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Diagnosis Code Requirements on Released Notes (article)

PIMSY requires users to have a Diagnosis Code assigned to the Session notes when the billing code on the notes is billable and the insurance is not self-pay.  We have found across the board if these codes are not assigned properly then the billing is disrupted later in the process. 

Instructions:

The system will automatically assign a DX Code to the session note if the following are true:

  • There is a Primary Diagnosis on the chart
  • That diagnosis has a date prior to the session date of the note
  • The diagnosis is on the Client and not a relative
  • The diagnosis has a status of Active
  • The Division on the DX code on the chart is empty or the Division on the DX code on the chart matches the Division of the note.
  • The Diagnosis type (ICD 10 etc.) on the DX code in the chart is accepted by the payer. You can see the Payer Management area / Coding Requirements section for which codes the Payer accepts.

If the criteria doesn’t match, a Diagnosis Code won’t be assigned to the note and the session won’t have everything it needs to be billed.

If you see this message when you try to release a note . . .

diagnosis03.png

Here is what to do:

  1. Go back into the client’s chart and make sure you have a diagnosis on the chart that matches the criteria above. If you do, then re-save the note and the system should go back and re-stamp that diagnosis in the note for billing and allow you to release the note.
  2. Click the Change button on the Reference tab on a Progress Note or the Change button on the Diagnosis tab on an Assessment Note. This will allow you to specify exactly which DX code goes with that note even if it isn’t the primary or doesn’t match the criteria above.  Sometimes Session notes are based on diagnosis other than the primary DX code on the chart.  This feature allows control over which DX code you are working on. Simply highlight the row and hit the Save Primary Diagnosis.  It will NOT make the selected code the primary code in the chart.  It is just for this session note.
  3. If you really don’t need a DX code then the PIMSY administrator can access the Payer Management area and remove the DX code requirement for payers. Simply click the Additional Details button on the selected Payer Details screen and find the question called “Diagnosis Code is NOT required for this Payer” and check Yes.

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If you cannot find what you need in this article, please contact Support (email) or call 877.334.8512 ext. 3.

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