This indicates the point of patient origin for the admission or visit. Ub04 cms 1450 claim form instructions for inpatient. A reserved for assignment by the nubc discontinued effective 101 2007. A code indicating the point of patient origin for this admission. User question database questions manual performance. Point of origin source of admission form locator 16. Fl 15 point of origin for admission or visit 39 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. The point of origin for the patient would be assigned under the code structure for newborn as 6 born outside this hospital. The national ub04 uniform billing manual contains important coding information. The revision date and transmittal number cms manual system. Enter the beginning and ending service dates of for the period. A newborn is born in an ambulance on the way to the hospital. Dataelem0270 manual performance measurement network.
California division of workers compensation medical. Enter 00 for cents if the amount is a whole number. The patient is then transported to the hospitals nursery for admission as an inpatient. The nubc approved the discontinuation of point of origin code 7 the new p7 condition code for public health reporting only was created solely for indicating. Hospital discharge data system user manual august 2018. The ub04 claim form is used to submit claims for inpatient and outpatient services by institutional facilities. The nucc reference instruction manual must remain intact. The national uniform billing committee nubc disclaimer for manual changes only. August 2019 nubc meeting tentative agenda as of 8619. The following instructions explain how to complete the ub04 claim form and whether a.
Point of originvisit previously source of admission codes 2011. Updated versions of this instruction manual are released each july. Discharge status using the twodigit codes from the nubc manual. Condition codes using the twodigit codes from the nubc manual for up to 11 occurrences.
Nubc maintains lists of approved coding for the form. Billing manual by calling 3124223390 or by accessing the nubc website. What would be the implications if a vendor choose not to send a specific hcos quarterly dataset by the submission deadline due to. Official ub04 data specifications manual 2020 page 3. This manual, ed by the american hospital association, is the only official source of ub data. Special billing instructions for specific ihcp benefit plans. This article impacts codes discontinued by the national uniform billing committee nubc will be discontinued for cms manual system. The following fields have been updated to match the fields in the nubc manual.
Tips for completing the ub04 cms1450 claim form revised 04. Instructions for completing the ub04 claim form san francisco. Pharmacies submit drug claims at the point of sale pos. A reserved for assignment by the nubc discontinued effective 1012007.