PROCEDURE CODE DESCRIPTION IS MISSING OR INVALID

[mbpros]

For a drug code I am having claims reject saying PROCEDURE CODE DESCRIPTION IS MISSING OR INVALID.

I know in the past when I had to list a description for an unlisted CPT code I could change the Code Type to Product Charge and the Description would then go on the claim. I do have for this Drug Code the Code Type set as Product Charge, but the description is not going on the EDI Claim.

Help!

Thanks,
Steve

[Gavin Walker]

Hi Steve, first you need to go to Revenue Management and edit the Receiver record and make sure the Use Drug Loop option is checked.

Then in Transaction Entry click the Details button and enter the NDC Code, Unit Price, Unit Count, Unit of Measure and the Reference if necessary. The information in Transaction entry defaults from the Procedure Code record.

[mbpros]

Hey, Gavin:

Do I make the code a Procedure Code or Product Charge? I know the IGuide used to send the description when the Code Type was Product Charge...and apparently the description must go along on the claim.

Steve

[mbpros]

Hey, Gavin:

Regarding the above..I tried both Procedure Charge and Product Charge but the description did not appear for either. See below for the service part of the EDI Claim. You can see the NDC Code listed, the units, the units of measurement, but there is no description:

SV1*HC:J3490*318.36*UN*84***1:2
DTP*472*D8*20200422
REF*6R*5099
PS1*1558544841*0
LIN**N4*50458002803
CTP****84*ME
LX*1
SV1*HC:J3490*318.36*UN*84***1:2
DTP*472*D8*20200429
REF*6R*5100
PS1*1558544841*0
LIN**N4*50458002803
CTP****84*ME
LX*1
SV1*HC:J3490*318.36*UN*84***1:2
DTP*472*D8*20200506
REF*6R*5101
PS1*1558544841*0
LIN**N4*50458002803
CTP****84*ME
SE*9999*0001
GE*9999*1
IEA*9999*000000001

[Gavin Walker]

Steve, if the above doesn't work then you need to enter a transaction note on that procedure as follows:

1. Select EDI: Unclassified Description in the Other Note Field

2. Enter the procedure description.

That should take care of it.

[mbpros]

Not sure the above instructions are correct. First, you are referring to claim level for EDI Note and not line level, right? Or should I do Line Note rather than claim level? And then I select ADD for Additional Information and just enter the description under Text. But I'm thinking I should do Line Level and not Claim Level, right? And so I'd have to do this every time?

Okay if true, but check into this with eMDs...For drug codes there must be a way (and same for other codes that require a description) whereby the description would go on the claims? Again, I'm not sure if they changed the IGuide but the description used to go on claims if I chose Product Charge.

Steve

[Gavin Walker]

Line Level. In Transaction Entry there is the Details Button and Note Button you can click when you select the Procedure.

[mbpros]

Thanks..I have used that before...and I did submit one claim as a test this morning with line level notes. If any issues, I'll let you know. Thanks again.

[mbpros]

Ok...that line level description did not work. Claim still rejected: 2400~SV1~01:7 PROCEDURE CODE DESCRIPTION IS MISSING OR INVALID;
Element Number:352; Segment Position:26;.

I do have the description on each line level, but they obviously want the description in another field. Again, it used to be that if I had the Code Type as Product Charge (not Procedure Charge) the description would go on the claim (this was for unlisted codes, not for NDC).

Please check into this with eMDs and advise what has to be done to fix this.

Thanks,
Steve

[mbpros]

Regarding the above, I found out that I was correct. Claims were rejecting by Change Healthcare with the ADD for Additional Info for Line Item. Instead it needed NOC (for Not Otherwise Classified) with the Procedure Code Description. In Change Healthcare's Portal I could change the ADD to NOC and that allowed the claims to go through.

But in Medisoft, I believe the NOC comes into play when the Code type is Product Charge. BUT when you have NDC info no description is going on the EDI Claim, even though I have it as Product Charge. So again can you check with eMDs about this?

Thanks,
Steve

[mbpros]

OK...IGNORE ALL ABOVE. I figured it out in the Help Menu of Medisoft:

How to Populate the 2400 SV 101-7 Elements for NOC Procedure Codes
NOC (Not Otherwise Classified) procedure codes need to have the 2400 SV101-7 element populated to get the claims accepted at many carriers. Below are instructions of how to populate that element for Medisoft.

In transaction entry, if the end-user does not have NDC drug information on the service line or on the procedure code, Revenue Management will always pull the description directly off the procedure code itself and write it to 2400 SV101-7. This handles all payers and clearinghouses who want to see the procedure description for all non-drug related procedure codes.

In transaction entry, if the end-user does have NDC drug information on the service line or on the procedure code, Revenue Management will never pull any description for the procedure code and will leave 2400 SV101-7 empty. This handles all payers and clearinghouses who do not want to see the procedure description for all drug related procedure codes.

In transaction entry, if you do have NDC drug information on the service line or on the procedure code, but are getting the “PSV10100:SL PROC DESCRIPTION REQUIRED” rejection because Revenue Management is not pulling any description for the procedure code, highlight the service line, click the Note button,” select EDI: Unclassified procedure description from the drop-down list, and enter a custom description for the procedure/service. Revenue Management will always pull a custom description from the Note button regardless of whether you have NDC drug information present or not. This handles all payers and clearinghouses who want to see the procedure description for all “unclassified” or “other” procedure codes, even if drug information might be present.