Change in Outpatient Hospital Claim Billing

The implementation of NCTracks on July 1, 2013, included a requirement that a HCPCS code must be billed with all revenue codes on outpatient hospital claims. That requirement has been changed. If the revenue code required a HCPCS code prior to July 1, then it will continue to do so. If the revenue code did not require a HCPCS code until after July 1, then it is no longer required, however, is encouraged to be billed on the claim when possible since DMA is capturing the data for future use. If a HCPCS code is submitted with a revenue code, it will need to be a current, valid HCPCS code on the date of service.

Outpatient claims billed with a revenue code but no procedure code will still report Edit 00435 (OUTPATIENT HOSPITAL CLAIM REQUIRE HCPCS CODE TO BE BILLED WITH REVENUE CODE) on the Remittance Advice (RA), but it will not cause the claim to deny. The EOB will be changed in the near future to remove the word “require�. Until then, the current EOB will be displayed and the line detail will be paid.

This change is effective based on date of processing, so claims previously denied for Edit 00435 can be resubmitted by the provider. For electronic claim submission, providers can submit a replacement claim to the previously denied claim and put the previous TCN as the replacement claim number, per the 837I billing guidelines.