clinician needs to make the modifications. Select the diagnosis for edit and change the Ranking and Bill Order.