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May 30, 2019

Billing Reminder: Claim Change Reason (Condition) Code D9

A claim change reason code is submitted when adjusting or canceling a claim. Each of the claim change reason codes are used to describe a specific reason for adjusting or canceling a claim. Only one code can be submitted on the adjustment or cancel claim. Providers should choose the one claim change reason code that best describes the adjustment request.

What You Need to Know
The claim change reason code D9 is used when an adjustment (type of bill XX7) is submitted with when multiple changes are being made, or any change not identified by the other claim change reason codes. When a D9 claim change reason code is submitted, CGS is required to suspend the adjustment request and investigate. Therefore, it is important that you include a detailed explanation of what is being adjusted in the Remarks field (UB-04 FL 80 / FISS Claim Page 04). If an explanation is not provided, your adjustment request will be sent to the return to provider (RTP) file with reason code 37541.

The following chart provides a description for each of the claim change reason (condition) codes.


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