Reason Code W7025 - JF Part A

Reason Code Narrative

PROCEDURE AND SEX CONFLICT

Common Reason Code Errors

• Beneficiary sex located in UB04 FL 11 or electronic equivalent or on page one of Direct Data Entry (DDE) is not compatible with one or more of procedure codes listed in FL 74 A-E
• Beneficiary sex listed in DDE does not match Common Working File (CWF) data

Common Reason Code Corrections

• Check beneficiary records to ensure that correct sex has been listed
• Verify correct procedure codes have been reported on claim
• Verify if CWF matches local file and if there is no match found, contact Provider Contact center to have corrections made to patient's local file

Resources

• CMS Definitions of Medicare Code Edits
• CMS Integrated Outpatient Code Editor (IOCE)
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 25

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