We need some clarification on the 2430 loop SVD03-2 segment in a COB electronic 5010 file. What should populate in the SVD03-2 segment in the 2430 loop when the ERA file from the primary payer contains info in both the SVC01-2 and SVC06-2? Should the SVD03-2 contain the details from the SVC06-2 which is defined in the guide for 835 transactions as the Composite Medical Procedure and is only to be populated when the adjudicated procedure code provided in the SVC01is different from the submitted procedure code from the original claim. The SVC01-2 is defined as the adjudicated procedure code.
In this example we are seeing some payers report an NDC code in the SVC06-2 of the 835 file.
Reference: 005010X222 (837P)
The SVD03 composite element is the procedure code used to adjudicate this service line. The SVD03 note states “This element contains the procedure code that was used to pay this service line.” This code would be located in the 835 remittance advice (SVC01) from the previous payer. The note on SVC01 states “This is the adjudicated medical procedure information.” SVD03-2 should contain the code from the SVC01-2 from the 835. The 837 guides do not reference the NDC codes in the SVD segment. SVC06 in the 835 identifies the submitted procedure code, doesn’t relate to the SVD03 composite, and would represent the value in SV101 in the 837P.