Assigning the correct patient discharge status code is just as important. Ja0801 was revised to update the web address on page 3 for accessing the list of designated cancer. Occurrence codes and dates refer to the ub04 data specifications manual for usage requirements. A detailed description for each code may be found in wha information centers ub04 discharge status codes document. The patient status code form locator 17 on the ub04 claim form identifies patient status as of statement covers through date and is required on all institutional inpatient and outpatient claim types. Hospital ub04 claim filing instructions, section 2 billing book. Instructions for completing the ub04 claim form the ub04 claim form is used to submit claims for inpatient and outpatient services by. Fl 16 discharge hour 21 fl 17 patient status 21 fl 1828 condition codes 23 fl 29 accident state 32 fl 30 reserved for assignment by nubc 32 fl 34 occurrence codes and dates 32 fl 3536 occurrence span codes and dates 36 fl 37 not used 38. Use is limited to use in medicare, medicaid, or other programs. Patient discharge status code ffs back to top this variable is contained in the following files.
Completing the ub04 claim form guidelines for facility. Clarification of patient discharge status codes and hospital transfer policies ja0801. Use the twodigit codes from the nubc manual for up to 11 occurrences. Section 2 ub04 claim filing instructions november 2012 2. For these and other discharge codes, and for assistance in the proper reporting of patient discharge status, please refer to the national uniform billing committee. A complete listing of all codes is accessible from the national uniform billing committee nubc official ub04 data specifications manual type of bill tob fl 4. Patient control number enter your facilitys unique account number. Oct 29, 2007 1 select ub04 claim submission from the top menu or click on the new ub04 claim the following fields will need to be completed under the service use. The ltchcare data set is the assessment instrument used for all patients receiving inpatient services in a facility certified as a hospital and designated as a ltch under the medicare program. The ub04s are similar to the cms or hcfa 1500 forms, but used by hospitals and clinics rather than physician or other provider services. The ub04 paper claim form should be legibly printed by hand or electronically. A patient discharge status code is a twodigit code that identifies where the patient is at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a claim.
Tips for completing the ub04 cms1450 claim form 9b unlabeled field required this field is for entering the patients city. Based on location and status combination reason code is to. The codes are grouped for wish wisconsin interactive statistics on health as shown in the table below. A patient discharge status code is a twodigit code entered into form locator fl 17 on the ub04 claim form that identifies the patients status at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a claim found in fl 6 on the ub04. We are actively responding to all phone and email inquiries. Conditional c fields must be completed if the information applies to the situation or the service provided. Indicate the beneficiarys disposition or discharge status at the end of service for the period covered on this bill, as reported in field 6, statement covers period. Ub04 discharge status codes a patient discharge status code is a twodigit code entered into form locator fl 17 on the ub04 claim form that identifies the patients status at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a claim found in fl 6 on the ub04. New patient discharge status codes on ub04 claim form effective october 1, 20. Changes are being made to various software modules to accommodate this change and allow these additional codes to be processed. The logic of the grouper software assumes that this information is accurate and the grouper does not make any. New patient discharge status codes on ub04 claim form effective october 1, 20 the national uniform billing committee nubc was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and payers for handling health care claims.
Enter the appropriate code to indicate patient status as of the statement covers through date. Ub04 claim form instructions geisinger health plan. Place 61 in the first value code field locator and the cbsa code in the dollar amount. This manual, ed by the american hospital association, is the only official source of ub data. A patient discharge status code is a twodigit code that identifies where the patient is at the conclusion of a health care facility encounter or at the end of a billing cycle the through date of a claim. Unitedhealthcare community plan will deny claims when the patient discharge status is inconsistent with the type of bill reported. The codes listed on this billing codes sheet represent those most frequently submitted on home health rapsclaims. Patient discharge status conditionally required 1828. The discharge status code identifies where the patient is being. The patient discharge status code indicates the disposition or discharge status of the hospitalized patient.
Pay to address pay to address if different than field 1. Discharged transferred to a nursing facility certified under medicaid but not certified under medicare. The joint commission is aware that there are additional ub04. Patient assessment information is collected on admission, at discharge and death. Ensuring occurrence code 22 is billed correctly on skilled implementation date. Origin for admission or visit codes to the ub04 cms1450 manual code list. New patient discharge status codes on ub04 claim form. Mississippi medicaid provider billing handbook section. Sep, 2017 general information is also provided about the use of national ub04 revenue codes. Point of origin for admission or visit codes centers for medicare this article is based on change request cr 6801 which updates the pointof.
The patient discharge status codes listed below is not an allinclusive list. Following is a comprehensive breakdown in specific detail of features required in ub04 software to ensure ub04 billing success. Patient discharge status enter the code indicating the disposition or discharge status of the patient on the ending service date of the period covered on this bill, as reported in fl6. Hospital ub04 claim filing instructions, section 2. Billing code 412001p department of health and human 31 jul 2018. In light of the evolving covid19 situation, we want to assure you that resdac remains open for business. Icd10 cm codes for claims with discharge date on or after october 1, 2015 can be reported. Required 1828 condition codes 1828 enter condition codes if they are applicable. Required for inpatient, hospice, and nursing home claims. How to code the ub04 billing medicare part a for snf services is a game of numbers, but, believe it or not, the digits of interest are not dollar amounts. Learn vocabulary, terms, and more with flashcards, games, and other study tools. The ub04 form locator tool is designed to help facilities understand the definitions of the codes needed for claim submission.
Clarification of patient discharge status codes and hospital cms. Enter the appropriate twodigit condition code or codes if applicable to the patients condition 29 situational. Understanding ub04 billing practice management software. Claim includes a twodigit facility type code and a onedigit claim frequency code. No other publication governmental or privatecommercial can be considered authoritative. Mar 15, 2018 for questions concerning clarification on the proper usage of patient discharge status codes, providers should be utilizing the ub04 manual cwf cms. Electronically, the patient status code is submitted in the 2300 cl103. Report this code when the patient is dischargedtransferred to home. See appendix a for a partial list of the patients discharge status codes and more information on the complete list. Dischargedtransferred to a nursing facility certified under medicaid but not certified under medicare. Enter the patients 2 digit status code as of the through date of the billing period form locator 6.
Enter a code from the code structure below indicating the patient. Committee nubc official ub04 data specifications manual 2008. Enter the appropriate twodigit code indicating the patients discharge status. Software systems designed to manage complex ub04 billing departments can be expensive, and if not designed specifically for your institutional setting, they can be a poor fit and more of a hindrance. Clarification of patient discharge status codes and. Form locators 18 01 discharge to home or selfcare routine. The inpatient prospective payment system ipps pricer looks at various icd9cm codes to determine the new technology addon payment. An affordable, easytouse hcfa 1500 cms 1500 and ub04 cms 1450 medical billing claim form software. Accident state 2 digit character abbreviation of the state where the accident occurred.
Enter patient discharge status code in 2digit numeric format. This includes items such as cpt codes, cdt codes, icd10 and other ub04 codes. Click on the form locator headers for definitions to the codes used when filing the ub04 claim to medicare or enter the code in. Ub04 special billing instructions for inpatient services ub. Enter the patients 2digit status at the end of the period covered by this bill through discharge always include both digits. Required if applicable this field indicates the discharge status of the patient when service. This code identifies the drg based on the grouper software and is required. The 837i institutional is the standard format used by institutional providers to transmit health care claims. Although developed by the centers for medicare and medicaid cms, the form has become the standard form used by all insurance carriers. New patient discharge status codes on ub04 claim form effective october 1, 20 the national uniform billing committee nubc was formed to develop a single billing form and standard data set that could be used nationwide by institutional providers and. Home health agency feeforservice, hospice feeforservice, inpatient feeforservice, outpatient feeforservice, skilled nursing facility feeforservice.
Condition codes required if a condition code applies to this claim, such as c1, c3, aj, or applicable abortion codes. April 1, 2019 patient discharge status code is other than be removed, copied, or utilized within any software, product for questions concerning clarification on the proper usage of patient discharge. Dec 4, 2018 completion of the ub04 claim form for medical services. Software that is used to calculate the diagnosis related group payment group is called an. Enter the drg based on software for inpatient claims when required under contract grouper with a payer. Completing the ub04 claim form guidelines for facilityinstitutional providers medica follows national and state uniform billing guidelines for the submission of ub04 claim forms, although some fields required by medicare or other payers may not be necessary for medica claims. In instances where an acutecare provider including critical hptenncare technical.
Enter the code indicating the disposition or discharge status of the patient on the ending service date of the period covered on this. A1 birth date wisconsin medicaid program measurement year my 2018, 1118 the 3m ppr software evaluates discharge status codes to determine if the patient was transferred. Patient discharge status faqs department of health ny. Clarification of patient discharge status codes and hospital. Report this code when the patient is discharged transferred to home. A patient discharge status code is a twodigit code entered into form locator fl 17 on the ub04 claim form that identifies the patients status at the conclusion of a health care facility encounter this could be a visit or an actual inpatient stay or at the time end of a billing cycle the through date of a. Required if applicable this field indicates the discharge status of the patient when service is endedcomplete.
Patient discharge status enter one of the following twodigit codes for the patients status as of the through date. The ub04 uniform billing form is the standard claim form that any institutional provider can use for the billing of medical and mental health claims. If the facility has some medicare certified beds you should use patient status code 03 or 04 depending on the level of care the patient is receiving and if they are placed in a medicare certified bed or not. If the patients condition is the result of an accident. Msdrg codes where additional codes were available in october 20. National uniform billing committee nubc official ub04 data specifications. Snf billers work with hundreds of diagnosis and procedure codes, known as icd9cm, hcpcs, and cpt codes. Home health medicare billing codes sheet core based statistical area cbsa value code fl 3941 61 cbsa code for where hh services were provided. Mar 15, 2018 concerning clarification on the proper usage of patient discharge status be utilizing the ub04 manual which is maintained by the national clarification of patient discharge status codes and cms. Claims with missing or invalid required r field information will be rejected or denied. Ub 04 medicare discharge status code cms 1500 claim form. Medicare billing form cms1450 and the 837 institutional mln booklet page 3 of 11.
Required on all inpatient, observation, or emergency room care claims. Ub04 ub92 and ub04 forms are medical insurance claim forms used by facilities such as hospitals, inpatient and outpatient clinics and ambulatory surgery centers to bill insurance companies for services rendered. Completing the ub04 claim form guidelines for facilityinstitutional providers. Enter one of the following twodigit codes for the patients status as of the through date 01 discharged to home or self care. Patient discharge stat 2 numeric characters that indicates the patients discharge status at the ending date of service.
A complete listing of all codes is accessible from the national uniform billing committee nubc official ub04 data specifications manual. Hospital patient discharge status wisconsin department of. Patient discharge status codes are part of the official ub04 data specifications manual and are used nationwide by institutional, private, and public providers, and payers of health care claims. Use this field to report the status of the patient upon discharge. Status code 03 is also used if the patient moves from an acute inpatient. Codes that identify special circumstances, events, or room accommodations that may. Patient discharge status discharge patient status code. Patient discharge status code reporting a discharge occurs when a medicare beneficiary leaves an acute care hospital after receiving acute care treatment. Point of origin and discharge status codes for designated disaster alternate care sites. Completion of this field is not required on rural health clinic rhc and federally qualified health center fqhc claims. Clarification of patient discharge status codes and cms. Place 61 in the first value code field locator and the cbsa code in the dollar amount column followed by two zeros. Ub04 claim form instructions form locator name instructions 1. Jan 07, 2016 in cases in which two or more patient discharge status codes apply, providers should code the highest level of care known.