RFI #
1788
S codes unbundled to E,K & A
Description
Primary uses S codes. Secondary uses E, K, A codes. Supplier unbundles billed charges for S codes to
billed charges for E + K + A codes.
Must S code and primary's payment for it be reported on the 837 to the secondary payer?
Or, can primary's payments for E + K + A codes be summed to on claim to secondary payer?
RFI Response
The guide addresses the coordination of benefits bundling and unbundling in section 1.4.1.4 of the front matter of the 837 professional guide. All codes must be provided to the secondary payer. In the example provided, the S code value would be placed in the SV1 segment and separate 2430 loop SVD segments would contain each of the E, K and A code values on the secondary claim.
DOCUMENT ID
005010X222