What is a condition code 69?
Asked by: Dr. Brook Leffler DDS | Last update: July 14, 2025Score: 4.1/5 (19 votes)
What is patient status code 69?
69 Discharged/transferred to a designated disaster alternative care site. 70 Discharged/transferred to another type of healthcare institution not defined elsewhere in this code list.
What is a condition code on a medical claim?
Condition codes (a.k.a. reason 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 a facility claim.
What is the condition code 68 for Medicare?
Condition code 61 -- a code that indicates this bill is a cost outlier. Click here for an example. Condition code 67 -- a code that indicates the beneficiary has elected not to use lifetime reserve (LTR) days. Condition code 68 -- a code that indicates the beneficiary has elected to use lifetime reserve (LTR) days.
What is Medicare 64 condition code?
Enter condition code 64 to indicate that the claim is not a "clean" claim, and therefore, not subject to the mandated claims processing timeliness standard. 5. Interest Payment on Clean Non-PIP Claims, Not Paid Timely.
WHAT ARE CONDITION CODES IN MEDICAL HOSPITAL BILLING | UB04
What is Medicare condition code 69?
Condition code 69 (teaching hospitals only - code indicates a request for a supplemental payment for Indirect Medical Education/Graduate Medical Education/Nursing and Allied Health)
What is 56 condition code?
Condition code 56 (Medical Appropriateness) the patient's SNF admission was delayed more than 30 days after hospital discharge because the patient's condition made it inappropriate to begin active care within that period.
What is the Medicare condition code 73?
73 Self-Care in Training - Providers enter this code to indicate the billing is for special dialysis services where a patient and his/her helper (if necessary) were learning to perform dialysis. 74 Home – Providers enter this code to indicate the billing is for a patient who received dialysis services at home.
What is the Medicare code 70?
New Patient Status Discharge Code 70 to Define Discharges or Transfers to Other Types of Health Care Institutions not Defined Elsewhere in the UB-04 (CMS-1450) Manual Code List.
What is Medicare condition code 49?
Condition codes 49 or 50 identify a replacement device, and value code FD communicates the credit amount or the replaced device cost reduction.
What is a Medicare condition code 65?
Status Code 61 - Discharged/transferred to a hospital-based, Medicare- approved swing bed. Status Code 65 - Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital (for future use).
What is condition code 71?
71 - Full Care in Unit - Providers enter this code to indicate the billing is for a patient who received staff-assisted dialysis services in a hospital or renal dialysis facility.
How to bill Medicare benefits exhausted?
A TAR is required to bill Medi-Cal for Part A benefits exhausted. The Part B payment is entered in the Prior Payment field (Box 54) on the UB-04 claim. (Inpatient Medicare Part A coinsurance and deductible in this example were previously billed on a separate UB-04 claim for Part A covered days.)
What is specialty code 69?
69. Clinical laboratory (billing independently) 70. Single or Multi-specialty clinic or group practice (PA Group)
What is the denial code 69?
What is Denial Code 69. Denial code 69 refers to a day outlier amount. This means that the claim has been denied because the billed amount for a specific day of service exceeds the expected or usual amount for that particular service.
What is ICD 10 code 69?
69 is a specific code within the ICD-10 classification system that falls under the broader category of codes for diabetes mellitus. Type 2 diabetes mellitus is a chronic condition characterized by insulin resistance and impaired insulin secretion.
What does code 70 mean in a hospital?
70. Discharged / transferred to another type of health care institution not defined elsewhere in this list. 82. Discharged / transferred to a short-term general hospital for inpatient care with a planned acute care hospital inpatient readmission.
What is Medicare condition code 68?
To indicate that the beneficiary does or does not wish to utilize their lifetime reserve days, adhere a condition code 67 or 68 when submitting the claim. Remarks are not necessary.
What is the 30 day rule for Medicare?
You must enter the SNF within a short time (generally 30 days) of leaving the hospital and require skilled services related to your hospital stay. After you leave the SNF, if you re-enter the same or another SNF within 30 days, you don't need another 3-day qualifying hospital stay to get additional SNF benefits.
What is the condition code 69?
The provider uses Condition code 69 to indicate that the claim is being submitted as a no-pay bill to the PS&R report type 118 for MA enrollees in non-IPPS hospitals and non-IPPS units to capture MA inpatient days for purposes of calculating the DGME and/or N&AH payment through the cost report.
What is condition code 80?
Condition code 80 refers to the Home Dialysis-Nursing facility. The subcodes starting from 81-99 get reserved by NUBC. In addition to numeric codes, the alphanumeric condition codes help with medical programs and procedures.
What is the 57 condition code?
However, the definition for condition code 57 indicates the patient previously received Medicare covered SNF care within 30 days of this readmission and would not necessarily apply in all payment ban situations.
What is the condition code 64 for Medicare?
When a claim is suspended and an additional documentation request is triggered, Medicare systems append condition code 64 (other than clean claim) on the claim record. It is appropriate for condition code 64 to be added to these claims, since the documentation request has occurred.
What is condition code 47?
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 is condition code 44 requirements?
Condition Code 44 is a billing code used when a hospital determines that a traditional Medicare patient admitted as an inpatient does not meet the medical necessity for inpatient care.