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Provider Notice issued 02/27/09
Discontinuance of Occurrence Codes 53 (Mother’s Discharge Date) and 58 (Level II or Level III Perinatal)
| To: |
Participating Hospitals: Chief Executive Officers, Chief Financial Officers, and Patient Accounts Managers |
| Date: | February 27, 2009 |
| Re: |
Discontinuance of Occurrence Codes 53 (Mother’s Discharge Date) and 58 (Level II or Level III Perinatal) |
|
The purpose of this notice is to advise hospitals reimbursed by the per diem reimbursement methodology of a change in billing requirements. It does not impact hospitals reimbursed by the Diagnosis-Related Group (DRG) payment system.
Per diem reimbursed hospitals have utilized Occurrence Code 53 and the mother’s discharge date on newborns’ claims. Any reimbursement for the newborn stay was based upon the date range beginning with the mother’s discharge date and ending with the date prior to the baby’s discharge. If a baby was placed in a Perinatal Level II or Level III nursery, the hospital had to utilize Occurrence Code 58. Reimbursement was based upon the entire newborn stay.
Pursuant to UB claim form coding guidelines, Occurrence Codes 53 and 58 are no longer valid. Effective with admissions on and after April 1, 2009, the department will no longer utilize Occurrence Codes 53 and 58 for claim payment determination. In processing claims, the department groups all inpatient claims to a DRG, regardless of payment methodology. Claims with admissions on and after April 1, 2009, that group to DRG 391 will be paid at zero. Claims with admissions on and after April 1, 2009, that group to any other valid DRG will continue to be paid based upon the hospital’s per diem rate.
Any applicable claim containing Occurrence Code 53 or 58 with an admission date through March 31, 2009, must be submitted on the UB-04 paper claim format.
Any questions regarding this notice may be directed to the Bureau of Comprehensive Health Services at 1-877-782-5565.
Theresa A. Eagleson, Administrator Division of Medical Programs |