FLs 39-41 on the UB-04 are used for reporting value codes-two-digit numeric or alphanumeric codes that identify monetary data that affect the processing and payment of the claim. For example, if Medicare is a secondary payer on a claim, the amount received from the primary payer is indicated with the use of a value code. The value code indicates who the payer is (such as a liability insurer, the Department of Veterans Affairs, an EGHP, a public health service, or another federal agency). The dollar amount entered in the form locator along with the code indicates the exact amount of the payment received. This amount is then subtracted from the total reported charges on the claim to determine the final payment due on the claim.
Every value code must be accompanied by an amount. The amount is most often a dollar amount. Nondollar amounts are expressed as units, such as days, hours, or the number of visits. In order to process UB-04 forms efficiently, the patient account specialist must be familiar with the relationship between each value code and the type of data (dollar amount, unit, or number of visits) it represents.
Certain value codes bring up complicated billing scenarios because they require the use of other value codes. Examples are the use of MSP value codes and the value codes for physical, occupational, speech, or cardiac rehabilitation therapy services.
Many value codes contain data that must be coordinated with data in several other fields on the UB-04. For example, certain MSP value codes must be used in conjunction with accident-related occurrence codes 01-06 (FLs 31-34) as well as with the value code required for reporting the hour of the accident (value code 45). In addition, if an
MSP value code is used in conjunction with a request for a conditional primary payment, the appropriate payer, insured, and employer information must be used in FLs 50-65 and the appropriate occurrence code (usually code 24) in FLs 31-34. UB-04 condition codes, occurrence codes, value codes, and revenue codes are designed to interact so that they communicate a number of billing situations to the payer.
