D9 Condition Code Remarks

I have a claim in Return to Provider (RTP) status with a D9 condition code and it will not process, what do I need to do to get this claim to process?

Providers need to verify they are using the condition code D9 appropriately. If no other condition code describes your reason for the adjustment, then use condition code D9. If a provider submits an adjustment claim to Medicare with condition code D9, the claim will have to have one of the verbatim remarks as indicated below in order for the claim to process. If a provider submits an adjustment with condition code D9 and there are no remarks or they do not have any of the remarks listed below "verbatim," then Medicare will return the claims back to the provider to correct with reason code 37541.

Please make sure what is bold below is entered verbatim on the first line of the "Remarks" section. This should be the only thing on the first line of remarks:

  • Patient control nbr - If you are changing or adding a patient control number
  • Admission hour - If you are changing or adding the admission hour
  • Admission type - If you are changing or adding the admission type
  • Admission source - If you are changing or adding the admission source
  • Medical record number - If you are changing or adding the medical record number
  • Condition code - If you are changing or adding a condition code
  • Occ codes - If you are changing or adding an occurrence code
  • Occ span codes - If you are changing or adding an occurrence span code. Example if you are adding a 3 day qualifying hospital stay
  • Value codes - If you are changing or adding a value code
  • Modifier - If you are changing or adding a modifier
  • Date of service - If you are changing a date of service on a line or changing the statement from and to dates, use a D0.
  • Units - If you are changing units
  • Conditional payment - This should only be used if the original claim has rejected with a MSP reason code and a conditional payment is being done
  • Recalculation - If you want your claim recalculated for a different payment
  • IME payment - If you are adjusting your claim for an IME payment
  • Multiple changes - Please put what your changes are. Example: If you are changing a modifier and a unit
  • Other - These claims will suspend to a file location if the remark is not valid

Choosing a remark listed above will prevent the claim being returned back to you.

Page Last Updated: Thursday, 05-Apr-2012 11:37:24 CDT