Insert Placeholders and Reserved for Local Use (Box 19)

These 2 boxes work together. The Insert Placeholders box is the selection list for patient specific items that will appear in box 19 for this insurance carrier. Reserved for Local Use (Box 19) displays the items chosen. The selection list includes items that are patient specific, although a global option can also be entered:

•      Nature of Illness – This is an old Medicare requirement to denote the patient’s status such as Acute, Chronic, Recurrence, etc. It is usually not required. The nature of illness is now shown to Medicare by the use of the AT modifier, for Active Treatment.

•      Subluxation Level –

o  Always select this item. It turns on the text function in the patient file for box 19. If no entry is made in the patient file, it will leave box 19 blank. If this item is not selected, then data entered in the text field in the patient file will not generate into the claim.

o  In the past Medicare required identification of a specific subluxation level. This is no longer needed for Medicare in box 19. The specification of subluxation level(s) must be in the SOAP notes.

o  If you treat Medicaid patients, there are certain explanatory codes that must appear in box 19, such as Y- Pregnant. In order to enter such codes in box 19, select Subluxation Level so it appears in Reserved for Local Use (Box 19). In the patient’s Insurance Policy CMS tab, type the Medicaid explanation code in the Subluxation box.

•      Treatment Number - In the past Medicare required knowing how many visits the patient has had. This is no longer needed for Medicare in box 19. If Medicare changes the rules again, this option remains functional.

•      X-Ray Date – Another Medicare requirement is to show the date of the most recent x-ray which substantiates the need for care (the subluxation). This is required if the PART exam documentation is not being used to demonstrate the need for treatment.

•      Exam Code

•      Diagnosis 1-4 – These are the 4 primary diagnoses and usually appear in box 21. There are some insurance carriers that want the ICD diagnosis codes to be in box 19. This selection will move the ICD codes out of box 21 and into box 19.

•      Diagnosis 5-8 – When you have entered more than 4 diagnoses on a patient, and want them to appear on the CMS-1500, some insurance carriers want any ICD codes in excess of 4 to appear in box 19 and not in box 21. ChiroSuiteEHR allows up to 12 active ICD codes to be present in a patient file. This option only refers to diagnosis codes 5 to 8.

•      Diagnosis 9-12  - When you have entered more than 8 diagnoses on a patient, and want them to appear on the CMS-1500, some insurance carriers want any ICD codes in excess of 8 to appear in box 19 and not in box 21. ChiroSuiteEHR allows up to 12 active ICD codes to be present in a patient file. This option only refers to diagnosis codes 9 to 12.

•      Diagnosis 1-12 – This option prints all 12 ICD diagnosis codes in box 19.

•      Demo45 Date Last Seen – This option was included for the Medicare Demonstration Project and no longer applies.

•      Demo45 UPIN 17a– This option was included for the Medicare Demonstration Project and no longer applies.

•      Provider Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Provider Taxonomy number, it is entered in the Provider catalog.

•      Clinic Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Clinic Taxonomy number, it is entered in the Provider catalog.

•      Service Facility Taxonomy is a number issued in many states for special programs. It is used mostly by Medicaid, but not in all states. If you have a Service Facility Taxonomy number, it is entered in the Service Facility tab of the Provider catalog.