Reason Code 31577 - JE Part A

Reason Code Narrative

THIS REASON CODE IS ASSIGNED ON RHC CLAIMS (TOB 71X) WHEN THE SAME REVENUE CODE (520, 521, 522, 524, 525, OR 528) IS BILLED MULTIPLE TIMES FOR THE SAME DATE OF SERVICE.

Common Reason Code Errors

Only one encounter is billed per day unless the patient leaves and later returns with a different illness or impairment suffered later on the same day.

• This reason code is generated on Rural Health Clinic (RHC) claims TOB 71X that include a clinic visit revenue code (52X) with more than one unit or more than one clinic visit revenue code has been billed for same date of service.
• If beneficiary had more than one separate and distinct visit to RHC on same date of service, condition code G0 must be included on claim.

Common Reason Code Corrections

• Change unit to 1 for revenue code 52X or 91X and F9.
• Submit two separate bills since patient would have left and later returned with a different illness or impairment.

Note: An exception would be separately payable preventative services performed on same date of service.

Resource

• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 9, Section 100

View reason code list, return to Reason Code Guidance page.