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Back  RFI # 1601: 837I 5010A2 2310B Oper Phys

Formal vs. Informal Help Informal Formal

Submitter

Meredith Haddock

Description

1) On an 837I version 5010A2 claim, if a principal procedure code is reported in the HI01-2 of Loop ID-2300*HI*BR, should Loop ID-2310B Operating Physician always be required/reported?
2) What determines what is a "surgical procedure" versus "non-surgical procedure" to determine when to report Loop ID-2310B Operating Physician? (based on the guideline in the TR3 for this loop)

Submitter Assigned Keywords

2310B, Operating Physician, Principal Procedure, 2300-HI*BR, HI*BR, 5010A2, 837I

Response

The 2310B operating physician is only required if a procedure code listed on the claim is a surgical procedure. The surgical procedure could by submitted either as a principal procedure (2300 HI with a BR/BBR qualifier) or as the other procedure (2300 HI with BQ/BBQ qualifier).

A procedure is considered surgical if the code in the ICD-9-CM or ICD-10-PCS indicates surgery.
Submission 6/4/2012
Status Date 7/11/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Page326
Set ID837I
Table2
Loop2310B
Segment IDNM1
Industry NameOperating Physician Name