Reason Code 15202 - Skilled Nursing Facility

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).

Fully Covered Days Without Provider Liable and Leave of Absence

Common Reason Code Errors

  • Revenue code 0022 covered units do not match number of covered units billed on revenue codes 01X-21X
  • Covered units for revenue code 0022 do not match number of covered days on claim

Common Reason Code Corrections

  • Verify that number of covered units on revenue code 0022 are equal to the covered units on revenue codes 01X-21X
  • Verify that number of covered days reflected in value code 80, or electronic equivalent, equals to the total covered units in revenue code 0022
  • Covered days should equal the total days billed on claim

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

Claim with Leave of Absence Using the 74 Occurrence Span Code (OSC)

Common Reason Code Errors

  • 18X revenue code is billed with covered units or charges
  • 74 OSC is billed without a 18X revenue code
  • 18X revenue code is billed without 74 OSC
  • Number of days reflected in 74 OSC do not match number of days reported in 18X revenue code
  • Days associated with value code 81, or electronic equivalent, do not equal units billed on 18X revenue code

Common Reason Code Corrections

  • Number of days reflected in 74 OSC shall match units on 18X revenue code
  • No covered units should be reflected on 18X revenue code
  • No charges should be billed on 18X revenue code
  • Verify days associated with 81 value code, or electronic equivalent, equal number of units on 18X revenue code

Claim with Provider Liable Days Using 77 OSC

Common Reason Code Errors

  • Partial provider liable claim is billed with days as non-covered with value code 81 or electronic equivalent
  • Number of days reflected in 77 OSC do not match provider liable revenue code 0022 units

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 in 77 OSC match provider liable revenue code 0022 units

Resources

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

Last Updated May 22, 2018