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Form Locator 06 Statement Covers Period (From-Through)
The Statement Covers Period "From Date" found within Form Locator 06 ("From Date") may be the same or a different date than the "Admission Date" found within Form Locator 12. The dates may coincide in some circumstances, but should not be confused.
Issue:When a patient receives OP services 3 calendar days prior to an IP admission, the OP charges may need to be included on the IP bill. On an initial bill the "From Date" would be prior to the "Admission Date" FL 12. Some payers will not accept a claim in this format.
Today, Medicare has edits prohibiting a PRIOR "Admission Date" to the Statement "From Date" and will reject claims for submission.
Resolution: Medicare may update edits in October 2011. View details here
3 Day Window-NEW Condition Code approved for April 2011: Condition Code 51-Attestation of Unrelated Outpatient Non-diagnostic Services-the hospital attests that the OP diagnostic service provided within 3 calendar days (1 calendar day for non-subsection hospitals) prior to the admission is not related to the admission to the IP stay. For use on outpatient claims only and dates of service from June 25, 2010.
Revised Definitions Effective: January 1, 2011
Occurrence code 50
Title: Assessment Date
Definition: Code indicating an assessment date as defined by the assessment instrument applicable to this provider type (e.g. Minimum Data Set (MDS) for skilled nursing).
Occurrence code 52
Title: Medical Certification/Recertification Date
Revised Definition: The date of the most recent non-hospice medical certification or recertification of the patient. Use Occurrence Code 27 for Date of Hospice Certification or Recertification.
Occurrence Code 54
Title: Physician Follow-Up Date
Revised Definition: Last date of a physician follow-up with the patient.
NEW Condition Codes H3, H4, H5
Effective: for dates of service after January 1, 2011
Limited for use on TOB 72x only- paid under ESRD PPS
H3-Reoccurrence of GI Bleed Comorbid Category
H4-Reoccurrence of Pneumonia Comorbid Category
H5-Reoccurrence of Pericarditis Comorbid Category
UB04 Change Implementation Calendar
UB04 Version 5.00 Clarifications/Errata/Updates
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