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Back  RFI # 1435: 5010 837i DOS for TOB 12x

Formal vs. Informal Help Informal Formal

Submitter

Artis D'Ann

Description

The v5010 837i TR3 Guide states that the Service Date (2400/DTP*472) is only allowed for outpatient claims. Further, the TR3 Guide states in section 1.12.6 that the NUBC rules must be used for defining inpatient, outpatient, and exceptions to those definitions.

According to the UB-04 Manual, Type of Bill (TOB) 12x and 22x "... are considered inpatient bills solely for the application of HIPAA transaction code set requirements." This seems to indicate that for TOBs 12x and 22x, the Service Line Date should not be reported, as these are inpatient TOBs. However, the UB-04 also states, "UB-04 and 837i: Medicare claims require that every revenue code have an associated line-item date of service or dates of service range for bill types 012X, 013X, 014X, 022X, 023X, 032X, 033X, 034X, 071X, 072X, 073X, 074X, 075X, 076X, 081X, 082X, 083X, and 085X."

Should the Service Date be reported in the v5010 837i transaction for TOB 12x and 22x or not?

Submitter Assigned Keywords

5010, Service Date, Type of Bill 12, TOB, DOS

Response

Type of Bill 012x and 022x are designated as outpatient for billing purposes by the NUBC, even though they are “physically” inpatients. When a patient is not eligible, entitled or has exhausted certain benefits under Medicare Part A, specific services based on revenue code, may be submitted for consideration under Medicare Part B (the funding source). As indicated in the NUBC Manual in the section titled "Inpatient Part B Only -- Type of Bill 012x and 022x", HCPCS, Units, and Service Date are reported just like an outpatient claim for these revenue codes that are covered by Medicare Part B.
Submission 10/18/2011
Status Date 12/8/2011
Status F - Final
Primary References
Document 005010X223
Section2.4
Set ID837i
Table2
Loop2400
Segment Position4550
Segment IDDTP
Secondary References
RFI ID 1884
Document UB-04 Manual
SectionFL4/FL45