Occurrence Codes

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Code Description
1 Accident/Medical Coverage - Code indicating accident-related injury for which there is medical payment coverage. Provide the date of accident/injury
2 No-Fault Insurance Involved-including auto accident/other - Date of an accident, including auto or other, where the State has applicable no-fault or liability laws (i.e., legal basis for settlement without admission or proof of guilt).
3 Accident/TORT liability - Date of an accident resulting from a third party's action that may involve a civil court action in an attempt to require payment by the third party, other than no-fault liability.
4 Accident/employment related
5 Accident/No medical or liability coverage - Code indicating accident related injury for which there is no medical payment or third-party liability coverage. Provide date of accident or injury.
6 Crime Victim
8 Reserved for National Assignment
9 Start of infertility treatment Cycle
10 Last menstrual period
11 Onset of Symptoms/Illness - (outpatient claims only). If beneficiary receiving a combination of PT/OT/SLP only one 11 occurrence code is required
12 Date of Onset for a Chronically Dependent Individual (CDI)
13-15 Reserved for National Assignment
16 Date of last therapy - Code indicates the last day of therapy services (e.g., physical, occupational or speech therapy).
17 Date occupational therapy plan established or last reviewed
18 Date of patient/beneficiary retirement
19 Date of retirement of spouse
20 Guarantee of Payment Began-(Part A hospital claims only)-date hospital begins claiming payment.
21 UR Notice Received (Part A SNF Claims Only) - date of receipt by the SNF and hospital of URC finding an admission or further stay was not medically necessary.
22 Date Active Care Ended - date a covered level of care ended in SNF or general hospital or date active care ended in psych or tuberculosis hospital or date patient was released on trial basis from residential facility. *Code not required if code "21" is used.
23 Date of Cancellation of Hospice Election Period. For FI Use Only. Providers Do Not Report. *Not required if code 21 is used.
24 Date insurance denied
25 Date coverage benefits are terminated by primary payer.
26 Date SNF bed available to the Inpatient who requires only SNF level care
27 Date of Hospice Certification or re-certification
28 Date CORF Plan established or last reviewed
29 Date outpatient physical therapy plan established or last reviewed
30 Date outpatient speech language pathology plan established or last reviewed
31 Date beneficiary notified of intent to bill (accommodations) - beneficiary does not (or no longer) require covered level of inpatient care.
32 Date beneficiary notified of intent to bill (diagnostic procedures or treatment) is not reasonable or necessary under Medicare
33 First day of the Medicare Coordination Period for ESRD Beneficiaries covered by an EGHP. Required only for ESRD beneficiaries.
34 Date of the election of extended care services (used by Religious Nonmedical Health Care Institutions ONLY)
35 Date physical therapy treatment started
36 Date of Inpatient hospital discharge for a covered transplant procedure(s). NOTE: When patient received a covered and non-covered transplant, the covered transplant predominates.
37 Date of Inpatient hospital discharge - patient received a non-covered transplant
38 Date treatment started for Home IV Therapy
39 Date discharged on a continuous course of IV therapy
40 Scheduled date of Admission (this code may only be used on an outpatient claim)
41 Date of First Test for Pre-admission Testing (this code may be used only if date of admission was scheduled prior to administration of test(s))
42 Hospice discharge due to patient revocation
43 Scheduled date of Cancelled Surgery
44 Date treatment started for occupational therapy
45 Date treatment started for speech-language pathology
46 Date treatment started for cardiac rehabilitation
47 Date cost outlier status begins, beneficiary must have regular coinsurance and/or lifetime reserve days available beginning on this date to allow coverage of additional daily charges to receive cost outlier payments
48-49 Payer Codes - for use by third party payers only. The CMS assigns for FI use. Providers do not report these codes.
50 Assessment Date for IRF, SNF and SB PPS Note: Not required for SNF HIPPS code AAAxx
51 Date of last Kt/V reading
55 Date of Death
A1 Birth Date Insured A - birth date of insured in whose name the insurance is carried.
A2 Effective Date-Insured A Policy - first date insurance is in force.
A3 Benefits Exhausted - last date benefits are available and no payment can be made by Payer A.
A4 Split Bill Date (date patient became Medicaid eligible due to medically needy spend down)
A5-AZ Reserved for National Assignment
B1 Birth Date - Insured B
B2 Effective Date-Insured B Policy
B3 Benefits Exhausted
B4-BZ Reserved for National Assignment
C1 Birth Date-Insured C
C2 Effective Date-Insured C Policy
C3 Benefits Exhausted
C4-CZ Reserved for National Assignment
D0-DQ Reserved for National Assignment
DR Reserved for Disaster Related code
DS-DZ Reserved for National Assignment
E0 Reserved for National Assignment
E1 Birthdate-Insured D
E2 Effective Date-Insured D Policy
E3 Benefits Exhausted
E4-EZ Reserved for National Assignment
F0 Reserved for National Assignment
F1 Birthdate-Insured E
F2 Effective Date-Insured E Policy
F3 Benefits Exhausted
F4-FZ Reserved for National Assignment
G0 Reserved for National Assignment
G1 Birthdate-Insured F
G2 Effective Date-Insured F Policy
G3 Benefits Exhausted
G4-GZ Reserved for National Assignment
H0-HZ Reserved for National Assignment
J0-LZ Reserved for State Assignment. Discontinued Effective October 16, 2003.
M0-ZZ See Instructions in Form Locator 36-Occurrence Span Codes and Dates

 

Last Updated Wed, 26 Sep 2018 09:03:54 +0000