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Back  RFI # 220: Usage of SVC06 in 835

Formal vs. Informal Help Informal Formal

Submitter

Strickland Curtis

Description

We are having a discussion with our EDI Translation Software provider in regards to interpreting various rules/conditions within the HIPAA Implementation Guides (IG). Please respond to the following questions:

EDI 835 - The rule states for SVC06:
This is REQUIRED when the adjudicated procedure code provided in SVC01 is different from the submitted procedure code from the original claim. This is NOT USED when the submitted code is the same as the code on SVC01.

The software provider says this does not mean that SVC01-2 & SVC06-2 cannot be the same value. We put the same data through two (2) Third-party Testing Services which issue errors for that occurrence.

Please let us know which interpretation is correct.

Response

This issue is explicitly addressed in guide 004010X091 on page 142. The note on SVC06 reads "This is REQUIRED when the adjudicated procedure code provided in SVC01 is different from the submitted procedure code from the original claim. This is NOT USED when the submitted code is the same as the code on SVC01." This note applies to SVC06 and references SVC01 composites as a whole, not to each individual component of the composites separately.

An example of an invalid combination is:

SVC01=HC:12345:12
SVC06=HC:12345:12


Valid combination examples are:

SVC01=HC:12345:12
SVC06=HC:12346:12

SVC01=HC:12345:12
SVC06=HC:12345:34

SVC01=HC:12345:12
SVC06=HC:12345:12:34

SVC01=HC:12345:12:23
SVC06=HC:12345:12
Submission 3/17/2005
Status Date 3/21/2005
Status F - Final
Primary References
Document 004010X091
Section3
Page142
Set ID835
Table2
Loop2110
Segment Position1
Segment IDSVC
Element Position06
Component Position2
Industry NameProcedure Code