Reason Code W7042 - JE Part A

Reason Code Narrative

STANDARD NARRATIVE: MULTIPLE MEDICAL VISITS ON SAME DAY WITH SAME REVENUE CODE WITHOUT CONDITION CODE 'G0'.

Common Reason Code Errors

• Multiple medical visits on same day with same revenue code without condition code 'G0'.
• This code is required to allow payment for OPPS facilities.

Common Reason Code Corrections

• Use 'G0' condition code when multiple medical visits occur on same day in same revenue center but visits were distinct and constituted independent visits. i.e. 510 or 450 revenue codes.
• Verify coding and ensure there are no duplicate revenue code lines billed.
• If multiple visits occurred on same day, 'G0' condition code should be present on second claim.

Note: Critical Access Hospitals (CAHs) are not allowed to use condition code 'G0'.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 180.4
• CMS Change Request (CR) 5425 (Appendix B)

View reason code list, return to Reason Code Guidance page.