Reason Code 12206 - JE Part A

Reason Code Narrative

WHEN THE FROM AND THROUGH DATES ARE NOT THE SAME ON INPATIENT OR SNF BILL TYPES 11X, 18X, 21X, 28X, 41X, OR 51X, THE NUMBER OF DAYS REPRESENTED MUST EQUAL THE SUM OF THE COVERED DAYS PLUS THE NON-COVERED DAYS, UNLESS THE PATIENT STATUS IS 30, THEN 1 ADDITIONAL DAY IS USED IN THE CALCULATION. IF THE DATES ARE THE SAME THE BILL MUST SHOW ONLY 1 DAY. THIS REASON CODE WILL BE BYPASSED IF THE TYPE OF BILL IS XX5 AND THE UB82-92 INDICATOR IS A '9' AND THERE ARE NO COVERED DAYS.

Common Reason Code Errors

• The number of days represented by the "from" and "through" dates on the claim have not been counted correctly.

Common Reason Code Corrections

• Verify if the patient status is a discharge status. If so, the through date is not included in the count.
• Verify if the patient status is 30 (still a patient). If so, the through date is added to the count of total days.

Resources

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3, Section 40.2.4
• DDE User Manual [PDF]

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