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Elizabeth M. Whitehorn, Director

Provider Notice issued 05/23/03

New UB-92 Condition Codes for Abortion Procedures

​To: ​Enrolled Hospitals
​Date: ​May 23, 2003
​Re: ​New UP-92 Condition Codes for Abortion Procedures

 

The National Uniform Billing Committee (NUBC) approved a national condition code list relating to abortion procedures. The new codes were effective for dates of service on or after October 1, 2002.

The Department previously used local condition codes A7, A8, and 96 to identify conditions relating to abortion services, and has continued to accept claims containing these condition codes. However, effective for inpatient admissions or outpatient service dates on or after October 15, 2003, the Department will no longer accept claims containing condition codes A7, A8, or 96.

The Department only reimburses for abortion procedures performed under limited circumstances, and will not utilize all of the new NUBC condition codes. Only new condition codes AA, AB, AD, and AE will be accepted, pursuant to Department policy regarding payment for abortion services. The appropriate condition code must still be placed within Form Locators 24-30 on the UB-92 claim format.

The condition codes are defined by the NUBC as follows:

AA

Abortion Performed Due to Rape

AB

Abortion Performed Due to Incest

AD

Abortion Performed Due to a Life Endangering Physical Condition Caused By, Arising From or Exacerbated By the Pregnancy Itself

AE

Abortion Performed Due to Physical Health of Mother That Is Not Life Endangering

If you have any questions regarding this notice, please contact your hospital's medical assistance consultant in the Bureau of Comprehensive Health Services at 217-782-5565.

Anne Marie Murphy, Ph.D.

Administrator

Division of Medical Programs