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Back  RFI # 1840: 837P Admission Date

Formal vs. Informal Help Informal Formal

Submitter

Julia Dunicheva

Description

This is a clarification of RFI 1449.
Even though Place of service codes do not have inpatient/outpatient designation, is it possible to say for some that they are not inpatient such as codes 11, 22, 24, 32 and thus Admission Date should not be sent for them?

Response

The situational rule for the 837P loop ID 2300 DTP segment for Admission Date reads:

“Required on all ambulance claims when the patient was known to be admitted to the hospital.

OR

Required on all claims involving inpatient medical visits.

If not required by this implementation guide, do not send.”

For the second portion of this rule, two factors must both be true:

The patient must be a hospital inpatient meaning that the patient has been formally admitted as such pursuant to an order for inpatient hospital admission by a physician.

and,

The patient had a face-to-face session with a professional health care provider, known as a medical visit.

Thus, whether or not the hospital admission date must be included in a professional claim depends on factors that cannot be gleaned from other data solely within that claim, such as Place of Service. The only definitive way to test compliance would require examining/matching the 837I hospital inpatient claim with the 837P professional claim.
Submission 8/5/2013
Status Date 12/6/2013
Status F - Final
Primary References
Document 005010X222
Section2.4
Set ID837
Loop2300
Segment IDDTP
Industry NameAdmission Date