What is the condition code 69?
Asked by: Toni Littel | Last update: November 24, 2025Score: 4.5/5 (27 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 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 a 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 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 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.
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 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 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 16?
16. A severe error occurred that erased the remainder of the command stream. This condition code results from one of the following: The program cannot open a system output data set. (For example, a SYSPRINT DD statement was missing.)
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 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 is 69 condition code?
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 condition code 72?
Occurrence Span Code 72 to track the total, contiguous outpatient care prior to inpatient. admission in the hospital. This will enable CMS to identify claims in which the beneficiary. received care as an outpatient for 1 or more midnights and was subsequently admitted as an.
What is condition code 40?
Same Day Transfer
SNF admits a patient who's expected to stay overnight but transfers before the following midnight to a Medicare-participating facility. Report: Same admission From and Through dates. Zero covered days. Condition Code 40.
What is the condition code 64?
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 a condition code 44?
, condition code 44 is: For use on outpatient claims only, when the physician ordered inpatient services, but upon internal utilization review performed before the claim was originally submitted, the hospital determined the services did not meet its inpatient criteria.
What is 27 condition code?
Hospitals may append modifier –27 to the second and subsequent E/M code when more than one E/M service is provided to indicate that the E/M service is “separate and distinct E/M encounter” from the service previously provided that same day in the same or different hospital outpatient setting.
What is condition code 01?
Understanding the Conditions/Situations Mentioned by NUBC
The NUBC's 2007 manual lists 99 situations with numeric codes ranging from 01-99. For example, sub-code 01 refers to the Military Service-Related situation explained as medical conditions incurred during military service.
What is condition code 92?
New condition code "92" identifies claims for Intensive Outpatient Program (IOP) services. Intensive Outpatient Program (IOP) services will get per diem payments under the Outpatient Prospective Payment System (OPPS) when billed by an OPPS provider.
What is a condition code 52?
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.