Last Modified: 5/7/2020
Location: FL, PR, USVI
Business: Part A
Q: When should occurrence span code (OSC) 70 be used?
A: OSC70 should be coded on the cost outlier claim when the beneficiary’s benefit days have exhausted and there are extra days within the inlier portion of the claim. The claim may be paid up to the diagnosis related group (DRG), as long as there are benefit days remaining for the claim.
Answering this question will assist in submitting the claim correctly. Did the beneficiary’s regular, coinsurance or lifetime reserve days exhaust during the inlier portion of the stay?
• If no -- submit claim as regular inpatient claim or follow guidelines for using occurrence code 47 and A3, if applicable.
• If yes --
• Did the regular benefit days exhaust during the inlier period?
• Indicate occurrence span code 70.
• Did lifetime reserve days exhaust during the inlier period? Note: Lifetime reserve days can be billed only in the inlier period when these are the only benefit days available at the time of admission.
• The from and through dates should represent the period of time during the prospective payment system (PPS) inlier stay for which the benefit days are exhausted.
If a beneficiary has at least one regular benefit day remaining in the benefit period available for use at the time of admission, the entire stay up to the DRG cutoff will be paid for by Medicare.
All charges for dates within the occurrence span code 70 should be billed as covered.
• OSC 70 -- Non-utilization dates (for payer use on hospital bills only). The from/through dates during a prospective payment system (PPS) inlier stay for which the beneficiary has exhausted all regular days and/or coinsurance days, but which is covered on the cost report.
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