Reason Code 38038
Reason Code Narrative
On Outpatient OPPS Types of Bills (12X, 13X, 14X, 34X, 75X, 76X, or any bill containing Code 07), the following condition exists:
- A history claim is present that contains overlapping dates, with the Provider Numbers equal, and at least one-line item Date of Service is equal (for OPPS services) without
- Condition Code 'G0' '20' or '21' present on the claim. For this condition an adjustment bill must be submitted.
Common Reason Code Errors
- Claim submitted is duplicate of previously submitted claim and one of above-mentioned conditions exists.
Common Reason Code Corrections
- Verify if claims should be billed separately or combined.
- Examples of separately billable services are ambulance, repetitive, preventive.
- Verify duplicate services have appropriate modifiers, if applicable.
- If additional charges must be included on prior claim submit, an adjustment.
- Do not submit a new claim.
- CMS Internet Only Manual (IOM), Medicare Claims Processing Manual, Publication 100-04, Chapter 1
- CMS IOM, Medicare Claims Processing Manual, Publication 100-04, Chapter 4
- CMS IOM, Medicare Claims Processing Manual, Publication 100-04, Chapter 9
Last Updated Oct 31, 2019