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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

Revised 9/13/2018