Reason Code 15202

Description
On inpatient hospital or inpatient SNF bills with covered days greater than zero, the accommodation days shown with revenue codes 10x–21x must be equal to the cost report days. Outpatient claims should not be billed with covered days.

Resolution

  • Verify the dates of service and patient status
  • Verify the number of covered and non-covered days
  • Verify the number of units shown with the accommodation revenue codes
  • Verify the dates shown with occurrence span codes
  • When billing condition code 04 and 69 charges should be submitted as covered
  • When billing occurrence span code 77 charges should be submitted as covered
  • If your claim is an adjustment; please ensure all lines are covered when resubmitting your claim
  • If billing SNF and occurrence code 22 is present, you may bill covered up to the occurrence code 22. Then you should bill 210 until discharge. *Note when billing occurrence span code 74 it must be billed with rev code 180 and there should be no money associated with this line on your claim.
  • Condition code 04 is informational only and should always be billed with covered charges, units and days
  • When billing occurrence code M1 claim days and units should be non-covered
  • When billing condition code 21 days and units should be submitted as non-covered

Resource
CMS Internet Only Manual (IOM), Publication 100-4, Medicare Claims Processing Manual.