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Back  RFI # 289: Reporting revenue code in 835

Formal vs. Informal Help Informal Formal

Submitter

Dyan Anderson

Description

We submit both institutional and professional 837 claims. The institutional claim requires a revenue code in SV201 which may or may not contain a HCPCS code in SV202-2. Revenue codes are not reported in the professional 837 claim. Is the revenue code required to be reported in the 835 transaction SVC service line segment whenever an institutional payment/adjustment is reported? Shouldn't SVC01-2 or SVC04 contain a revenue code in the 835 if sending a SVC segment for an institutional revenue line? Otherwise, how is the provider expected to identify or distinguish between institutional versus professional payments?

Submitter Assigned Keywords

835 revenue code SVC01-2 SVC04

Response

This issue is explicitly addressed in guide 004010X091. The note on the SVC segment position 4 reads:

"Required when an NUBC revenue code was considered during adjudication in addition to a procedure code already identified in SVC01. If the original claim and adjudication only referenced an NUBC revenue code, that is supplied in SVC01 and this element is not used."

Therefore, if a claim adjudication used only a Revenue Code, that must be reported in SVC01. If the claim adjudication used both a Revenue Code and a HCPCS code, then the HCPCS code must be reported in SVC01 and the Revenue code in SVC04.

There is nothing within the 835 intended to identify a claim as institutional versus professional. If a provider wants that distinction on a returning claim, then the provider must code the CLM01 element of the 837 to convey that information and that will be returned in CLP01 of the 835.
Submission 7/29/2005
Status Date 9/16/2005
Status F - Final
Primary References
Document 004010X091
SectionLoop2110
Page139
Set ID835
Table2
Loop2110
Segment Position070
Segment IDSVC
Element Position4
Component Position1