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DF - Corresponding procedure invalid, omitted, or is paid at zero

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Background:

Most premiums service codes cannot be billed alone. If the parent service is not entered in the same claim, or is invalid, the premium code is ineligible for payment. As an example, trying to bill special visit premium without a consult/assessment code on the same claim and date. 

Most common errors to be aware are:

  • The premium service code does not have a parent service code on the same claim. As an example: E083 MRP premium must have an inpatient visit service code on the same claim.

The premium service code is not eligible to be billed for the parent service code. Examples: You can not bill special visit premium K994 (evening premium) with procedure Z360 bronchoscopy. Instead, use E409 evening premium with a procedure.

  • You can not bill a travel premium without a first person seen. You must enter both.

Solution:

Check for the following potential issues.

  • Premium code has a parent service code on the same date and same claim
  • Premium code is being billed with an eligible parent code

Once you have found the issue, you will need to add the correct parent code, change the premium code, or you may need to remove the premium code all together.

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