Box 18-28 - Condition Codes

  • Updated

Box Definition

Boxes 18-28 are patient condition codes.  These codes are used to report conditions or events related to the bill that may affect the processing of the bill.  Condition codes should be entered in a two-character alphanumeric or numeric sequence and occur no more than 11 times on a claim instance.




CMS-1500: N/A

In AveaOffice:

Condition codes can only be added in AveaOffice by creating a claim rule. See Service Grouping Rule - Adding Patient Condition Codes for steps on creating the rule.

To create a new Service Grouping Rule, first navigate to Management Center > Claim Rules > Create Service Grouping Rule.



From there you will want to specify the service, the conditions of the claim rule, and the condition code(s) requested by the payer.




EDI Loop/Segment

Loop 2300, Segment HI, Qualifier BG



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