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Back  RFI # 1304: 837D quantity and tooth number

Formal vs. Informal Help Informal Formal

Submitter

Barbara Hollerung

Description

Please explain the SV306 situational rule and it's relationship to TOO02. When a procedure is performed more than once and oral cavity and tooth numbers need to be identified., is it appropriate to submit quantity greater than one and multiple tooth numbers on the same claim line?

Submitter Assigned Keywords

quantity tooth number

Response

It is only appropriate to submit the Procedure Count (SV306) when the procedure was performed more than once and there is no tooth number or oral cavity involved. SV306 must not be sent with a value of one.

It is only appropriate to submit quantity greater than one when there is no tooth number or oral cavity involved. As a result of the 835 Transaction not containing tooth numbers or oral cavity designation codes, the situational rule to limit the use of multiple teeth per line was added to the 837D guide. An example: If a line was reported for extractions and multiple teeth were reported on the line and one of those tooth numbers denied for some reason, the 835 would have no way of indicating which tooth number was denied. This would cause issues with the office knowing which procedure to post in their accounts receivables.
Submission 4/25/2011
Status Date 7/8/2011
Status F - Final
Primary References
Document 005010X224
Section2400
Page286
Set IDSV306