Skip to Main Content

Print | Bookmark | Email | Font Size: + |

Reason Code Search and Resolution

Disclaimer: This is not a complete list of reason codes.

The Reason Code Search and Resolution tool allows you to view a reason code description and determine how to prevent/resolve the edit. You may search by reason code or keyword. All records matching your search criteria will be returned for your review. You may also select "Show all Reason Codes" to view the complete list.

If the reason code you enter does not display here, you may access any reason code description in the Fiscal Intermediary Standard System (FISS) Direct Data Entry (DDE) Reason Codes Inquiry Menu (Option 17) . For additional information, please reference the FISS DDE User Manual.

Search by:

Reason Code 31503

Description:

The total units on the level of care lines (0651, 0652, 0655, 0656) do not equal the number of days in the billing period.

Resolution:

  • Ensure the total the number of days (i.e. units) for the level of care lines equals the number of days indicated by the FROM and TO date on the claim.

    In the example below, the FROM and TO date reflect 11 days (0520YY-0530YY). However, the revenue code page (FISS Page 02) shows 31 days of routine home care (0651) were billed.

    31503

  • For continuous home care, each 0652 revenue code line is equivalent to one day of care, regardless of the units billed on the 0652 line.

    In the example below, the FROM and TO date reflect 31 days (1001YY-1031YY). However, the revenue code page (FISS Page 02) shows a total of 32 days (4 routine home care days + 1 day of continuous home care + 27 routine home care days = 32 days) were billed.

    31503

Disclaimer: CGS' online tools and calculators are informational and educational tools only, designed to assist suppliers and providers in submitting claims correctly. CGS makes no guarantee that this resource will result in Medicare reimbursement for services provided. Although we've made every reasonable effort to provide effective resources, CGS is not responsible for the consequences of any decisions or actions taken in reliance upon or as a result of the information that these tools provide. CGS is not responsible for any human or mechanical errors or omissions.

spacer

26 Century Blvd Ste ST610, Nashville, TN 37214-3685 © CGS Administrators, LLC. All Rights Reserved