Condition Code in Medical Billing
A condition code in medical billing is a two-digit code used on claims to provide additional information about a patient’s condition or circumstances that may affect payment.
Condition Code in Medical Billing Explained
Condition codes are used to describe specific situations related to the patient’s care, such as whether the services were medically necessary, provided in a specific facility, or related to certain coverage policies. These codes help payers make decisions about claim approval and payment.
For example, a condition code might be used to indicate that a service was provided as part of a research study or that it was an emergency treatment.
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