Reason Code 38038

Published 12/16/2019

A history claim is present that contains overlapping dates, with the provider numbers equal, and at least one line item date of service is equal (for OPPS services) without condition code “G0,” “20” or “21” present on the claim.

Verify OPPS bill types 12X, 13X, 14X, 76X, 75X, or any claim reporting condition code (CC) 07 doesn’t overlap service dates from same provider unless CC G0, 20 or 21 is present. Adjust previously processed claim to add charges.

If ancillary services are being billed, a Part A inpatient claim (benefits exhaust or no entitlement), a 121 type of bill for ancillary services may be billed, and a 131 type of bill for ER visit only.

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