Add or Remove Condition Codes

This rule is used to add or remove condition codes from a claim. Claim condition codes can only be added when the claim has been corrected and a rule is in place.

Workflow

Let's review how to create a claim rule to add or remove add or remove condition codes on a claim!

• 1. Navigate to Management Center > Claim Rules.
     
     
  2. Click Create Claim Form  Rule.
     
  3. Select the Practice.
     
  4. Next, give the rule a name.
  5. Update the Claim Type to Institutional or Professional.
     
  6. Select Conditions to create criteria a claim should meet before the rule will apply.
     
  7. Next, click on the Behaviors dropdown.
  8. Select Claim Condition Codes.
     
     
  9. Next, click Add.
     
  10. Update the dropdown to one of the following choices:
      1. Omit to create the claim without the Condition Code when present.
      2. Require and Write to Claim to always require the Condition Code to be written. 
      3. Write to Claim if Present to only include the condition code when that information is selected during the correction process.
         
  11. To create multiple behaviors, repeat steps 7-10.
  12. Click Save to complete the process.
       

Box Number(s)

• UB-04:  Box 18-28 - Condition Codes
• CMS-1500: Box 10d - Claim Codes

Helpful Hints

• If one of your conditions is payer-based, select Current Sequence Behavioral instead of the Primary Behavioral Payer. This will ensure the rule applies to secondary and tertiary claims when needed. 
• To read more about how to set claim rule conditions and order, see the Claim Rule: Setting Claim Rule Conditions article.
• To read more about how to set up a claim rule to be effective as of a certain date, see the Scheduled Change Sets article.