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Last Modified: 8/6/2010
Location: FL, PR, USVI
Business: Part A
31256
Claims billed on or after 07/03/06, type of bill (TOB) of '12x', '13x', '22x', '23x', '34x', '74x', or '75x' with revenue code 043X without an occurrence code '17' or claim billed with occurrence code '17' without revenue code 043X.
Resources/tips to avoid or correct this return to provider (RTP) claim
This reason code occurs as the claim either contains:
• Revenue code 043X, indicating occupational therapy (OT) services, but there is no occurrence code '17', which is the date outpatient OT plan was established or last reviewed; or
• Occurrence code '17', without revenue code 043X on the claim.
With the implementation of change request (CR) 4310 
in July 2006, specific edits are applied to claims containing therapy services. Therapy services are reflected by use of these revenue codes:
in July 2006, specific edits are applied to claims containing therapy services. Therapy services are reflected by use of these revenue codes: • 042X -- Physical therapy (PT)
• 043X -- Occupational therapy (OT)
• 044X -- Speech-language pathology (SLP)
Steps you can take to correct this RTP:
1. Research the claim to determine if the revenue code and/or occurrence code combination billed on the claim is correct and accurate reflection of the medical records.
2. Correct the claim
• Add occurrence code '17' or revenue code 043X, or remove them as necessary to correct claim.
, make the correction and PF9 the claim.• Correct your electronic claim and resubmit.
References
• Therapy coding requirements -- The Centers for Medicare & Medicaid Services (CMS) Internet-only manual (IOM) Publication 100-04, chapter 5, section 20 .
.• Information on revenue codes -- CMS IOM Publication 100-04, chapter 5, section 40.3 and Publication 100-04, chapter 25, section 75.4 .
and Publication 100-04, chapter 25, section 75.4 .• See also CR 4310 "Corrections to Common Working File Editing of Home Health Prospective Payment System Claims Regarding Non-covered Episodes and Prior Inpatient Stays and Fiscal Intermediary Shared System Implementation of 2006 Therapy Code Update" .
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Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
