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Back  RFI # 1242: 837I HCPCS qualifier deleted

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Submitter

Toni Butler

Description

Currently, our providers send a CPT-4 principal surgery code and secondary surgery codes using the HCPCS qualifier in HI01-1 (2300 loop) in version 4010. Our state Medicaid client has never implemented ICD-9 or ICD-10 procedures in their system.

In 5010, the HCPCS qualifier has been deleted from the HI01-1 element in the 2300 loop for the 837I. This leaves only ICD-9 and ICD-10 procedure code qualifiers as valid. Is there another loop or element available at the claim level to submit HCPCS or CPT-4 surgery codes?

Response

There is no other loop or element at the claim level in the 5010 837 Institutional Claim to submit a Principal or Other Procedure Code. The requirement to report ICD procedure codes for the Principal and Other Procedure Codes for inpatient claims is consistent with HIPAA regulations and the UB-04 Manual.
Submission 2/18/2011
Status Date 3/21/2011
Status F - Final
Primary References
Document 005010X223
SectionHI
Page188
Set IDHI01-1
Loop2300