Reason Code Narrative

PARTIAL HOSPITALIZATION SERVICE FOR NON MENTAL HEALTH DIAGNOSIS.

Common Reason Code Errors

• Condition code 41 is billed for a partial hospital program (PHP) where mental health services are not approved.
• Non PHP revenue codes have been billed on a PHP claim.
• PHP has been billed but no mental health diagnosis is present.

Common Reason Code Corrections

• Verify condition code 41 is billed appropriately
• Verify revenue codes billed are correct and valid for a PHP claim
• Verify all relevant diagnosis codes have been billed to support PHP services provided

Resources

• CMS Integrated Outpatient Code Editor (IOCE)
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260

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