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FISS/DDE Provider Online Guide: Resources


FISS Claim Change/Condition Reason Codes

The following adjustment/cancel claim change reason codes may be reported in the COND CODE field on CLAIM PAGE 01 of the adjustment/cancel claim record.

For Adjustment Claims Only (TOB XX7)

Condition Code Description
D0 Change in service dates
D1 Change in charges
D2 Change in revenue code/HCPCS/HIPPS
D3 Second or subsequent interim PPS payment
D4 Change in diagnosis/procedure code
D7 Change to make Medicare secondary
D8 Change to make Medicare primary
D9 Other change
E0 Change in patient status

For Cancel Claims Only (TOB XX8)

Condition Code Description
D5 Incorrect MID/provider number
D6 Duplicate/Overpayment
  • Only one reason code may be reported on the adjustment/cancel claim request
  • If more than one reason could apply, choose the single reason that best describes the adjustment being requested
  • Use reason code D1 only when the charges are the only change on the claim
  • If reason code D9 is reported, indicate the reason for the adjustment in the REMARKS field on CLAIM PAGE 04

 

FISS/DDE Provider Online Guide: Resources - FISS Claim Change/Condition Reason Codes
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