FL 66 (Diagnosis and Procedure Code Qualifier) on the UB-04 is used to report the version of ICD being used on the claim. Currently, as per HIPAA requirements, only the ICD-9-CM version may be used. When ICD-10-CM is implemented in the future, version 10 will be reported.
FLs 66–75 of the UB-04 claim form contain the clinical information needed to process the claim, including diagnosis codes, POA indicators, and procedure codes. FL 67 is used to report the ICD-9-CM diagnosis code that describes the patient's principal diagnosis. Third-party payers use the principal diagnosis to determine whether the services listed on the claim are medically necessary. FL 67 also requires a POA indicator for the principal diagnosis so that the payer can determine whether the condition was present at the time of admission or developed during the stay. A POA indicator may lead to a lower reimbursement if the hospital is considered responsible for a hospital-acquired condition or infection.
FLs 67A–Q are used to report secondary diagnoses—other medical conditions that are listed because they have an effect on the treatment received or on the length of the patient's stay. The HIM department should make sure the appropriate secondary diagnosis codes are listed, including applicable codes for comorbidities and complications, E codes, and V codes, as their presence may increase the hospital's reimbursement. In addition, a POA indicator is required for each diagnosis code, as it is also a factor in determining reimbursement. POA indicators are always reported in the shaded box in the last position of a diagnosis code field.
FL 69 (Admitting Diagnosis Code) is used to report the main diagnosis code that represents the patient's diagnosis or symptoms at the time of inpatient admission. In some cases, the admitting diagnosis and the principal diagnosis are different. At the time of admission, the problem may be diagnosed as one condition; after evaluation, it may turn out to be another. Similarly, FLs 70a–c are used on outpatient claims to record the patient's reason for an unscheduled visit. FL 70 contains three fields, a–c, for reporting up to three reason-for-visit codes.
A new field on the UB-04, FL 71 (PPS Code), is used to identify the claim's DRG. This is required only if the hospital's DRG contract with the payer stipulates that it be provided. The field is not used for Medicare claims.
FL 72 is used to report the external cause of injury, poisoning, or other adverse effect, known as an E code, together with a POA indicator. On the UB-04, FL 72 contains three fields, a–c, for reporting up to three E codes and POA indicators. Completion of this field is desirable when appropriate, but it is not required by payers.
FL 74 (Principal Procedure Code and Date) is used to report a principal procedure on an inpatient claim. It is usually a surgical procedure and is the procedure most closely related to the principal diagnosis. FLs 74a–e (Other Procedure Codes and Dates) are used to report up to five procedure codes and corresponding dates for significant procedures that were performed during the billing period on the claim, other than the principal procedure. These procedures should reflect conditions that coexisted at the time of admission and were treated.
