Box 21(A-L) Diagnosis
What’s in the box?
This area is used to list a maximum of 12 diagnosis codes that describe the patient’s condition. The diagnosis code listed on Line A is considered the primary or principal diagnosis. Each diagnosis code is linked to at least one procedure (these links - or ‘pointers’ - are reported in Box 24E.
This box also includes an ICD Indicator in the top right corner. This indicates the version of the ICD code set that is being reported. This box always shows ‘0’ to indicate the ICD-10 code set.
Where does this info live in Jane?
The diagnosis code order in Box 21 is a reflection of the diagnosis codes added to an Appointment in Jane.
The first diagnosis code listed on the first procedure will be considered the primary diagnosis, and thus will be sent on Line A. Every other diagnosis code will follow in order.
📍Pro Tip: You can easily rearrange the order of your diagnosis codes by clicking on the blue double-sided arrow under each procedure. Simply drag and drop to change the ordering!
📍Key Note: A maximum of 12 diagnosis codes are allowed on both paper and electronic claims. If you add more than 12 diagnosis codes to a visit, only the first 12 will be included on the submission.
For more info on adding CPT & diagnosis codes to your appointments, you can check out our guide: Start Billing 2: CPT & Diagnosis codes.
Is this required?
Yes - you need to list at least one diagnosis code. Likewise, each procedure in Box 24E needs to point to at least one diagnosis code.
What about the EDI file?
The list of diagnosis codes is sent in Loop 2300 - Claim Info.
The codes are listed in Loop 2300, Segment HI.
- Segment HI technically has one element - H101 - but it can have many sub-elements, where each sub-element is a unique diagnosis code.
- Note that like CMS1500s, a maximum of 12 diagnosis codes can be sent.
- The first diagnosis code listed is considered the primary or principal diagnosis.
- Each diagnosis code is prefixed with ‘ABK’ which indicates the diagnosis code is part of the ICD-10 code set.
We currently include the decimal places on diagnosis codes reported in Loop 2300, HI01 for all supported clearinghouse options excluding Availity. Guidelines suggest that decimal places should not be included in the EDI (or CMS1500) because they are implied, but in our experience Availity is the only party that will flag decimal inclusion and reject claims as a result.
If you are running into rejections because of decimal points being included on electronic or paper claims, let us know!