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Back  RFI # 1510: Elig Outpatient Surgical Codes

Formal vs. Informal Help Informal Formal

Submitter

Farmer Richard

Description

Is EB*1**50~MSG*Surgical~ permitted in a 5010 271 response? This information could be coded as EB*1**2~III*22 and the 5010 TR3 Note 2 for the MSG says, in part, “Under no circumstances can an information source use the MSG segment to relay information that can be sent using codified information in existing data elements”.

In other words, is the Place of Service code 22 "Hospital Outpatient" equivalent to the Service Type Code 50 "Hospital - Outpatient" and is the information source required to make this interpretation in order to avoid uses an MSG?

Submitter Assigned Keywords

Eligibility 271 Outpatient Surgical

Response

Service Type Code 50 (Hospital – Outpatient) is to be used to identify benefits provided in an Outpatient Hospital, not to identify the location of service. Service Type Code 2 (Surgical) in EB03 and Place of Service Code 22 (Outpatient Hospital) would be the compliant method of returning this information and use of an MSG segment would be prohibited since this information can be codified.
Submission 1/30/2012
Status Date 3/6/2012
Status F - Final
Primary References
Document 005010X279
Section1.4.12
Page38
Secondary References
RFI ID 1967
Document 005010X279
Section2.6
Page299
Segment IDEB
Element Position03
Code Value50