Reason Code C7113 - JE Part A

Reason Code Narrative

AN INPATIENT CLAIM WITH THE ADMISSION DATE LESS THAN FOUR DAYS FROM THE OUTPATIENT HISTORY THRU DATE, OR IF PRESENT, THE OCCURRENCE SPAN CODE '72' DATE, AND THE OUTPATIENT CLAIM IS FOR THE DIAGNOSTIC SERVICES ONLY.

Common Reason Code Errors

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

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

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