We have an issue where our X12 claim validator will not pass the HIPPS Home Health code 2AGLS.
The code is being sent in the service line SV202 - 2 of the 837I - 005010X223 - Institutional Claim. The qualifier in the SV202 - 1 is HP - Health Insurance Prospective Payment System (HIPPS) Skilled Nursing Facility Rate Code. In the 837I TR3 the note at the bottom of the HIPPS codes is as follows; CODE SOURCE 716: Health Insurance Prospective Payment System (HIPPS) Rate Code for Skilled Nursing Facilities.
I was advised that code source 716 is only for the Skilled Nursing Facilities HIPPS codes. My questions are;
1. Is there a separate code list for the Home Health HIPPS codes?
2. What is the qualifier for the Home Health HIPPS codes if it is not HP and why isn't it listed in the 837I TR3?
Yes, separate code lists exists for case mix classification groups, but there is only one qualifier used for HIPPS codes. The abstract in Appendix A for Code Source 716 further defines the case mix classification groups and includes the use for home health claims as well as claims for inpatient rehabilitation facilities.
ASC X12 TG2 WG2 will modify the name for Code Source 716 in a future version of the code source dictionary to clarify its use.