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Anesthesia Coding Alert

New Policy:

Check ZIP Code to Combat Some Denials

Published on Mon Nov 05, 2007

Those extra four digits can really make a difference

If you suddenly begin receiving denials with remarks such as "Adjustment Reason Code 16" or "Remark Code MA 130," don't despair. Chances are, the correction could be as simple as extending the ZIP code on your claims.


New ZIP Code Policy Is in Effect

Medicare carriers and fiscal intermediaries use the ZIP code on your claim where the physician performed the service to determine which payment locality they follow for Medicare Physician Fee Schedule (MPFS) and anesthesia services.

The problem: Some five-digit ZIP codes fall into more than one payment locality and might even cross county or state lines. That affects reimbursement, so CMS now requires providers in these problem-prone areas to submit claims with a nine-digit ZIP code.

Exception: The change excludes services provided in home (or in other places of service considered the same as home) because CMS does not now require ZIP codes for these services.


Take Action Against These Denial Codes

If you should submit a nine-digit ZIP code but only report five digits, CMS will treat your claim as unprocessable. The denial codes you'll see include:

  • Adjustment Reason Code 16 -- Claim/service lacks information which is needed for adjudication. Additional information is supplied using remittance advice remark codes whenever appropriate.
  • Remark Code MA 130 -- Your claim contains incomplete and/or invalid information, and no appeals rights are afforded because the claim is unprocessable. Please submit a new claim with the complete/correct information.
  • Remark Code MA 114 -- Missing/incomplete information on where the services were furnished.

Play it safe: What if you submit a claim with a nine-digit code when you only need five? The carrier will ignore the extra four digits and pay the claim based on the five digits. If some of your claims need nine digits and others only need five, you might want to file the full nine-digit code for all procedures.

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