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MIR-2007-03AB, March 2007
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. There was 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 were editing with reason code E61#8 when blood deductible is applied to revenue code lines 383-389.
CMS indicated that the CWF edit would be disabled on January 1, 2007. After some delay, the edit was corrected in production based on CWF changes on January 29, 2007.
CMS Joint Signature Memorandum (JSM-07202) (January 16, 2007)
Additional Information Provided by National Government Services
National Government Services fiscal intermediary standard system (FISS) reason code 32204 continues to edit incorrectly on inpatient claims. Providers should continue to 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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