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Reason Code W7092

Reason Code Narrative

All applicable bill types will be returned to you when a device-dependent procedure is reported without a device code. When reporting procedure codes that require the use of devices, you must also report the applicable HCPCS codes and charges for all devices that are used to perform the procedures (where such codes exist). 

Common Reasons for Claim to Return to Provider (RTP)

The Outpatient Code Editor (OCE) will RTP any claim submitted with:

  • A device-intensive procedure code billed without at least one device code required for the procedure on the same claim with the same date of service
  • A device code billed without the procedure code that is necessary for the device to have therapeutic benefit to the patient on the same claim with the same date of service

Resolution

Verify the following to correct the claim:

  • The procedure and device code(s) reported on the claim are correct
  • The procedure / device code(s) are submitted on the same claim with the same date of service
  • If the procedure was discontinued, a device code is not required, but one of the following modifiers should be reported with the procedure code: 
    • 52 (Reduced services)
    • 73 (Discontinued outpatient procedure prior to anesthesia administration)
    • 74 (Discontinued outpatient procedure after anesthesia administration)
  • If there is no applicable HCPCS code for the device, C1889 (Implantable/insertable device, not otherwise classified) may be reported
  • For certain device-intensive procedures, providers may bypass the device edit requiring at least one device HCPCS code for the procedure
    • For situations where no device was performed with certain device-intensive procedures, providers may bypass the edit by reporting modifier CG
    • For the list of procedures that can be reported with the CG modifier, refer to the edit 92 bypass list in the Integrated Outpatient Code Editor (OCE) Specifications found in the Outpatient Code Editor (OCE) Quarterly Release Files
      • Reference the corresponding bypass column in the DATA_HCPCS table in the quarterly data files

A complete CMS device to procedure and/or procedure to device file is no longer available. 

Only those codes being added or deleted from the edit will be available in the CMS Outpatient Code Editor (OCE) Quarterly Release Files on the CMS website in the OCE Coding section.

Please make corrections and resubmit.