We have a question from a physician regarding an imagined hindrance to him being able to report all the conditions. He feels because he can only link 4 diagnosis codes to a line item, even though 12 were entered into box 21 of claim form, he believes the payers are only capturing those 4 diagnosis codes from a HCC perspective. He asked if he could bill a 2nd "ghost" CPT code line item in order to link the remaining diagnosis codes which were not linked to the first line item in order to make sure all the HCC codes were reported. I suppose he could be right, but I feel the payer for risk adjustment purposes probably capture all ICD10 codes reported in box 21 of claim form and not just those listed in box 24c (the 4 linked to the line item). Does ANYBODY have any guidance on this they can share? It would be most helpful.

Ruth, CPC, CEMC
Arkansas