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Edit 00225
Procedure Inconsistent with Sterilization Code
HIPAA Claim Adjustment Reason Code:16
Remark Code: N180
HIPAA Healthcare Claim Status Code: 454
Entity Identifier Code: N/A
Potential Causes:
The claim has a Sterilization Condition Code, but the Procedure Code is not for a Sterilization procedure.
Solution:
Verify that the correct Procedure Code was entered. If the procedure is not for sterilization then remove the Sterilization Condition Code.
| 837 Institutional |
Loop 2300, NTE (Claim Note)
NTE01 = ADD (to indicate additional information)
NTE02 = AI (Sterilization)
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Loop 2400, SV2 (Institutional Service Line) - (Non-Inpatient)
SV202-1 = HC (Product/Service ID Qualifier)
SV202-2 = Procedure Code – Enter HCPCS procedure code (Product/Service ID) |
| 837 Professional |
Loop 2300, HI (Condition Information)
HI01-1 = BG (Condition)
HI01-2 = A1 (Sterilization)
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
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