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Back  RFI # 322: Repeating HI Segments - 837I

Formal vs. Informal Help Informal Formal

Submitter

Sarah Hataway

Description

There are several HI segments that can repeat twice (condition, occurrence, diagnosis and surgical codes). Is it compliant for a provider to submit a claim with 11 diagnosis codes, 1 primary and 10 other; splitting the other diagnosis codes into two separate segments - 5 in each HI segment or should all 10 be sent in the first HI segment?
For example:
HI*BK:0000
HI*BF:1111*BF:2222*BF:3333*BF:4444*BF:5555
HI*BF:6666*BF:7777*BF:8888*BF:9999*BF:AAAA
OR
HI*BK:0000
HI*BF:1111*BF:2222*BF:3333*BF:4444*BF:5555*HI*BF:6666*BF:7777*BF:8888*BF:9999*BF:AAAA
Are both of these examples compliant?

Submitter Assigned Keywords

repeating HI segments 837 Institutional

Response

The workgroup strongly recommends to submitters that the second segment iteration not be used unless all 12 available slots are used in the first iteration. There is a risk that some receiving systems may incorrectly not look for the second segment iteration when all available elements are not used in the first segment; thereby either ignoring or suspending diagnosis codes in the second segment.
Submission 9/8/2005
Status Date 11/11/2005
Status F - Final
Primary References
Document 004010X096A1
Section3
Page232
Set ID837I
TableH
Loop2300
Segment IDHI
Industry NameOther Diagnosis Information