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Back  RFI # 1627: 5010 837/2430 Line Splitting

Formal vs. Informal Help Informal Formal

Submitter

Pamela Maklari

Description

Section 1.4.1.4 indicates that unbundling occurs when one submitted procedure code is paid and reported back as two or more procedure codes but it does not mention whether the procedure codes must be different. Section 1.4.1.4 also states “See the latest version of the 835 Remittance Advice implementation guide for an explanation on how bundling and unbundling are handled in that transaction.” Sections 1.4, 1.4.1, 1.4.1.4 & 1.7.1 include references to the 835. Section 1.4.1.2 includes a crosswalk from the 835 to the 837/2430 loop. Other than section 1.5 Business Terminology, Unbundling that includes the statement “Unbundling also occurs when the units of service reported on one service line are broken out to two or more service lines for different reimbursement rates”, line splitting is not specifically addressed in the 837 TR3.
Can you provide clarification of the rules for split line items in the 837/2430 loop? Is the intent that rules for reporting line splitting in the 837 are the same as in the 835 TR3?

Submitter Assigned Keywords

5010 837 2430 Line Splitting

Response

Yes, it is the intent that reporting line splitting in the 837 is the same as it is in the 835. The Work Group will consider adding an example that addresses this scenario in a future TR3. The details are found in TR3 005010X221 (835) section 1.10.2.14.1, Service Line Splitting.
Submission 7/16/2012
Status Date 10/16/2012
Status F - Final
Primary References
Document 005010X222
Section1.4.1
Page480
Set ID837