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Query Regarding Interpretation of Diagnosis Codes in ExplanationOfBenefit (EOB) Resource
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Arnab Biswas
Jan 22, 2025, 2:05:57 PMJan 22
to Beneficiary Claims Data API (BCDA) Community
Hi BCDA Team,
I am currently working with the ExplanationOfBenefit (EOB) resource and have encountered a scenario that requires clarification regarding the interpretation of diagnosis codes in relation to EOB items.
In the EOB resource, diagnosis and procedure codes are typically associated with specific items or services using fields such as diagnosisSequence and procedureSequence within the item array. These fields establish a link between each item and one or more diagnosis or procedure codes, providing essential context for the service or treatment associated with the claim.
However, we have observed instances where the diagnosis object contains up to 8 diagnosis codes, yet only 4 of these codes are referenced within the items. This discrepancy leaves 6 codes unlinked to any items in the EOB.
Could you clarify how to interpret the remaining diagnosis codes that are not linked to any items? Do they serve a specific purpose within the claim structure, and is there a recommended approach to establishing a relationship between these unreferenced codes and the items in the EOB?
Your assistance in clarifying this matter would be greatly appreciated.
In the EOB resource, diagnosis and procedure codes are typically associated with specific items or services using fields such as diagnosisSequence and procedureSequence within the item array. These fields establish a link between each item and one or more diagnosis or procedure codes, providing essential context for the service or treatment associated with the claim.
However, we have observed instances where the diagnosis object contains up to 8 diagnosis codes, yet only 4 of these codes are referenced within the items. This discrepancy leaves 6 codes unlinked to any items in the EOB.
Could you clarify how to interpret the remaining diagnosis codes that are not linked to any items? Do they serve a specific purpose within the claim structure, and is there a recommended approach to establishing a relationship between these unreferenced codes and the items in the EOB?
Your assistance in clarifying this matter would be greatly appreciated.
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