Reason Code W7049

Reason Code Narrative

SERVICE ON THE SAME DAY AS INPATIENT PROCEDURE (LINE-ITEM DENIAL)

Common Reason Code Errors

  • Outpatient items and services submitted with an inpatient procedure are not payable under outpatient prospective payment system (OPPS)
    • All other line items on the same day as the line with a C status indicator are denied (line item denial/rejection flag = 1, APC return buffer)
      • For example, OCE System Flag 1:
        HCPCS with a status indicator ‘C’ are inpatient procedures and are not considered payable
  • Reference the status indicator which identifies if the HCPCS code is paid under OPPS prior to claim submission
  • The full list of status indicators and their definitions is published in Addendum D1 of the OPPS/ASC proposed and final rules each year

Common Reason Code Corrections

  • If the HCPCS code is incorrect, you may request a corrected claim to appeals
  • Direct Data entry (DDE) - The process for reviewing OCE flag status indicators for the desired HCPCS codes is as follows:
    • Open the claim and go to 02 (MAP171)
    • Press the “F2” or “F11” key to review the line items details (MAP171A)
    • Review the OCE flag status (IND) 1 field

Resources

 

Last Updated Fri, 19 Nov 2021 17:44:34 +0000