Louisiana DHH Medicaid UB-92 Code Reference for LTC NF/ADHC/ICF-MR/ Hospice (Room & Board)

Transcription

1 Louisiana DHH Medicaid UB-92 Code Reference for LTC NF/ADHC/ICF-MR/ Hospice (Room & Board) Release Name: Long Term Care Release Date: 10/1/2003 Revised: 8/1/2003 Prepared By: Shannon L. Clark, HIPAA Operations Lead Mike Crum, HIPAA Analyst

2 UB-92 CODE REFERENCE FOR LONG TERM CARE SERVICES This document lists the full set of bill types, patient statuses and revenue codes that are valid for submission on the UB-92 claim form for Long Term Care (LTC) claims. This list, which has been excerpted from the Louisiana Medicaid UB-92 LTC Billing Instructions, is intended as a quick reference guide for these values. For additional information on completing the full UB-92 claim form for LTC claims, adjustments and/or voids, please refer to the UB-92 LTC Billing Instructions. VALID BILL TYPES Type of Bill (Field 4) on the UB-92 claim form indicates the specific type of facility, bill classification, and frequency for services specified on the UB-92 claim form. This field, commonly known as Bill Type, is a required field on the UB-92. This 3-digit code requires one digit each, in the following format. The first digit identifies the type of facility. The second classifies the type of care. The third indicates the sequence of this bill in this particular episode of care. It is referred to as a "frequency" code. Below are the valid code structures, arranged by applicable provider type, of all Bill Types permitted on the UB-92 claim form for LTC claims. Code Structure FOR NURSING HOME PROVIDERS: 1st Digit - Type of Facility 2 Skilled Nursing (LOC = ICF I) (LOC = ICF II) (LOC = SNF) (LOC = SNF Technology Dependent Care) (LOC = SNF Infectious Disease) (LOC = NF Rehab) (LOC = NF Complex Care) Skilled Nursing/ Intermediate Care (LOC = Case Mix) Page 1

3 2nd Digit - Classification 7 Subacute Inpatient (SNF/Case Mix) 5 Intermediate Care Level I 6 - Intermediate Care Level II 3rd Digit - Frequency Definition 1 - Admit Through Discharge Claim Use this code for a claim encompassing an entire course of treatment for which you expect payment, i.e., no further claims will be submitted for this patient. 2 - Interim - First Claim Use this code for the first of an expected series of claims for a course of treatment. 3 - Interim - Continuing Claim Use this code when a claim for a course of treatment has been submitted and further claims are expected to be submitted. 4 - Interim - Final Claim Use this code for a claim which is the last claim. The "Through" date of this bill (Field 6) is the discharge date or date of death. 7 Adjustment/Replacement of Prior Claim Use this code to correct a previously submitted and paid claim. 8 - Void/Cancel of a Prior Claim Use this code to void a previously submitted and paid claim. FOR ICF/MR PROVIDERS: 1st Digit - Type of Facility 6 - Intermediate Care (LOC = ICF/MR) 2nd Digit - Classification 5 Intermediate Care Level I 6 - Intermediate Care Level II 3rd Digit - Frequency Definition 1 - Admit Through Discharge Claim Use this code for a claim encompassing an entire course of treatment for which you expect Page 2

4 payment, i.e., no further claims will be submitted for this patient. 2 - Interim - First Claim Use this code for the first of an expected series of claims for a course of treatment. 3 - Interim - Continuing Claim Use this code when a claim for a course of treatment has been submitted and further claims are expected to be submitted. 4 - Interim - Final Claim Use this code for a claim which is the last claim. The "Through" date of this bill (Field 6) is the discharge date or date of death. 7 Adjustment/Replacement of Prior Claim Use this code to correct a previously submitted and paid claim. 8 - Void/Cancel of a Prior Claim Use this code to void a previously submitted and paid claim. FOR HOSPICE PROVIDERS (Used for LTC Room and Board ONLY. Do not use for billing hospice services.): 1st Digit - Type of Facility 2 Skilled Nursing (LOC = SNF/Hospice in Nursing Facility) (LOC = ICF I/Hospice in Nursing Facility 2nd Digit - Classification 7 Subacute Inpatient (SNF/Case Mix) Use for all service dates, even those prior to 01/01/03 3rd Digit - Frequency Definition 1 - Admit Through Discharge Claim Use this code for a claim encompassing an entire (Entire Claim) course of treatment for which you expect payment, i.e., no further claims will be submitted for this patient. 2 - Interim - First Claim Use this code for the first of an expected series of claims for a course of treatment. 3 - Interim - Continuing Claim Use this code when a claim for a course of treatment has been submitted and further claims are expected to be submitted. Page 3

5 4 - Interim - Final Claim Use this code for a claim which is the last claim. The "Through" date of this bill (Field 6) is the discharge date or date of death. 7 Adjustment/Replacement of Prior Claim Use this code to correct a previously submitted and paid claim. 8 - Void/Cancel of a Prior Claim Use this code to void a previously submitted and paid claim. FOR ADULT DAY HEALTH CARE (ADHC) PROVIDERS: 1st Digit - Type of Facility 8 - Special Facility (LOC = Adult Day Health Care) 2nd Digit - Classification 9 Other (Adult Day Health Care - ADHC) 3rd Digit - Frequency Definition 1 - Admit Through Discharge Claim Use this code for a claim encompassing an entire course of treatment for which you expect payment, i.e., no further claims will be submitted for this patient. 2 - Interim - First Claim Use this code for the first of an expected series of claims for a course of treatment. 3 - Interim - Continuing Claim Use this code when a claim for a course of treatment has been submitted and further claims are expected to be submitted. 4 - Interim - Final Claim Use this code for a claim which is the last claim. The "Through" date of this bill (Field 6) is the discharge date or date of death. 7 Adjustment/Replacement of Prior Claim Use this code to correct a previously submitted and paid claim. 8 - Void/Cancel of a Prior Claim Use this code to void a previously submitted and paid claim. Page 4

6 VALID PATIENT STATUSES Patient Status (Field 22) indicates the patient s status as of the Through date of the billing period (Field 6). Code Structure 01 Discharged to home or self care (routine discharge). 02 Discharged/transferred to another short-term general hospital for inpatient care 03 Discharged/transferred to a skilled nursing facility (SNF) 04 Discharged/transferred to an intermediate care facility (ICF) 05 Discharged/transferred to another type of institution for inpatient care 06 Discharged/transferred to home under care of organized home health services organization 07 Left against medical advice or discontinued care 08 Discharged/transferred to home under care of Home IV (Intravenous Therapy) provider 09 Admitted as inpatient to a hospital 20 Expired/Discharged Due to Death 30 Still a patient 61 Discharged/transferred within this institution to hospital-based Medicare approved swingbed 62 Discharged/transferred to a rehabilitation facility including rehabilitation distinct part units of a hospital 63 Discharged/transferred to a long term care hospital VALID REVENUE CODES Revenue Code and Description (Fields 42-43) are used to identify provided services on the UB-92 claim form. The following revenue codes and descriptions are valid for the provider types indicated when billing LA Medicaid on the UB-92. The corresponding Level of Care codes previously submitted on the Turnaround Document (TAD) are also listed below as a crosswalk for your reference. Code Description Level of Care & Description FOR ALL PROVIDERS (Excluding ADHC Providers): 183 Leave of Absence Subcategory Therapeutic A Home Leave 185 Leave of Absence Subcategory Nursing Home (for Hospitalization) B Hospital Leave Page 5

7 FOR NURSING HOME PROVIDERS: 022 Skilled Nursing Facility Prospective Payment 88 Case Mix (Formerly LOC 20, System (RUGS) 21, 22) (For Dates of Service 01/01/03 and after) 118 Room & Board-Private Subacute Rehabilitation 31 NF Rehabilitation 190 Subacute Care-General Classification 20 SNF/Hospice in Nursing Facility 191 Subacute Care Level I (Skilled Care) 21 ICF I/Hospice in Nursing Facility 192 Subacute Care Level II (Comprehensive Care) 22 ICF II 193 Subacute Care Level III (Complex Care) 32 NF Complex Care 194 Subacute Care Level IV 28 SNF Technology Dependent Care 199 Other Subacute Care 30 SNF Infectious Disease FOR ICF-MR PROVIDERS: 911 Psychiatric/Psychological Services General 26 ICF-MR FOR HOSPICE PROVIDERS: 022 Skilled Nursing Facility Prospective Payment 88 Case Mix (Formerly LOC 20, System (RUGS) 21, 22) (For Dates of Service 01/01/03 and after) 190 Subacute Care-General Classification 20 SNF/Hospice in Nursing Facility 191 Subacute Care Level I (Skilled Care) 21 ICF I/Hospice in Nursing Facility Page 6

8 FOR ADULT DAY HEALTH CARE (ADHC) PROVIDERS: 932 Medical Rehabilitation Day Program- Subcategory 2 Full Day 27 Adult Day Health Care Page 7