License for Use of "Physicians' Current Procedural Terminology", (CPT) Fourth Edition

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POINT AND CLICK LICENSE FOR USE OF "CURRENT DENTAL TERMINOLOGY", ("CDT")

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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

Keyword

Reason Code 31018

Description:

For claims with dates of service prior to January 1, 2020 under the Home Health Prospective Payment System (HH PPS):

There is a span of more than 60 days between the "FROM" and "TO" date submitted on the claim.
- Example 1: "FROM" date billed is March 15 and the "TO" date billed is May 14, which equals 61 days
- Example 2: "FROM" date billed is March 15, and the "TO" date billed is July 12, which equals 120 days
There is less than 60 days between the "FROM" and "TO" date submitted, and a patient status code "30" appears on the claim.
- Example: "FROM" date billed is March 15 and the "TO" date billed is May 11, which equals 58 days. Patient status code "30" indicates the beneficiary remains a patient of the HHA at the end of the episode; therefore, the span between the "FROM" and "TO" dates cannot be less than 60 days.

For claims with dates of service on or after January 1, 2020, under the Patient-Driven Groupings Model (PDGM):

There is a span of more than 30 days between the "FROM" and "TO" date submitted on the claim.
- Example 1: "FROM" date billed is March 15 and the "TO" date billed is April 14, which equals 31 days
- Example 2: "FROM" date billed is March 15, and the "TO" date billed is May 13, which equals 60 days
There is less than 30 days between the "FROM" and "TO" date submitted, and a patient status code "30" appears on the claim.
- Example: "FROM" date billed is March 15 and the "TO" date billed is April 11, which equals 28 days. Patient status code "30" indicates the beneficiary remains a patient of the HHA at the end of the period of care; therefore, the span between the "FROM" and "TO" dates cannot be less than 30 days.

Resolution:

Under the HH PPS the unit of payment is a 60-day episode of care. Under the PDGM the unit of payment is a 30-day period of care.
Verify the "FROM" and "TO" dates submitted on home health claims to ensure there is never a span of more than 60/30 calendar days submitted on a final claim (type of bill 329)
To determine the 60th day of an episode based on the "FROM" date, access the Home Health 60-Day Episode Calendar Schedule quick resource tool. To determine the 30th day of a period of care based on the "FROM" date, access the Home Health Patient-Driven Groupings Model (PDGM) 30-Day Period of Care Billing Schedule.
If the span of days is less than 60/30 days, and the patient was discharged, enter the appropriate patient status code as of the "TO" date on the claim

This code is entered in the "STAT" field found on FISS claim page 01 or form locator 17 on the CMS-1450 form
A listing of patient status codes is available by accessing the following resources:

Claim Page 01 - Entering a RAP or Claim Web page (HH PPS)
Submitting a Final Claim under the Home Health Patient-Driven Groupings Model Web page (PDGM)
Home Health Medicare Billing Codes Sheetquick resource tool
National Uniform Billing Committee (NUBC) Official UB-04 Data Specifications Manual

If you are using a billing software that calculates the episode dates and you are receiving this error, address this issue with your software vendor.

Updated: 01/21/2020

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.