Edit 02085


After Hour Procedure Requires Second Service Line on Claim

HIPAA Claim Adjustment Reason Code: B15
    Remark Code: N/A
HIPAA Healthcare Claim Status Code: 454
    Entity Identifier Code: N/A

Potential Causes:
This edit only applies to claims with the following CPT (HCPS Level 1) codes:

99050 (SERVICES PROVIDED IN THE OFFICE AT TIMES OTHER THAN REGULARLY SCHEDULED OFFICE HOURS, OR DAYS WHEN THE OFFICE IS NORMALLY CLOSED (EG, HOLIDAYS, SATURDAY OR SUNDAY), IN ADDITION TO BASIC SERVICE)

and/or

99051 (SERVICE(S) PROVIDED IN THE OFFICE DURING REGULARLY SCHEDULED EVENING, WEEKEND, OR HOLIDAY OFFICE HOURS, IN ADDITION TO BASIC SERVICE).

Service lines reporting these procedure codes must be accompanied by other service lines on the claim with the same service date.

Solution:
Refer to the original source for the claim and verify that there were no other HCPCS codes. If there were no other HCPCS codes that should have appeared on the claim the claim is not payable. If there were other HCPCS codes correct the claim and resubmit.

837 Institutional

Loop 2400 SV2 (Institutional Service Line) SV202-2 (Procedure Code)

837 Professional and 837 Dental

Loop 2400 SV1 (Professional Service Line) SV101-2 (Procedure Code)