Which requirement must be met to bill a Condition Code 44?

• A. The change must be made prior to discharge.
• B. The claim has not been submitted.
• C. The MD concurs with the UM decision.
• D. The occurrence is documented in the medical record.

Answer: (A)

Timing of changes to a hospital claim matters. To bill this code, the change must be entered before the patient is discharged. Implementing the adjustment while the claim is still open ensures the claim reflects the final status and billing details at the time of discharge, which keeps payments and DRG calculations accurate and avoids post-discharge edits that can delay payment or trigger audits. If the discharge has already occurred, this code isn’t billable; other adjustment pathways would apply instead. The other options describe conditions that aren’t about when the change can be made, so they don’t determine eligibility for this code.