Monthly Archives: May 2016

1500 Claim Form clarification and use of Block 24E “Diagnosis Pointer” and Specific Rules for Medicare claims

Many billing programs will automatically default to include the letters corresponding to the diagnosis in block 21. If you have 4 (or more) diagnosis in block 24e it will often simply default to ABCD. Having this protocol as a default should not lead to any problems except in two instances. The first being when attempting to “diagnosis point” to a specific diagnosis or region. For example Manual Therapy, 97140, must be done to a region that is not part of the CMT and a simple way to do this is specifically point only to the diagnosis that corresponds to the separate and distinct region from where 97140 is being performed and pointing the other regions to the CMT.

The instruction manual for the 1500 describes use of 24E in this manner:

In 24E, enter the diagnosis code reference letter (pointer) as shown in Item Number 21 to relate the date of service and the procedures performed to the primary diagnosis. When multiple

services are performed, the primary reference letter for each service should be listed first, other applicable services should follow. The reference letter(s) should be letters A through L or multiple letters as applicable. Each letter must be entered separately. Do not enter A-E or similar but 4 separate letters. Enter letters left justified in the field. Do not use commas between the letters. There may be a maximum of 4 letters listed in 24E any additional are simply not reported in this section.

The second instance is for Medicare claims which allows only one letter in 24E and for chiropractic claims for spinal CMT it will always be “A “as it corresponds to the primary diagnosis of subluxation (segmental dysfunction).

The Medicare claim form instructions states as follows

Item 24E Diagnosis Code Reference Number
This is a required field. Enter the diagnosis code reference number or letter (as appropriate, per form version) as shown in Item 21 to relate the date of service and the procedures performed to the primary diagnosis. Enter only one reference number/letter per line item. When multiple services are performed, enter the primary reference number/letter for each service. This will be a letter from A to L.


Medicare will deny claims if you have multiple letters in 24E, if you have noted you have done this in past and Medicare has paid, consider yourself lucky and note they are simply being more strict about adherence to claim form protocols.

Please verify with your billing software that they are aware of this rule and make the necessary corrections to be sure your format is compliant.