OPEN: HH, Certain Part A Claims: Reason Code W7113, Supplementary or Additional Code Not Allowed as Principal Diagnosis

Published 05/21/2025

OPEN: Home Health and Certain Part A Claims – Reason Code W7113, Supplementary or Additional Code Not Allowed as Principal Diagnosis
Current Status Date  
Open May 21, 2025 Status: A system update will be implemented by June 2, 2025, and will fix this issue.

Provider Action: Providers with the affected TOBs mentioned below may return their RTP claims for processing on or after June 2, 2025. If the claims are resubmitted prior to June 2, they and new claims affected by this issue will suspend until June 2 when the fix is implemented.

Issue Description

With the April 2025 implementation of Change Request (CR) 13992, TOBs 013X, 014X, 023X, 032X, 034X, 071X, 072X, 074X, 075X, 076X, 077X, 085X and 087X have edited incorrectly with reason code W7113. This has caused claims to RTP for reason code W7113, an unacceptable principal diagnosis. The list of unacceptable principal diagnosis additions related to this issue are listed in CR 13992.

Claims with TOBs 012X, 022X, 081X and 082X are correctly editing reason code W7113 and shall continue to RTP, as they contain an unacceptable principal diagnosis code.

 


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