Error JY

High Urgency

ICU Readmission Billing Rule

Billing for an ICU readmission within 48 hours must continue at the previous daily rate, not reset to Day 1.

Official Description: When a patient is readmitted to ICU with in 48 hours with the same or similar problem, billing continues at the same rate as if there were no break.

How to Fix It

Follow these steps in order to resolve the error.

Verify the patient's hospital record to confirm the initial ICU discharge and subsequent readmission both occurred within a 48-hour period for the same or a similar diagnosis.
Review your previous billings for this patient. Identify the last sequential ICU daily fee that was paid before the discharge.
Do not bill a 'Day 1' ICU fee (e.g., 12211 or 13211) for the readmission. You must bill the next consecutive day's fee code.
Example: If the last paid claim was for ICU Day 3 (e.g., 12213), the claim for the readmission date must be for ICU Day 4 (e.g., 12214).
Correct the fee item on the rejected claim to reflect the continuous care sequence and resubmit the claim through Teleplan.
If the claim is rejected again or the billing sequence is complex, contact the Teleplan Service Desk at 604-683-7151 for clarification.