News You Can Use: The UB-04 is Coming Soon -- Prepare Now for a Smooth Transition.

Starting May 23, you’ll have to use the new UB-04 form to accommodate the new National Provider Identifier (NPI) numbers. But if you don’t start testing the form earlier, you could be jeopardizing your claims.

You aren’t required to start using the UB-04 until May 23, but you can start submitting claims with it as early as March 1, 2007, says Felice Landry, senior billing consultant with Reingruber & Company in St. Petersburg, Fla.

Try to start testing the new form as early as possible so you can keep an eye out for any unusual errors, Landry says. “Just like when you replace software at home, you need to pay attention to those little bugs,” she says.

Warning: Make sure your new 10-digit NPI matches your current provider number. If you don’t test the form to check this before May 23, all of your claims could be rejected, Landry says. “And that means no money!”


More Room for Diagnosis Codes

After field locator 56, which provides space for the new NPI, the most noticeable change on the UB-04 is the expansion of the diagnosis code field (67), to accept 18 ICD-9 codes. That gives you room to report up to eight additional diagnosis codes.

Field locator 67 should contain the ICD-9 code for the disease condition that most accurately reflects the main reason the patient is being treated, said Glenda J. Schuler, RHIT, CPC, CPC-H, at the November 2006 Ingenix Essentials conference in Orlando, Fla.

Take note: For outpatient claims, FL 67 contains the medical-necessity information, Schuler said. It does not directly affect reimbursement unless diagnosis codes fail to support medical necessity. For inpatient claims, this field drives the DRG, she said.

Field locator 67 A-Q provide space to report the ICD-9-CM codes corresponding to all conditions that coexist at the time of admission, that develop subsequently, or that affect the treatment received and/or the length of stay, Schuler said. Exclude diagnoses that relate to an earlier episode that have no bearing on the current hospital stay, she said.

A twist: Even though the diagnosis code field has been expanded, Medicare will ignore these eight new spaces, according to the Centers for Medicare & Medicaid Services’ Transmittal 1104. Still, you should make sure you’re putting in correct data -- wrong data can create processing problems, Landry says.


Check These Field Locators

Field locator 69 -- the admitting diagnosis -- is required for inpatient admissions. List the ICD-9-CM diagnosis code describing the patient’s diagnosis at the time of admission here, Schuler said.

Field locator 70 A-C requests that you enter the patient’s reason for the visit. These three ICD-9 diagnosis code spaces should describe the patient’s reason for the visit at the time of outpatient registration, Schuler said. [...]

- Published on 2007-03-01