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Update: DRG Claims Erroneously Denied with RAD Code 9953 Resolved

January 26, 2016

A previously published NewsFlash identified a claim processing issue that caused diagnosis-related group (DRG) claims to be erroneously denied with Remittance Advice Details (RAD) code 9953: APR-DRG – Length of Stay Invalid for Interim Claim. This issue has been resolved.

Hospital providers may resubmit Level 1 or Level 2 administrative day claims (with revenue code 169, 190 or 199) and rehabilitation claims (with revenue code 118, 128, 138 or 158) that were previously denied with Remittance Advice Detail (RAD) code 9953: APR-DRG – Length of Stay Invalid for Interim Claim with admission dates on or after July 1, 2013, through November 13, 2015.

Type of Bill Code for Acute Inpatient Intensive Rehabilitation (AIIR), Administrative Day, and Medicare Crossover Claims:

Code Description
111 Regular Inpatient Claim: Admit through discharge
112 First Interim Claim: Continuous stay inpatient claim
113 Subsequent Interim Claim: Continuous stay inpatient claim
114 Final Interim Claim: Continuous stay inpatient claim

Type of Bill Code for Inpatient Claims with Medicare Part B:

Code Description
121 Inpatient Claim with Medicare Part B: Admit through discharge
122 Inpatient Claim with Medicare Part B: Interim, first claim
123 Inpatient Claim with Medicare Part B: Interim, continuing claim
124 Inpatient Claim with Medicare Part B: Interim, final claim

Resubmission claims must contain the following information to receive reimbursement:

  • Appropriate revenue code: 169, 190, 199, 118, 128, 138, or 158 in Box 42 (Rev. CD field)
  • Appropriate delay reason code
    • −  Delay Reason Code “11” in Box 37 if the claim is submitted more than six months but less than 12 months from the date of admission

      −  Delay reason code “10” in Box 37 if the claim is submitted more than 12 months from the date of admission

  • The following statement in the Remarks field: “DRG claim that previously denied with RAD code 9953”

Timeliness will be waived for claims previously denied with Remittance Advice Details (RAD) code 9953: APR-DRG – Length of Stay Invalid for Interim Claim with admission dates on or after July 1, 2013, through November 13, 2015.

Timeliness for resubmitted claims that meet the above criteria will be waived through June 1, 2016. Failure to follow the above instructions could result in claims being denied or processed incorrectly.