Reason Code W7049 - JF Part A
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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
- For example, OCE System Flag 1:
- 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)
- 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
- HCPCS codes and their status indicators, APC groups and OPPS payment rates are posted quarterly to the OPPS website under Hospital Outpatient PPS, Addendum A and Addendum B Updates
- Refer to Outpatient Code Editor (OCE) which edits a claim for accuracy of submitted data in determining if packaging is applicable
View reason code list, return to Reason Code Guidance page.
Last Updated Mon, 16 Jan 2023 18:02:09 +0000