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UB-04 SNF Re-Admission Coding

What code is used to reflect the dates of the 3-day qualifying stay?  What field(s) does it go in?

  • Occurrence code 70 in UB-04 field 35-36.

If a patient transfers back to the hospital during their stay in the facility and returns within 30 days, what dates of the qualifying hospital stay are used on the claim? 

  • The original dates of the qualifying hospital stay.

If a patient returns to a facility within 30 days and a discharge claim was submitted prior to readmission, is a claim submitted?  What should be included in it?

  • The billing department must submit another bill with the current admission date as the admission day for the current stay in field 12.
  • Condition code 57 (SNF admission) must be reported in condition code fields 18-28 to inform CWF that the new admission is eligible for coverage using the previous hospital stay because it is within the 30 day window.
  • Occurrence span code 70 with qualifying hospital stay goes in field 35-36.

If a patient is readmitted to a facility prior to a submitted discharge claim from a previous admission, what must be on it?

  • The current admission date as the admission day for the current stay in field 12.
  • Condition code 57 in condition code fields 18-28.
  • Occurrence span code 70 with qualifying hospital stay goes in fields 35-36.
  • Occurrence span code 74 showing the “from” and “through” dates for the LOA and the number of non-covered days.

Sources: CMS MLN SNF Billing Reference (November 2015) and Medicare Claims Processing Manual, Chapter 25.