Rules for using diagnosis in billing

Resolution

Areas and Hierarchy of Dx Entries used in Billing...

1. Diagnosis treated (entered on a service).
2. Authorization Details
3. Authorization Header
4. Benefit assignment
5. Client Diagnosis Record - If not entered on any of the 4 above. Then we have rules for using diagnosis in billing if DX only entered under Client's Health Information:
   1. Priority must be Primary.
   2. ICD9/ICD10 code must not be empty.
   3. Diagnosis dates must match date of service (from date before service, end date empty or after).
   4. Diagnosis with code 799.9/R69 (meaning "diagnosis deferred") comes after all others. 

If you are NOT holding claims for missing diagnosis, and the client is in fact missing Diagnosis, the system will output 7999/R69 (ICD9/10) in the HI segment of the CLM Loop.