What does condition code 51 mean?
Asked by: Mia Schimmel | Last update: November 10, 2023Score: 4.5/5 (10 votes)
Condition Code 51 Attestation of Unrelated Outpatient Non-diagnostic Services. This condition code is for use on outpatient facility claims.
What is a condition code 51?
Condition code 51, "Attestation of Unrelated Outpatient Non-diagnostic Services" is used to indicate the non-diagnostic services are clinically distinct or independent from the reason for the beneficiary's admission in order to bill them separate from the inpatient claim.
What is a condition code on a claim?
Currently, Condition Codes are designed to allow the collection of information related to the patient, particular services, service venue and billing parameters which impact the processing of an Institutional claim.
What is a condition code 21?
Condition code 21 can also be used to indicate a no payment claim is being submitted at a beneficiary's request, or other insurer's request, to obtain a denial from Medicare in order to receive payment from another insurer.
What is a condition code 44 after discharge?
A Condition Code 44 is a billing code used when it is determined that a traditional Medicare patient does not meet medical necessity for an inpatient admission. An order to change the patient status from Inpatient to Observation (bill type 13x or 85x) MUST occur PRIOR TO DISCHARGE.
CONDITION CODES – EICR – WHAT THEY MEAN – HOW TO DETERMINE THE CORRECT CODE TO USE
What is discharge status code 50?
Patient status code "50: Hospice home" should be used if the patient went to his/her own home or an alternative setting that is the patient's "home", such as a nursing facility, and will receive in-home hospice services.
What is discharge status code 52?
Condition codes. Condition code 52 is required to report a discharge due to the patient's unavailability/inability to receive hospice services from the hospice which has been responsible for the patient. Condition code 85 is required when the hospice recertification is not received within the required time.
What is value code 50 51 52?
Background: This instruction removes the requirement for providers to report the total number of therapy visits using value code 50 – physical therapy, 51 – occupational therapy, 52 – speech therapy, and 53 – cardiac rehab.
What is a condition code 30?
Condition Code 30 means "Qualified Clinical Trial". It must appear on the hospital inpatient or outpatient claim when billing for items/services related to a Qualified Clinical Trial or qualified study regardless of whether all services on the claim are related to the clinical trial or not.
What does condition code 47 mean?
COND CODES. Condition Codes. Enter condition code 47 for a patient transferred from another HHA. HHAs can also use cc 47 when the patient has been discharged from another HHA, but the discharge claim has not been submitted or processed at the time of the new admission.
What does condition code 10 mean?
FLs 24 thru 30 - Condition Codes.--The following condition codes must be completed where. applicable: 08 - Beneficiary would not provide information concerning other insurance coverage. 09 - Neither patient nor spouse employed. 10 - Patient and/or spouse is employed, but no GHP.
What is a condition code 41?
Condition code Hospitals and CAHs report condition code 41 to indicate claim is for partial hospitalization services. furnished.
What is condition code 40?
Occurrence Code 40 (Scheduled Date of Admission): This code and corresponding date indicate when the patient will be admitted to the hospital as an inpatient. This code is valid only on an outpatient claim and must be used in conjunction with occurrence code 41 (Date of First Test for Preadmission Testing).
What is condition code 53?
53 ‐ Initial placement of a medical device provided as part of a clinical trial or free sample. (This condition code is for outpatient claims that have received a device credit upon initial medical device placement in a clinical trial or a free sample. It does not apply to inpatient claims.)
What is condition code 49?
Condition Code 49: Product Replacement within Product Lifecycle—Replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly.
What are condition codes 45?
Condition Code 45 (Ambiguous Gender Category)
For UB-04 billing, Condition Code 45 alerts us that the gender/procedure or gender/diagnosis conflict is not an error, allowing the claim to continue normal processing.
What are the 4 conditional codes?
- N: was the result negative?
- Z: was the result zero?
- V: was there an overflow (added two positive numbers and got negative, or vice versa)?
- C: was there a carry-out?
What is condition code 80?
Occurrence Span Code: 80 Title: Prior Same-SNF Stay Dates for Payment Ban Purposes Definition: The from/through dates of a prior same-SNF stay indicating a patient resided in the SNF prior to, and if applicable, during a payment ban period up until their discharge to a hospital.
What is condition code 20?
Claims are billed with condition code 20 at a beneficiary's request, where the provider has already advised the beneficiary that Medicare is not likely to cover the service(s) in question.
What does modifier 51 mean?
Modifier 51 Multiple Procedures indicates that multiple procedures were performed at the same session. It applies to: Different procedures performed at the same session. A single procedure performed multiple times at different sites.
What is an example of a 51 modifier?
Example 2: Colonoscopy (45378) performed at the same session as upper endoscopy (43200). Use modifier 51 on the upper endoscopy (43200) because the RVU's are lower than the colonoscopy (45378). 45378, 43200-51.
What is the modifier 51 guideline?
CPT guidelines explain the 51 modifier should apply when “multiple procedures, other than E/M services, are performed at the same session by the same individual. The additional procedure(s) or service(s) may be identified by appending modifier 51 to the additional procedure or service code(s).”
What is discharge code 69?
Patient Discharge Status Code 69 - Discharged/transferred to a Designated Disaster Alternative Care Site.
What is discharge code 55?
This CR requires that hospice agencies report occurrence code 55 to report date of death. If a discharge status code of 40 (expired at home), 41 (expired in medical facility), or 42 (expired – place unknown) is present on a hospice claim, occurrence code 55 with date of death must also be present on the claim.
What is discharge code 42?
In Med Learn Matters SE0801, CMS states condition code 42 is to be used to indicate home care continuing post-discharge that is not related (i.e. condition or diagnosis) to the inpatient admission.