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Back  RFI # 1280: 837I 4010 to 5010 crosswalk

Formal vs. Informal Help Informal Formal

Submitter

Holtsford Laurie

Description

Our HIS vendor is taking our "other physician" NM1*73 in loop 2310C in the 4010A1 version and crosswalking it to "other operating physician" NM1*ZZ in loop 2310C in the 5010 version. If you look at the CMS side to side comparison, they do list these beside each other however, I don't believe it would be correct to automatically assign a qualifier ZZ for other operating. In my 5010 testing, I have physicians dropping with the NM1*ZZ where there are no operative episodes and the physician is actually listed as a referring physician in the HIS system not an operating physician. I am trying to work through this with our vendor however, I thought you might be able to give me some backup in my logic. Our HIS vendor keeps insisting that CMS crosswalked it that way. I doubt that CMS wants us to list an other operating physician if there was no surgery performed. Thank you for any insight.

Submitter Assigned Keywords

other physician

Response

This issue is explicitly addressed in guide 005010X223. Loop 2310C is named "Other Operating Physician Name". Loop 2310F is named "Referring Provider".

The 2310 situational rule reads "Required when another Operating Physician is involved. If not required by the implementation guide, do not send." The TR3 Notes read:

"1. The Other Operating Physician is the individual performing a secondary surgical procedure or assisting the Operating Physician.
2. This Other Operating Physician segment can only be used when Operating Physician information (Loop ID-2310B) is also sent on this claim."

Identification of a provider that is not an "Other Operating Provider" as defined, like a referring provider, in loop 2310C is not permitted by the guide. The referring provider must be reported in loop 2310F.
Submission 3/22/2011
Status Date 5/12/2011
Status F - Final
Primary References
Document 005010X223
Section2
Page331
Set ID2310
Table2
Loop2310C
Segment PositionNM101
Segment IDZZ