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Back  RFI # 127: Outpatient principal procedure

Formal vs. Informal Help Informal Formal


David Foulke


Can the HI Principal Procedure segment be used for Institutional outpatient claims? Situational notes seem to restrict to inpatient usage only. This is a summary of the formal response, click for the formal response letter.

Submitter Assigned Keywords

outpatient principal procedure


The segment’s Situational Rule does not explicitly prohibit use on outpatient claims; therefore, the segment can be sent.

As Situational Usage is explained on page 46, when the defined conditions are not true, the item "should not be used". However, "should not be used" is a recommendation and not a prohibition. Usage can only be prohibited by a situational rule that states when the item may not be sent.
Submission 11/8/2004
Status Date 3/1/2005
Status F - Final
Primary References
Document 004010x096
Set ID837I
Segment Position231
Segment IDHI
Industry NamePrinciple Procedure