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Back  RFI # 2167: Primary Procedure Code in Auth

Formal vs. Informal Help Informal Formal

Submitter

Kenneth Greenspan

Description

I've heard about a notion of a primary procedure code along with additional procedure codes for 1 service line in some authorization work flows. I don't see this in the structure of the 278 005010x217 auth submission layout. The 278 allows only 1 procedure code per service line. I also can't find that 837's allow > 1 procedure code per line. Is there any literature anywhere that supports a primary procedure code structure within the industry?

Submitter Assigned Keywords

Primary Procedure 278

Response

No, there is no primary procedure code data element within the 278 or 837 transactions.
While there is no primary procedure code, the 837I 00510X223 institutional claim does allows for the submission of a principal procedure code and other procedure codes on inpatient claims.

For 837I transactions these values are reported using ICD-10-PCS codes on the claim level not on the line level. The principal procedure is reported in the 2300 HI with a BBR qualifier and the other procedures are reported in the 2300 HI with a BBQ qualifier.

The 278 does not allow submitters to designate a principal procedure code. Each inpatient procedure code should be reported as individual institutional services lines in the 2000F SV202-2 with ZZ qualifier.
Submission 8/2/2016
Status Date 9/29/2016
Status F - Final
Primary References
Document 005010X217
Section2
Page247
Table2
Loop2000F
Segment IDSV1
Element Position01
Component Position2
Industry NameProcedure Code