The ub04 is the replacement for the ub92 form and represents the culmination of a fouryear study that involved numerous public surveys and discussions at various nubc meetings. Jul 6, 2015 implementation of new national uniform billing committee nubc code 53 initial placement of a medical device provided as part of a cms manual system. Status are taken from the national uniform billing committee nubc manual. Description fl01 billing provider name fl01 billing provider street address. 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. The following fields have been updated to match the fields in the nubc manual. Aarp health insurance plans pdf download medicare replacement pdf download medicare benefits pdf download. R2250cp 07012011 nonsystems internet only manual iom. Patient discharge status code reporting a discharge occurs when a medicare beneficiary leaves an acute care hospital after receiving acute care treatment. The chars system is currently authorized under revised code of washington rcw. When the discharge date is different than the statement through date, the discharge date is reported using.
As the health care industry prepared for hipaa implementation, it. Up to 22 revenue codes and associated charges may be entered on each ub04 claim form. The data elements and codes are developed and maintained by the national uniform billing committee. National uniform billing committee, american hospital association. Nov 2, 2007 status code 70 and a definition change to existing patient discharge meeting nubc has redefined the patient discharge status code 05 to. Medicare 75 general instructions for completion of form cms1450 for billing. The codes should be listed alphanumerically from left to right, beginning with fl31a. June 2011 snf outpatient page 1 of 3 skilled nursing facility snf part b outpatient claims locator 1 billing provider name, address, and telephone number minimum requirement is the providers name, city, state, and 9digit zip code. If discharging on your final scheduled visit, as initially plotted at soceval, make sure that the service code is a 19 for discipline only, or 18 for agency dc oasis. National uniform billing committee nubc update to chapter 25 effective date. Locator 3 patient control number the unique patient account number assigned by the provider. The national uniform billing committee nubc is responsible for the design. Billing highlights skilled nursing facility part b. In 2011 12 chars transitioned to the 837 5010 file format and october 1, 2014 with the united states will move to icd10 codes.
Official ub04 data specifications manual 2020 page 20. May 1, 2017 current edition of the nubc manual for a list and descriptions of valid discharge the date of denial in the occurrence code fields 34 ab. Jan 07, 2016 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. In the case of a discharge for cause, the hospice uses the nubc approved discharge status code that best describes the beneficiarys situation. Highmark blue shield billing highlights june 2011 snf outpatient page 3 of 3. Ub 04 medicare discharge status code cms 1500 claim form. Fl16 discharge hour fl17 patient discharge status fl18 condition code fl19 condition code. Some fields have been have been changed or codes have been added or deleted for existing fields. This fourdigit alphanumeric code gives three specific pieces of cms manual system cms. The national uniform billing committee nubc created a new patient discharge code to define discharges or transfers to courtlaw enforcement. To view and utilize the link and search functions of the manual, you will need to have. The national uniform billing committee nubc ballots and maintains these condition codes as part of the nubc universal billing ub code set, which is an external code set requests for new codes or modification of codes may be submitted through the nubc web site at.
These are 99238, hospital discharge day management 30 minutes or less, and 99239, hospital discharge day management more than 30 minutes. Complete this field if an admission or a discharge other than to home or self care occurred during the. Instructions for completing the ub04 claim form the ub04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities for example, outpatient departments, rural health clinics, chronic dialysis and adult day health care. Admission type code 9 and admission source code 9 are not allowed. Report this code when the patient is dischargedtransferred to. Hmsa has determined that it will use the national uniform billing committee nubc official ub04 data specifications manual as the standard source for codes and code descriptions to be entered in the various form locators fl. The national uniform billing committee nubc created a new patient discharge. This section contains medicare requirements for use of codes maintained by the nubc that are. For status codes, please refer to the nubc ub04 manual. Locator 16 discharge hour required on inpatient claims with a frequency code of 1 or 4 last digit of bill type.
The discharging facility should ensure that documentation in the patients medical record supports the billed discharge status code. System chars discharge data to the department of health doh. Again, care must be taken to make sure that these codes are as accurate and detailed as they can possibly be. This manual contains the updated specifications for the data elements and codes included on the cms1450 and used. Ub04 data specifications manual and the centers for medicare and medicaid services cms international classification of diseases, ninth revision, clinical modification icd9cm official guidelines for coding and reporting. Dataelem0247 manual performance measurement network. Aarp health insurance plans pdf download medicare replacement pdf download aarp medicarerx plans united healthcare pdf download medicare benefits pdf download. Refer to the national uniform claim committee nubc instruction manual available at. Apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms.
Patient nameidentifier required the patient is the person who received services. Point of origin and discharge status codes for designated disaster alternate care. 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. A ub04 with field descriptions and instructions is included in the link below. The ub04 manual also contains a section established for state guidelines. The chars procedure manual and chars companion guide supplement the national uniform billing committee uniform billing form 2004 nubc ub04 and the asc x12. The code usage includes transfers to incarceration facilities such as jail, prison or other detention facilities. Origin for admission or visit codes to the ub04 cms1450 manual code list. June 2011 snf outpatient page 1 of 3 skilled nursing facility snf part b outpatient claims locator 1 billing provider name, address, and telephone number. The emedny system allows new york medicaid providers to submit claims and receive payments for medicaidcovered services provided to eligible members. Because this data element is critical in determining the population for many measures, the abstractor should not assume that the ub04 value is what is reflected in the medical record.
Chars follows nubc standards except for state specific requirements. Cl1 02 previously called the source of admission change this is only required for ip. The manual was created in adobe acrobat portable document format pdf. New patient discharge status codes type of bills tob 32x and 34x. Instead, the hospice reports condition code h2 to indicate a discharge for cause.
Fl 16 discharge hour 48 fl 17 patient discharge status 49 fl 1828 condition codes 65 fl 29 accident state 81 fl 30 reserved for assignment by the nubc 82 fl 34 occurrence codes and dates 83 fl 3536 occurrence span codes and dates 92 fl 37 reserved for assignment by the nubc 96. Emedny information inpatient hospital version 2011 01 61 2011. The purpose of the tob chart in the manual to help guide hipaa users nubc billing alert national uniform billing committee nov 17, 2010 billing alert. The hospice does not report occurrence code 42 on their claim.
You can access the ub04 billing information adopted by the nubc by subscribing to the official ub04 data specifications manual. If your last plotted visit is an 11, contact the office and ask that it be changed to an 18 or 19. Poa that was developed to assist the national uniform billing committee nubc in its deliberations on whether to add poa to the ub. Sep 18, 2014 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. Chars procedure manual washington state department of. Locator 17 patient discharge status 01 discharged 30 still patient locator 38 responsible. Patient address required the patient address will be the facility address. Committee nubc payer only codes to the medicare claims processing manual, chapter 1 value. Enter the appropriate twocharacter condition codes. The provider enters the code indicating the source of the referral. For discharge dates after and including august 2, 2011, the value of 7 will fail. Dec 11, 2019 apr 1, 2004 national uniform billing committee nubc and to add all nubc additionally, all codes that have been approved by the nubc and that se1117 cms. Most common payer idhealth plan id numbers naic codes.
Hospital discharge discharges for charity or free standard codes and submit them to the tdh hdds staff. This manual, ed by the american hospital association, is the only official source of ub data. It is a refresher from the provider billing manual. In 201112 chars transitioned to the 837 5010 file format. The purpose of the hospital discharge data system hdds is to collect and summarize hospital. Complete list of military separation codes on documents. Billing committees nubc official ub04 data specifications manual. Apr 28, 2011 search for the rhc billing manual for revenue code 0900 from both rhcs. The effective date on or after the date of service for outpatient claims and on or after the date of discharge for inpatient claims. Instructions, ub04 dialysis ohio department of medicaid.
Discharge status codes approved effective october 1, 20. The values for discharge status are taken from the national uniform billing committee nubc manual which is used by the billinghim to complete the ub04. This manual, ed by the american hospital association, is the only. Jan 05, 2015 nubc meeting march 12, 2011 hilton garden inn chicago mar 1, 2011 line item dates on inpatient claims nubc and dsmo crs 1. Download a sample of the form by visiting the cms forms list web page.
Providers using the cd will need to retain all bulletins received throughout the year to use in addition to the cd. Most of your questions relate to the two most frequent discharge service codes you use, which are for patients whove been admitted. Manual developed by the national uniform billing committee nubc. All inpatient discharges including psychiatric andor behavioral health, rehabilitation. Select the appropriate code from the nubc ub04 manual. Enter the discharge hour as described in the ub04 manual. Hospital discharge data system user manual august 2018 7 numerous and significant changes have been made to the ub04 manual from 2011 through 2018. Nubc occurrence code s february 20, 2020 admin no comments. National uniform billing committee nubc update to chapter 25.
Masshealth billing guide for the ub04 executive office of. New york state ub04 billing guidelines version 2011 01 61 2011. Locator 15 point of origin for admission or visit previously known as source of admission. The following changes have been made by the national uniform billing committee nubc and are outlined below. Tips for completing the ub04 cms1450 claim form revised 04.
New patient discharge status code 21 to define discharges billing committee nubc created a new patient discharge code to. Uniform billing committee nubc at its february 2005 meeting. West virginia hospital inpatient data system data element specifications guide february 7, 2011 page 3. This includes claims with a frequency code of 1 admit through discharge. Military separation codes are contained in your military records and may be annotated on various military separation documents. No other publication governmental or privatecommercial can be considered authoritative. In addition to 99238 and 99239, you can bill two other discharge codes. Many types of providers use the ub04 claim form to. The national uniform billing committee nubc has approved the. Point of originvisit previously source of admission codes 2011. Ub04 claim form this document explains the ub04 claim form, which is used for submitting claims for reimbursement for specially designated facilities. Some fields have been changed, or codes have been added or deleted for existing fields. National uniform billing committee nubc maintains the type of bill code set. Nubc voted to accept the ub82 and its associated data manual for implementation as a.
Homecare homebase discharge procedures a planned discharge. Nubc meeting march 12, 2011 hilton garden inn chicago mar 1, 2011 line item dates on inpatient claims nubc and dsmo crs 1. The instructions included in this section are excerpts from medicare instructions rev. These codes are subject to change, and the department of defense will no longer allow the military services to release the meanings of these codes to the general public. The discharge status code identifies where the patient is being discharged to at the end of their facility stay or transferred to such as an acutepostacute facility. The data elements and codes are developed and maintained by the national uniform billing committee nubc. The purpose of the tob chart in the manual to help guide hipaa users nubc billing alert national uniform billing committee nov 17, 2010. The nubc official data specifications manual lists these codes and their detailed descriptions. Billing highlights skilled nursing facility part b outpatient. To view a sample alp ub04 claim form, see appendix a. Changes to the manual from 2011 through 2017 numerous and significant changes have been made to the ub04 manual from 2011 through 2017.
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