Section title: Requests for Interpretation
RFI #
2338
SV107 and Dates of Service
Description

1. Is it required to verify that all DX codes used in the 2300 Loop HI - HEALTH CARE DIAGNOSIS CODE composites, are valid against the 2400 Loop DTP - DATE - SERVICE DATE?
Or
2. Is it only required to verify that the DX codes in the 2300 Loop HI - HEALTH CARE DIAGNOSIS CODE composites that are "pointed to" in the SV107 are valid against the 2400 Loop DTP - DATE - SERVICE DATE?
I believe the correct answer is 2 and only codes referenced in the SV107 composite need to be checked for validation against the service date. However, I am looking for written verification.

Response

The receiver of an 837 professional claim transaction (typically a payer) is required to accept transactions with 1 to 12 diagnosis code pointers in a service line that have been reported by the sender. How the receiver validates the diagnosis codes against date of service and the pointers is up to the receiver and not within the scope of X12.

DOCUMENT ID
005010X222