Reason Code 15202 - Skilled Nursing Facility - JE Part A

Reason Code Narrative

UNITS OF SERVICE: ON INPATIENT OR SNF CLAIMS WITH COVERED DAYS GREATER THAN ZERO THE ACCOMMODATION DAYS SHOWN WITH REVENUE CODE 10X-21X MUST BE EQUAL TO THE COVERED DAYS IN ITEM 7, AND IN COST REPORT DAYS (PG 1).

Fully Covered Days Without Provider Liable and Leave of Absence

Common Reason Code Errors

• Revenue code 0022 covered units do not match the number of covered units billed on revenue codes 10X-21X.
• Covered units for revenue code 0022 do not match the number of covered days on the claim.

Common Reason Code Corrections

• Verify that the number of covered units on revenue code 0022 are equal to the covered units on revenue codes 10X-21X.
• Verify that the number of covered days reflected in value code 80, or the electronic equivalent, equals to the total covered units in revenue code 0022.
• Covered days should equal the total days billed on the claim.

Note: If the patient status is equal to 30, the through date of the claim must be included in the days billed.

Claim with Leave of Absence Using the 74 Occurrence Span Code (OSC)

Common Reason Code Errors

• 18X revenue code is billed with covered units or charges.
• 74 OSC is billed without a 18X revenue code.
• 18X revenue code is billed without 74 OSC
• The number of days reflected in the 74 OSC do not match the number of days reported in the 18X revenue code.
• Days associated with value code 81, or the electronic equivalent, do not equal the units billed on the 18X revenue code.

Common Reason Code Corrections

• The number of days reflected in the 74 OSC shall match the units on the 18X revenue code.
• No covered units should be reflected on the 18X revenue code.
• No charges should be billed on the 18X revenue code.
• Verify that the days associated with the 81 value code, or the electronic equivalent, equal the number of units on the 18X revenue code.

Claim with Provider Liable Days Using 77 OSC

Common Reason Code Errors

• Partial provider liable claim is billed with the days as non-covered with value code 81 or the electronic equivalent.
• The number of days reflected in the 77 OSC do not match provider liable revenue code 0022 units.

Common Reason Code Corrections

• Days for provider liability should be billed as covered using value code 80 or the electronic equivalent.
• Verify number of days reflected in the 77 OSC match the provider liable revenue code 0022 units.

Resources

• SNF and Swing Bed Billing Chart
• CMS Internet Only Manual (IOM), Publicaiton 100-04, Medicare Claims Processing Manual, Chapter 6
• CMS IOM, Publication 100-02, Medicare Benefit Policy Manual, Chapter 8

View reason code list, return to Reason Code Guidance page.