Issue 2006-05, May 2006

Updated Instruction for Submitting SNF Adjustments for Changing a HIPPS Code

Providers should disregard previous instructions for adjusting the Health Insurance Prospective Payment System (HIPPS) code on Part A SNF inpatient claims. Begin using these new instructions immediately.

For new adjustments being submitted with any HIPPS code changes, use the D4 adjustment reason code in the condition code field.

The following are the most common reasons to change a HIPPS code:

1. The RUG code changes due to Minimum Data Set (MDS) correction - D4

2. The HIPPS code needs to be changed due to a clerical error - D4

Very Important – Please Read
For HIPPS code adjustments that were previously processed with no reimbursement to the provider, please send an adjustment to the adjustment that was not reimbursed. Use the D9 adjustment reason code condition code and indicate in remarks that you are adjusting because you received no reimbursement on your previous adjustment. These adjustments will be processed with reimbursement.

The narrative for reason code 37559 has been updated to reflect these new instructions.

37559 Condition code D4 is required when the adjustment is due to a change in the HIPPS code and the HIPPS codes on the adjustment and original bill are not the same. Correct and resubmit if appropriate.

NOTE: If submitting an adjustment for the first time, condition code D4 is required. However, if adjustment was previously submitted and processed with no reimbursement, condition code D9 should be used on the second adjustment with remarks stating “adjusting due to no reimbursement.”