Required Use of Occurrence Codes 40 and 41 for Presurgical and Preadmission Testing

Date Issued: 1/1/2012

Effective March 1, 2012, occurrence codes 40 and 41 must both appear on claims submissions for presurgical testing (PST) and preadmission testing (PAT) for all lines of business. Occurrence codes 40 and 41 are both required to identify the length of time between the PST/PAT services and the admission or outpatient surgery. These codes are defined as follows:

  • Occurrence Code 40 (Scheduled Date of Admission): This code and corresponding date indicate when the patient will be admitted to the hospital as an inpatient. This code is valid only on an outpatient claim and must be used in conjunction with occurrence code 41 (Date of First Test for Preadmission Testing).
  • Occurrence Code 41 (Date of First Test for Preadmission Testing): This code and corresponding date indicate when the first outpatient diagnostic test was performed as part of preadmission testing. The date associated with this occurrence code must be the same or prior to the admission date reported with occurrence code 40 (Scheduled Date of Admission). Occurrence code 41 must be used in conjunction with occurrence code 40.

Please note: Failure to include occurrence code 40 when occurrence code 41 is reported may result in denial of the claim.

If you have any questions, please contact us at our Message Center by signing in through the EmblemHealth provider page.