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Back  RFI # 1005: Loop2300:HI

Formal vs. Informal Help Informal Formal

Submitter

Deepti Dabral

Description

2300 Loop: HI - CONDITION INFORMATION segment: It just says Required when condition information applies to the claim. Not sure what it means. Is this segment required for Eye care industry? What is the industry code and do we need to generate HI02 till HI09? From where can we get the code list?

Response

This issue is addressed in guide 005010X222. Condition Codes are one set of codes available from the NUBC under code source # 132. Submitters are responsible for monitoring external code lists and using them when a code represents information applicable to that claim." . Required when Condition Code information applies means, if the condition identified by the code is present, then the Condition Code must be sent. For instance, if an elective abortion was performed Condition Code AH must be sent to identify this condition was present on the claim. Only the conditions present must be sent. If only one condition is present then only the HI02 is sent. Other HI elements would only be sent if numerous conditions were present.

Recommendation

Condition Codes valid for use on the professional claim are available from

National Uniform Claim Committee, web site at www.nucc.org

These codes have been posted on the NUCC website with the permission of the National Uniform Billing Committee (NUBC).

American Hospital Association

One North Franklin

Chicago, IL 60606
Submission 3/25/2010
Status Date 5/28/2010
Status F - Final
Primary References
Document 005010X222
Section2.4
Page252
Set ID837