Reason Code C7080

Description
An Outpatient claim has a "From"/"Through" date that overlaps an inpatient claim and the provider number is different. Or, a home health claim has a detail line item date of service (LIDOS) that overlaps an Inpatient, RNHCI, or SNF claim on history and the provider number is different.

Resolution
Review patient's eligibility to determine overlapping date. Check for common errors.

  • Outpatient or Home Health LIDOS overlap an inpatient stay and should be billed to inpatient facility
  • Outpatient or Home Health LIDOS billed incorrectly; or
  • Repetitive services billed without occurrence span code 74 and inpatient dates of service (DOS)
  • If another facility must update their date of service, reach out and request they update their claim

If requiring a LIDOS correction:

  • Submit an adjustment through Direct Data Entry (DDE)
  • Use type of bill (TOB) XX7
  • Correct applicable LIDOS
  • Add remarks to explain adjustment
  • Select most appropriate adjustment reason code

If charges should be bundled in an inpatient stay:

  • Submit charges to inpatient facility
  • If not already in place, create a payment arrangement
  • Inpatient facility will need to pay provider of outpatient or Home Health services directly

If requiring a claim adjustment to add 74 occurrence span code:

  • Submit an adjustment through Direct Data Entry (DDE)
  • Use type of bill (TOB) XX7
  • Add occurrence span code 74 and use from/through dates of service for overlapping inpatient claim
  • Add remarks to explain adjustment
  • Select most appropriate adjustment reason code

Resource: CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, chapter 1 (PDF, 1.62 MB), section 50.2.2. 

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