What is condition code 69?
Asked by: Vallie Prosacco | Last update: September 5, 2023Score: 4.2/5 (6 votes)
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 are condition codes on UB04?
Condition codes are a 2-digit numerical or alphanumeric representation of aspects of a patient, services provided, the type of service venue, and/or billing situations that can impact the processing of an institutional claim by a payer. These codes are listed in boxes 18-28 on the UB04 form.
What does condition code D9 mean?
The claim change reason code D9 is used when an adjustment (type of bill XX7) is submitted with when multiple changes are being made, or any change not identified by the other claim change reason codes. When a D9 claim change reason code is submitted, CGS is required to suspend the adjustment request and investigate.
What is the condition code 67?
Outlier related definitions
Condition code (CC) 61: Cost outlier. Providers do not report this code. Indicates the bill is paid as an outlier. CC 67: Report this code to indicate the beneficiary has elected not to use LTR days.
What is the condition code 64?
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.
Status Register / Condition code
What does condition code 77 mean?
Condition code (CC) 77, is entered when a provider accepts or is obligated/required due to a contractual arrangement or law to accept payment from the primary payer as payment in full.
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 71 condition code?
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.
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 is condition code 72?
This code is commonly used to indicate that the patient has passed two necessary midnights in the hospital, but less than two as inpatient. This code will not exempt the admission from audit, but it doesn't necessarily indicate that auditing these cases will result in an automatic denial.
What does condition code 51 mean?
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 condition code 49?
49 Product Replacement within Product Lifecycle Replacement of a product earlier than the anticipated lifecycle. 50 Product Replacement for Known Recall of a Product Manufacturer or FDA has identified the product for recall and therefore replacement.
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 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 is a condition code 89?
Condition Code 89: Opioid Treatment Program/Indicates claim is for opioid treatment program services.
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 50?
• Occurrence Code 50: Assessment Date is defined as “Code indicating an assessment date as defined by the assessment instrument applicable to this provider type (e.g. Minimum Data Set for skilled nursing). For IRFs, this is the date assessment data was transmitted to the CMS National Assessment Collection Database.”
What is condition code 27?
This code can be used only when the beneficiary has revoked the benefit, has been decertified or discharged. It cannot be used in transfer situations. Occurrence code 27 is reported only on the claim for the billing period in which the certification or recertification was obtained.
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 62?
62 PIP bill not reported by providers. Bill was paid under PIP and recorded by system. 63 Bypass CWF edit for incarcerated beneficiaries. Services rendered to a prisoner or a patient in State or local custody (meets requirements of 42 CFR 411.4(b) for payment).
What is condition code 84?
AKI Claim Criteria
For payment under Medicare, ESRD facilities shall report all items and services furnished to be beneficiaries with AKI by submitting the 72x type of bill with condition code 84 – Dialysis for Acute Kidney Injury (AKI) on a monthly basis.
What is condition code 85?
Condition code 85 (delayed recertifcation of hospice terminal illness) is also required for claims received on or after 01.01.
What is condition code 07?
Condition Codes
For a complete list of codes, see the NUBC manual. 07 Treatment of Non- terminal Condition for Hospice Code indicates the patient has elected hospice care but the provider is not treating the terminal condition, and is, therefore, requesting regular Medicare payment.
What is condition code 01?
For example, the sub-code 01 refers to the Military Service-Related situation explained as medical conditions incurred during military service. The sub-code 09 refers to Patient is Homeless explained as the patient is homeless.
What is condition code 29?
Condition code 29 is used to identify when a disabled beneficiary and/or family member's large group health plan (LGHP) is secondary to Medicare.