PART TWO. The UB-04 Claim Form. Chapter 10. Occurrence Codes and Dates. LEARNING OUTCOMES After completing this chapter, you will be able to define the key terms and:
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Occurrence Codes and Dates
After completing this chapter, you will be able to define the key terms and:
Discuss the codes that are used in FLs 31-34 of the UB-04 to report significant events, or occurrences, connected with claims that affect how they are processed and paid.
Understand the four categories of occurrence codes.
Discuss the types of codes that are used in FLs 35-36 of the UB-04 to report occurrence spans and dates.
Explain various billing situations that arise when particular occurrence codes and occurrence span codes are used.
Recognize which occurrence codes and occurrence span codes contain data that must be coordinated with other fields on the UB-04.
Explain what information belongs in FL 38, Responsible Party Name and Address, of the UB-04 form.
An occurrence code is a two-digit numeric or alphanumeric code that defines a significant event that happened in connection with a claim and affects payer processing of the claim. Occurrence codes and dates factor into payer liability decisions, patient coverage, appropriateness of the services rendered, and Medicare Secondary Payer development. They cover a wide range of circumstances and range from 01 to 69 and A0 to LZ.
Occurrence span codes are two-digit numeric or alphanumeric codes that identify significant events that happened over a span of time and affect claim processing and payment. Every occurrence span code must have a beginning (from) date and an ending (through) date in MMDDYY format. Occurrence span codes cover a wide range of circumstances and have two ranges: 70 to 99 and M0 to ZZ.