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Back  RFI # 1788: S codes unbundled to E,K & A

Formal vs. Informal Help Informal Formal

Submitter

Ann Walton

Description

Primary uses S codes. Secondary uses E,K, A codes.
Supplier unbundles billed charges for S codes to
billed charges for E + K + A codes.

Must S code and primary's payment for it be reported on the 837 to the secondary payer?

Or, can primary's payments for E + K + A codes be summed to
on claim to secondary payer?

Submitter Assigned Keywords

Unbundle S codes to E + K + A codes

Response

The guide addresses the coordination of benefits bundling and unbundling in section 1.4.1.4 of the front matter of the 837 professional guide. All codes must be provided to the secondary payer. In the example provided, the S code value would be placed in the SV1 segment and separate 2430 loop SVD segments would contain each of the E, K and A code values on the secondary claim.
Submission 5/9/2013
Status Date 7/12/2013
Status F - Final
Primary References
Document 005010X222
Section1.4.1
Set ID837P
Table2
Loop2400