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Back  RFI # 1095: Patient reason for visit

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

Segment HI Patient reason for visit has a note requiring its usage for outpatient visits.
At the same time section 1.12.6 says that UB-04 designations of inpatient/outpatient claims should be used including exceptions. One of the exceptions is for Patient reason for visit limiting requirement to unscheduled outpatient visits but allowing its usage for other outpatient visits.
So should segment Patient reason for visit be required for all outpatient visits or only for unscheduled ones ?

Response

NUBC's Billing Manual specifies the definition of "Unscheduled Outpatient Visits" and under what circumstances this element is required for an outpatient claim within the instructions for Form Locator 70a-c (Patient's Reason for Visit) and Form Locator 04 (Type of Bill). It was the workgroup's intent for this requirement to be designated by the NUBC's Manual, and this direction is clarified in the 5010 guide's front matter sections 1.5 and 1.12.6.
Submission 7/1/2010
Status Date 5/12/2011
Status F - Final
Primary References
Document 005010X223
Section2.3.1
Page189
Set ID837
Loop2300
Segment IDHI
Industry NamePATIENT’S REASON FOR VISIT