Texas Department of Insurance

   
Website Survey

UB-92 - Institutional Providers

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Data Elements that are necessary, if applicable

(unless otherwise agreed to by contract)

Field # Data Element
7 Covered days - applicable if Medicare is a primary or secondary payor
8 Noncovered days - applicable if Medicare is a primary or secondary payor
9 Coinsurance days - applicable if Medicare is a primary or secondary payor
10 Lifetime reserve days - applicable if Medicare is a primary or secondary payor and patient was an inpatient
21 Discharge hour - applicable if patient was an inpatient or was admitted for outpatient observation
24-30 Condition codes - applicable if the HCFA UB-92 manual contains a condition code appropriate to the patient´s condition
31-36 Occurrence codes and dates - applicable if the UCFA UB-92 manual contains an occurrence code appropriate to the patient´s condition
36 Occurrence span code, from and through dates - applicable if the HCFA UB-92 manual contains an occurrence span code appropriate to the patient´s condition
44 HCPCS/Rates - applicable if Medicare is a primary or secondary payor
54 Prior payments - payor and patient - applicable if payments have been made to the provider by or on behalf of the patient or subscriber or by a primary plan
75 Diagnoses codes other than principal diagnosis code - applicable of there are diagnoses other than the principal diagnosis
79 Procedure coding methods used - applicable if the HCFA UB-92 manual indicates a procedural coding method appropriate to the patient´s condition
80 Principal procedure code - applicable if patient has undergone an inpatient or outpatient surgical procedure
81 Other procedure code - applicable as an extension of field 80 if additional surgical procedures were performed


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Last updated: 04/09/2007




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