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Back  RFI # 1417: 2400 LOOP SV107 - 2 - 5010

Formal vs. Informal Help Informal Formal

Submitter

bence gene

Description

RFI # 931 states that Diagnosis Code Pointers in SV107 are not required to point to every diagnosis code received in the HI segment. That RFI was specific to version 4010. We are experiencing the same situation in version 5010. A compliance checker is rejecting professional claims when all diagnoses reported in the HI segment do not have at least one pointer in SV107 pointing back to them. Is the requirement related to diagnosis codes and pointers different in version 5010 such that this is not compliant with the guide, or is there still no specific requirement that each diagnosis code have at least one SV107 pointer associating it with at least one service line?

Guide reference 1:
Guide – 005010X222A1
Section – 2
Page – 228
Set ID – 837
Table – 2
Loop – 2300
Segment – HI

Guide Reference 2:
Guide – 005010X222A1
Section – 2
Page – 358
Set ID – 837
Table – 2
Loop – 2400
Segment – SV1
Element – 07

Submitter Assigned Keywords

no pointer for diag code

Response

There is no 837 Implementation guide requirement in version 4010 or version 5010 that every diagnosis code in the 2300 HI Diagnosis Code segment must be "pointed to" by a service line Diagnosis Code Pointer (SV107). In terms of the implementation guide, there can be reported diagnosis codes that do not relate to any of the services reported in the claim.
Submission 9/26/2011
Status Date 12/16/2011
Status F - Final
Primary References
Document 005010X222
Section2.2