Why is reason code 37578 not working on my claim?
Reason Code 37578 is causing claims submitted via Direct Data Entry (DDE) to go to the Return to Provider (RTP) file incorrectly. 09.25.2020 – This issue has been resolved.
What is the reason for adjustment code 37541?
Reason Code 37541 Description: Provider submitted adjustment (XX7 or XXQ) is for 'Other' reasons not identifiable with specific claim change reason (condition code) which equals 'D9'.
What does reason code 37257 mean for home health claims?
How Do I…? Some 2021 home health claims are going to the return to provider (RTP) file incorrectly with reason code 37257 indicating that the Core-Based Statistical Area (CBSA) and Federal Information Processing Standards (FIPS) code combinations are invalid.
What is the reason code 32206 for Medicare?
Reason Code 32206. Description: The revenue code is not valid for this type of bill, or the covered charges are not valid for this type of bill, or services not covered by Medicare. Resolution: Verify revenue code billed on line editing. Correct, and F9 claim. Top. Reason Code 32400. Description:
What does XX7 mean on a provider submitted adjustment?
Provider submitted adjustment (XX7 or XXQ) indicates adjustment is due to changes in charges. Condition D1 is present and all charges on the adjustment bill equal the charges on the original claim. If D1 is present, covered charges must differ.
What is a XX7 bill?
The adjustment (XX7) or Cancel (XX8) bill contains an invalid cross reference DCN. The cross reference DCN should be the Document Control Number of the original processed claim that is either being adjusted or canceled.
What is the frequency code of an adjusted claim?
An adjusted claim contains frequency code equal to a ‘7’, ‘Q’, or ‘8’, and there is no claim change reason code (condition code D0, D1, D2, D3, D4, D5, D6, D7, D8, D9, or E0.
Is Medicare a secondary or tertiary?
Medicare is secondary or tertiary and the dollar amount entered in the PD AMT field on MAP1719 (F11 on page 3) is not equal to the dollar amount entered for the MSP Value Code (12, 13, 14, 15, 41, 43, or 47).
General Information
CPT codes, descriptions and other data only are copyright 2020 American Medical Association. All Rights Reserved. Applicable FARS/HHSARS apply.
Article Guidance
This article gives guidance for billing, coding, and other guidelines in relation to local coverage policy for L37578-Micro-Invasive Glaucoma Surgery (MIGS).
ICD-10-CM Codes that Support Medical Necessity
It is the provider’s responsibility to select codes carried out to the highest level of specificity and selected from the ICD-10-CM code book appropriate to the year in which the service is rendered for the claim (s) submitted.
Bill Type Codes
Contractors may specify Bill Types to help providers identify those Bill Types typically used to report this service. Absence of a Bill Type does not guarantee that the article does not apply to that Bill Type.
Revenue Codes
Contractors may specify Revenue Codes to help providers identify those Revenue Codes typically used to report this service. In most instances Revenue Codes are purely advisory. Unless specified in the article, services reported under other Revenue Codes are equally subject to this coverage determination.
Reason Code Narrative
UB92 PROVIDER SUBMITTED ADJUSTMENT (XX7) IS MAKING A LINE ITEM COVERED THAT WAS NONCOVERED ON ORIGINAL CLAIM. SAME REVENUE CODE ON BOTH CLAIMS WITH COVERED CHARGES ON ADJUSTMENT, BUT NON COVERED CHARGES ON ORIGINAL.
Common Reason Code Errors
A non-covered line on original claim is being moved to covered on an adjustment and claim change condition code D1 is not being billed.
Common Reason Code Corrections
Changes made to covered charges need to be billed with a D1 claim change condition code.
About MUHAMMAD NADEEM
Muhammad Nadeem is an internal medicine provider established in Milwaukee, Wisconsin and his medical specialization is internal medicine (pulmonary disease) with more than 35 years of experience. The NPI number of Muhammad Nadeem is 1760580955 and was assigned on September 2006.
Clinician Utilization
The following Healthcare Common Procedure Coding System (HCPCS) codes were publicly reported as the top services rendered by this provider under the Medicare program for the year 2017. The reported codes are based on the top 5 codes for each available Medicare specialty, excluding evaluation and management codes.
Quality Reporting
The following quality measures meets Medicare's statistical reporting standards for the year 2018. Not all providers report the same information, because not all providers give the same services to patients. The quality information is just a snapshot of some the care providers give to their patients.
Hospital Affiliations
Medicare hospital affiliation is identified through self-reporting data, inpatient, outpatient, physician and ancillary service claims linked by the Medicare claims NPI number and place of service code.
Additional Identifiers
Additional identifier (s) currently or formerly used as an identifier for the provider. The codes may include UPIN, NSC, OSCAR, DEA, Medicaid State or PIN identification numbers.
Other Providers at the same location
The following 9 providers are registered at the same or nearby location.
NPI Footnotes
What is the National Provider Indentifier (NPI)? The NPI is 10-position all-numeric identification number assigned by the NPPES to uniquely identify a health care provider.
What is comment 76?
Comment (76): Some commenters requested we clarify when SPR analyses would be required. Several commenters requested we clarify how SPRs will be identified, what criteria will be used to identify SPRs, and whether threats will always be used to identify SPRs.
What is Executive Order 12866?
Executive Order 12866 provides that the Office of Information and Regulatory Affairs (OIRA) in the Office of Management and Budget will review all significant regulations. OIRA has determined that this policy is significant.
