EDI Medical UB-04 Claims Procedures (Security Health Plan)
EDI Medical UB-04 Claims processing procedures: EDI Medical UB-04 Claims completion for inpatient and outpatient services billed by hospitals, skilled nursing facilities, home health agencies and other institutional providers (Continuation).
66. Diagnosis code qualifier – This reflects which ICD-9 edition used – Not required.
67. Principal diagnosis code – The full ICD-9-CM diagnosis code, including the fourth and fifth digits, if applicable, that describes the principal diagnosis (the condition established after study to be chiefly responsible for causing the hospitalization or use of other hospital services). The POA indicator for the primary diagnosis must be included in the eighth digit of this field. (Required)
67. a – q Other diagnosis codes – This field contains the full ICD-9-CM diagnosis codes, including the fourth and fifth digits, if applicable, corresponding to all conditions that coexist at the time of admission, that develop subsequently or that affect the treatment received and/or the length of stay. Diagnoses that relate to an earlier episode that has no bearing on the current hospital stay should be excluded. The POA indicator for the secondary diagnosis must be included in the eighth digit of this field. (Required)
68. Unlabeled field – This field not used for provider reporting. For State use only.
69. Admitting diagnosis/patient’s reason for visit – Reporting the complete ICD-9-CM code describing the patient’s diagnosis or reason for visit at the time of admission or outpatient registration, including the fourth and fifth digits when appropriate. (Required)
70. Patients reason for visit codes
71. PPS code – Not used.
72. External cause of injury – The full ICD-9-CM code, including the fourth and fifth digits. Health Care of activities are encouraged to report an E Code whenever there is a diagnosis of an injury, poisoning or other adverse effect.
73. Unlabeled field – This field not used for provider reporting. For State use only.
74. Principal procedure code and date – The ICD-9-CM code for the principal procedure performed during the period covered by the bill and the date on which the principal procedure described on the bill was performed. (Required) For inpatient and home IV therapy services, if surgery is performed during the inpatient stay from which the course of therapy is initiated.
74. a – e Other procedure code and dates – This field allows reporting of up to five ICD-9-CM codes to identify the significant procedures performed during the billing period, other than the principal procedure, and the corresponding dates when the procedures were performed. Report those that are most important for the episode of care and specifically any therapeutic procedures closely related to the principal diagnosis. (Required) For inpatient and home IV therapy services, if surgery is performed during the inpatient stay from which the course of therapy is initiated.
75. Unlabeled field – This field not used for provider reporting. For State use only.
UB-04 Claims Processing Procedures (Part 1)
UB-04 Claims Processing Procedures (Part 2)