Attention: Trading Partners Diagnosis Code Limits on Claims

There are limits to the number of diagnosis codes that can be submitted on a claim. The limits for an 837 transaction are set by the Accredited Standards Committee (ASC) of the American National Standards Institute (ANSI), and are specific to claim type. NCTracks adheres to the ANSI standards for 5010 ASC X12 Electronic Data Interchange (EDI) transactions, which are mandated by HIPAA (Health Insurance Portability and Accountability Act). Similarly, NCTracks has a limit of 26 diagnosis codes that can be submitted on a claim keyed directly into the provider portal.

Some providers have recently attempted to submit claims that exceed the limit of diagnosis codes. The NCTracks provider portal will not allow more than 26 diagnosis codes to be keyed into a claim. If NCTracks receives an 837 I, D, or P transaction with too many diagnosis codes, the transaction is rejected for syntax/structure check. However, claim submission software and billing agents may be truncating 837 transactions so they do not exceed the limit for diagnosis codes.

The 5010 ASC X12 837 transaction limits on diagnosis codes are provided here for reference.

Field Name

Transaction

Loop

Segment

ICD-10

Occurrence

Principal Diagnosis

837I

2300

HI01-1

ABK

1 occur

Admitting Diagnosis

837I

2300

HI01-1

ABJ

1 occur

Patient's Reason For Visit

837I

2300

HI01-1
HI02-1
HI03-1

APR

up to 3 occurs

External Cause of Injury

837I

2300

HI01-1
HI02-1
HI03-1
HI04-1
HI05-1
HI06-1
HI07-1
HI08-1
HI09-1
HI10-1
HI11-1
HI12-1

ABN

up to 12 occurs

Other Diagnosis Information

837I

2300

HI01-1
HI02-1
HI03-1
HI04-1
HI05-1
HI06-1
HI07-1
HI08-1
HI09-1
HI10-1
HI11-1
HI12-1

ABF

up to 12 occurs

Principal Procedure Information

837I

2300

HI01-1

BBR

1 occur

Other Procedure Information

837I

2300

HI01-1
HI02-1
HI03-1
HI04-1
HI05-1
HI06-1
HI07-1
HI08-1
HI09-1
HI10-1
HI11-1
HI12-1

BBQ

up to 12 occurs

 

 

 

 

 

 

Dental Primary Diagnosis

837D

2300

HI01-1

ABK

1st occur

Dental Secondary Diagnosis

837D

2300

HI02-1
HI03-1
HI04-1

ABF

2nd - 4th occur

 

 

 

 

 

 

Professional Primary Diagnosis

837P

2300

HI01-1

ABK

1st occur

Professional Secondary Diagnosis

837P

2300

HI02-1
HI03-1
HI04-1
HI05-1
HI06-1
HI07-1
HI08-1
HI09-1
HI10-1
HI11-1
HI12-1

ABF

2nd - 12th occur

Regardless of the claim transmission method, NCTracks cannot accept claims with a number of diagnosis codes that exceeds the ANSI X12 standard. For additional information, refer to the Trading Partner Information page on the NCTracks provider portal.