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Back  RFI # 577: Bundling from history

Formal vs. Informal Help Informal Formal

Submitter

Barbara Sesny

Description

When procedures A & B billed on same claim bundle into procedure C the charges are combined. How should this be done when procedure A is on a history claim and procedure B on the current claim? We plan to adjust the history claim to deny and pay procedure C on the current claim but don't know how to represent the procedures or charges.

Response

This in not explicitly addressed in the 4010 guide.

Recommendation

Reverse claim 1 (proc A), reference claim 2 (proc B). Process claim 2 (proc B), reference claim 1 (proc A), adjust accordingly and use SVC06.

To reference the other claim, use the Other Claim Related Identification REF segment with REF01 code F8 (Original Reference Number). The other claim Claim Number from CLP07 is sent in REF02.
Submission 7/9/2007
Status Date 2/6/2008
Status F - Final
Primary References
Document 004010X091A1
Section2.2.6
Page26
Set ID835