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Back  RFI # 136: RPT Modifier Change on 835

Formal vs. Informal Help Informal Formal

Submitter

Thomas Coyle

Description

SVC06 - 1 on the 835 is used to report the originally submitted procedure code if the adjudicated code has been changed. My question is related to the modifiers. Does changing modifiers (adding, changing or deleting) count has a change? Also does changing the order of the modifier count as a change?

Submitter Assigned Keywords

SVC06-1 original modifier

Response

This issue is explicitly answered in guide X091 in section 3.1 on page 142. The instructions for SVC06 indicate that the composite is used when the adjudicated code in SVC01 is different than the submitted code. This statement applies to all parts of the composite, including the modifiers. If the payer reordering of the modifiers changed the outcome of the adjudication, then the order also represents a change, requiring use of SVC06.
Submission 11/11/2004
Status Date 11/15/2004
Status F - Final
Primary References
Document 004010X091A
Section3
Page143
Set IDXX
Loop2110
Segment Position070
Segment IDSVC
Element Position06