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

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