Claim coding guidance with ending of PHE

• By: Maureen Carland
• On: 04/19/2023 12:43:03
• In: Quality/Regulatory

The weekly MLN connects newsletter of the Centers for Medicare and Medicaid Services (CMS) has released updated claim coding guidance regarding the use of the DR condition code on claims following the conclusion of the COVID-19 public health emergency (PHE). The guidance, titled COVID-19: Reporting CR Modifier & DR Condition Code After Public Health Emergency, corrects the previous guidance published on March 16.
 
According to the updated guidance, skilled nursing facility and swing bed providers should continue to use the condition code DR on Medicare Part A claims for residents with admission dates before May 12, 2023, for benefit period and 3-day qualifying hospital stay waivers. This means that the DR condition code would remain on claims for those residents until they are discharged from Medicare Part A coverage or until their 100-day benefit period ends. However, the DR condition code should not be used on SNF Part A claims for residents with admission dates on or after May 12, 2023. The CMS notice is included below for reference.
 
For more information, see Section 10 of the Medicare Claims Processing Manual, Chapter 38.
 
Staff contact: mcarland@mehca.org