W7042

FISS Narrative:
Multiple medical visits on same day with same revenue code without condition code "G0."

Explanation and suggestion:

  • The "G0" condition code should be used when multiple medical visits occur on the same day in the same revenue center, but the visits were distinct, and constituted independent visits
  • This code is required to allow payment under OPPS
  • Verify coding and ensure there are no duplicate revenue code lines billed
  • If multiple visits occurred on the same day, ensure that a "G0" condition code is present on the claim
  • If necessary, correct and resubmit the claim

Reference:

  • CMS IOM 100-4 (PDF, 1.13 MB), Chapter 4, section 180.4 - Proper Reporting of Condition Code G0 (Zero)
  • Review the 'Reporting Multiple Outpatient Visits that Occur the Same Day' article for JJ Part A or JM Part A

Contact Palmetto GBA JM Part A Medicare


Provider Contact Center: 855-696-0705

Email Part A

Contact a specific JM Part A department

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