Top Occurrence Codes Used In Snf Billing And What They Mean

By Author: Charlie Robinson
Total Articles: 44
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Have you ever realized what will happen when one key date is missed from a Medicare claim?

In Skilled Nursing Facility billing, even one small mistake in recording key patient events can lead to claim denials or loss of payments. This is why Occurrence Codes are used to help report important details correctly.

The use of occurrence codes in medical billing began its journey with the UB-82 form in the early 1980s and is still used today on the UB-04 form as part of standardized claims. As Medicare rules and healthcare regulations became more complex, providers required a clear and consistent way to report important dates and events. These include hospital stays, the end of skilled care, therapy initiation, or periods when services were not covered. The need for structured communication between providers and payers led to the development of Occurrence Codes and Occurrence Span Codes.

With SNFs under increasing pressure to optimize reimbursement and reduce claim errors, understanding these codes has become more important than ever. This blog explores the top occurrence codes used in SNF billing and what they ...
... represent so as to use them correctly for both compliance and cash flow.

Overview of Occurrence Codes

Occurrence Codes and Occurrence Span Codes are standardized two-digit codes used on institutional claims (UB-04 forms) to report significant events that directly impact billing, coverage, or Medicare eligibility. These codes are accompanied by date(s) and are submitted in designated form locators:

• Occurrence Codes: Represent specific, one-time events tied to a single calendar date (e.g., date active care ended, or therapy started).

• Occurrence Span Codes: Represent a period or span of days, capturing events like a qualifying hospital stay or leave of absence.

They are critical for explaining the circumstances surrounding a patient’s stay to ensure that SNFs meet documentation requirements and help Medicare Administrative Contractors (MACs) process claims efficiently.

Occurrence Codes Used in SNF Billing

Occurrence and occurrence span codes help Medicare understand the timing of key events such as hospital stays, therapy start dates, and changes in patient care. The following are the most commonly used codes in SNF billing, along with what they mean:

• Occurrence Code 22 – Date Active Care Ended

This code is used to report the last day the patient received skilled nursing or rehab services. After this date, Medicare stops covering the stay unless a new qualifying event happens. It is important to include this code when skilled care ends, especially if the patient remains in the facility under non-covered or custodial care.

• Occurrence Code 50 – Assessment Reference Date (ARD)

This code depicts the official date of the Minimum Data Set (MDS) assessment used for Medicare billing and care planning. It helps determine the correct billing period and ensures that services match the patient’s documented care plan. If this code is incorrect or missing, it can cause billing mismatches and claim issues.

• Occurrence Codes - Therapy-Related

These codes help document the timing of therapy services, which are often a major part of skilled nursing care. They show that therapy plans were made and services were provided within expected timeframes. These codes support medical necessity and help avoid delays in reimbursement. It includes:
• Code 29: Date physical therapy plan was established
• Code 35: Date physical therapy treatment began
• Code 17: Date occupational therapy plan was established
• Code 44: Date occupational therapy treatment began

• Occurrence Span Code 70 – Qualifying Hospital Stay

This code is used to report the exact date range of a patient’s inpatient hospital stay before being admitted to the SNF. Medicare requires that a patient must have had a minimum 3-day inpatient hospital stay within 30 days prior to SNF admission to qualify for care coverage. If this code is missing or wrong, the SNF claim can be denied. That’s why it is important to include code 70 to show the patient meets Medicare’s rules for skilled nursing coverage.

• Occurrence Span Code 74 – Leave of Absence (LOA)

This code is used when a resident temporarily leaves the SNF, for example, for a hospital visit or personal leave, or other authorized absence. It shows the “from” and “through” dates when the patient was not physically present in the facility. Using the occurrence span code 74 correctly helps ensure the facility doesn’t bill for days when care wasn’t provided to avoid overpayments or billing errors.

• Occurrence Span Code 77 – Provider Liability Period

This code is used when the SNF is financially responsible for services during a specific time period due to errors, denials, or delays in authorization. It indicates the date range when the facility, not Medicare, must cover the costs of care. Therefore, you can prevent confusion during audits or reviews with the help of these codes.

• Occurrence Span Code 78 – SNF Prior Stay Dates

This code is used when a patient is re-admitted to an SNF after being discharged from a previous SNF stay within the past 60 days. It helps Medicare decide if the stay is part of the same benefit period or a new one. Using it correctly ensures that coverage days are counted properly.

Conclusion

Every code tells a story of patient care, compliance, and financial responsibility. Occurrence and occurrence span codes are essential tools in the SNF billing that ensure Medicare understands exactly when, why, and how services were delivered. From verifying a 3-day qualifying hospital stay to documenting therapy start dates, using these codes correctly can be the difference between a paid claim and a costly denial.

But the fact is that keeping up with Medicare rules, coding updates, and audit-proof documentation is easier said than done. The most viable solution is outsourcing SNF billing and coding services to experts like 24/7 Medical Billing Services to take the pressure off their internal teams. With a dedicated team trained in SNF regulations and coding compliance, we help facilities simplify billing, avoid costly errors, and accelerate reimbursements.

Ready to decode the complexity of occurrence codes and reclaim control of your revenue? Let 24/7 Medical Billing Services guide the way.

FAQs

Q1. Are occurrence codes required for private insurance claims, too?
Though mostly tied to Medicare, many private payers also require similar coding formats.

Q2. Do occurrence codes affect the number of covered days under Medicare?
Incorrect codes can misrepresent benefit periods and reduce covered days.

Q3. Are occurrence codes used in appeal processes?
They are often reviewed to justify coverage decisions during appeals.

Q4. How often are occurrence code guidelines updated?
CMS reviews and may update guidelines annually or as policy changes require.

Q5. Can occurrence codes trigger medical necessity reviews?
Certain codes can flag Medicare to review whether services were necessary and appropriate.

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