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HCPCS Procedure Code is invalid in Professional Service

Updated: 09/26/2023|Views: 25837

Rejection Message

HCPCS Procedure Code is invalid in Professional Service

Rejection Details

This rejection indicates one of the procedure (CPT/HCPCS) codes billed on the claim is not valid for the date(s) of service.

Resolution

Refer to an up-to-date CPT/HCPCS codebook (or online coding resource) to verify all codes submitted on the claim are valid for the date(s) of service being billed.  
Note: Customer Care cannot assist with coding recommendations. Contact your biller/coder with any CPT or ICD code related questions.
icon_tip.png Tip: To help prevent code related rejections, use the claim scrubbing feature for all encounters. remove/void the service line with the invalid code as necessary.

  • If an invalid procedure code was identified, follow the steps below to update the invalid code or remove/void the service line with the invalid code.
  • If all procedure codes are valid for the date(s) of service being billed, contact Customer Care.
  • To update the invalid procedure code:
    1. Click Encounters > Track Claim Status. The Find Claim window opens.
    2. Look for and double click the appropriate claim to open. The Edit Claim window opens.
    3. Double click the Encounter ID number. The Edit Encounter window opens.
    4. Enter a valid procedure code in the Procedure field.
    5. Click Save & Rebill. Then, resubmit all affected claims when ready.

EditEncounter_Procedures_ProcedureCode.png

  • To remove/void the service line with the invalid procedure code:
    1. Click Encounters > Track Claim Status. The Find Claim window opens.
    2. Look for and double click the appropriate claim to open. The Edit Claim window opens.
    3. Click Action > Void. Additional options expand.
    4. Enter any Notes if necessary then click Apply. The service line is voided.
    5. Close the Edit Claim window then rebill and resubmit all affected claims when ready.

EditClaim_Action_Void.png

 

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