Noncovered Admission Followed by Covered Level of Care

40.2.1 - Noncovered Admission Followed by Covered Level of Care (Rev. 3030, Issued: 08-22-14, Effective: ASC X12: January 1, 2012, ICD-10: Upon Implementation of ICD-10, Implementation: ICD-10: Upon Implementation of ICD-10, ASC X12: September, 23 2014) Where a beneficiary receives noncovered care at admission, and is notified as such, but subsequently is furnished covered level of care during the same hospital stay, the admission is deemed to have occurred when covered services became medically needed and rendered. This is applicable to PPS and non-PPS billings. The following billing entries identify this situation: • Admission date (not the deemed date). • Occurrence code "31" and the date the hospital provided notice to the beneficiary. • Occurrence span code 76 indicates the noncovered span from admission date through the day before covered care started. • Value code 31 is used to indicate the amount which was charged the beneficiary for noncovered services. • Noncovered charges related to the noncovered services. • The principal diagnosis is shown as the diagnosis that caused the covered level of care. • Only procedures performed during the covered level of care are shown on the bill. If a no payment bill for the noncovered level of care has been processed, the hospital prepares and forwards a new initial bill.