how to report eight DX code in CMS 1500 – ambulance claim does need dx?

Enter the patient’s diagnosis/condition. With the exception of claims submitted by ambulance suppliers (specialty type 59), all physician and nonphysician specialties (i.e., PA, NP, CNS, CRNA) must use an ICD-9-CM code number and code to the highest level of specificity for the date of service.
Enter up to four diagnoses in priority order. All narrative diagnoses for nonphysician specialties shall be submitted on an attachment.

NOTE: Although ambulance suppliers are not required to submit ICD-9 codes on the claim, NAS highly encourages them to do so with the code that best describes the sign, symptom, and/or condition of the beneficiary at the time of transport.

Enter the diagnosis code only, not the description. Any extraneous data in this field will cause an up front rejection of your claim. Do not use decimal points.

NOTE: You may place up to eight diagnosis codes on the claim form. The diagnosis that is pointed to in Item 24E must be placed in one of the first four diagnoses entry spaces in Item 21. Any indicator other than a 1, 2, 3, or 4 in Item 24E will cause the claim to deny as unprocessable. Place additional
diagnosis codes 5-8 (if necessary) in Item 19. Enter only the number (with decimal if needed) and separate each diagnosis in Item 19 with a comma. [For example: 719.41, 719.42, 816.00]