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Back  RFI # 1405: unbundling discrepancy

Formal vs. Informal Help Informal Formal

Submitter

Brian Reitz

Description

CMS requests assistance with unbundling:
Scenario: For 5010 837 transactions, there is a conflict between the Unbundling instructions in Section 1.4.1.4 (pg. 25 of 837I and P), where the original service line and procedure code are unbundled into two (2) 2430 SVD segments with the new, unbundled codes, and the TR3 Notes (Note #1) for the 2430 SVD.
In balancing the payment information, when 3 SVDs are used, we’d like to confirm if it would be proper to submit the 1st SVD with 0 payment for the original procedure code, with no adjustments, followed by the other 2 SVDs, with the unbundled procedures and the payments and CAS adjustments balancing as per Section 1.4.1.4. If that is not correct, please provide guidance.

Submitter Assigned Keywords

unbundling

Response

Section 1.4.1.4 provides a clear example of unbundling. That example is for a case where a submitted procedure code A is adjudicated as procedure B and procedure C. Within the 2300 loop for the submitted service, the SV1 segment identifies the submitted procedure code. The 2430 loop occurs twice, once for adjudicated code B and once for adjudicated code C. There is no 2430 loop (SVD segment) reporting the submitted procedure code and a zero payment amount.
Submission 9/14/2011
Status Date 12/8/2011
Status F - Final
Primary References
Document 005010X222
Section1.4.1.4
Page25