Reason Code 11503

Published 12/16/2019

Description
Qualifying hospital stay is not within 30 days of SNF (21x, 18x, 28x, 51x) admission date (occurrence code 70 span thru date is more than 30 days prior to SNF admit date). However, condition code 55, 56, 57, 58 or M3 are not present on the claim. This edit will also assign on subsequent 183, 184, 213 and 214 TOBs whereby the initial 182 and 212 TOB received reason code 11503.

Resolution
If the qualifying hospital stay dates are correct and one of the following conditions applies, add the appropriate condition code.

Resource

  • CMS Internet Only Manual (IOM), Publication100-04, chapter 6 (PDF)
  • CMS Internet Only Manual (IOM), Publication 100-02, chapter 8 (PDF), section 20.2.2