Disease codes on sick leave with explanations

26.06.2019

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4 min.

A sick leave certificate is the main document indicating a previous illness or injury. It is the only basis for calculating insurance payments, the amount of which is established by the accounting department of the enterprise. The information on the forms is presented in such a way that it can only be understood if you have certain knowledge. Sick leave codes and their decoding allow you to make the correct accruals.

What does the reason for disability code mean?

It shows in encrypted form on what basis the person was given a ballot. This code is entered on the sick leave certificate in the “Cause of disability” field. It consists of three blocks:

1. Two cells labeled “code”. They indicate the code of the reason why the employee went to the doctor on the first visit and received a certificate of incapacity for work.
2. Three cells with the signature “additional code”. They are filled out only in certain cases (see table).
3. Two cells labeled “change code.” They are filled out in a situation where the cause of disability has changed (for example, when the original diagnosis is corrected).

All meanings with explanations are given on the back of the ballot form.

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Table with decoding of disability codes on sick leave

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How to mark violations of the regime

Certain circumstances reduce insurance compensation. One of them is violation of the regime on the part of the employee. Among such disability codes on a sick leave certificate are determined:

• 23 — violation of the treatment schedule;
• 24 — missed visits to the doctor, including multiple failures to contact the doctor;
• 25 - return without a certificate of incapacity for work, which is equivalent to absenteeism;
• 26 - complete refusal to attend a medical examination;
• 27 - arriving at the commission late;
• 28 - other violations.

Advice! It is important not to violate the hospital regime, especially when it comes to long-term treatment. This could result in a significant reduction in your payout. The doctor enters data that is interpreted before benefits are calculated.

Causes of illness and legal consequences for the employer

Sick leave codes 01, 02

Code 01 on the sick leave means that the employee was absent from work due to illness (flu, pneumonia, sinusitis, etc.).

Code 02 means that the person missed work due to injury.

Having received a bulletin with one of these codes, the personnel officer must reflect the information in the work time sheet (usually they use forms No. T-12 or No. T-13, approved by Resolution of the State Statistics Committee dated 01/05/04 No. 1). The corresponding days are marked with the symbols “B” or “19”.

Next, the accountant calculates the average earnings, and the Social Insurance Fund transfers temporary disability benefits (for more details, see: “Payment of sick leave in 2022”). In this case, the employer pays for the first three days at his own expense. The remaining days, starting from the fourth, are financed by the FSS. This is stated in paragraph 1 of part 2 of article 3 of the Federal Law of December 29, 2006 No. 255-FZ “On compulsory social insurance in case of temporary disability and in connection with maternity.”

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Sick leave code 04

Code 04 on the certificate of incapacity for work means that the person missed work due to an accident at work or its consequences.

In the report card in form No. T-12 or No. T-13, days of absence are marked with the symbols “B” or “19”.

Benefits under such a bulletin are issued for the entire time until the date of recovery or until the fact of permanent loss of ability to work is established. The payment amount is calculated based on 100% of average earnings, regardless of length of service, but for a full calendar month cannot exceed the maximum amount. It is equal to the maximum monthly insurance payment approved by law, multiplied by four (Article 9 of Federal Law No. 125-FZ of July 24, 1998).

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Other codes on the hospital form

The health worker can enter one of seven codes in a separate line of the document (“Other”):

Errors in codes. What to do?

When filling out the sick leave form, you must adhere to the following requirements:

• all entries are made in block letters;
• you cannot go beyond the boundaries of the cells;
• Blots, strikeouts, and corrections are not allowed in the codes.

You cannot use a corrector or cover up incorrectly written codes. If a medical institution employee makes a mistake, he will have to issue a duplicate certificate of incapacity for work.

Mode violation codes 23, 24

Significant information is contained in the field of the sick leave sheet, which is called “Notes on violation of the regime.” A two-digit code and the date of violation are entered here. The following marks are most often used.

Code 23 indicates non-compliance with the prescribed regimen, unauthorized leaving the hospital, traveling for treatment to another administrative region without the permission of the attending physician.

Code 24 indicates late attendance at a doctor's appointment.

If these values ​​are present, then starting from the date specified in this field, the benefit is calculated in an amount that does not exceed for a full calendar month the minimum wage established for the current year and multiplied by the regional coefficient (if any). This rule applies even if the employee’s actual average earnings exceed the minimum wage.

Example

The specialist's experience is 15 years, his average earnings are more than the minimum wage.

From February 10 to February 17, 2022, he was treated in a hospital. On February 14, the employee violated the regime, and the doctor made a note on the bulletin.

Benefit amount:

• for the period from February 10 to February 13 - based on the actual average earnings multiplied by 100%;
• for the period from February 14 to 17 - according to the formula: minimum wage for 2022, divided by 28 (the number of days in February) and multiplied by 4 (the number of days of sick leave, starting from the date when the regime was violated).

Calculation of used sick leave days and accruals when caring for several children at the same time

The calculation of used days of care and sick leave accruals in the case of caring for several children at the same time has been improved. The calculation of accruals results in a zero amount, because the benefit is paid at the expense of the Social Insurance Fund. But the size of the benefit from the Social Insurance Fund may be important if the organization makes additional payments for sick days.

As it was . Previously, all sick leave was calculated based on one child care option.

How it became . Now, when calculating accruals, each day of child care is calculated separately, the most preferential payment option is selected, then days of care with the same payment terms are collapsed into periods. The program operates according to the following algorithm:

1. The terms of payment for each child are calculated separately - as if for each case of care there is a separate sick leave.
2. Where periods of care intersect, the one that will provide the highest payment is selected.
3. Days of care for other children during overlap periods are also written off.
4. Payments are not summed up, but the best conditions of care are selected - those that provide the highest payment.

Let’s say an employee is given sick leave to care for two children and the periods of care overlap:

• Period of care for one child (Ivan) from November 8 to 17
• Period of care for another child (Anna) from November 17 to 19

Crossing – 1 day 11/17/2021

This year, the employee used childcare days:

• For Ivan - 55 days used, remaining 5 days.
• For Anna – 0 days used, remaining 60 days.

Because the balance of unused days to care for child Ivan is 5 days, and sick leave to care for him was issued for 10 days (from November 8 to 17), only the first 5 days of care are paid for by the Social Insurance Fund - from November 8 to 12.

On November 13, the unpaid period for caring for Ivan begins. But as of November 17, the employee is already entitled to child care benefits for Anna. The program compares 2 payment options for the day of November 17:

• There is no allowance for caring for Ivan.
• There is an allowance for Anna's care.

The most profitable option for an employee on the day of intersection of care cases is to assign child care benefits to Anna. Therefore, only the days from November 13 to November 16 fall into the unpaid period. For November 7, the employee is assigned a benefit.

The number of “spent” days of care is recorded separately for each child.

The amount of the accrued benefit is not visible in the document, but it can be seen in the Accruals in the Social Insurance Result . These amounts are taken into account when calculating the additional payment for sick days.

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Line “Other” (code 31, 36)

It contains additional information in encrypted form. Here are some of them.

Code 31 means that a person needs long-term treatment, and although he was given a certificate of incapacity for work, he continues to be ill. In this case, he submits the primary sheet to the accounting department and receives benefits for the first part of the illness. In this document, the “Get Started” field is not filled in. And in the “Other” field there is code 31, which stands for “continues to hurt.”

Code 36 indicates the following situation. The employee, while on sick leave, missed his next doctor's appointment. And when he showed up (later than the appointed date), he was recognized as able to work. The ballot fields are filled in as follows:

• “Notes on violation of the regime” - worth 24 and the date of the missed appointment;
• “Exemption from work” - the period from the onset of illness to the date of the missed appointment is indicated;
• “Other” - costs 36;
• “Get Started” remains blank.

ATTENTION. The benefit for the ballot, in which code 36 is indicated in the “Other” field, is calculated as follows. From the onset of illness to the date preceding the absence - based on actual average earnings. For a day of failure to appear - in an amount not exceeding for a full calendar month the minimum wage established for the current year and multiplied by the regional coefficient (if any). From the date following the day of failure to appear, benefits are not accrued at all (letter from the Moscow branch of the FSS dated September 01, 2020 No. 14-15/7710-2216l; see “The capital FSS clarified how to calculate benefits if there is a note on the sick leave for violation of the regime ").

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What happens if you don’t enter the code in the BL?

This field is required. Failure to identify the relative will invalidate the document , and the employer will most likely not certify it. And if this violation is overlooked, and according to this document the person goes on sick leave, the employer will have every right to declare absenteeism.

It should be noted that filling out the field about caring for a relative in the document is necessary according to the rules for drawing up a regulatory document.

That's all the nuances of filling out this document regarding care for relatives. This paper is an official document, and its execution occurs according to certain rules, in accordance with existing legislation.

What codes should an employer provide?

The employer should put the subordination code in the bulletin and fill out the “Calculation conditions” field (the codes are given on the back of the sick leave form).

Doctors indicate all other codes, in particular: reasons for disability, notes on violation of the regime and the corresponding values ​​in the “Other” field.

IMPORTANT. If doctors filled out a sick leave certificate with errors (including incorrect disease codes), and the accounting department paid for it, the Social Insurance Fund will most likely refuse to reimburse the benefit. But the courts support policyholders in such situations.

Why are codes written on sick leave?

The certificate of incapacity for work contains a lot of data that doctors and employers cannot do without. First of all, it contains data about the patient, namely, his name, patronymic and surname, company name, TIN. The information is recorded by the doctor, who opens the sheet if the person is unable to work for some time.

The most important section of the document is the part in which the codes for the reasons for disability are indicated. Several cells have been allocated for them:

• two – the code itself (from 01 to 15);
• three – to indicate an additional cipher (017-021);
• two – the changed code is recorded here, if necessary (the diagnosis has been clarified).

There are several purposes for using codes, in particular:

1. Compact and economical use of the form.
2. Simplifying and optimizing the work of HR staff. There is no need to understand the doctor’s often “unreadable” handwriting.
3. Minimizing the likelihood of errors.
4. Maintaining medical confidentiality.
5. Opportunity to cooperate with medical institutions abroad.

Important! The decoding of the codes is on the back of the form. Therefore, it is not difficult to understand the numbers and clarify the reasons for the employee’s absence.