Chapter IV: Inquiries Submenu (01)
Adjustment Reason Codes (16)
Purpose
An adjustment reason code is a two-digit alphanumeric code reported on a claim adjustment to identify the specific reason the claim is being adjusted.
This option allows you to review the available adjustment reason codes so that the appropriate coding can be included on the adjusted claim.
The Adjustment Reason Codes option is used to validate the adjustment reason code a provider can enter on a claim adjustment.
To access the ADJUSTMENT REASON CODES option from the FISS Online System INQUIRIES submenu, type ‘16’ at the Enter Menu Selection: prompt, then press <Enter>.
Upon selecting the ADJUSTMENT REASON CODES option, the initial Adjustment Reason Codes Inquiry Selection Screen is available:
| Field | Description |
|---|---|
| PLAN CODE | Plan Code - used to differentiate between MACs that share a processing site (one-position numeric field). The valid values are 1 through 9. Default value = 1 |
| REASON CODE | Allows you to enter the adjustment reason code you want to review (two-position alphanumeric field) |
| S | Selection option (one-position alpha field) |
| PC | Plan Code - used to differentiate between MACs that share a processing site (one-position numeric field). The valid values are 1 through 9. Default value = 1 |
| RC | Adjustment Reason Code (two-position alphanumeric field) |
| HC | HIGLAS Adjustment Reason Code (two-position alphanumeric field) Note: This field only displays on NON-HIGLAS sites. |
| TYPE | Claim Type - identifies the type of claim associated with this reason code (one-position alpha field) Valid Values (also listed on screen under CLAIM TYPES): I - Inpatient/SNF O - Outpatient H - Home Health/CORF A - All claims |
| NARRATIVE | Narrative - displays the short description for the adjustment reason code (64-position alphanumeric field) |
To view a list of all adjustment reason codes, press the <Enter> key. The Adjustment Reason Codes Inquiry Selection Screen refreshes to provide a list of available adjustment reason codes, including the details reported by the screen’s fields.
The adjustment reason codes are listed in alphanumeric order, starting with Adjustment Reason Code AA. Press the <F6/PF6> key to scroll forward to access additional codes.
To review the narrative and details for a specific adjustment reason code, tab down to the appropriate adjustment reason code, type an S in the S (Selection) field and press the <Enter> key. The ADJUSTMENT REASON CODE UPDATE SCREEN INQUIRY screen will be displayed.
In the example included below, Adjustment Reason Code OC is displayed:
| Field | Description |
|---|---|
| PLAN CODE | Plan Code - used to differentiate between MACs that share a processing site (one-position numeric field). The valid values are 1 through 9. Default value = 1 |
| REASON CODE | Allows you to enter the adjustment reason code you want to review (two-position alphanumeric field) |
| HIGLAS REASON CODE | HIGLAS Adjustment Reason Code (two-position alphanumeric field) Note: This field only displays on NON-HIGLAS sites. |
| CLAIM TYPE | Claim Type - identifies the type of claim associated with this reason code (one-position alpha field) Valid Values (also listed on screen under CLAIM TYPES): I - Inpatient/SNF O - Outpatient H - Home Health/CORF A - All claims |
| NARRATIVE | Narrative - displays the short description for the adjustment reason code (64-position alphanumeric field) |
There is another method for reviewing the narrative and details for a specific adjustment reason code.
From the initial Adjustment Reason Codes Inquiry Selection Screen, type the adjustment reason code in the REASON CODE: field, and press the <Enter> key. The ADJUSTMENT REASON CODE UPDATE SCREEN INQUIRY screen will be displayed.
In the example included below, Adjustment Reason Code OC is displayed.
Revised 8/16/2023