EDI 5010 Documentation 837 Professional - Loop 2300 Health care Diagnosis Code

2300 Health care diagnosis code

        

One of the main purposes of 5010 is to support the upcoming change to ICD-10 diagnosis and procedure codes – a change providers must make by October 1, 2013. To help prepare for ICD-10, 5010 now requires a Diagnosis Code on all claims, and the maximum number of Diagnosis Codes was increased from eight in 4010 to 12 in 5010. Although you can report 12 diagnosis codes at the claim level, you can only point or link four codes to a specific service at the service line level.

Loop	Seg ID	Segment Name	Format	Length	Ref#	Req	Value
2300	HI	Health care Diagnosis code	ID	2		R	HI
		Element Separator	AN	1			*
	HI01-1	Code List Qualifier Code	ID	1/3	1270	R	BK = Principal Diagnosis
		Component Element separator		1			:
	HI01-2	Industry Code	AN	1/30	1271	R	Print Primary Diagnosis code
		Element Separator	AN	1			*
	HI02-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis Code
		Component Element separator		1			:
	HI02-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI03-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis Code
		Component Element separator		1			:
	HI03-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI04-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis Code
		Component Element separator		1			:
	HI04-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI05-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis Code
		Component Element separator		1			:
	HI05-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI06-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI06-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI07-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI07-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI08-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI08-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI09-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI09-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI10-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI10-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI11-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI11-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Element Separator	AN	1			*
	HI12-1	Code List Qualifier Code	ID	1/3	1270	R	BF = Diagnosis
		Component Element separator		1			:
	HI12-2	Industry Code	AN	1/30	1271	R	Print Diagnosis code
		Segment Terminator					~

 

Example
Claim Setup

Field	Value
Claim No	252
Claim Location	NY Office
Place of Service	11 - Office
Rendering Provider	David Mark
ICD Code	410,415, 368.34, 522.3

Line items

Procedure Code	Mod1	Mod2	Mod3	Mod4	ICD	FromDOS	ToDOS	Units	Unit Charges
99214					1,2,3,4	01/09/2012	01/09/2012	1	40
92570					1	01/09/2012	01/09/2012	1	180.04
90371					3,4	01/09/2012	01/09/2012	1	83

HI*BK:410*BF:415*BF:36834*BF:5223~



By Loop

2300 - Claim Information	CLM	CLM*252*303.04***11:B:1*Y*A*Y*Y~
2300 - Claim Information - Clia Number	REF	REF*X4*CL324234~
2300 - Claim Information - ICDs	HI	HI*BK:410*BF:415*BF:36834*BF:5223~
2310B - Rendering Provider Name	NM1	NM1*82*1*Mark*David****XX*1111111111~
2310D - Service Facility Location	NM1	NM1*77*2*NY Office*****XX*1336177328~
2310D - Service Facility Location	N3	N3*5081 Tellus. Avenue*668-2204 Non Rd.~
2310D - Service Facility Location	N4	N4*White Plains*NY*809051232~
2310D - Service Facility Location	REF	REF*LU*484345~
2400 - Service Line	LX	LX*1~
2400 - Service Line	SV1	SV1*HC:99214*40*UN*1*11**1:2:3:4~
2400 - Service Line	DTP	DTP*472*RD8*20120109-20120109~
2400 - Service Line	REF	REF*6R*1140~
2400 - Service Line	LX	LX*2~
2400 - Service Line	SV1	SV1*HC:92570*180.04*UN*1*11**1~
2400 - Service Line	DTP	DTP*472*RD8*20120109-20120109~
2400 - Service Line	REF	REF*6R*1141~
2400 - Service Line	LX	LX*3~
2400 - Service Line	SV1	SV1*HC:90371*83*UN*1*11**3:4~
2400 - Service Line	DTP	DTP*472*RD8*20120109-20120109~
2400 - Service Line	REF	REF*6R*1142~

        

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