Leave of Absence Reminders – Coding and Reimbursement

Blue Cross and Blue Shield of North Carolina (Blue Cross NC) would like to remind providers of correct billing when filing for leave of absence (LOA) days. In a recent review of claims, providers are using LOA days inappropriately to join multiple admissions together. Please see the billing guidelines below on when it is appropriate to file for LOA day(s).  

• It is appropriate to report LOA days when a member's care involves a planned readmission.
  • Leave of absence days are not eligible for reimbursement and are to be reported using revenue code 018x.
• It is inappropriate for facilities to use LOA days to join admissions when the second admission is unexpected. 
  • For example: A member is admitted as an inpatient Oct 1, 2023, and discharged on Oct 3, 2023, with the member returning to the facility on Oct 6, 2023, unexpectedly where they are readmitted until discharged on Oct 8, 2023. The days the member was absent from the facility (Oct 4 to Oct 5) should not be reported as LOA days. It would also be inappropriate to file a claim for a single admission Oct 1 to Oct 8, 2023.

Combined admissions with LOA days will continue to be returned to providers as filing errors with instruction to refile two (2) separate inpatient claims.

For more information on hospital admissions and leave of absence days, please review our Provider Blue Book or Policies (Commercial / Medicare).