OPEN: Reason Code 37549


Reason Code 37549

Current Status

Date

 

Initial

June 15, 2021

Status:
CMS instructs MACs to bypass any existing reason code(s) that assign on provider submitted adjustment claims for a DRG weight increase, when the DRG code on the adjustment claim is the same as the DRG code on the original claim.  Palmetto GBA has set the processing system to suspend claims with reason code 37549 so they can manually be bypassed.  The automated edit updates for reason code 37549, effective October 1, 2021 will be implemented on October 4, 2021.

Provider Action:
Any provider submitted adjustment claims for a DRG weight increase, when the DRG code on the adjustment claim is the same as the DRG code on the original claim, that have been returned to the provider (RTP) in stat/location T B9997 with reason code 37549; may be returned to the processing system (F9) for manual bypass.

Identified

May 11, 2021

Issue 

Change Request 12216, Updates to Reason Code Bypass for Editing on Provider Submitted Adjustment Claims Resulting in a Diagnosis Related Group (DRG) Weight Increase, issued May 11, 2021, is to update the reason code 37549 and bypass for editing on provider submitted adjustment claims resulting in a DRG weight increase, but the DRG code on the claim is not changed as a result of the adjustment.


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Last Updated: 06/17/2021