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.
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Fee schedules, relative value units, conversion factors and/or related components are not assigned by the AMA, are not part of CPT, and the AMA is not recommending their use. The AMA does not directly or indirectly practice medicine or dispense medical services. The AMA assumes no liability for data contained or not contained herein.
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