Did You Know Putting Condition Code D9 on Your Claim Will Cause it to Suspend?

When you make an adjustment or cancel a previously processed claim, you are required to include a condition code on your claim that explains the reason for the change. Only one claim change condition code may be reported on the claim. Providers should assure they select the one that best describes the claim change even if more than one change was made to the claim. Providers are also reminded not to select D9 unless no other code applies as it will cause the claim to suspend for manual review. 

Claim Change Reasons:

  • D0 - Changes to service dates

  • D1 - Changes in charges

  • D2 - Changes in revenue code/HCPC

  • D3 - Second or subsequent interim PPS bill

  • D4 - Change in Grouper input (DRG)

  • D5 - Cancel only to correct a patient's Medicare ID number or provider number

  • D6 - Cancel only - duplicate payment, outpatient to inpatient overlap, OIG overpayment

  • D7 - Change to make Medicare secondary payer

  • D8 - Change to make Medicare primary payer

  • D9 - Any other changes

Contact Palmetto GBA JM Part HHH Medicare

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Provider Contact Center: 855-696-0705

TDD: 866-830-3188

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