Eli's Rehab Report

Published on Fri Mar 12, 2010 PDF

Question: I'm in a hospital outpatient setting, and my billing and medical record department would like me to investigate occurrence codes for rehab to find more information in writing about their requirements. Can you confirm if these codes are required for hospital-based outpatient services? As I understand, the occurrence code has something to do with plan of care documentation.

--Georgia subscriber

Answer: Yes, occurrence codes do apply to hospitalbased outpatient therapy services. In addition, they apply to all providers who submit claims on the UB-04 claim form (or the 837I for those that submit claims electronically). For a written reference, begin reading Section 20 on page 32 of the Medicare Claims Processing Manual at www.cms.hhs.gov/manuals/downloads/clm104c05.pdf.

Remember: The word "shall" means mandatory.

The manual states: "Providers billing to intermediaries shall report:

􀁺 The date the therapy plan of care was either established or last reviewed (see §220.1.3B) in Occurrence Code 17, 29, or 30.

􀁺 The first day of treatment in Occurrence Code 35, 44, or 45."

Occurrence code 17 is the date the occupational therapy plan of care was established or last reviewed. Occurrence code 29 is the same, but for physical therapy, and occurrence code 30 is the same but for speech-language pathology.

Occurrence code 35 is the first date of treatment for physical therapy. Occurrence code 44 is the first date of treatment for occupational therapy, and occurrence code 45 is the first date of treatment for speech.

Here is the link where you can find the occurrence codes: www.cms.hhs.gov/manuals/downloads/clm104c25.pdf. You would enter the codes in fields 31-34 on the UB-04 claim form. Occurrence code 11, which is the date of the onset of symptoms/illness, is also required.

--Reader Questions were answered by Rick Gawenda, PT, director of finance for Kinetix Advanced Physical Therapy, Inc. and president/CEO of Gawenda Seminars & Consulting.