License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

End User License Agreement

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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.

Search by:

Reason Code

Keyword

Reason Code C7080

Description:

A line item date of service (LIDOS) submitted on a home health claim overlaps a date of service on an inpatient claim. Per the Medicare Claims Processing Manual ( Pub. 100-04, Ch. 10, § 30.9), "Claims for institutional inpatient services, that is inpatient hospital and skilled nursing facility services, will continue to have priority over claims for home health services under HH PPS."

Resolution:

CGS encourages you to use the date of the first Medicare billable visit in the episode as the date of service you submit with revenue code 027X or 0623 when billing non-routine or surgical dressing/wound care supplies. In many cases, this is the LIDOS that overlaps the inpatient stay.
If the inpatient facility has submitted their billing, you may be able to determine which date overlaps the inpatient stay by reviewing the DOEBA and DOLBA dates found on the beneficiary's eligibility file (ELGA page 01 or the myCGS Inpatient tab). Please be aware that the DOEBA and DOLBA dates reflect the first and last billing dates in an inpatient benefit period, and the beneficiary may have had multiple inpatient stays during a single inpatient benefit period.
- If you are unable to determine the overlapping date by looking at the beneficiary's eligibility file, please call the Provider Contact Center to receive this information. A listing of telephone numbers is accessible on the Customer Service Telephone Numbers Web page.
- Access the rejected claim to determine which dates of service on your home health claim overlap the inpatient stay. This information is available on FISS Page 02. You may need to press the F6 key to scroll forward to view all of the FISS revenue pages.
- Adjust the rejected claim using FISS Adjustment Option 33 to remove the incorrect date of service on FISS Page 02.
  - REMINDER: when claims reject, charges are placed into the "NCOV CHARGES" (non-covered charges) field on FISS Page 02. When using FISS for online adjustments, the revenue detail lines must be deleted and added back by re-entering the revenue code information in new detail lines.
  - For more information about adding and deleting revenue lines, access Chapter 5 - Claims Correctionof the Fiscal Intermediary Standard System (FISS) Guide. Detailed instructions are also found here for using FISS to adjust a rejected claim.
  - REMINDER: to select a rejected claim, you must change the "P" that defaults in the S/LOC field to an "R" and enter "B9997". You may also need to change the TOB to "32".
- Ensure that all of the required data elements for an adjustment are present prior to submitting it to Medicare. These include:
  - Type of bill (the third digit must be a "7")
  - Claim Change Reason Code
  - Document Control Number
  - Adjustment Reason Code (if submitting via FISS)
  - Remarks explaining the reason for the adjustment
- A listing of available Claim Change Reason Codes and Adjustment Reason Codes can be accessed from Chapter 5 - Claims Correctionof the Fiscal Intermediary Standard System (FISS) Guide.

Updated: 12.22.15

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.