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Back  RFI # 607: SVC Segment

Formal vs. Informal Help Informal Formal

Submitter

Jennifer McMullin

Description

Consider the following scenario. An 837 is submitted with both a procedure code and a revenue code on a single service line. The claim is adjudicated and pays off of the procedure code, not the revenue code. In this scenario, how should the SVC in the 835 be populated? SV101 = Procedure Code and SV04 = Blank OR SV101 = Procedure Code and SV04 = Revenue Code. Again, the key thing to remember is that the claim paid off of the procedure code, not the revenue code.

Submitter Assigned Keywords

SVC

Response

This issue is explicitly addressed in guide 004010X091. The note on SVC04 states "Required when an NUBC revenue code was considered during adjudication in addition to a procedure code already identified in SVC01." For the scenario identified, independent of the basis for payment, if the Revenue code was considered during the adjudication process then SVC04 is required. If the Revenue code was not considered then SVC04 can be left blank.
Submission 10/23/2007
Status Date 10/29/2007
Status F - Final
Primary References
Document 004010X091A1
SectionLOOP2110
Page140
Set ID835