Claim edit: Mismatched DME procedure code on a service line
Stedi now rejects 837P professional claims with a service line where the durable medical equipment (DME) procedure code doesn't match the line's procedure code.
How the edit works
DME is equipment a patient uses at home over time, such as a wheelchair or an oxygen concentrator.
A service line can report a procedure code in two places:
SV1-01-02(Procedure Code) of Loop2400(Service Line Number) – the code for the billed serviceSV5-01-02(Procedure Code) of Loop2400(Service Line Number) – the code for the DME
X12 standards require the two codes to match. If they differ, the payer may reject the claim.
The JSON Professional Claims endpoint doesn't accept a separate DME procedure code. The edit applies only to claims you submit as raw X12 or through SFTP.
This edit catches the issue before the claim reaches the payer. It prevents payer rejections, which take longer to resolve and delay payment for the provider.
Rejection errors
How you get the error depends on how you submit the claim.
If you submit a claim using the Professional Claims Raw X12 endpoint and the claim fails the edit, you'll get back an error response in real time. The response includes details in the errors array:
{
"errors": [
{
"code": "33",
"description": "Invalid Durable Medical Equipment procedure code. The DME procedure code must match the service procedure code on the same line. Line 1 reports DME code 99901 against procedure code 80369. Correct and resubmit.",
"followupAction": "Please Correct and Resubmit"
}
]
}Professional claims submitted through the Create Professional Claim (CMS-1500) JSON endpoint can't fail this edit. The endpoint doesn't accept a DME procedure code.
If you submit a claim using SFTP and the claim fails the edit, Stedi will reject the claim with a 277CA claim acknowledgment. The acknowledgment will include a related claim status category code, claim status code, and error message:
STC*A7>454**U*******A8>490**Invalid Durable Medical Equipment procedure code. The DME procedure code must match the service procedure code on the same line. Line 1 reports DME code 99901 against procedure code 80369. Correct and resubmit.~