Reason Code C7010
Reason Code Narrative
THE EDITED INPATIENT OR OUTPATIENT CLAIM HAS FROM/THRU DATES THAT OVERLAP A HOSPICE ELECTION PERIOD AND IS NOT INDICATED AS TREATMENT OF A NON-TERMINAL CONDITION (CONDITION CODE '07') OR A MCCD/DMD NOTICE OF ELECTION (89A) FROM DATE OVERLAPS A HOSPICE ELECTION PERIOD.
Common Reason Code Errors
- Common Working File shows a hospice election period open during claim dates of services (DOS).
- A non-hospice related claim has been billed without the 07 (zero 7) condition code.
- Condition code 07 indicates that, although beneficiary elected Medicare hospice benefit, services he/she received were for treatment or management of conditions not related to his/her hospice terminal illness.
Common Reason Code Corrections
- If services being provided are related to the open CWF hospice election period, claim must be billed to hospice, not Medicare.
- If services are not related to hospice election period append a 07 condition code to claim.
Help Avoid This Rejection
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- CMS Internet Only Manual (IOM), Publication 100-02, Medicare Benefit Policy Manual, Chapter 9
- CMS IOM, Publication 100-04, Medicare Claims Processing Manual, Chapter 11, Section 30.3
Last Updated Oct 31, 2019