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Condition Code G0 Reminder
National Government Services has noticed an increase in the number of claims reporting CC G0 (zero) inappropriately. Please review the following information so that your claims are not rejected or denied due to inappropriate use of CC G0.
CMS instructs hospitals subject to the OPPS to report CC G0 on FLs 24-30 (or the corresponding electronic equivalent location) when multiple medical visits occurred on the same day in the same revenue center but the visits were distinct and constituted independent visits.
Proper Use of Condition Code G0
As a reminder, multiple medical visits on the same day in the same revenue center may be submitted on separate claims when the visits are separate and distinct. Hospitals should report CC G0 on the second claim. If you do not report condition code G0 then your claim will either be returned to you for correction or rejected. Appropriate reporting of CC G0 allows for accurate payment under OPPS in this situation. Note that the OCE contains an edit that will reject multiple medical visits on the same day with the same revenue code without the presence of CC G0.
Example of the appropriate use of CC G0:
A beneficiary was seen in the same emergency room twice on the same day. In the morning, the beneficiary was treated for a broken arm. Later that same day, the beneficiary returned for treatment of chest pain. The two visits occurred on the same day and in the same revenue center; however, the visits were distinct and constituted independent visits. Therefore, it is appropriate to report CC G0 on the claim line representing the second visit.
Provider Action
Update any policies and procedures with this information and share with applicable staff.
Related Content
- CMS IOM Publication 100-04, Medicare Claims Processing Manual, Chapter 4
- Section 170 - Hospital and CMHC Reporting Requirements for Services Performed on the Same Day
- Section 180.4 - Proper Reporting of Condition Code G0 (zero)