Serious Reportable Events, CR 19740
February 26, 2013
Serious Reportable Events, CR 19740 In accordance with the Affordable Care Act (ACA) to improve patient safety, providers are required to report to payers when serious reportable events (also known as never or serious adverse events) have occurred. These serious reportable events are conditions that the provider should have reasonably been able to prevent while the patient was in their care (examples: erroneous surgical events, product or device events, patient protection events, care management events, environmental events, and criminal events). Claims submitted for these events will not be paid.
For inpatient (IP) institutional claims, submit claims with 0110 type of bill when one of the following diagnoses is present on the claim:
• E876.5 – Performance of wrong operation (procedure) on correct patient • E876.6 – Performance of operation (procedure) on patient not scheduled for surgery • E876.7 – Performance of correct operation (procedure) on wrong side/body part
Diagnosis code must be reported in diagnosis position 2-9.
All other non-IP institutional and Professional claims require the above diagnosis codes in addition to modifiers on each claim line that pertains to serious reportable events.
Below are the required modifiers:
• PA - Surgical or otherwise invasive procedure on the wrong body part • PB - Surgical or otherwise invasive procedure on the wrong patient • PC - Wrong surgery on patient
If there are services during an inpatient or outpatient stay that would be covered, they must be reported on a separate claim. You can identify these claims on your Remittance Advice (RA) by this reason code:
• Claims Adjustment Reason Code (CARC) CO 50- “These are non-covered services because this is not deemed a 'medical necessity' by the payer.”