The 005010X223 837I states that "0" is an acceptable billed amount. However, does this mean that the payer must accept the zero billed amount?
When billing two or more surgical procedures on the same claim, the payer is asking the provider to bill an itemized charge for each procedure or line item on the claim. The provider is that since "0" is an acceptable value per 005010X223 837I Loop 2400 Segment SV203, the payer is out of compliance for not accepting the zero charge. The payer has a published guide for billing multiple surgeries on the same day:
If the claim includes two by including the itemized charge for each procedure (line item on the claim) and repeating the revenue codes with respective CPT codes as appropriate with one unit each. Enter Itemized charges for each line.
Do not bill zero dollars ($0.00), one cent (.01), or one dollar ($1.00) on the additional line, and do not bill greater than one unit on each line.
When the provider bills the claim with the above scenario, the claim is rejected back to the provider asking for the itemized charges.
The rejection is a compliant transaction with the X12 TR3. The receiver appears to be enforcing specific business rules that require an appropriate amount to be included or each line item. Although the X12 standard technically allows for a zero amount, trading partners are allowed to reject X12 transactions for business rules as long as those rules are consistent with the TR3.
Several payers do not permit zero bills, even though the standard accommodates them. However, some payers require certain procedures, such as no-cost drugs, to be billed with a zero amount. This demonstrates the variability in payer requirements regarding zero billing.