Condition File

Most charges require just one diagnosis (DX) . However there are circumstances when a single encounter may result in multiple DX. When reporting multiple DX, insurance payers want to know which DX is primary , but other DX will also print on the claim form to support the coding.

Introducing the Condition file.

Situations when a new condition is needed

· New Set of Diagnosis,

· New Admit-Discharge dates

· New Authorization #

· New Referring Doctor

· New Injury Work Comp

When entering charges, user will need to choose which condition to use. Since many patient visits are for continuing care, chances are that the previous diagnosis will carry over to the current visit. If the services requires an Authorization #, then that can carry forward as well by selecting the same condition.

Items unique to each Condition:

Conditions

Date : 09/11/08 Descrip. : March PT Services

Dx 1 : ______ ______________ Dx 2 : _____ ________________

Dx 3 : ______ ______________ Dx 4 : _____ ________________

Refer Doc : 11 FRYER,KENNETH M.D. Auth #: _____________

Onset Dt:__/__/__ Inj Dt:__/__/__ Box 19 Note: ____________

Admit Date :00/00/00 Disch Date :00/00/00

Start Disability :00/00/00 End Disability :00/00/00

Employment: N Accident : N Other Accident : N

Explanation:

· Date: The date this condition was created or effective

· Description: User defined, makes it easier to choose the correct condition. Example: Back Injury; March PT Services, Torn Achilles

· Refer Doctor: On main registration screen, there is already a Referring Doctor. If a different Referring Doctor is needed for a specific set of charges, enter it here on the Condition File.

· Diagnosis: Enter up to four (4) diagnosis.

· Auth Code: Enter an Authorization code that applies to this set of charges. For example, if an entire month of Physical Therapy charges have the same Auth #, enter it here; instead of entering it on each individual charge line with “T\auth # “

· Accident, Employment, Other Accident: Enter Y or N for each field.

· Admit , Discharge, Onset, Dates: If applicable, enter a date. If a patient goes in and out of hospital 3 times, then there will be 3 Condition records created.

· Box 19 Note: If the type of service requires some particular documentation in Box 19 of the CMS1500 insurance form, enter it here. By entering it once on this Condition record, you do not have to enter it on each Charge TRX.

Entering Charges

Existing Conditions are displayed when a new patient is selected.

You will need to select an existing Condition by clicking on the desired line.

If a new condition is needed, or you need to change existing conditions, click on Condition A/C

To ADD new condition:

• Click on Add
• Fill out Condition screen. The Date will default to today’s date. You may change the date to the date this condition is first effective.
• When done with form, click SUBMIT to add a new condition.

To Change existing condition:

• At bottom of screen, a box labled Select Condition will display existing conditions
  Click on an existing condition.
• Make necessary changes, then click SUBMIT