Reason Code W7031
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
- CMS Definitions of Medicare Code Edits
- CMS Integrated Outpatient Code Editor (IOCE)
- CMS Internet Only Manual (IOM), Publication 100-04, Chapter 4, Section 260
- Appendix C of the OCE
View reason code list, return to Reason Code Guidance page.
Last Updated May 22, 2018