Reason Code W7042 - JE Part A
Reason Code W7042
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'.
- 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.
Last Updated Tue, 22 May 2018 13:18:31 +0000