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Back  RFI # 1520: 837I 5010 Admission Date

Formal vs. Informal Help Informal Formal

Submitter

Vicki Mills

Description

Conflicting information has been identified indicating the Admission Date and Hour are required on all Institutional claims. TR3 states these are only required on inpatient claims. Please confirm.

Response

Admission date and hour are required on inpatient claims, not all institutional claims. This is based on the UB04 definition of "inpatient" and "outpatient". However, the UB04 manual's definition of "inpatient" and "outpatient" can be different, depending on the type of bill (Form Locator 04) and the data element being evaluated.

For example, the manual considers type of bill 033X (Home Health) as "outpatient" for most data elements, including Admitting Diagnosis. However, the manual considers type of bill 033X to be "inpatient" for the Admission Date element.

Section 1.12.6 of the 837I TR3 refers to these situations as "exceptions to the general rules". Exceptions like this one for Admission Date are recognized by the TR3 as defining the 837I data element requirements.

We will consider enhancing the explanation of these exceptions in a future TR3.
Submission 2/9/2012
Status Date 4/9/2012
Status F - Final
Primary References
Document 005010X223
Section2.4
Page153