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).

Claim without Provider Liable or Free Days

Common Reason Code Errors

• Covered units on revenue code 01X-21X do not match number of covered days in value code 80, or electronic equivalent
• Number of units reflected in revenuecode 01X-21X does not match number of days on claim

Common Reason Code Corrections

• Verify that number of covered units with revenue code 01X-21X are equal to covered days in value code 80, or electronic equivalent
• Covered days should equal total days billed on claim

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

Fully Covered Claim with Covered Non-Utilization Days (free days)

Common Reason Code Errors

• Free days reflected in 70 Occurrence Span Code (OSC) do not match number of non-covered days in value code 81, or electronic equivalent
• Covered units on revenue code 01X-21X do not match number of total days in value codes 80 and 81, or electronic equivalents

Common Reason Code Corrections

• Free days are reflected as non-covered days in value code 81 or electronic equivalent but units and charges associated with them should be listed as covered on revenue code 01X-21X

Claim with Provider Liable Days Using 77 OSC

Common Reason Code Errors

• Partial provider liable days in 77 OSC are billed with value code 81 or electronic equivalent

• Number of days reflected in 77 OSC is shown as covered units on revenue code 01X-21X

Common Reason Code Corrections

• Days for provider liability should be billed as covered using value code 80 or electronic equivalent
• Verify number of days reflected with 77 OSC equals provider liable units/charges in revenue code 01X-21X

Resources

• Inpatient Hospital Billing Guide
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 3

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