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Last Modified: 12/30/2011
Location: FL, PR, USVI
Business: Part A
38105
Whether any revenue (REV) code lines are equal or not, outpatient types of bills (13x, 14x, 83x, or 85x) cannot have overlapping dates when the provider numbers are equal unless:
1. One of the claims is for a PAP smear only
2. One of the claims is for mammography screening only
3. The outpatient claim has a span code (OSC) '74' and the ambulatory surgery center (ASC) claim has a date of service within the span code '74' dates
Resources/tips to avoid or correct this reject code
Claims reject for this reason when a separate outpatient claim is submitted and there are already outpatient services paid with none of the services described above being reported. Repetitive services are excluded.
• Click here 
to view the Medicare Learning Network (MLN) MattersŪ article MM3633, addressing Hospital Billing for Repetitive Services.
to view the Medicare Learning Network (MLN) MattersŪ article MM3633, addressing Hospital Billing for Repetitive Services.Review the claim and check against other claims submitted to make sure claims are coded correctly.
• If necessary, add the occurrence span code (OSC) '74' on the appropriate claim, make the correction and resubmit.
• If OSC '74' doesn't apply, adjust the previous claim to add the additional codes.
• Note: Critical access hospitals (CAHs) -- TOB 85x -- are not paid under the outpatient prospective payment system (OPPS). Claims for CAH services should be billed together on one claim.
Definitions
• TOB 13x -- claim for hospital outpatient services
• TOB 14x -- claim for hospital laboratory services provided to non-patients
• TOB 83x -- ambulatory surgery center (ASC) claim
• TOB 85x -- Critical Access Hospital (CAH) claim
• Occurrence span code (OSC) 74 -- Non-covered level off care/leave of absence dates
Please use your browser's back button to return to the referring page.Source: FCSO Education Action Team
