Claim Reporting Codes

Examples of code types the CMS-1450 and 837I require include:

• CPT/HCPCS codes: Identify medical procedures, services, and equipment
• Condition codes: Describe conditions affecting the claim’s processing
• Health Insurance Prospective Payment System (HIPPS) codes: Used for certain prospective payment systems, like skilled nursing facilities
• ICD-10 codes: Represent patient diagnoses
• Modifiers: Provide additional information about services or procedures performed
• Occurrence codes: Detail significant events related to the claim’s billing period
• Occurrence span codes: Specify events with associated time spans
• Revenue codes: Indicate specific departments or services within a facility
• Value codes: Show monetary amounts or other values relevant to the claim

Review the Code Sources Job Aid to look up specific codes for each FL. It offers guidance on where to find codes in CMS-1450 and 837I billing formats.