diagnosis pointer

what is the diagnosis pointer(Field 24E) for dx code 789.79 in HCFA 1500 for ambulatory services.

re: diagnosis pointer

It is the number correlating to the box you entered the dx code in. So if that is the first dx, then you will enter 1 as the dx pointer.

re: diagnosis pointer

So incase if i have two dx codes to be entered and dx code 789.79 is in second line item then would the diagnosis pointer be 2. The denial that we are receiving is STATD AS SERV LINE BOX 24E CONTAINS AN INVALID POINTER VALUE ALSO STATED THE ICD INDICATOR IN BOX 21 IS INVALID.We had billed the claim according to ICD 9 with indicator 9.The dx code was 789.79 or 780.4 with CPT® 1 as A0429 and CPT® 2 as A0425 and pointers as 1 for each in field 24E.
Kindly suggest.

re: diagnosis pointer

I'm not sure why the indicator as 9. For each CPT® you use the coordinating number for the icd-9.
Example: dx codes listed as 1. 728.71 2. 110.1 3.703.8. CPTs listed as 1.99212 --dx indicator would be 1.
2. 11721--dx indicators would be 2,3.
You can't use an indicator number that is higher than the number of dx codes listed. Hopefully this helps.

re: diagnosis pointer

Yes it is helping me, however is this applicable for ambulatory services also...As the CPT® that i mentioned earlier are for ambulatory services

re: diagnosis pointer

It would still apply. You just want to make sure to coordinate the dx with the CPT® and use the appropriate number.

re: diagnosis pointer

Thank u for the help...could you also help me understand the denial reason that we are receiveing from BCBS and Wellcare.
BCBS denied as:115 DIAGNOSIS CODE POINTER INVALID for CPT® codes A0422,A0425 and A0429 and for same CPT® by wellcare got denied as :"SERVICE LINE BOX 24E CONTAINS AN INVALID POINTER VALUE-ALLOWABLE POINTER VALUES ARE A-L" ALSO STATING THE ICD INDICATOR IN BOX 21 IS MISSING OR INVALID;IT SHOULD INDICATE THE VERSION OF THE ICD CODE SET BEING REPORTED-ALLOWABLE VALUES ARE 9 OR 0. What should be the action taken?

re: diagnosis pointer

This is still all the same thing. What dx pointer(number) do you have assigned to the CPT® codes? Is it the number, or letter, that coordinates with the box the dx is in? As far as indicating icd , are you using icd-9? I have not had to indicate which icd I am using yet except on Medicaid(and that is on their website).

re: diagnosis pointer

Are you submitting claims thru Navinet for BCBS?

re: diagnosis pointer

Yes, we are billing thru navinet and all the claim billed to wellcare are also electronic.

re: diagnosis pointer

have you tried resubmitting with the corrected dx pointer?

re: diagnosis pointer

Yes, we have re submitted the claim recently waiting for the carrier to response.