Reason Code W7031 - JE Part A

Reason Code Narrative

PARTIAL HOSPITALIZATION ON THE SAME DAY AS ELECTORCONVULSIVE THERAPY OR SIGNIFICANT PROCEDURE.

Common Reason Code Errors

• Partial Hospitalization Program (PHP) services have been billed on same day as CPT 90871 for multiple seizures in one day
• PHP services billed on same day as a significant procedure

Note: Significant procedures are those with an Outpatient Code Editor (OCE) flag of an "S" or "T."

Common Reason Code Corrections

• Verify PHP has not been billed on same day as CPT 90871
• Verify PHP services have not been billed on same day as a significant procedure

Resources

• CMS Definitions of Medicare Code Edits
• CMS Integrated Outpatient Code Editor (IOCE)
• CMS Internet Only Manual (IOM), Publication 100-04, Medicare Claims Processing Manual, Chapter 4, Section 260
• Appendix C of the OCE

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