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MIR-2006-10AB, October 2006
The following information Applies to Delaware Providers Only
CWF Edit E61#8 Update Based on CMS Instruction
Background
Effective for dates of service on or after July 1, 2005, the Centers for Medicare & Medicaid Services (CMS) issued Change Request (CR) 3681 for billing blood and blood products under the OPPS. CR 3681 described how blood charges are to be reported on revenue codes 38X (Blood) and 39X (Blood Storage/Processing) so that proper payment and blood deductible could be applied.
Issue
On July 18, 2006, the CMS was notified of a discrepancy between the outpatient prospective payment system (OPPS) Pricer output and Common Working File (CWF) editing. Currently, there is a CWF Edit (61#8) that ensures that blood deductible is only applied to revenue code lines 380-382. Because the OPPS Pricer applies blood deductible to all 38X revenue code lines as communicated in CR 3681 (effective July 1, 2005), some OPPS claims are editing with reason code E61#8 when blood deductible is applied to revenue code lines 383-389.
The CMS will disable CWF edit 61#8, effective July 1, 2005, since CMS was not aware such a consistency edit ever existed in CWF, and because we do not have/foresee any reason to increase hospital reporting burden when it does not have an affect on CMS data integrity (i.e., APC rate-setting). In other words, the CMS does not perform cost analysis for individual revenue codes (i.e., 381, 382, 383), but rather on a group of revenue codes such as all 38X lines (380-389).
Until the CWF edit is disabled on January 1, 2007, providers will have claims that receive edit E61#8 returned with reason code E61#8 so that the revenue codes can be updated. The provider must change revenue code lines 383-389 to one of the following revenue code lines: 380, 381, or 382. By doing so, the resubmitted claim will price the same and avoid the unintentional CWF edit until the edit is disabled.
E61#8:
Based on recent CMS instruction, providers are to bill using revenue codes 0380, 0381, or 0382 in place of 0383 thru 0389 until January 1, 2007. By doing this, the resubmitted claim will price the same and avoid the unintentional CWF edit until the edit is disabled. Correct revenue codes and resubmit the claim.
CMS Joint Signature Memorandum (JSM-06640) (August 24, 2006)
Additional Information Provided by Empire Medicare Services
Empire Medicare Services is also aware that the fiscal intermediary standard system (FISS) reason code 32204 is not editing correctly on inpatient claims. Providers should use blood revenue codes 380, 381, or 382 in place of 383-389, until the edit is corrected.
32204
The blood pint not replaced count is greater than zero, but a blood revenue code is not present on the claim. The following are blood revenue codes: 380, 381, 382, 384, 385, 386, 387, 388, and 389. If there is no blood revenue code present, then value code 39 must equal value code 37. Please verify the information billed and submit a new claim, if appropriate.
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