Medical Billing - EA0 Record Fields 32 Through 38

By: Michael Russell

This is the fourth in our medical billing series on the EA0 record. We pick up our discussion of this record with one of the most complex pieces of information that is sent with every medical claim.

EA0 fields 32 - 35, positions 179 - 198, are the four diagnosis codes fields. Diagnosis codes are probably the most important pieces of information that is transmitted to the payer of services. There are probably around 15,000 different diagnosis codes, though it is doubtful that anybody knows the exact number as they are constantly being updated with new diseases being discovered all the time. Each code is assigned a three to five digit number of combination of numbers and characters. These are commonly referred to as ICD9 codes, but there are other codes as well, depending on the physician specialty.

The reason these codes are so critical is that each diagnosis code corresponds to a particular illness or procedure that may or may not be covered, in full, in part, or not at all, by the particular insurance the patient has. Diagnosis codes are one of the first things that the payer looks at to determine if a claim is paid in full, part or not at all. There are four fields for diagnosis codes but only one is required to be sent. Each claim must have at least one diagnosis. Additional codes are usually sent if additional supporting information is needed in order for a claim to be paid. If at least one of these fields is not filled in, the claim will most certainly be denied, as this is the only place in the claim file where the actual problem with the patient is transmitted.

EA0 field 36, position 199, is the assignment indicator. This is the indicator that tells the payer if accept assignment is on for this claim. In English, what this means is that the biller does not have a contract with the payer but is willing to accept the payer's rates for billing this claim. Doctors do this in order to not lose business, otherwise the patient will probably choose to go some place else where they doctor is either a participating doctor or will accept assignment.

EA0 field 37, position 200, is the provider signature indicator. This is similar to the patient signature indicator. This indicates that the physician physically signed a piece of paper corresponding to this claim and is certifying that all the information in it is correct, to the best of his knowledge. This is purely for legal purposes.

EA0 field 38, positions 201 - 208, is the provider signature date. This is the date that the physician or provider of services actually signs off on the claim being sent to the payer for payment. This date must be after or no earlier than the date the patient was admitted and treated or the claim will be denied.

In our next installment of medical billing of the EA0 record for electronic claims transmission, we'll continue with field number 39.

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