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February 9, 2018

PRV (Patient Reason for Visit) Segment

Beginning October 2017, CMS added the PRV field as a field to be reviewed for ICD-10 codes for NCD edits.  The PRV field was not a field that was reviewed by the system for ICD-10 codes to show medical necessity. Effective January 2018, per CGS Medical Director review and decision, this field will be included for LCD edits

CGS is in the process of adding this new requirement to the system for LCD edits. We recommend that any ICD-10 code in the PRV field should be included in the main ICD-10 field as well. We hope to have this completed by the end of February 2018.

Any date of service prior to January 2018 we will not be including the PRV field in the LCD edits.


MLN Matters MM9672 Update FISS Editing to Include All Three patient Reason for Visit Code FieldsExternal PDF


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