Billing, News, Skilled Nursing Facility

SNFs: Are you billing Occurrence Code 22 correctly?

By The Bottom Line.

In an MLN Matters article issued on October 5, 2018, CMS described systems changes they made to ensure SNFs and swing beds bill Occurrence Code 22 correctly. It also ensures the same benefit period logic used for SNF claims is used for swing bed claims. As a result of these changes, MACs will return to provider an inpatient SNF claim (TOB 21X or swing bed claim with TOB 18X) when all of the following are present on the claim:

  • OC ‘22’ and
  • OC ‘22’ date is equal to the through date of the claim and
  • Patient discharge status code is other than ‘30’.

The effective date for these changes is April 1, 2019. Read the official instruction issued to MACs and the MLN article.