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Jurisdiction 11 Part A

FISS Narrative

  • This reason code only applies to SNF and inpatient bills only with TOBs 11x, 41x, 18x, 21x, 22x, 23x, 24x and 51x
  • Covered days: The sum of the utilization days calculated plus the number of the non-utilization days calculated must equal the number of days between the 'From' and 'Thru' dates in the statement covers period unless:
    1. Patient status = 30 (add one day to the calculation)
    2. Transfer – The 'From' and 'Thru' date are the same, patient status 02, 03, 05, 50, 51, 61, 62, 63, 71 or 72 with a condition code 40
    3. The 'From' and 'Thru' days are the same but no condition code 40 present

Explanation and Suggestion:

  • This reason code is an indication that the total number of days represented by the 'From' and 'Thru' dates has not been calculated correctly
  • This reason code may frequently be received in conjunction with reason code 12206 (above)
  • Be certain to take note of the factors indicated in the reason code narrative to assure that the days are being calculated as expected by FISS and the Medicare program


last updated on 08/11/2015
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