32404

FISS Narrative:
According to the revenue code file a HCPCS code is required. However, the HCPCS code that was entered on the claim was not found on the HCPCS file; or the revenue code that was entered does not require a HCPCS code. Please refer to the most current CPT-4 or HCPC coding book to verify that the HCPC being billed is valid for the dates of service on the claim.

Explanation and Suggestion:

  • On the 0023 revenue code line of the final claim, the HHA must report the HIPPS code. The first four positions of the code must be identical to the value reported on the RAP. The fifth position may vary from the letter value reported on the RAP to the corresponding number which represents the same non-routine supply severity level but reports that non-routine supplies were not provided.
  • In addition to the 0023 revenue code line of the final claim, all service or discipline visits must also be reported with the appropriate revenue code and corresponding HCPCS code (G-codes)
  • HCPCS codes are not required for supply revenue codes 0270 and 0623
  • Reminder on the final claim: In addition to the 0023 line information, there must be a line entered with a discipline revenue code, corresponding HCPCS code and a service date that matches the 0023 line date. This line reflects the first billable service in the episode.
  • Make any necessary corrections and resubmit. 
  • Notify software vendors if necessary

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