EOB Codes and Descriptions - Kymmis.com

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KYEOB828829MEDICAID DESCRIPTIONKENTUCKY EOB/ESC CROSSWALK TO HIPAAMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESCLAIM/DETAIL DENIED. THIS REVENUE CODEIS NOT PAYABLE FOR THIS PROVIDERSPECIALTY CODE. 828 B7CLAIM/DETAIL DENIED. PROVIDER NOTELIGIBLE TO RECEIVE PAYMENT FORSERVICES PROVIDED TO KCHIP PHASE IIIRECIPIENTS. 829 B7HIPAA ADJ RSN CODEDESCRIPTIONThis provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.This provider was notcertified/eligible to be paid for thisprocedure/ service on this date ofservice.Provider contracted/ negotiatedrate expired or not on file.830 NO DRG FOUND 830 147CLAIM DENIED. DRG CANNOT USE831 DIAGNOSIS CODE. 831 A8 Claim denied; ungroupable DRG MA6396 Non-covered charge(s).832 CLAIM DENIED. DRG CRITERIA NOT MET. 832 A8 Claim denied; ungroupable DRG96 Non-covered charge(s).833 CLAIM DENIED. DRG INVALID AGE. 833 A8 Claim denied; ungroupable DRGThe diagnosis is inconsistent with9 the patient's age.96 Non-covered charge(s).834 DRG INVALID SEX. 834 A8 Claim denied; ungroupable DRG10The diagnosis is inconsistent withthe patient's gender.96 Non-covered charge(s).835 DRG INVALID DISCHARGE STATUS. 835 A8 Claim denied; ungroupable DRG N5096 Non-covered charge(s).836 DRG INVALID PRINCIPLE DIAGNOSIS. 836 A8 Claim denied; ungroupable DRG MA6396 Non-covered charge(s).CLAIM DENIED. DRG DENY 469 THROUGH837 470 837 A8 Claim denied; ungroupable DRG96 Non-covered charge(s).838 RESERVED FOR DRG 96 Non-covered charge(s).839 RESERVED FOR DRG 96 Non-covered charge(s).HIPAA HIPAA REMARK CODEREMARKDESCRIPTIONService denied because paymentalready made for similar procedureM86 within set time frame.M50Missing/incomplete/invalid revenuecode(s).Missing/incomplete/invalid principaldiagnosis.Missing/incomplete/invalid dischargeinformation.Missing/incomplete/invalid principaldiagnosis.840 PROCEDURE CODE HAS BEEN REBUNDLED. 840 97842Payment is included in theallowance for anotherservice/procedure.N19PROCEDURE CODE IS MUTUALLYEXCLUSIVE. 842 96 Non-covered charge(s). MA66843 PROCEDURE CODE IS INCIDENTAL. 843 96 Non-covered charge(s). N19M15Separately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Procedure code incidental to primaryprocedure.Missing/incomplete/invalid principalprocedure code or date.Procedure code incidental to primaryprocedure.844PROCEDURE CODE IS NOT INDICATED FORSEPARATE REIMBURSEMENT. 844 97Payment is included in theallowance for anotherservice/procedure.M15N19Separately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Procedure code incidental to primaryprocedure.845 VISIT IS WITHIN ONE DAY PRE OP RANGE. 845 97846PROCEDURE CODE INCLUDES UNILATERALAND BILATERAL PERFORMANCE 846 97Payment is included in theallowance for anotherservice/procedure.Payment is included in theallowance for anotherservice/procedure.M15M144Separately billed services/tests havebeen bundled as they are consideredcomponents of the same procedure.Separate payment is not allowed.Pre-/post-operative care payment isincluded in the allowance for surgery/ procedure.847 PROCEDURE IS A BILATERAL OR DUPLICATE 847 18 Duplicate claim/service.848PLEASE PAY SPECIFIED PROCEDURECODES. 848849PROCEDURE DOES NOT REQUIRE ANASSISTANT SURGEON. 849 54Multiple physicians/ assistants arenot covered in this case.850851PROCEDURE CODE IS INVALID FORPATIENTS AGE. 850, 852 6PROCEDURE CODE IS INVALID FORPATIENTS SEX. 852 7The procedure/revenue code isinconsistent with the patient's age.The procedure/revenue code isinconsistent with the patient'sgender.MA66MA66Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.Page 40 of 46 Date: 3/30/2005
KENTUCKY EOB/ESC CROSSWALK TO HIPAAKYEOBMEDICAID DESCRIPTIONMMIS EXCEPTIONCODE(S)HIPAAADJ RSNCODESHIPAA ADJ RSN CODEDESCRIPTIONHIPAAREMARKHIPAA REMARK CODEDESCRIPTION852853GMIS - INAPPROPRIATE PROCEDURE CODEFOR RECIPIENT'S AGE. 850, 852 6The procedure/revenue code isinconsistent with the patient's age.PEDIATRIC PROCEDURE AGE SHOULD BE 1TO 17 YEARS 850, 852 96 Non-covered charge(s).MA66Missing/incomplete/invalid principalprocedure code or date.6The procedure/revenue code isinconsistent with the patient's age.854MATERNITY PROCEDURE AGE SHOULD BE12 - 55 YEARS. 850 6856 PROCEDURE NOT INDICATED FOR A MALE 856 7857PROCEDURE NOT INDICATED FOR AFEMALE 856 7The procedure/revenue code isinconsistent with the patient's age.The procedure/revenue code isinconsistent with the patient'sgender.The procedure/revenue code isinconsistent with the patient'sgender.MA66MA66Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.858 CLAIM DENIED. COSMETIC PROCEDURE. 858 50These are non-covered servicesbecause this is not deemed a`medical necessity' by the payer.859 CLAIM DENIED. DUPLICATE PROCEDURE. 846 18 Duplicate claim/service.860CLAIM DENIED. EXPERIMENTALPROCEDURE. 860 96 Non-covered charge(s).861 CLAIM DENIED. OBSOLETE PROCEDURE. 861 96 Non-covered charge(s). MA66PROCEDURE CODES DOES NOT REQUIREMultiple physicians/ assistants are863 AN Assistant SURGEON 863 54 not covered in this case.The procedure code/bill type isPROCEDURE CODE IS INVALID FORinconsistent with the place of864 LOCATION. 864 5 service.MA66PROCEDURE CODE NEEDS TO BE865 REPLACED. 865 A1 Claim denied charges. N19866867MA66PROCEDURE NEEDS TO BE REPLACED FORSURFACES BILLED. 866 A1 Claim denied charges. N19MA66PROCEDURE CODE NEEDS TO BEREPLACED FOR SURFACES BILLED. 867 A1 Claim denied charges. N19MA66Missing/incomplete/invalid principalprocedure code or date.Missing/incomplete/invalid principalprocedure code or date.Procedure code incidental to primaryprocedure.Missing/incomplete/invalid principalprocedure code or date.Procedure code incidental to primaryprocedure.Missing/incomplete/invalid principalprocedure code or date.Procedure code incidental to primaryprocedure.Missing/incomplete/invalid principalprocedure code or date.879CLAIM DENIED. PROCEDURE REQUIRESDOCUMENTATION 879 16Claim/service lacks informationwhich is needed for adjudication.Additional information is suppliedusing remittance advice remarkscodes whenever appropriate.N29Missingdocumentation/orders/notes/summary/report/invoice.880CLAIM DENIED. PROCEDURE CODE IS FORPATIENTS UP TO AGE 14 880 6The procedure/revenue code isinconsistent with the patient's age.881882883884885CLAIM DENIED. PROCEDURE CODE IS FORPATIENTS OVER AGE 14. 880 6The procedure/revenue code isinconsistent with the patient's age.CLAIM DENIED. COSMETIC PROCEDURENOT PAYABLE BY MEDICAID 882 96 Non-covered charge(s).50These are non-covered servicesbecause this is not deemed a`medical necessity' by the payer.CLAIM DENIED. DUPLICATE PROCEDUREHAS BEEN PAID. 883 18 Duplicate claim/service. M86CLAIM DENIED PROCEDURE IS CONSIDEREDEXPERIMENTAL 884 96 Non-covered charge(s).55Claim/service denied becauseprocedure /treatment is deemedexperimental/ investigational bythe payer.CLAIM DENIED. PROCEDURE ISCONSIDERED OBSOLETE. 885 N65M63N2096 Non-covered charge(s). M67Service denied because paymentalready made for similar procedurewithin set time frame.We do not pay for more than one ofthese on the same day.Service not payable with otherservice rendered on the same date.Procedure code or procedure ratecount cannot be determined, or wasnot on file, for the date of service/provider.Missing/incomplete/invalid otherprocedure code(s) and/or date(s).Page 41 of 46 Date: 3/30/2005
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EOB Codes and Descriptions - Kymmis.com

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