How to Split Claims
This article is republished by the express written permission of ChiroCode Institute © 2009- www.chirocode.com
"When reporting line item services on multiple page claims, only the diagnosis code(s) reported on the first page may be used and must be repeated on subsequent pages. If more than four diagnoses are required to report the line services, the claim must be split and the services related to the additional diagnoses must be billed as a separate claim."
-National Uniform Claim Committee (NUCC), July 2008
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Here is a welcomed solution to having more than four diagnostic codes on a 1500 claim form. The instruction comes from CMS. The claim form has only four diagnostic positions, and the diagnosis must point to its associated procedure.
Historically, splitting the claim was viewed by some as being not appropriate and had the appearance of fraud. Interestingly, with our new age of processing by computers, this old perception is now dead. Computers can now compare all services instantly, no matter how many claim forms they may be on.
Presently, from a computer processing perspective, splitting the claim is recommended. Do so when more than one procedure and its appropriate diagnostic code is needed. It makes good sense. Why cram every procedure and diagnostic code onto one claim form when they do not fit? Keep it simple for those computers. Splitting claims will expedite processing while preserving the integrity of the procedure and its associated diagnostic code(s). Obviously, this new protocol will also reduce rejections.
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