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 31485

Description:

Occurrence code (OC) 27 is required on all hospice notice of elections (NOEs) and initial claims following a hospice election. The date included with OC 27 should match the FROM date and the ADMIT date, except for hospice transfer claim. A hospice NOE/claim will receive this error when:

An NOE(8XA) is submitted without OC 27;
The OC 27 date on the NOE does not match the 'FROM' date and the 'ADMIT DATE';
An initial claim (8X1 or 8X2) following the hospice election or transfer (i.e. the 'FROM' date and 'ADMIT DATE' on the claim are the same) is submitted without OC 27; or
For an initial hospice election, the OC 27 date on the initial claim does not match the 'FROM' date and the 'ADMIT DATE'.
For a hospice transfer, the OC 27 date is either:
- The START DATE of the current benefit period (as shown on ELGH/ELGA) that your claim falls within; or
- The START DATE of the next benefit period (according to ELGH/ELGA) when your claim's dates of service overlap the TERM DATE of the current benefit period.

Resolution:

Ensure that your NOE (8XA) includes OC 27 with a date that matches the 'FROM' date and the 'ADMIT DATE'.
Ensure that your initial claim (8X1 or 8X2) includes OC 27, and the date submitted with it matches the 'FROM' date and the 'ADMIT DATE'.
For hospice transfers, ensure your initial claim (8X1 or 8X2) must include OC 27. The date submitted with the OC 27 is the START DATE of the current benefit period, OR the START DATE of the next benefit period.

Example: ELGH shows the following:

If the dates of service on your initial claim are between March 18 and June 15, 20YY, the OC 27 date on your initial claim would be '031820YY'

If the dates of service on your initial claim are after June 15, 20YY, the OC 27 date on your initial claim would be '061620YY'.

Updated: 12.14.18

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.