A two-digit numeric or alphanumeric code that identifies a special condition or unique circumstance about a claim.
What is a condition code?
100
A patient or his or her spouse who is over age sixty-five and who is eligible for group health insurance through employment or the employment of the spouse.
What is a working aged person?
100
Insurance codes
Ptient condition codes
Rom codes
TRICARE, product replacement, and skilled nursing facility (SNF) information codes
Other special codes
What are the major categories of condition codes?
100
This must accompany every occurrence code.
What is a date?
100
After tonight there are four of these left.
What are weeks in the quarter?
200
A two-digit numeric or alphanumeric code that defines a significant event that happened in connection with a claim that affects payer processing of the claim.
What is an occurrence code?
200
The only source of inpatient services in a given geographical area.
What is a sole community hospital?
200
Accident-related codes
Medical condition codes
Insurance-related codes
Service-related codes
What are the categories of occurrence code?
200
If more than one of these are reported, enter the codes in alphaneumeric sequence in the following order: FLs 35a and 36a should be filled in first, then FLs 35b and 36b.
What are occurrence span codes?
300
A two-digit numeric or alphanumeric code used to identify a dollar amount, unit amount, or number of visits associated with a claim.
What is a value code?
300
Inpatient days of care not covered by the primary payer.
What are non-covered days?
300
(For Medicare billing) These are required only on inpatient claims that contain excluded diagnoses.
What are QIO approval indicator codes?
300
When a window envelope is used for mailing a bill, this field will show through the window.
What is FL 38?
400
TRICARE requires this for nonemergency inpatient mental health care services.
What is a nonavailablity statement?
400
A patient may receive an NEMB for these services.
What are services that are excluded (never paid) from Medicare coverage?
400
Provides health care benefits to children under the age of 21 who are enrolled in Medicaid and emphasizes preventive care.
What is EPSDT (Early and Periodic Screening, Diagnosis, and Treatment)?
400
For hospitals, these will not exceed 150. For inpatient SNF claims, these will not exceed 100.
What are covered days?
500
Its goal is to identify abuse of the Medicare payment system by focusing medical review efforts on claims that represent the greatest risk of inappropriate payment.
What is a focused medical review?
500
A benefit period for hospitalization as defined by a health plan.
What is a spell of illness?
500
This must fall within the from and through dates specified in FL 6.
What is the date associated with an occurrence code?
500
When this is used, the accomodation room charges on the bill should be based on the hospital's typical semiprivate room rate, not on the rate for the special care unit.