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Back  RFI # 1609: External Code Sources

Formal vs. Informal Help Informal Formal

Submitter

Joyce Petrucci

Description

Question on Final answer to RFI 1545: The UB04 manual states for Value Code 45 (Accident Hour) that the official codes list is:
00, 01, 02, etc. The RFI 1545 is stating to not use the leading zero. Does this mean, that the external code source's rules DO NOT apply? I am reading RFI 1545 to mean just that, so consequently, code 00 (correct by UB04 and required by payers) is NOT correct by the TR3. This is causing much confusion with payers and providers on whether to follow the official external code source's rules. Another example being using the highest level of specificity for diagnosis codes, which is required by the ICD-9 manuals, but silent in the TR3. In EDI, a code 01 can be a completely different meaning than code 1.

Submitter Assigned Keywords

Value Code 45

Response

The submitter is asking two questions

Sending leading zeros on decimal fields - Section B.1.1.3.1.2 of the guide states in the third paragraph "Leading zeros must be suppressed unless necessary to satisfy a minimum length requirement." The minimum length for the value code amount is 1, so a leading zero is not necessary and must be suppressed. A value of zero for the hour should be reported as 0 not 00.

Level of specificity for diagnosis codes – Submitters need to refer to The Official ICD-9-CM Guidelines for Coding and Reporting regarding specificity requirements. The Guidelines are named in the regulation at §162.1002(a)(b) as part of the mandate under HIPAA.
Submission 6/19/2012
Status Date 9/18/2012
Status F - Final
Primary References
Document 005010X223
SectionB.1.1.3.