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Edit 00230
Procedure Indicates Abortion/Valid Abortion Code Not Present
HIPAA Claim Adjustment Reason Code:16
Remark Code: N56
HIPAA Healthcare Claim Status Code: 454
Entity Identifier Code: N/A
Potential Causes:
The Procedure Code on the claim is for an abortion, but there is no abortion code on the claim.
Solution:
Check the Procedure Code to ensure the correct procedure was billed. If the correct procedure was billed, a valid Abortion Code must be entered. For Abortion Code entries please refer to the 837 Institutional Supplemental Companion Guide, Section on Condition Codes, or the 837 Professional Supplemental Companion Guide, Section on Special Program Code and Abortion Codes, located on this site (www.nyhipaadesk.com). Enter the data in the loop and the segments provided, and resubmit.
| 837 Institutional |
Loop 2300, HI (Principal Procedure Information) - (Inpatient of Clinic)
HI01-1 = BR (Code List Qualifier Code)
HI01-2 = Principal Procedure Code (Industry Code)
Or
Loop 2300 HI (Condition Information)
HI01-1 = BG (Condition)
HI01-2 = Condition Code (See Supplemental Guide for Abortion Codes)
Or
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) |
Abortion Code:
| 837 Professional |
Loop 2300 CLM (Claim Information)
CLM12 = 07 (Induced Abortion Danger to Life) or 08 (Induced Abortion Rape or Incest)
Or
Loop 2300 NTE (Claim Note)
NTE01 = ADD (Additional Information)
NTE02 = Claim Note Test (See list from 837P Supplemental Guide) |
Procedure Code:
| 837 Professional |
Loop 2400, SV1 (Professional Service)
SV101-1 = HC (Product/Service ID Qualifier)
SV101-2 = Procedure Code (Product/Service ID) |
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