C7565

FISS Narrative:
This edit identifies an outpatient 13x, 14x, or 85x type of bill (TOB) for laboratory services under ESRD Consolidated Billing (CB) contains dates of service overlapping a covered ESRD outpatient claim, TOB 72x.

Explanation and Suggestion:
Outpatient services subject to ESRD CB which are not related to a patient’s ESRD diagnosis can be reimbursed separately. Provider must add an 'AY' modifier to appropriate line items on outpatient claim and system will bypass ESRD CB edits. You may refer to the ESRD Consolidated Billing homepage for a list of ESRD CB services.

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