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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