What are occurrence codes on a claim?
Asked by: Dr. Zion Sporer PhD | Last update: June 24, 2025Score: 5/5 (37 votes)
What does occurrence code 24 mean?
AN OCCURRENCE CODE 24 IS PRESENT ON THE CLAIM; HOWEVER, NO VALUE CODE IS PRESENT OR YOU ARE BILLING FOR A MEDICARE PRIMARY PAYMENT. THERE IS AN OCCURRENCE CODE 24 ON THE CLAIM AND YOUR REMARKS DO NOT SUFFICIENTLY EXPLAIN WHY THE PRIMARY INSURER DID NOT PAY THIS CLAIM.
What does occurrence code 05 mean?
05 Other Accident Code indicates the date of an accident not described by the above codes. This code is used to report that the provider has developed for other casualty related payers and has determined there are none.
What does occurrence code 19 mean?
FLs 32 thru 36 - Occurrence Codes and Dates.--The following occurrence codes must be completed. where applicable: 18 - Date of retirement (patient/beneficiary) 19 - Date of retirement (spouse) 24 - Date insurance denied.
What does occurrence code 50 mean?
Inpatient Rehabilitation Facility (IRF) Prospective Payment System (PPS) will use occurrence code 50 to report the date on which assessment data was transmitted to the CMS National Assessment Collection Database. Occurrence code 50 must be reported on all IRF PPS (11x bill types)
OCCURRENCE CODES IN MEDICAL BILLING #UB04 #rcmservices #RCMl #insurance #providers #patient
What are occurrence codes?
A code to describe specific event(s) relating to this billing period covered by the claim.
What is occurrence code 70?
OCCURRENCE SPAN CODES. 70 Qualifying Stay Dates (SNF)/Non-Utilization Dates: Dates represent at least a three-day hospital stay that qualifies the client for Medicare payment of SNF services billed.
What is occurrence code 17?
The date the occupational therapy (OT) care plan was established or last updated. This corresponds with occurrence code 17 on the claim. The date the speech-language pathology (SLP) care plan was established or last updated.
What is occurrence code 27?
This code can be used only when the beneficiary has revoked the benefit, has been decertified or discharged. It cannot be used in transfer situations. Occurrence code 27 is reported only on the claim for the billing period in which the certification or recertification was obtained.
What is occurrence code 55?
Medicare systems shall accept and process new occurrence code 55 used to report date of death.
What is occurrence code 51?
• Occurrence code 51: Date of last Kt/V reading. For in-center hemodialysis patients, this is the date of. the last reading taken during the billing period.
What is occurrence code 16?
In all cases where an End of Therapy-OMRA is completed, SNFs must submit occurrence code 16, date of last therapy, to indicate the last day of therapy services (e.g. physical therapy, occupational, and speech language pathology) for the beneficiary.
What is a 32 occurrence code?
Occurrence code 32 on a claim signifies that an ABN, Form R-131, was given to a beneficiary on a specific date. This code must be employed if this specific ABN form is given, and condition code 20 will not be used on the subsequent claim (i.e., no charges will be submitted as non-covered).
What is occurrence code 22?
iii) Occurrence Code 22 (date active care ended, i.e., date covered SNF level of care ended) = include the date active care ended; this should match the statement covers through date on the claim.
What is occurrence code 48?
Occurrence Codes
23 - Date of Cancellation of Hospice Election period. 48 - Date hospice face-to-face encounter was untimely 49 – Not currently used by Medicare.
What is occurrence code 10?
A code to describe specific event(s) relating to this billing period covered by the claim. (These are From Locators 31, 32, 33, 34, 35, and 36 - Occurrence Codes on the UB04.) These fields can be used for either occurrences or occurrence spans.
What is occurrence code 24?
If filing for a Conditional Payment, report with Occurrence Code 24. Date Insurance denied - Date of receipt of a denial of coverage by a higher priority payer. This could be date of primary payer's Explanation of Benefit (EOB) statement, letter or other documentation.
What is occurrence code 61?
Occurrence code 61 – “Hospital Discharge Date” is reported, but not required, on final admission claims and continuing claims, if applicable.
What is occurrence code 72?
Occurrence Span Code 72; Identification of Outpatient Time Associated with an Inpatient Hospital Admission and Inpatient Claim for Payment. hospital care.
What is occurrence code 41?
Occurrence Code 41 (Date of First Test for Preadmission Testing): This code and corresponding date indicate when the first outpatient diagnostic test was performed as part of preadmission testing.
What is occurrence code 18?
18 Date of retirement (patient/bene) - Code indicates the date of retirement for the patient/bene. 19 Date of retirement spouse - Code indicates the date of retirement for the patient's spouse.
What is occurrence code 80?
Occurrence Span Code: 80 Title: Prior Same-SNF Stay Dates for Payment Ban Purposes Definition: The from/through dates of a prior same-SNF stay indicating a patient resided in the SNF prior to, and if applicable, during a payment ban period up until their discharge to a hospital.
What is occurrence code 47?
Occurrence code 47 -- indicates the first day the inpatient cost outlier threshold is reached or the date after the DRG cutoff date.