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Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

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Reason Code 39073

Description:

This reason code will assign when your claim includes one or more diagnosis codes that match a Medicare Secondary Payer (MSP) record on the Common Working File (CWF).

Resolution:

Check the patient's eligibility file to determine whether your services may be related to the MSP record. You can also access myCGS to view specific diagnosis codes associated with MSP insurance types. Refer to the myCGS Enhancement: Diagnoses Associated with Medicare Secondary Payer (MSP) Records for details.

If your services are unrelated to the MSP record, and there is no new accident/injury, submit an adjustment to remove the related diagnosis code(s) from your claim once the claim has moved to R B9997.

If your services are related to the MSP record, submit an adjustment with the appropriate MSP information. Refer to the Medicare Secondary Payer Billing and AdjustmentsPDF quick resource tool for more information.

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

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