Condition Code 53

kendalb

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Would condition code 53 (initial placement of a medical device provided as part of a clinical trial or a free sample) be used for a chemo patient that is receiving free drugs? I need to notify the payer that the drug are being provided at no charge.

Any insight will be helpful.
 

thomas7331

True Blue
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I believe condition code 53 is specific to devices. I don't know of a specific guideline set up for drugs provided at no cost, but for payers requiring the drug coding to be on the claim, in the past we had success by using modifier FB and billing a $0.00 charge, or a $0.01 charge if the billing system or clearinghouse does not allow for a zero dollar charge to appear on the claim.
 
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According to the MAC for my area, if the drugs were free, as in donated, then you'd enter this information on the 1500 form:
Item 19 "Drug Donated"
Item 24D Drug (HCPCS) code
Item 28 billed amount of $0.01

This may differ from the guidelines where you are.

If the drugs were free because the facility is doing a charity write-off for the patient, then that's a whole different situation.
 
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