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Back  RFI # 763: SVC01-01: No ICD9 in 277/835?

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Submitter

Robert Patrick

Description

I’ve noticed that the 835 SVC01-01 in the 5010 TR3 does not allow ICD-9-CM codes to be returned (same case with 276/277), yet the 837 transaction still allows ICD-9-CM codes to be submitted & ICD-10.

Could someone please explain why the 837 codes do not correspond exactly to the codes available for the 5010 835 or 276/277 in this case?

If an 837 is submitted with only ICD-9 codes (or ICD-10 codes) what codes are supposed to be returned on the corresponding 835 or 276/277 since these are not allowed?

Submitter Assigned Keywords

SVC01-01 Procedure Code ICD-9 835 277 276 837 ICD9 ICD-9-CM

Response

In the 5010 837I, ICD-9 & ICD-10 procedure codes are submitted at the claim level in Loop 2300 HI segments for inpatient claims only, while revenue code are submitted at the line level Loop 2400 SV2 segments.

In both the 835 and 276/277, the SVC segment contains line level procedure and revenue code data, not claim level, therefore the claim level ICD-9 and ICD-10 procedure codes would never be reported in the line level SVC segments. Additionally, per the 5010 – 835, Section 1.10.2.4.1 Institutional-Specific Use, remittance detail for inpatient claims generally does not include service level information. However, if service level data is reported, the revenue codes submitted in the SV2 segment would be reported in the SVC segment of the 835 and 276/277.
Submission 4/14/2009
Status Date 6/10/2009
Status F - Final
Primary References
Document 005010X221
Section2.4
Page187
Set ID835
Table2
Loop2110