What is the condition code in medical billing?
Asked by: Una Schroeder | Last update: February 10, 2025Score: 4.3/5 (23 votes)
What is conditions code?
a set of single bits that indicate specific conditions within a computer. The values of the condition codes are often determined by the outcome of a prior software operation and their principal use is to govern choices between alternative instruction sequences.
What is the 30 condition code?
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 C mean?
C. SERVICEABLE (PRIORITY ISSUE) Items which are serviceable and issuable to selected customers, but which must be issued before SCCs A and B materiel to avoid loss as a usable asset. Includes materiel with less than 3 months shelf-life remaining.
What is a claim related condition code?
The code that indicates a condition relating to an institutional claim that may affect payer processing.
WHAT ARE CONDITION CODES IN MEDICAL HOSPITAL BILLING | UB04
What is a billing condition code?
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 condition code 84?
For payment under Medicare, ESRD facilities shall report all items and services furnished to 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 does condition code D mean?
D Serviceable (Test/Modification). Serviceable materiel requiring test, alteration, modification, technical data marking, conversion, or disassembly. Includes items that require surveillance laboratory analysis, functional testing, and technical evaluation by higher authority to verify serviceability.
What is condition code H?
Supply Condition Codes
Economically repairable property which requires repair, overhaul or reconditioning; includes repairable items which are radioactively contaminated. H. Property which has been determined to be unserviceable and does not meet the repair criteria.
What does C5 condition code mean?
The patient's need for inpatient services was reviewed and the QIO found that none of the stay was medically necessary. C5. Post-payment Review Applicable. Any medical review is completed after the claim is paid.
What is 20 condition code?
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 condition code 40 used for?
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 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 30?
• Condition code 30 (qualifying clinical trial) is reported at the claim level. Page 14. • HCPCS modifier 'QV' (only for institutional outpatient claims) • Diagnosis code V70.7 (Examination of participant in clinical trial) reported as the. secondary diagnosis.
What are conditions coding?
In computer science, conditionals (that is, conditional statements, conditional expressions and conditional constructs) are programming language constructs that perform different computations or actions or return different values depending on the value of a Boolean expression, called a condition.
What is a condition code 21 billing?
These no-payment claims are referred to as “billing for denial” when they are submitted with the condition code 21 (billing for denial notice).
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 h?
Condition H provides patients, family members and visitors direct access to emergency response when there are sudden changes or concerns about a patient's condition.
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 a condition code in medical billing?
As per National Uniform Billing Committee (NUBC), condition codes help identify conditions or events related to the bill. These are specific form locators in the UB-04 form to describe the conditions or events for the applicable billing period.
What is condition code 07?
07. Treatment of a non-terminal condition for a hospice patient. Report this code when the patient has elected hospice care, but the provider is not treating the patient for the terminal condition.
What is condition code A6?
Condition code “A6” is required when billing the influenza or pneumococcal vaccine(s) and/or administration.
What is condition code 80?
80 Home Dialysis in Nursing Facility (NF) – Beneficiary receives home dialysis in NF including SNF. (Effective 3/3/05.)
What is condition code 44 billing?
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.
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.