Intellect™
GUIDELINES FOR OCCURRENCE AND
OCCURRENCE SPAN UTILIZATION
These codes are required for completion of the form CMS-1450 for billing when there is a Condition Code that applies to this claim.
Form Locators (FLs) 31, 32, 33, and 34 are Occurrence Code/Date Situational codes.
Due to the varied nature of Occurrence and Occurrence Span Codes, provisions have been made to allow the use of both type codes within each. The Occurrence Span Code can contain an occurrence code where the 'Through' date would not contain an entry. This allows as many as 10 Occurrence Codes to be utilized. With respect to Occurrence Codes, complete field 31a - 34a (line level) before the 'b' fields. Occurrence and Occurrence Span codes are mutually exclusive. An example of Occurrence Code use: A Medicare beneficiary was confined in hospital from January 1, 2005 to January 10, 2005, however, his Medicare Part A benefits were exhausted as of January 8, 2005, and he was not entitled to Part B benefits. Therefore, Form Locator 31 should contain code A3 and the date 010805.
The provider enters code(s) and associated date(s) defining specific event(s) relating to this billing period. Event codes are two alpha-numeric digits, and dates are six numeric digits (MMDDYY). When occurrence codes 01-04 and 24 are entered, the provider must make sure the entry includes the appropriate value code in FLs 39-41, if there is another payer involved. Occurrence and occurrence span codes are mutually exclusive. When FLs 36 A and B are fully used with occurrence span codes, FLs 34a and 34b and 35a and 35b may be used to contain the 'From' and 'Through' dates of other occurrence span codes. In this case, the code in FL 34 is the occurrence span code and the occurrence span 'From' dates is in the date field. FL 35 contains the same occurrence span code as the code in FL 34, and the occurrence span 'Through' date is in the date field. Other payers may require other codes, and while Medicare does not use them, they may be entered on the bill if convenient.