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Back  RFI # 155: ICD-9-CM Procedure Codes

Formal vs. Informal Help Informal Formal

Submitter

Heather olson

Description

Is it compliant for a payer to require providers to include on the 837I, in Loop 2300, HI segment, HCPCS codes on outpatient claims?
While HIPAA does not govern paper claims, this payer is also requiring providers to put HCPCS codes in form locators 80 and 81.

Submitter Assigned Keywords

ICD-9-CM

Response

The HI Principal Procedure Information segment is required on Home IV therapy claims or encounters when surgery was performed during the inpatient stay from which the course of therapy was initiated. The HI Principal Procedure Information segment is also required on inpatient claims or encounters when a procedure was performed.

Therefore the answer is no. Submitters are not prohibited from sending the segment for outpatient claims however a receiver cannot require the segment for outpatient claims.
Submission 11/30/2004
Status Date 3/1/2005
Status F - Final
Primary References
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