Reason Code W7047

Reason Code Narrative

SERVICE NOT SEPARATELY PAYABLE (LINE-ITEM REJECTION)

Common Reason Code Errors

  • Items and services that are considered an integral part of another service that is paid under outpatient prospective payment system (OPPS)
    • No separate payment is made for packaged incidental services
      • For example: routine supplies, anesthesia, recovery room use, and most drugs are considered part of surgical procedure. Items mentioned are packaged into the ambulatory payment classification (APC) payment for the surgical procedure

Common Reason Code Corrections

  • Reference the status indicator which identifies if the HCPCS code is paid under OPPS before submission of claim(s)
    • The full list of status indicators and their definitions is published in Addendum D1 of the OPPS/ASC proposed and final rules each year
      • For example, OCE System Flag 1:
        HCPCS with a status indicator ‘N’ are packaged incidental services and are not considered payable
  • Bundled into a denied service, appeal the denied service.
    If payable service if found favorable on appeal, bundled services can be adjusted to covered.
  • Claim is missing a payable service all together. Verify if only packaged services were provided, or if other payable services were missing. Can adjust to add payable service.
  • Direct data entry (DDE) - The process for reviewing the OCE flag status indicators for the desired HCPCS code is as follows:
    • Open the claim, go to page 2 (MAP171)
    • Press the F2 or F11 key to review the line items details (MAP171A)
    • Review the OCE flag status indicators (IND) 1 field

Resources

 

Last Updated Fri, 19 Nov 2021 15:09:00 +0000