Adjustment/Cancel Condition Codes

Use this reference guide to determine which condition code would be most appropriate in coding your adjustment/cancel claim.

D0 (zero) This code should be used when the From and Thru date of a claim is changed. 

*When you are only changing the admit date use condition code D9. 

D1 If another condition code does not apply and there is a change to the COVERED charges, this code should be used. 

*Use this code when adding a modifier to a line that would make the charges covered on the adjustment claim that were non-covered on the previous claim.

*Use this code when the previous claim rejected for home health, hospice, HMO and other overlap reasons that have been updated.

D2 This code is used when there is a change to the revenue codes, HCPC codes or HIPPS code. *This code is not used for a change in the RUG code. 

D3 This code is used for a second or subsequent interim PPS bill by inpatient PPS hospitals only.

D4 Change in grouper input (ICD Diagnosis codes, ICD Procedure codes, and RUG codes) 

*This code is only used if a provider is changing or adding an ICD or RUG code. 

* If the provider is only deleting these codes, then the D9 with remarks would be more appropriate.  

D5 This code is used when canceling a claim to correct the HIC number or provider number. 

*Condition code only applicable on an xx8 type of bill. 

D6 This code is used when canceling a claim for reasons other than the HIC number or provider number. Used when canceling a claim to repay a payment. 

*Condition code only applicable to an xx8 type of bill. 

D7 This code should be used when the original claim shows Medicare on the primary payer line and now the adjustment claim shows Medicare on the secondary payer line. 

D8 This code should be used when the original claim shows Medicare on the secondary payer line and now the adjustment claim shows Medicare on the primary payer line. 

D9 This code is used for adjustments not described in any other condition codes. Remarks are required when using the D9 condition code to make a change. 

*This code is used in place of the D7 when adjusting the claim for “conditional payment”. 

*This code is used if adding a modifier to change liability and there is no change to the covered charge amount. 

*This code is used when adding or changing occurrence, occurrence span and/or value codes that do not affect the covered charges. 

E0 (zero) This code is used when the ONLY change on the claim is a correction to the patient status.