Reason Code C7113

Description

An inpatient claim with the admission date less than four days from the outpatient history thru date, or if present, the occurrence span code "72" date, and the outpatient claim is for diagnostic services only.

An outpatient claim containing diagnostic services falls within 72 hours of the admission date of the inpatient claim.

Resolution

Roll all diagnostic services into the inpatient claim.

Non-diagnostic services, other than ambulance and maintenance renal dialysis services, provided within 72 hours of an inpatient admission must be reviewed by the facility. If services are not related include condition code 51 in "Condition Code" field.

Resource: Medicare Claims Processing Manual (PDF), IOM 100-4, Chapter 3, Section 40.3 Outpatient Services Treated as Inpatient Services