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 10X-21X do not match the number of covered days in value code 80, or the electronic equivalent.
• Number of units reflected in revenue code 10X-21X does not match the number of days on the claim.

Common Reason Code Corrections

• Verify that the number of covered units with revenue code 10X-21X are equal to the covered days in value code 80, or the electronic equivalent.
• Covered days should equal the total days billed on the claim.

Note: If the patient status is equal to 30, the through date of the claim must be included in the 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 the number of non-covered days in value code 81, or the electronic equivalent.
• Covered units on revenue code 10X-21X do not match the number of total days in value codes 80 and 81, or the electronic equivalents.

Common Reason Code Corrections

• Free days are reflected as non-covered days in value code 81 or the electronic equivalent, but the units and charges associated with them should be listed as covered on revenue code 10X-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 the electronic equivalent.
• The number of days reflected in the 77 OSC is shown as covered units on revenue code 10X-21X.

Common Reason Code Corrections

• Days for provider liability should be billed as covered using value code 80 or the electronic equivalent.
• Verify the number of days reflected with the 77 OSC equals the provider liable units/charges in revenue code 10X-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.