Cardiology Question for the Week of June 25, 2018

Cardiology Compliance Question of the Week

Question:

For Medicare claims, what condition codes should hospitals report for device-replacement procedures that occur from a recall or premature failure (whether the device is provided at no cost or with a credit)?

Answer:

According to the Centers for Medicare & Medicaid Services, hospitals are required to use one of the following condition codes:

49 Product replacement within product lifecycle—replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly
50 Product replacement for known recall of a product—manufacturer or Food & Drug Administration has identified the product for recall and therefore replacement.

This information can be found in the Medicare Claims Processing Manual, Chapter 3—Inpatient Hospital Billing, section 100.8 at https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Downloads/clm104c03.pdf.

Disclaimer: Every reasonable effort was made to ensure the accuracy of this information at the time it was published. However, due to the nature of industry changes over time we cannot guarantee its validity after the year it was published.