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Edit 00154
Recipient Age Greater than Maximum Primary Diagnosis
HIPAA Claim Adjustment Reason Code: 9
Remark Code: N/A
HIPAA Healthcare Claim Status Code: 255
Entity Identifier Code: N/A
Potential Causes:
The age of the recipient is higher than the maximum age assigned to the diagnosis code entered on the claim.
Solution:
Check the Diagnosis Code entered to ensure the correct Diagnosis is on the claim. Refer to the ICD9 Diagnosis Coding Manual for the age limitations on some Diagnosis Codes. Check the age of the recipient using MEVS. If the Date of Birth is incorrect on MEVS, then contact the Local Department of Social Services. Enter the data in the loop and the segment provided, and resubmit.
| 837 Institutional |
Loop 2300 HI (Principal, Admitting, E-Code and Patient Reason For Visit Diagnosis Information)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = ICD-9-CM or 7999 |
| 837 Professional |
Loop 2300 HI (Health Care Diagnosis Code)
HI01-1 = BK (Principal Diagnosis)
HI01-2 = Principal Diagnosis
And
Loop 2400 SV1 (Professional Service)
SV107 -1 = Primary Diagnosis Code Pointer |
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