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AD5 - Service code only allowed once per patient per day

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Background:

The service code submitted is only allowed once per patient per day and it has been billed by another physician. Physicians are suggested to communicate with each other whenever they provide similar services to the same patient on the same date.

Solution:

  • Delete the service code and resubmit
  • Resubmit with an alternative code.
  • If the other physician has billed by mistake, he/she needs to submit an RA inquiry to reverse the payment for the service claimed before you can resubmit the code.

As an example, you have billed code C122 (2nd day subsequent visit) and received rejection AD5. This service code is only allowed once per admission period, and likely another physician has billed this code already. Change the code to the Subsequent visit 1st five weeks (C132 for internal medicine), and resubmit.

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