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Medicare News Update Medicare Information Resource
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MIR-2006-11A, November 2006
Frequently Asked Questions – Reason Code 38038
Question:
Each day, when I check the fiscal intermediary standard system (FISS) on claims correction, I find that I am receiving several claims returned to the provider (RTP) for reason code 38038. What am I doing wrong?
Answer:
Outpatient claims will receive reason code 38038 when an outpatient claim has been processed and the provider is submitting another claim for the same dates of service; late charges are not permitted under the outpatient prospective system (OPPS). The provider must submit an adjustment to add any services to a processed claim except if condition code 20, 21, or G0 is present on the claim.
| 38038 |
Effective for 8/1/00 dates of service, whether any revenue code lines are equal or not, outpatient OPPS bill types cannot have overlapping dates unless condition code “G0” or “20” or “21” is present on the claim. |
Condition codes G0, 20, or 21 may only be used if appropriate. If the services are not separate evaluation and management medical visits on the same day, an adjustment must be submitted. If the services are separate evaluation and management medical visits, the claim may be resubmitted with condition code G0. Correct and resubmit if appropriate.
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