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Allwell Coding Tip Sheets And Forms

Occasionally, a reported diagnosis may be omitted from a claim due to errors or limitations of electronic claims submission. Improve the capture of risk adjustment conditions by entering the diagnosis codes on the claim correctly.

Diagnosis “pointers” connect the diagnosis made by the provider to each CPT® code billed on the claim. Only four (4) diagnosis pointers can be listed per CPT® code.

  • Identify the 4 most important or serious diagnoses that the procedure is intended to treat
  • Enter the diagnosis pointers in order of severity.

Maximize reporting opportunities:

Avoid missing eligible risk adjustment conditions by thorough documentation and accurate diagnosis coding.

  • Address all conditions present at the time of the encounter that require treatment or management.
  • Report all chronic conditions that impact treatment or care, even if stable. This includes pertinent status codes.
  • Explicitly state each diagnosis and provide documented evidence of support in the medical record.
  • Capture all valid ICD-10 diagnosis codes in the appropriate order on the claim form. 

Always follow the current ICD-10-CM Official Guidelines for Coding & Reporting[1] Refer to the Medicare Claims Processing Manual2 for additional information.

1500 Claim Form Instructions (PDF) - Coming soon

Health Insurance Claim Form (PDF) - Coming soon