Medicare Information Resource, Issue 2007-3A:Quick Tip: Counting Covered Days Appropriately to Avoid Reason Codes 31486, 15202, and 12206

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MIR-2007-3A, March 2007

Quick Tips from Provider Education and Training

Quick Tip: Counting Covered Days Appropriately to Avoid Reason Codes 31486, 15202, and 12206

When billing an inpatient claim, the FROM and THROUGH dates should match what is entered in the COVERED DAYS field. In addition, the number of units entered for the accommodation revenue codes (010X-021X) must match what is entered in the COVERED DAYS field.

Avoiding Reason Codes 31486, 15202, and 12206

Reason code 31486 will occur on inpatient skilled nursing facility (SNF) claims when the units for revenue code 0022 do not match the covered days entered on the claim. To avoid this reason code from occurring, providers should make sure the units entered for revenue code 0022 match what is entered in the COVERED DAYS field.

If occurrence span code 77 (provider liability) is on the claim, the units that are entered for revenue code 0022 will equal the total covered days minus the days for occurrence span code 77.

Reason code 15202 will occur on claims when the units entered in the COVERED DAYS field do not match the units entered for revenue codes (010X-021X). To avoid this reason code from occurring, providers should make sure the units entered in the COVERED DAYS field, match the units entered for revenue code (010X-021X).

Reason code 12206 will occur on claims when the FROM and THROUGH dates entered on the claim are not the same, and the number of units entered in the COVERED DAYS field do not reflect the FROM and THROUGH dates. This reason code can be avoided by making sure the FROM and THROUGH dates entered on the claim are reflected in the COVERED DAYS field (plus any noncovered days), unless the patient status is 30 (still patient); then you add one day to the count.

Claim Example:

The patient status is 30, dates of service (DOS) 01/01/2006-01/31/2006

Units entered in the COVERED DAYS field would be 31.

Since the patient status is 30, you count the last day.

If the patient status is anything other than 30, you do not count the last day of service. So, if the patient status is 01 (discharged to home), DOS 01/01/2006-01/31/2006, the days entered in the COVERED DAYS field would be 30. The date of discharge is not counted as a covered day.