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Institutional Services File Submission

Maryland

Versions: February 20, 2013• September 13, 2013• January 9, 2014Compare Versions


Name:Institutional Services File Submission
State:Maryland
Definition:Not provided
VersionJanuary 9, 2014

File Specification for Institutional Services File Submission

Data Element ID Data Element Description Type Format Length
Multiple versions1 Record Identifier Not Provided numeric 1
Multiple versions2 Patient IdentifierP (payor encrypted) Patient's unique identification number assigned by payor and encrypted. alphanumeric 12
Multiple versions3 Patient IdentifierU (UUID encrypted) Patient's universally unique identification (UUID) number generated using an encryption algorithm provided by MHCC. alphanumeric 12
Multiple versions4 Patient Year and Month of Birth Date of patient's birth using 00 instead of day. numeric CCYYMM00 8
Multiple versions5 Patient Sex Sex of the patient. numeric 1
Multiple versions6 Patient Zip Code +4-digit add-on Zip code of patient's residence. numeric 10
Multiple versions7 Date of Enrollment The start date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26) numeric CCYYMMDD 8
Multiple versions8 Date of Disenrollment The end date of enrollment for the patient in this delivery system (in this data submission time period). (see Source Company on page 26) numeric CCYYMMDD 8
Multiple versions9 Hospital/Facility Federal Tax ID Federal Employer Tax ID of the facility receiving payment for care. alphanumeric 9
Multiple versions10 Hospital/Facility National Provider Identifier (NPI) Number Federal identifier assigned by the federal government for use in all HIPAA transactions to an organization for billing purposes. alphanumeric 10
Multiple versions11 Hospital/Facility Medicare Provider Number Federal identifier assigned by the federal government for use in all Medicare transactions to an organization for billing purposes. alphanumeric 6
Multiple versions12 Hospital/Facility Participating Provider Flag Indicates if the service was provided at a hospital/facility that participates in the payor's network. numeric 1
Multiple versions13 Claim Control Number Internal payor claim number used for tracking. alphanumeric 23
Multiple versions14 Claim Paid Date The date a claim was authorized for payment. numeric CCYYMMDD 8
Multiple versions15 Record Type Identifies the type of facility or department in a facility where the service was provided. numeric 2
Multiple versions16 Type of Admission Applies only to hospital inpatient records. All other record types code "0". numeric 1
Multiple versions17 Point of Origin for Admission or Visit Applies only to hospital inpatient records. All other record types code "0". (Note: Assign the code where the patient originated from before presenting to the health care facility.) numeric 1
Multiple versions18 Patient Discharge Status Indicates the disposition of the patient at discharge. Applies only to hospital inpatient records. All other record types code "00". numeric 2
Multiple versions19 Service from date/Start of Service (if Inpatient, Date of Admission) First date of service for a procedure in this line item. numeric CCYYMMDD 8
Multiple versions20 Service thru date/End of Service (if Inpatient, Date of Discharge) Last date of service for a procedure in this line item. numeric CCYYMMDD 8
Multiple versions21 Diagnosis Code Indicator Indicates the volume of the International Classification of Diseases, Clinical Modification system used in assigning codes to diagnoses. numeric 1
Multiple versions22 Primary Diagnosis The primary ICD-9-CM or ICD-10-CM Diagnosis Code followed by a secondary diagnosis (up to 29 codes), if applicable at the time of service. Remove embedded decimal pt. alphanumeric 7
Multiple versions23 Primary Diagnosis Present on Admission (POA) Primary Diagnosis present on Admission. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions24 Other Diagnosis Code 1 ICD-9-CM/ICD-10-CM Diagnosis Code 1 Remove embedded decimal pt. alphanumeric 7
Multiple versions25 Other Diagnosis Code 1 Present on Admission 1 (POA) Diagnosis Code 1 present on Admission 1. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions26 Other Diagnosis Code 2 ICD-9-CM/ICD-10-CM Diagnosis Code 2 Remove embedded decimal pt. alphanumeric 7
Multiple versions27 Other Diagnosis Code 2 Present on Admission 2 (POA) Diagnosis Code 2 present on Admission 2. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions28 Other Diagnosis Code 3 ICD-9-CM/ICD-10-CM Diagnosis Code 3 Remove embedded decimal pt. alphanumeric 7
Multiple versions29 Other Diagnosis Code 3 Present on Admission 3 (POA) Diagnosis Code 3 present on Admission 3. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions30 Other Diagnosis Code 4 ICD-9-CM/ICD-10-CM Diagnosis Code 4 Remove embedded decimal pt. alphanumeric 7
Multiple versions31 Other Diagnosis Code 4 Present on Admission 4 (POA) Diagnosis Code 4 present on Admission 4. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions32 Other Diagnosis Code 5 ICD-9-CM/ICD-10-CM Diagnosis Code 5 Remove embedded decimal pt. alphanumeric 7
Multiple versions33 Other Diagnosis Code 5 Present on Admission 5 (POA) Diagnosis Code 5 present on Admission 5. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions34 Other Diagnosis Code 6 ICD-9-CM/ICD-10-CM Diagnosis Code 6 Remove embedded decimal pt. alphanumeric 7
Multiple versions35 Other Diagnosis Code 6 Present on Admission 6 (POA) Diagnosis Code 6 present on Admission 6. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions36 Other Diagnosis Code 7 ICD-9-CM/ICD-10-CM Diagnosis Code 7 Remove embedded decimal pt. alphanumeric 7
Multiple versions37 Other Diagnosis Code 7 Present on Admission 7 (POA) Diagnosis Code 7 present on Admission 7. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions38 Other Diagnosis Code 8 ICD-9-CM/ICD-10-CM Diagnosis Code 8 Remove embedded decimal pt. alphanumeric 7
Multiple versions39 Other Diagnosis Code 8 Present on Admission 8 (POA) Diagnosis Code 8 present on Admission 8. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions40 Other Diagnosis Code 9 ICD-9-CM/ICD-10-CM Diagnosis Code 9 Remove embedded decimal pt. alphanumeric 7
Multiple versions41 Other Diagnosis Code 9 Present on Admission 9 (POA) Diagnosis Code 9 present on Admission 9. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions42 Other Diagnosis Code 10 ICD-9-CM/ICD-10-CM Diagnosis Code 10 Remove embedded decimal pt. alphanumeric 7
Multiple versions43 Other Diagnosis Code 10 Present on Admission 10 (POA) Diagnosis Code 10 present on Admission 10. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions44 Other Diagnosis Code 11 ICD-9-CM/ICD-10-CM Diagnosis Code 11 Remove embedded decimal pt. alphanumeric 7
Multiple versions45 Other Diagnosis Code 11 Present on Admission 11 (POA) Diagnosis Code 11 present on Admission 11. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions46 Other Diagnosis Code 12 ICD-9-CM/ICD-10-CM Diagnosis Code 12 Remove embedded decimal pt. alphanumeric 7
Multiple versions47 Other Diagnosis Code 12 Present on Admission 12 (POA) Diagnosis Code 12 present on Admission 12. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions48 Other Diagnosis Code 13 ICD-9-CM/ICD-10-CM Diagnosis Code 13 Remove embedded decimal pt. alphanumeric 7
Multiple versions49 Other Diagnosis Code 13 Present on Admission 13 (POA) Diagnosis Code 13 present on Admission 13. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions50 Other Diagnosis Code 14 ICD-9-CM/ICD-10-CM Diagnosis Code 14 Remove embedded decimal pt. alphanumeric 7
Multiple versions51 Other Diagnosis Code 14 Present on Admission 14 (POA) Diagnosis Code 14 present on Admission 14. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions52 Other Diagnosis Code 15 ICD-9-CM/ICD-10-CM Diagnosis Code 15 Remove embedded decimal pt. alphanumeric 7
Multiple versions53 Other Diagnosis Code 15 Present on Admission 15 (POA) Diagnosis Code 15 present on Admission 15. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions54 Other Diagnosis Code 16 ICD-9-CM/ICD-10-CM Diagnosis Code 16 Remove embedded decimal pt. alphanumeric 7
Multiple versions55 Other Diagnosis Code 16 Present on Admission 16 (POA) Diagnosis Code 16 present on Admission 16. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions56 Other Diagnosis Code 17 ICD-9-CM/ICD-10-CM Diagnosis Code 17 Remove embedded decimal pt. alphanumeric 7
Multiple versions57 Other Diagnosis Code 17 Present on Admission 17 (POA) Diagnosis Code 17 present on Admission 17. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions58 Other Diagnosis Code 18 ICD-9-CM/ICD-10-CM Diagnosis Code 18 Remove embedded decimal pt. alphanumeric 7
Multiple versions59 Other Diagnosis Code 18 Present on Admission 18 (POA) Diagnosis Code 18 present on Admission 18. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions60 Other Diagnosis Code 19 ICD-9-CM/ICD-10-CM Diagnosis Code 19 Remove embedded decimal pt. alphanumeric 7
Multiple versions61 Other Diagnosis Code 19 Present on Admission 19 (POA) Diagnosis Code 19 present on Admission 19. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions62 Other Diagnosis Code 20 ICD-9-CM/ICD-10-CM Diagnosis Code 20 Remove embedded decimal pt. alphanumeric 7
Multiple versions63 Other Diagnosis Code 20 Present on Admission 20 (POA) Diagnosis Code 20 present on Admission 20. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions64 Other Diagnosis Code 21 ICD-9-CM/ICD-10-CM Diagnosis Code 21 Remove embedded decimal pt. alphanumeric 7
Multiple versions65 Other Diagnosis Code 21 Present on Admission 21 (POA) Diagnosis Code 21 present on Admission 21. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions66 Other Diagnosis Code 22 ICD-9-CM/ICD-10-CM Diagnosis Code 22 Remove embedded decimal pt. alphanumeric 7
Multiple versions67 Other Diagnosis Code 22 Present on Admission 22 (POA) Diagnosis Code 22 present on Admission 22. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions68 Other Diagnosis Code 23 ICD-9-CM/ICD-10-CM Diagnosis Code 23 Remove embedded decimal pt. alphanumeric 7
Multiple versions69 Other Diagnosis Code 23 Present on Admission 23 (POA) Diagnosis Code 23 present on Admission 23. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions70 Other Diagnosis Code 24 ICD-9-CM/ICD-10-CM Diagnosis Code 24 Remove embedded decimal pt. alphanumeric 7
Multiple versions71 Other Diagnosis Code 24 Present on Admission 24 (POA) Diagnosis Code 24 present on Admission 24. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions72 Other Diagnosis Code 25 ICD-9-CM/ICD-10-CM Diagnosis Code 25 Remove embedded decimal pt. alphanumeric 7
Multiple versions73 Other Diagnosis Code 25 Present on Admission 25 (POA) Diagnosis Code 25 present on Admission 25. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions74 Other Diagnosis Code 26 ICD-9-CM/ICD-10-CM Diagnosis Code 26 Remove embedded decimal pt. alphanumeric 7
Multiple versions75 Other Diagnosis Code 26 Present on Admission 26 (POA) Diagnosis Code 26 present on Admission 26. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions76 Other Diagnosis Code 27 ICD-9-CM/ICD-10-CM Diagnosis Code 27 Remove embedded decimal pt. alphanumeric 7
Multiple versions77 Other Diagnosis Code 27 Present on Admission 27 (POA) Diagnosis Code 27 present on Admission 27. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions78 Other Diagnosis Code 28 ICD-9-CM/ICD-10-CM Diagnosis Code 28 Remove embedded decimal pt. alphanumeric 7
Multiple versions79 Other Diagnosis Code 28 Present on Admission 28 (POA) Diagnosis Code 28 present on Admission 28. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions80 Other Diagnosis Code 29 ICD-9-CM/ICD-10-CM Diagnosis Code 29 Remove embedded decimal pt. alphanumeric 7
Multiple versions81 Other Diagnosis Code 29 Present on Admission 29 (POA) Diagnosis Code 29 present on Admission 29. Applies only to hospital inpatient records. All other record types code "0". alphanumeric 1
Multiple versions82 Attending Practitioner Individual National Provider Identifier (NPI) number Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner. alphanumeric 10
Multiple versions83 Operating Practitioner Individual National Provider Identifier (NPI) number Federal identifier assigned by the federal government for use in all HIPAA transactions to an individual practitioner. alphanumeric 10
Multiple versions84 Procedure Code Indicator Indicates the classification used in assigning codes to procedures. numeric 1
Multiple versions85 Principal Procedure Code 1 The principal health care service provided, followed by a secondary procedure (up to 15 codes), if applicable at the time of service. Remove embedded decimal pt. alphanumeric 6
Multiple versions86 Procedure Code1 Modifier I Discriminate code used by practitioners to distinguish that a health care service has been altered [by a specific condition] but not changed in definition or code. A modifier is added as a suffix to a procedure code field. alphanumeric 2
Multiple versions87 Procedure Code1 Modifier II Specific to Modifier I. alphanumeric 2
Multiple versions88 Other Procedure Code 2 Remove embedded decimal pt. alphanumeric 6
Multiple versions89 Procedure Code2 Modifier I Not Provided alphanumeric 2
Multiple versions90 Procedure Code2 Modifier II Not Provided alphanumeric 2
Multiple versions91 Other Procedure Code 3 Remove embedded decimal pt. alphanumeric 6
Multiple versions92 Procedure Code3 Modifier I Not Provided alphanumeric 2
Multiple versions93 Procedure Code3 Modifier II Not Provided alphanumeric 2
Multiple versions94 Other Procedure Code 4 Remove embedded decimal pt. alphanumeric 6
Multiple versions95 Procedure Code4 Modifier I Not Provided alphanumeric 2
Multiple versions96 Procedure Code4 Modifier II Not Provided alphanumeric 2
Multiple versions97 Other Procedure Code 5 Remove embedded decimal pt. alphanumeric 6
Multiple versions98 Procedure Code5 Modifier I Not Provided alphanumeric 2
Multiple versions99 Procedure Code5 Modifier II Not Provided alphanumeric 2
Multiple versions100 Other Procedure Code 6 Remove embedded decimal pt. alphanumeric 6
Multiple versions101 Procedure Code6 Modifier I Not Provided alphanumeric 2
Multiple versions102 Procedure Code6 Modifier II Not Provided alphanumeric 2
Multiple versions103 Other Procedure Code 7 Remove embedded decimal pt. alphanumeric 6
Multiple versions104 Procedure Code7 Modifier I Not Provided alphanumeric 2
Multiple versions105 Procedure Code7 Modifier II Not Provided alphanumeric 2
Multiple versions106 Other Procedure Code 8 Remove embedded decimal pt. alphanumeric 6
Multiple versions107 Procedure Code8 Modifier I Not Provided alphanumeric 2
Multiple versions108 Procedure Code8 Modifier II Not Provided alphanumeric 2
Multiple versions109 Other Procedure Code 9 Remove embedded decimal pt. alphanumeric 6
Multiple versions110 Procedure Code9 Modifier I Not Provided alphanumeric 2
Multiple versions111 Procedure Code9 Modifier II Not Provided alphanumeric 2
Multiple versions112 Other Procedure Code 10 Remove embedded decimal pt. alphanumeric 6
Multiple versions113 Procedure Code10 Modifier I Not Provided alphanumeric 2
Multiple versions114 Procedure Code10 Modifier II Not Provided alphanumeric 2
Multiple versions115 Other Procedure Code 11 Remove embedded decimal pt. alphanumeric 6
Multiple versions116 Procedure Code11 Modifier I Not Provided alphanumeric 2
Multiple versions117 Procedure Code11 Modifier II Not Provided alphanumeric 2
Multiple versions118 Other Procedure Code 12 Remove embedded decimal pt. alphanumeric 6
Multiple versions119 Procedure Code12 Modifier I Not Provided alphanumeric 2
Multiple versions120 Procedure Code12 Modifier II Not Provided alphanumeric 2
Multiple versions121 Other Procedure Code 13 Remove embedded decimal pt. alphanumeric 6
Multiple versions122 Procedure Code13 Modifier I Not Provided alphanumeric 2
Multiple versions123 Procedure Code13 Modifier II Not Provided alphanumeric 2
Multiple versions124 Other Procedure Code 14 Remove embedded decimal pt. alphanumeric 6
Multiple versions125 Procedure Code14 Modifier I Not Provided alphanumeric 2
Multiple versions126 Procedure Code14 Modifier II Not Provided alphanumeric 2
Multiple versions127 Other Procedure Code 15 Remove embedded decimal pt. alphanumeric 6
Multiple versions128 Procedure Code15 Modifier I Not Provided alphanumeric 2
Multiple versions129 Procedure Code15 Modifier II Not Provided alphanumeric 2
Multiple versions130 Diagnosis Related Groups (DRGs) Number The inpatient classifications based on diagnosis, procedure, age, gender and discharge disposition. alphanumeric 3
Multiple versions131 DRG Grouper Name The actual DRG Grouper used to produce the DRGs. numeric 1
Multiple versions132 DRG Grouper Version Version of DRG Grouper used. numeric 2
Multiple versions133 Billed Charge A provider's billed charges rounded to whole dollars. DO NOT USE DECIMALS numeric 9
Multiple versions134 Allowed Amount Total patient and payor liability. DO NOT USE DECIMALS numeric 9
Multiple versions135 Reimbursement Amount Amount paid by carrier to Tax ID # of provider as listed on claim. DO NOT USE DECIMALS numeric 9
Multiple versions136 Total Patient Deductible The fixed amount that the patient must pay for covered medical services/hospital stay before benefits are payable. numeric 9
Multiple versions137 Total Patient Coinsurance or Patient Co- payment The specified amount or percentage the patient is required to contribute towards covered medical services/hospital stay after any applicable deductible. numeric 9
Multiple versions138 Total Other Patient Obligations Any patient liability other than the deductible or coinsurance/co-payment. This could include obligations for out-of-network care (balance billing net of patient deductible, patient coinsurance/co-payment and payor reimbursement), non-covered services, or penalties. DO NOT USE DECIMALS numeric 9
Multiple versions139 Coordination of Benefit Savings or Other Payor Payments If you are not the primary insurer, report the amount paid by the primary payor. numeric 9
Multiple versions140 Type of Bill Not Provided alphanumeric 3
Multiple versions141 Patient Covered by Other Insurance Indicator Indicates whether patient has additional insurance coverage. numeric 1
Multiple versions142 Payor ID Number Payor assigned submission identification number. alphanumeric 4
Multiple versions143 Source System Identify the source system (platforms or business units) from which the data was obtained by using an alphabet letter (A, B, C, D, etc...) (Note: In your documentation on page 15, please be sure to list the source system that corresponds with the letter assigned.) For payors with all data coming from one system only, leave the field blank. alphanumeric 1
Multiple versions144 Revenue Code 1 Provide the codes used to identify specific accommodation and/or ancillary charges. numeric 4
Multiple versions145 Other Revenue Code 2 Not Provided numeric 4
Multiple versions146 Other Revenue Code 3 Not Provided numeric 4
Multiple versions147 Other Revenue Code 4 Not Provided numeric 4
Multiple versions148 Other Revenue Code 5 Not Provided numeric 4
Multiple versions149 Other Revenue Code 6 Not Provided numeric 4
Multiple versions150 Other Revenue Code 7 Not Provided numeric 4
Multiple versions151 Other Revenue Code 8 Not Provided numeric 4
Multiple versions152 Other Revenue Code 9 Not Provided numeric 4
Multiple versions153 Other Revenue Code 10 Not Provided numeric 4
Multiple versions154 Other Revenue Code 11 Not Provided numeric 4
Multiple versions155 Other Revenue Code 12 Not Provided numeric 4
Multiple versions156 Other Revenue Code 13 Not Provided numeric 4
Multiple versions157 Other Revenue Code 14 Not Provided numeric 4
Multiple versions158 Other Revenue Code 15 Not Provided numeric 4
Multiple versions159 Other Revenue Code 16 Not Provided numeric 4
Multiple versions160 Other Revenue Code 17 Not Provided numeric 4
Multiple versions161 Other Revenue Code 18 Not Provided numeric 4
Multiple versions162 Other Revenue Code 19 Not Provided numeric 4
Multiple versions163 Other Revenue Code 20 Not Provided numeric 4
Multiple versions164 Other Revenue Code 21 Not Provided numeric 4
Multiple versions165 Other Revenue Code 22 Not Provided numeric 4
166 Other Revenue Code 23 Not Provided numeric 4
167 Reporting Quarter Indicate the quarter number for which the data is being submitted. numeric 1

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Data Element ID Data Element Code Value
1 Record Identifier 4 Institutional Services
5 Patient Sex 1 Male
2 Female
3 Unknown
12 Hospital/Facility Participating Provider Flag 1 Participating
2 Non-Participating
3 Unknown/Not Coded
9 No Network for this Plan
15 Record Type 10 Hospital Inpatient - Undefined
11 Hospital Inpatient - Acute care
12 Hospital Inpatient - Children's Hospital
13 Hospital Inpatient - Mental health or Substance abuse
14 Hospital Inpatient - Rehabilitation, Long term care, SNF stay
20 Hospital Outpatient - Undefined
21 Hospital Outpatient - Ambulatory Surgery
22 Hospital Outpatient - Emergency Room
23 Hospital Outpatient - Other
30 Non-Hospital Facility
16 Type of Admission 0 Not a hospital inpatient record
1 Emergency
2 Urgent
3 Elective
4 Newborn
5 Trauma Center
6 Reserved for National Assignment
7 Reserved for National Assignment
8 Reserved for National Assignment
9 Information Not Available
17 Point of Origin for Admission or Visit 0 Not a hospital inpatient record
1 Normal delivery For Newborns (Type of Admission = 4)
1 Non-Health Facility Point of Origin Admissions other than Newborn
2 Premature delivery For Newborns (Type of Admission = 4)
2 Clinic or Physician's Office Admissions other than Newborn
3 Sick baby For Newborns (Type of Admission = 4)
3 Reserved for national assignment Admissions other than Newborn
4 Not used For Newborns (Type of Admission = 4)
4 Transfer from a Hospital (Different Facility) Admissions other than Newborn
5 Born inside this hospital For Newborns (Type of Admission = 4)
5 Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) Admissions other than Newborn
6 Born outside of this hospital For Newborns (Type of Admission = 4)
6 Transfer from Another Health Care Facility Admissions other than Newborn
8 Court/Law Enforcement Admissions other than Newborn
9 Information not available For Newborns (Type of Admission = 4)
9 Information Not Available Admissions other than Newborn
18 Patient Discharge Status 00 Not a hospital inpatient record
01 Routine (home or self care)
02 Another Short-term Hospital
03 Skilled Nursing Facility (SNF)
04 Intermediate Care Facility
05 Another type of facility (includes rehab facility, hospice, etc.)
06 Home Health Care (HHC)
07 Against medical advice (AMA)/Discontinued care
09 Missing/Unknown
20 Died/Expired
21 Diagnosis Code Indicator 1 ICD-9-CM
2 ICD-10-CM
3 Missing/Unknown
23 Primary Diagnosis Present on Admission (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
25 Other Diagnosis Code 1 Present on Admission 1 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
27 Other Diagnosis Code 2 Present on Admission 2 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
29 Other Diagnosis Code 3 Present on Admission 3 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
31 Other Diagnosis Code 4 Present on Admission 4 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
33 Other Diagnosis Code 5 Present on Admission 5 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
35 Other Diagnosis Code 6 Present on Admission 6 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
37 Other Diagnosis Code 7 Present on Admission 7 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
39 Other Diagnosis Code 8 Present on Admission 8 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
41 Other Diagnosis Code 9 Present on Admission 9 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
43 Other Diagnosis Code 10 Present on Admission 10 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
45 Other Diagnosis Code 11 Present on Admission 11 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
47 Other Diagnosis Code 12 Present on Admission 12 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
49 Other Diagnosis Code 13 Present on Admission 13 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
51 Other Diagnosis Code 14 Present on Admission 14 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
53 Other Diagnosis Code 15 Present on Admission 15 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
55 Other Diagnosis Code 16 Present on Admission 16 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
57 Other Diagnosis Code 17 Present on Admission 17 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
59 Other Diagnosis Code 18 Present on Admission 18 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
61 Other Diagnosis Code 19 Present on Admission 19 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
63 Other Diagnosis Code 20 Present on Admission 20 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
65 Other Diagnosis Code 21 Present on Admission 21 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
67 Other Diagnosis Code 22 Present on Admission 22 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
69 Other Diagnosis Code 23 Present on Admission 23 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
71 Other Diagnosis Code 24 Present on Admission 24 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
73 Other Diagnosis Code 25 Present on Admission 25 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
75 Other Diagnosis Code 26 Present on Admission 26 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
77 Other Diagnosis Code 27 Present on Admission 27 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
79 Other Diagnosis Code 28 Present on Admission 28 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
81 Other Diagnosis Code 29 Present on Admission 29 (POA) E Unreported/Not used = Exempt from POA reporting
N No = Not present at the time of inpatient admission
U Unknown = Documentation is insufficient to determine if condition is present on admission
W Clinically undetermined = Provider is unable to clinically determine whether condition was present on admission or not
Y Yes = Present at the time of inpatient admission
84 Procedure Code Indicator 1 ICD-9-CM
2 ICD-10-CM
3 CPT Code/HCPCS
131 DRG Grouper Name 1 All Patient DRGs (AP-DRGs)
2 All Patient Refined DRGs (APR-DRGs)
3 Centers for Medicare & Medicaid Services DRGs (CMS-DRGs)
4 Other Proprietary
140 Type of Bill 111 Hospital Inpatient (including Medicare Part A) Admit through Discharge
112 Hospital Inpatient (including Medicare Part A) Interim - First Claim Used
113 Hospital Inpatient (including Medicare Part A) Interim - Continuing Claims
114 Hospital Inpatient (including Medicare Part A) Interim - Last Claim
115 Hospital Inpatient (including Medicare Part A) Late Charge Only
116 Hospital Inpatient (including Medicare Part A) Adjustment of Prior Claim
117 Hospital Inpatient (including Medicare Part A) Replacement of Prior Claim
118 Hospital Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
121 Hospital Inpatient (including Medicare Part B Only) Admit through Discharge
122 Hospital Inpatient (including Medicare Part B Only) Interim - First Claim Used
123 Hospital Inpatient (including Medicare Part B Only) Interim - Continuing Claims
124 Hospital Inpatient (including Medicare Part B Only) Interim - Last Claim
125 Hospital Inpatient (including Medicare Part B Only) Late Charge Only
126 Hospital Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
127 Hospital Inpatient (including Medicare Part B Only) Replacement of Prior Claim
128 Hospital Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
131 Hospital Outpatient Admit through Discharge
132 Hospital Outpatient Interim - First Claim Used
133 Hospital Outpatient Interim - Continuing Claims
134 Hospital Outpatient Interim - Last Claim
135 Hospital Outpatient Late Charge Only
136 Hospital Outpatient Adjustment of Prior Claim
137 Hospital Outpatient Replacement of Prior Claim
138 Hospital Outpatient Void/Cancel of Prior Claim
141 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
142 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
143 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
144 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
145 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
146 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
147 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
148 Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
151 Hospital Nursing Facility Level I Admit through Discharge
152 Hospital Nursing Facility Level I Interim - First Claim Used
153 Hospital Nursing Facility Level I Interim - Continuing Claims
154 Hospital Nursing Facility Level I Interim - Last Claim
155 Hospital Nursing Facility Level I Late Charge Only
156 Hospital Nursing Facility Level I Adjustment of Prior Claim
157 Hospital Nursing Facility Level I Replacement of Prior Claim
158 Hospital Nursing Facility Level I Void/Cancel of Prior Claim
161 Hospital Nursing Facility Level II Admit through Discharge
162 Hospital Nursing Facility Level II Interim - First Claim Used
163 Hospital Nursing Facility Level II Interim - Continuing Claims
164 Hospital Nursing Facility Level II Interim - Last Claim
165 Hospital Nursing Facility Level II Late Charge Only
166 Hospital Nursing Facility Level II Adjustment of Prior Claim
167 Hospital Nursing Facility Level II Replacement of Prior Claim
168 Hospital Nursing Facility Level II Void/Cancel of Prior Claim
171 Hospital Intermediate Care - Level III Nursing Facility Admit through Discharge
172 Hospital Intermediate Care - Level III Nursing Facility Interim - First Claim Used
173 Hospital Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
174 Hospital Intermediate Care - Level III Nursing Facility Interim - Last Claim
175 Hospital Intermediate Care - Level III Nursing Facility Late Charge Only
176 Hospital Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
177 Hospital Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
178 Hospital Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
181 Hospital Swing Beds Admit through Discharge
182 Hospital Swing Beds Interim - First Claim Used
183 Hospital Swing Beds Interim - Continuing Claims
184 Hospital Swing Beds Interim - Last Claim
185 Hospital Swing Beds Late Charge Only
186 Hospital Swing Beds Adjustment of Prior Claim
187 Hospital Swing Beds Replacement of Prior Claim
188 Hospital Swing Beds Void/Cancel of Prior Claim
211 Skilled Nursing Inpatient (including Medicare Part A) Admit through Discharge
212 Skilled Nursing Inpatient (including Medicare Part A) Interim - First Claim Used
213 Skilled Nursing Inpatient (including Medicare Part A) Interim - Continuing Claims
214 Skilled Nursing Inpatient (including Medicare Part A) Interim - Last Claim
215 Skilled Nursing Inpatient (including Medicare Part A) Late Charge Only
216 Skilled Nursing Inpatient (including Medicare Part A) Adjustment of Prior Claim
217 Skilled Nursing Inpatient (including Medicare Part A) Replacement of Prior Claim
218 Skilled Nursing Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
221 Skilled Nursing Inpatient (including Medicare Part B Only) Admit through Discharge
222 Skilled Nursing Inpatient (including Medicare Part B Only) Interim - First Claim Used
223 Skilled Nursing Inpatient (including Medicare Part B Only) Interim - Continuing Claims
224 Skilled Nursing Inpatient (including Medicare Part B Only) Interim - Last Claim
225 Skilled Nursing Inpatient (including Medicare Part B Only) Late Charge Only
226 Skilled Nursing Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
227 Skilled Nursing Inpatient (including Medicare Part B Only) Replacement of Prior Claim
228 Skilled Nursing Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
231 Skilled Nursing Outpatient Admit through Discharge
232 Skilled Nursing Outpatient Interim - First Claim Used
233 Skilled Nursing Outpatient Interim - Continuing Claims
234 Skilled Nursing Outpatient Interim - Last Claim
235 Skilled Nursing Outpatient Late Charge Only
236 Skilled Nursing Outpatient Adjustment of Prior Claim
237 Skilled Nursing Outpatient Replacement of Prior Claim
238 Skilled Nursing Outpatient Void/Cancel of Prior Claim
241 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
242 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
243 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
244 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
245 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
246 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
247 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
248 Skilled Nursing Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
251 Skilled Nursing Nursing Facility Level I Admit through Discharge
252 Skilled Nursing Nursing Facility Level I Interim - First Claim Used
253 Skilled Nursing Nursing Facility Level I Interim - Continuing Claims
254 Skilled Nursing Nursing Facility Level I Interim - Last Claim
255 Skilled Nursing Nursing Facility Level I Late Charge Only
256 Skilled Nursing Nursing Facility Level I Adjustment of Prior Claim
257 Skilled Nursing Nursing Facility Level I Replacement of Prior Claim
258 Skilled Nursing Nursing Facility Level I Void/Cancel of Prior Claim
261 Skilled Nursing Nursing Facility Level II Admit through Discharge
262 Skilled Nursing Nursing Facility Level II Interim - First Claim Used
263 Skilled Nursing Nursing Facility Level II Interim - Continuing Claims
264 Skilled Nursing Nursing Facility Level II Interim - Last Claim
265 Skilled Nursing Nursing Facility Level II Late Charge Only
266 Skilled Nursing Nursing Facility Level II Adjustment of Prior Claim
267 Skilled Nursing Nursing Facility Level II Replacement of Prior Claim
268 Skilled Nursing Nursing Facility Level II Void/Cancel of Prior Claim
271 Skilled Nursing Intermediate Care - Level III Nursing Facility Admit through Discharge
272 Skilled Nursing Intermediate Care - Level III Nursing Facility Interim - First Claim Used
273 Skilled Nursing Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
274 Skilled Nursing Intermediate Care - Level III Nursing Facility Interim - Last Claim
275 Skilled Nursing Intermediate Care - Level III Nursing Facility Late Charge Only
276 Skilled Nursing Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
277 Skilled Nursing Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
278 Skilled Nursing Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
281 Skilled Nursing Swing Beds Admit through Discharge
282 Skilled Nursing Swing Beds Interim - First Claim Used
283 Skilled Nursing Swing Beds Interim - Continuing Claims
284 Skilled Nursing Swing Beds Interim - Last Claim
285 Skilled Nursing Swing Beds Late Charge Only
286 Skilled Nursing Swing Beds Adjustment of Prior Claim
287 Skilled Nursing Swing Beds Replacement of Prior Claim
288 Skilled Nursing Swing Beds Void/Cancel of Prior Claim
311 Home Health Inpatient (including Medicare Part A) Admit through Discharge
312 Home Health Inpatient (including Medicare Part A) Interim - First Claim Used
313 Home Health Inpatient (including Medicare Part A) Interim - Continuing Claims
314 Home Health Inpatient (including Medicare Part A) Interim - Last Claim
315 Home Health Inpatient (including Medicare Part A) Late Charge Only
316 Home Health Inpatient (including Medicare Part A) Adjustment of Prior Claim
317 Home Health Inpatient (including Medicare Part A) Replacement of Prior Claim
318 Home Health Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
321 Home Health Inpatient (including Medicare Part B Only) Admit through Discharge
322 Home Health Inpatient (including Medicare Part B Only) Interim - First Claim Used
323 Home Health Inpatient (including Medicare Part B Only) Interim - Continuing Claims
324 Home Health Inpatient (including Medicare Part B Only) Interim - Last Claim
325 Home Health Inpatient (including Medicare Part B Only) Late Charge Only
326 Home Health Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
327 Home Health Inpatient (including Medicare Part B Only) Replacement of Prior Claim
328 Home Health Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
331 Home Health Outpatient Admit through Discharge
332 Home Health Outpatient Interim - First Claim Used
333 Home Health Outpatient Interim - Continuing Claims
334 Home Health Outpatient Interim - Last Claim
335 Home Health Outpatient Late Charge Only
336 Home Health Outpatient Adjustment of Prior Claim
337 Home Health Outpatient Replacement of Prior Claim
338 Home Health Outpatient Void/Cancel of Prior Claim
341 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
342 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
343 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
344 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
345 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
346 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
347 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
348 Home Health Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
351 Home Health Nursing Facility Level I Admit through Discharge
352 Home Health Nursing Facility Level I Interim - First Claim Used
353 Home Health Nursing Facility Level I Interim - Continuing Claims
354 Home Health Nursing Facility Level I Interim - Last Claim
355 Home Health Nursing Facility Level I Late Charge Only
356 Home Health Nursing Facility Level I Adjustment of Prior Claim
357 Home Health Nursing Facility Level I Replacement of Prior Claim
358 Home Health Nursing Facility Level I Void/Cancel of Prior Claim
361 Home Health Nursing Facility Level II Admit through Discharge
362 Home Health Nursing Facility Level II Interim - First Claim Used
363 Home Health Nursing Facility Level II Interim - Continuing Claims
364 Home Health Nursing Facility Level II Interim - Last Claim
365 Home Health Nursing Facility Level II Late Charge Only
366 Home Health Nursing Facility Level II Adjustment of Prior Claim
367 Home Health Nursing Facility Level II Replacement of Prior Claim
368 Home Health Nursing Facility Level II Void/Cancel of Prior Claim
371 Home Health Intermediate Care - Level III Nursing Facility Admit through Discharge
372 Home Health Intermediate Care - Level III Nursing Facility Interim - First Claim Used
373 Home Health Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
374 Home Health Intermediate Care - Level III Nursing Facility Interim - Last Claim
375 Home Health Intermediate Care - Level III Nursing Facility Late Charge Only
376 Home Health Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
377 Home Health Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
378 Home Health Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
381 Home Health Swing Beds Admit through Discharge
382 Home Health Swing Beds Interim - First Claim Used
383 Home Health Swing Beds Interim - Continuing Claims
384 Home Health Swing Beds Interim - Last Claim
385 Home Health Swing Beds Late Charge Only
386 Home Health Swing Beds Adjustment of Prior Claim
387 Home Health Swing Beds Replacement of Prior Claim
388 Home Health Swing Beds Void/Cancel of Prior Claim
411 Christian Science Hospital Inpatient (including Medicare Part A) Admit through Discharge
412 Christian Science Hospital Inpatient (including Medicare Part A) Interim - First Claim Used
413 Christian Science Hospital Inpatient (including Medicare Part A) Interim - Continuing Claims
414 Christian Science Hospital Inpatient (including Medicare Part A) Interim - Last Claim
415 Christian Science Hospital Inpatient (including Medicare Part A) Late Charge Only
416 Christian Science Hospital Inpatient (including Medicare Part A) Adjustment of Prior Claim
417 Christian Science Hospital Inpatient (including Medicare Part A) Replacement of Prior Claim
418 Christian Science Hospital Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
421 Christian Science Hospital Inpatient (including Medicare Part B Only) Admit through Discharge
422 Christian Science Hospital Inpatient (including Medicare Part B Only) Interim - First Claim Used
423 Christian Science Hospital Inpatient (including Medicare Part B Only) Interim - Continuing Claims
424 Christian Science Hospital Inpatient (including Medicare Part B Only) Interim - Last Claim
425 Christian Science Hospital Inpatient (including Medicare Part B Only) Late Charge Only
426 Christian Science Hospital Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
427 Christian Science Hospital Inpatient (including Medicare Part B Only) Replacement of Prior Claim
428 Christian Science Hospital Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
431 Christian Science Hospital Outpatient Admit through Discharge
432 Christian Science Hospital Outpatient Interim - First Claim Used
433 Christian Science Hospital Outpatient Interim - Continuing Claims
434 Christian Science Hospital Outpatient Interim - Last Claim
435 Christian Science Hospital Outpatient Late Charge Only
436 Christian Science Hospital Outpatient Adjustment of Prior Claim
437 Christian Science Hospital Outpatient Replacement of Prior Claim
438 Christian Science Hospital Outpatient Void/Cancel of Prior Claim
441 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
442 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
443 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
444 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
445 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
446 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
447 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
448 Christian Science Hospital Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
451 Christian Science Hospital Nursing Facility Level I Admit through Discharge
452 Christian Science Hospital Nursing Facility Level I Interim - First Claim Used
453 Christian Science Hospital Nursing Facility Level I Interim - Continuing Claims
454 Christian Science Hospital Nursing Facility Level I Interim - Last Claim
455 Christian Science Hospital Nursing Facility Level I Late Charge Only
456 Christian Science Hospital Nursing Facility Level I Adjustment of Prior Claim
457 Christian Science Hospital Nursing Facility Level I Replacement of Prior Claim
458 Christian Science Hospital Nursing Facility Level I Void/Cancel of Prior Claim
461 Christian Science Hospital Nursing Facility Level II Admit through Discharge
462 Christian Science Hospital Nursing Facility Level II Interim - First Claim Used
463 Christian Science Hospital Nursing Facility Level II Interim - Continuing Claims
464 Christian Science Hospital Nursing Facility Level II Interim - Last Claim
465 Christian Science Hospital Nursing Facility Level II Late Charge Only
466 Christian Science Hospital Nursing Facility Level II Adjustment of Prior Claim
467 Christian Science Hospital Nursing Facility Level II Replacement of Prior Claim
468 Christian Science Hospital Nursing Facility Level II Void/Cancel of Prior Claim
471 Christian Science Hospital Intermediate Care - Level III Nursing Facility Admit through Discharge
472 Christian Science Hospital Intermediate Care - Level III Nursing Facility Interim - First Claim Used
473 Christian Science Hospital Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
474 Christian Science Hospital Intermediate Care - Level III Nursing Facility Interim - Last Claim
475 Christian Science Hospital Intermediate Care - Level III Nursing Facility Late Charge Only
476 Christian Science Hospital Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
477 Christian Science Hospital Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
478 Christian Science Hospital Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
481 Christian Science Hospital Swing Beds Admit through Discharge
482 Christian Science Hospital Swing Beds Interim - First Claim Used
483 Christian Science Hospital Swing Beds Interim - Continuing Claims
484 Christian Science Hospital Swing Beds Interim - Last Claim
485 Christian Science Hospital Swing Beds Late Charge Only
486 Christian Science Hospital Swing Beds Adjustment of Prior Claim
487 Christian Science Hospital Swing Beds Replacement of Prior Claim
488 Christian Science Hospital Swing Beds Void/Cancel of Prior Claim
511 Christian Science Extended Care Inpatient (including Medicare Part A) Admit through Discharge
512 Christian Science Extended Care Inpatient (including Medicare Part A) Interim - First Claim Used
513 Christian Science Extended Care Inpatient (including Medicare Part A) Interim - Continuing Claims
514 Christian Science Extended Care Inpatient (including Medicare Part A) Interim - Last Claim
515 Christian Science Extended Care Inpatient (including Medicare Part A) Late Charge Only
516 Christian Science Extended Care Inpatient (including Medicare Part A) Adjustment of Prior Claim
517 Christian Science Extended Care Inpatient (including Medicare Part A) Replacement of Prior Claim
518 Christian Science Extended Care Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
521 Christian Science Extended Care Inpatient (including Medicare Part B Only) Admit through Discharge
522 Christian Science Extended Care Inpatient (including Medicare Part B Only) Interim - First Claim Used
523 Christian Science Extended Care Inpatient (including Medicare Part B Only) Interim - Continuing Claims
524 Christian Science Extended Care Inpatient (including Medicare Part B Only) Interim - Last Claim
525 Christian Science Extended Care Inpatient (including Medicare Part B Only) Late Charge Only
526 Christian Science Extended Care Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
527 Christian Science Extended Care Inpatient (including Medicare Part B Only) Replacement of Prior Claim
528 Christian Science Extended Care Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
531 Christian Science Extended Care Outpatient Admit through Discharge
532 Christian Science Extended Care Outpatient Interim - First Claim Used
533 Christian Science Extended Care Outpatient Interim - Continuing Claims
534 Christian Science Extended Care Outpatient Interim - Last Claim
535 Christian Science Extended Care Outpatient Late Charge Only
536 Christian Science Extended Care Outpatient Adjustment of Prior Claim
537 Christian Science Extended Care Outpatient Replacement of Prior Claim
538 Christian Science Extended Care Outpatient Void/Cancel of Prior Claim
541 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
542 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
543 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
544 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
545 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
546 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
547 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
548 Christian Science Extended Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
551 Christian Science Extended Care Nursing Facility Level I Admit through Discharge
552 Christian Science Extended Care Nursing Facility Level I Interim - First Claim Used
553 Christian Science Extended Care Nursing Facility Level I Interim - Continuing Claims
554 Christian Science Extended Care Nursing Facility Level I Interim - Last Claim
555 Christian Science Extended Care Nursing Facility Level I Late Charge Only
556 Christian Science Extended Care Nursing Facility Level I Adjustment of Prior Claim
557 Christian Science Extended Care Nursing Facility Level I Replacement of Prior Claim
558 Christian Science Extended Care Nursing Facility Level I Void/Cancel of Prior Claim
561 Christian Science Extended Care Nursing Facility Level II Admit through Discharge
562 Christian Science Extended Care Nursing Facility Level II Interim - First Claim Used
563 Christian Science Extended Care Nursing Facility Level II Interim - Continuing Claims
564 Christian Science Extended Care Nursing Facility Level II Interim - Last Claim
565 Christian Science Extended Care Nursing Facility Level II Late Charge Only
566 Christian Science Extended Care Nursing Facility Level II Adjustment of Prior Claim
567 Christian Science Extended Care Nursing Facility Level II Replacement of Prior Claim
568 Christian Science Extended Care Nursing Facility Level II Void/Cancel of Prior Claim
571 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Admit through Discharge
572 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Interim - First Claim Used
573 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
574 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Interim - Last Claim
575 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Late Charge Only
576 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
577 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
578 Christian Science Extended Care Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
581 Christian Science Extended Care Swing Beds Admit through Discharge
582 Christian Science Extended Care Swing Beds Interim - First Claim Used
583 Christian Science Extended Care Swing Beds Interim - Continuing Claims
584 Christian Science Extended Care Swing Beds Interim - Last Claim
585 Christian Science Extended Care Swing Beds Late Charge Only
586 Christian Science Extended Care Swing Beds Adjustment of Prior Claim
587 Christian Science Extended Care Swing Beds Replacement of Prior Claim
588 Christian Science Extended Care Swing Beds Void/Cancel of Prior Claim
611 Intermediate Care Inpatient (including Medicare Part A) Admit through Discharge
612 Intermediate Care Inpatient (including Medicare Part A) Interim - First Claim Used
613 Intermediate Care Inpatient (including Medicare Part A) Interim - Continuing Claims
614 Intermediate Care Inpatient (including Medicare Part A) Interim - Last Claim
615 Intermediate Care Inpatient (including Medicare Part A) Late Charge Only
616 Intermediate Care Inpatient (including Medicare Part A) Adjustment of Prior Claim
617 Intermediate Care Inpatient (including Medicare Part A) Replacement of Prior Claim
618 Intermediate Care Inpatient (including Medicare Part A) Void/Cancel of Prior Claim
621 Intermediate Care Inpatient (including Medicare Part B Only) Admit through Discharge
622 Intermediate Care Inpatient (including Medicare Part B Only) Interim - First Claim Used
623 Intermediate Care Inpatient (including Medicare Part B Only) Interim - Continuing Claims
624 Intermediate Care Inpatient (including Medicare Part B Only) Interim - Last Claim
625 Intermediate Care Inpatient (including Medicare Part B Only) Late Charge Only
626 Intermediate Care Inpatient (including Medicare Part B Only) Adjustment of Prior Claim
627 Intermediate Care Inpatient (including Medicare Part B Only) Replacement of Prior Claim
628 Intermediate Care Inpatient (including Medicare Part B Only) Void/Cancel of Prior Claim
631 Intermediate Care Outpatient Admit through Discharge
632 Intermediate Care Outpatient Interim - First Claim Used
633 Intermediate Care Outpatient Interim - Continuing Claims
634 Intermediate Care Outpatient Interim - Last Claim
635 Intermediate Care Outpatient Late Charge Only
636 Intermediate Care Outpatient Adjustment of Prior Claim
637 Intermediate Care Outpatient Replacement of Prior Claim
638 Intermediate Care Outpatient Void/Cancel of Prior Claim
641 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Admit through Discharge
642 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - First Claim Used
643 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Continuing Claims
644 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Interim - Last Claim
645 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Late Charge Only
646 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Adjustment of Prior Claim
647 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Replacement of Prior Claim
648 Intermediate Care Other (for hospital referenced diagnostic services or home health not under a plan of treatment) Void/Cancel of Prior Claim
651 Intermediate Care Nursing Facility Level I Admit through Discharge
652 Intermediate Care Nursing Facility Level I Interim - First Claim Used
653 Intermediate Care Nursing Facility Level I Interim - Continuing Claims
654 Intermediate Care Nursing Facility Level I Interim - Last Claim
655 Intermediate Care Nursing Facility Level I Late Charge Only
656 Intermediate Care Nursing Facility Level I Adjustment of Prior Claim
657 Intermediate Care Nursing Facility Level I Replacement of Prior Claim
658 Intermediate Care Nursing Facility Level I Void/Cancel of Prior Claim
661 Intermediate Care Nursing Facility Level II Admit through Discharge
662 Intermediate Care Nursing Facility Level II Interim - First Claim Used
663 Intermediate Care Nursing Facility Level II Interim - Continuing Claims
664 Intermediate Care Nursing Facility Level II Interim - Last Claim
665 Intermediate Care Nursing Facility Level II Late Charge Only
666 Intermediate Care Nursing Facility Level II Adjustment of Prior Claim
667 Intermediate Care Nursing Facility Level II Replacement of Prior Claim
668 Intermediate Care Nursing Facility Level II Void/Cancel of Prior Claim
671 Intermediate Care Intermediate Care - Level III Nursing Facility Admit through Discharge
672 Intermediate Care Intermediate Care - Level III Nursing Facility Interim - First Claim Used
673 Intermediate Care Intermediate Care - Level III Nursing Facility Interim - Continuing Claims
674 Intermediate Care Intermediate Care - Level III Nursing Facility Interim - Last Claim
675 Intermediate Care Intermediate Care - Level III Nursing Facility Late Charge Only
676 Intermediate Care Intermediate Care - Level III Nursing Facility Adjustment of Prior Claim
677 Intermediate Care Intermediate Care - Level III Nursing Facility Replacement of Prior Claim
678 Intermediate Care Intermediate Care - Level III Nursing Facility Void/Cancel of Prior Claim
681 Intermediate Care Swing Beds Admit through Discharge
682 Intermediate Care Swing Beds Interim - First Claim Used
683 Intermediate Care Swing Beds Interim - Continuing Claims
684 Intermediate Care Swing Beds Interim - Last Claim
685 Intermediate Care Swing Beds Late Charge Only
686 Intermediate Care Swing Beds Adjustment of Prior Claim
687 Intermediate Care Swing Beds Replacement of Prior Claim
688 Intermediate Care Swing Beds Void/Cancel of Prior Claim
711 Clinic Rural Health Admit through Discharge
712 Clinic Rural Health Interim - First Claim Used
713 Clinic Rural Health Interim - Continuing Claims
714 Clinic Rural Health Interim - Last Claim
715 Clinic Rural Health Late Charge Only
716 Clinic Rural Health Adjustment of Prior Claim
717 Clinic Rural Health Replacement of Prior Claim
718 Clinic Rural Health Void/Cancel of Prior Claim
721 Clinic Hospital-based or Independent Renal Dialysis Center Admit through Discharge
722 Clinic Hospital-based or Independent Renal Dialysis Center Interim - First Claim Used
723 Clinic Hospital-based or Independent Renal Dialysis Center Interim - Continuing Claims
724 Clinic Hospital-based or Independent Renal Dialysis Center Interim - Last Claim
725 Clinic Hospital-based or Independent Renal Dialysis Center Late Charge Only
726 Clinic Hospital-based or Independent Renal Dialysis Center Adjustment of Prior Claim
727 Clinic Hospital-based or Independent Renal Dialysis Center Replacement of Prior Claim
728 Clinic Hospital-based or Independent Renal Dialysis Center Void/Cancel of Prior Claim
731 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Admit through Discharge
732 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Interim - First Claim Used
733 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Interim - Continuing Claims
734 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Interim - Last Claim
735 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Late Charge Only
736 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Adjustment of Prior Claim
737 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Replacement of Prior Claim
738 Clinic Freestanding Outpatient Rehabilitation Facility (ORF) Void/Cancel of Prior Claim
741 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Admit through Discharge
742 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim - First Claim Used
743 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim - Continuing Claims
744 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Interim - Last Claim
745 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Late Charge Only
746 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Adjustment of Prior Claim
747 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Replacement of Prior Claim
748 Clinic Comprehensive Outpatient Rehabilitation Facilities (CORFs) Void/Cancel of Prior Claim
751 Clinic Community Mental Health Center Admit through Discharge
752 Clinic Community Mental Health Center Interim - First Claim Used
753 Clinic Community Mental Health Center Interim - Continuing Claims
754 Clinic Community Mental Health Center Interim - Last Claim
755 Clinic Community Mental Health Center Late Charge Only
756 Clinic Community Mental Health Center Adjustment of Prior Claim
757 Clinic Community Mental Health Center Replacement of Prior Claim
758 Clinic Community Mental Health Center Void/Cancel of Prior Claim
791 Clinic Other Admit through Discharge
792 Clinic Other Interim - First Claim Used
793 Clinic Other Interim - Continuing Claims
794 Clinic Other Interim - Last Claim
795 Clinic Other Late Charge Only
796 Clinic Other Adjustment of Prior Claim
797 Clinic Other Replacement of Prior Claim
798 Clinic Other Void/Cancel of Prior Claim
811 Special Facility Hospice (Non-Hospital based) Admit through Discharge
812 Special Facility Hospice (Non-Hospital based) Interim - First Claim Used
813 Special Facility Hospice (Non-Hospital based) Interim - Continuing Claims
814 Special Facility Hospice (Non-Hospital based) Interim - Last Claim
815 Special Facility Hospice (Non-Hospital based) Late Charge Only
816 Special Facility Hospice (Non-Hospital based) Adjustment of Prior Claim
817 Special Facility Hospice (Non-Hospital based) Replacement of Prior Claim
818 Special Facility Hospice (Non-Hospital based) Void/Cancel of Prior Claim
821 Special Facility Hospice (Hospital-based) Admit through Discharge
822 Special Facility Hospice (Hospital-based) Interim - First Claim Used
823 Special Facility Hospice (Hospital-based) Interim - Continuing Claims
824 Special Facility Hospice (Hospital-based) Interim - Last Claim
825 Special Facility Hospice (Hospital-based) Late Charge Only
826 Special Facility Hospice (Hospital-based) Adjustment of Prior Claim
827 Special Facility Hospice (Hospital-based) Replacement of Prior Claim
828 Special Facility Hospice (Hospital-based) Void/Cancel of Prior Claim
831 Special Facility Ambulatory Surgery Center Admit through Discharge
832 Special Facility Ambulatory Surgery Center Interim - First Claim Used
833 Special Facility Ambulatory Surgery Center Interim - Continuing Claims
834 Special Facility Ambulatory Surgery Center Interim - Last Claim
835 Special Facility Ambulatory Surgery Center Late Charge Only
836 Special Facility Ambulatory Surgery Center Adjustment of Prior Claim
837 Special Facility Ambulatory Surgery Center Replacement of Prior Claim
838 Special Facility Ambulatory Surgery Center Void/Cancel of Prior Claim
841 Special Facility Freestanding Birthing Center Admit through Discharge
842 Special Facility Freestanding Birthing Center Interim - First Claim Used
843 Special Facility Freestanding Birthing Center Interim - Continuing Claims
844 Special Facility Freestanding Birthing Center Interim - Last Claim
845 Special Facility Freestanding Birthing Center Late Charge Only
846 Special Facility Freestanding Birthing Center Adjustment of Prior Claim
847 Special Facility Freestanding Birthing Center Replacement of Prior Claim
848 Special Facility Freestanding Birthing Center Void/Cancel of Prior Claim
891 Special Facility Other Admit through Discharge
892 Special Facility Other Interim - First Claim Used
893 Special Facility Other Interim - Continuing Claims
894 Special Facility Other Interim - Last Claim
895 Special Facility Other Late Charge Only
896 Special Facility Other Adjustment of Prior Claim
897 Special Facility Other Replacement of Prior Claim
898 Special Facility Other Void/Cancel of Prior Claim
141 Patient Covered by Other Insurance Indicator 0 No
1 Yes, other coverage is primary
2 Yes, other coverage is secondary
9 Unknown
167 Reporting Quarter 1 First Quarter = January 1 thru March 31
2 Second Quarter = April 1 thru June 30
3 Third Quarter = July 1 thru September 30
4 Fourth Quarter = October 1 thru December 31
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