Reason Code C7114 - JE Part A

Reason Code Narrative

AN OUTPATIENT CLAIM THAT CONTAINS THERAPEUTIC SERVICES AGAINST A POSTED INPATIENT HISTORY CLAIM WITH THE THRU DATE GREATER THAN THE INPATIENT ADMISSION DATE, MINUS FOUR DAYS, OR IS EQUAL TO THE ADMISSION DATE.

Common Reason Code Errors

• The admission date of an inpatient claim falls within 72 hours of the outpatient claim containing diagnostic services.

Common Reason Code Corrections

• Roll all diagnostic services into the inpatient claim.
• Non-diagnostic services, other than ambulance and maintenance renal dialysis services, provided within 72 hours of an inpatient admission must be reviewed by the facility. If services are not related include condition code 51 in "Condition Code" field.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 40.3

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