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Last Modified: 4/21/2011
Location: FL, PR, USVI
Business: Part A
38041
This outpatient claim (13x, 14x, 71x, 23x, 83x, or 85x) contains dates of service that equal or overlap a previously processed inpatient claim (11x only).
Resources/tips to avoid or correct this reject code
Services provided during a Part A hospital stay must be provided directly or under arrangement and billed by the admitting hospital. The only exceptions to this provision are services that are not covered under Part A benefits. These services should be billed as inpatient Part B services (type of bill 12x or 22x).
When an outpatient claim overlaps an inpatient claim, one of the following must occur to allow payment for both claims:
• The inpatient claim must be adjusted to add the outpatient charges to the inpatient claim
• The inpatient claim must be adjusted to add occurrence span code 74 with span thru dates that match the date(s) of the outpatient claim
• Occurrence span code 74 and span thru dates that equal the hospital claim admission through discharge dates is indicated on the outpatient claim
You can submit a separate claim for non-related non-diagnostic services.
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Source: FCSO Education Action Team
