Billing Code Data 837I upload-Data Elements_final.xlsx

[NCEZID] The National Healthcare Safety Network (NHSN)

Billing Code Data 837I upload-Data Elements_final.xlsx

OMB: 0920-0666

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Database Table Database Variable UB-04 Form Locator Label Variable Type Length Valid Values

Patient_PII PATIENT_PCN FL 03a Patient Control Number CHAR 50


Patient_PII PATIENT_MRN FL 03b Patient Medical Record Number CHAR 50


Encounter TYPE_BILL FL 04 loc1 Type of Bill CHAR 4 Inpatient:
011x= Hospital Inpatient
012x= Hospital Inpatient (Medicare Part B)

Ambulatory:
013x= Hospital Outpatient
014x= Hospital Laboratory Services for non-patients
083x= Ambulatory Surgery Center
085x= Critical Access Hospital

Form Approved OMB No. 0920-0666 Exp. Date 06/30/2026
Encounter ENCOUNTER_START_DATETIME FL 06 loc1 Beginning Service Date NUM 8 For Inpatient: Valid Range = Any date

For Outpatient: Valid Range = Any date between and including 1/1/ 2013 and 12/31/2013

Public reporting burden of this collection of information is estimated to average 5 minutes per response, including the time for reviewing instructions, searching existing data sources, gathering and maintaining the data needed, and completing and reviewing the collection of information. An agency may not conduct or sponsor, and a person is not required to respond to a collection of information unless it displays a currently valid OMB control number. Send comments regarding this burden estimate or any other aspect of this collection of information including suggestions for reducing this burden to CDC/ATSDR Reports Clearance Officer; 1600 Clifton Road NE, MS H21-8 Atlanta, Georgia 30333; ATTN: PRA (0920-0666)
Encounter ENCOUNTER_END_DATETIME FL 06 loc2 Ending Service Date NUM 8 For Inpatient: Valid Range= 2013;

For Outpatient: Valid Range = Any date on or after 1/1/2013


Patient_PII PATIENT_NAME_FIRST FL 08b Patient First Name CHAR 35


Patient_PII PATIENT_ADDRESS_1 FL 09a Patient Street Address Line 1 CHAR 55


Patient_PII PATIENT_ADDRESS_CITY FL 09b Patient City CHAR 30


Patient_PII PATIENT_ADDRESS_STATE FL 09c Patient State CHAR 2 Valid range: AL;AK; AZ; AR; CA; CO; CT; DE; DC; FL; GA; HI; ID; IL; IN; IA; KS; KY; LA; ME; MD; MA; MI; MN; MS; MO; MT; NE; NV; NH; NJ; NM; NY; NC; ND; OH; OK; OR; PA; RI; SC; SD; TN; TX; UT; VT; VA; WA; WV; WI; WY

Patient_PII PATIENT_ADDRESS_ZIP FL 09d Patient ZIP Code (Edited) CHAR 15 Valid range of first 5 digits = valid zip code listed in database purchased from http://www.zip-codes.com/zip (using the latest monthly update)

Patient_PII PATIENT_COUNTRY FL 09e Patient Country CHAR 3


Patient_PII PATIENT_DOB FL 10 Patient Date of Birth NUM 8 SAS Date Format: MMDDYY10.
Valid range: Month= 01-12; Day= 1-31
Valid month/day ranges:
For Month 04, 06, 09, and 11, Day = 01-30
For Month 01, 03, 05, 07, 08, 10, and 12,
Day = 01-31
For Month 02, Day = 01-28 or 29


Patient Array PATIENT_SEX FL 11 Patient Sex CHAR 1 M = Male
F = Female


Encounter ADMIT_DATETIME FL 12 Date of Admission NUM 8 Valid range: Month= 01-12; Day= 01-31
Valid Range = YYYY = survey year to survey year minus 1
Valid month/day ranges:
For Month 04, 06, 09, and 11, Day = 01-30
For Month 01, 03, 05, 07, 08, 10, and 12,
Day = 01-31
For Month 02, Day = 01-28 or 29


Encounter ADMIT_DATETIME FL 13 Admission Hour from UB-04 CHAR 16 Record as given

Encounter ADMIT_TYPE FL 14 Type of Admission NUM 2 1= Emergency
2= Urgent
3= Elective
4= Newborn
5= Trauma
6-8 Reserved
9= information not available


Encounter POINT_ORIGIN_CODE FL 15 Point of Origin CHAR 257 1= Non-health care facility point of origin
2= Clinic or Physician's Office
3= Reserved for assignment
4= Transfer from hospital
5= Transfer from SNF
6= Transfer from another Health Care facility
7= Reserved for assignment by NUBC
8= Court/law enforcement
9= Info not available
A= Reserved
B= Transfer from another home health agency

D= Transfer from 1 distinct unit of hosp. to another distinct unit of the same hosp. resulting in a separate claim
E= Transfer from an ASC
F= Transfer from a Hospice Facility
G-Z= Reserved
Codes for Newborn
1-4= Reserved
5= Born inside this hospital
6= Born outside this hospital
7-9= Reserved


N/A N/A FL 16 Discharge Hour from UB-04 CHAR 16 Record as given

Encounter DS_DISP_CODE FL 17 Discharge Status NUM 2 Standard Values are:
01= Discharged to home
02= Transf. to short-term hospital
03= Discharged to SNF
04= Discharged to custodial care or ICF
05= Discharged to Designated Cancer Center or Children's Hospital
06= Discharged to Home under care of organized home health service
07= Left against medical advice
08= Reserved
09= Admitted as Inpatient to Hospital
10-19= Reserved
20= Expired
21= Discharged to Court/Law Enforcement
22-29= Reserved
30= Still Patient
31-39= Reserved
40= Expired at Home
41= Expired in a Medical Facility
42= Expired Place Unknown
43= discharged to a federal health care facility
44-49= Reserved
50= Hospice-home
51= Hospice-medical facility
52-60= Reserved
61= Discharged to swing bed (SNF)
62= Discharged to IRF (rehab)
63= Discharged to a Medicare certified long term care hospital
64= Discharged to a nursing facility certified under Medicaid but not under Medicare
65= Discharged to Psychiatric Hospital
66= Discharged to a critical access hospital
67-68= Reserved
69= Discharged to Designated Disaster Alternative Care Site
70= Discharged to another type of health care institution not defined elsewhere
73-80= Reserved
81= Discharged to home with a Planned Readmission
82= Transf. to short-term hospital with a Planned Readmission
83= Discharged to SNF with a Planned Readmission
84= Discharged to custodial care or ICF with a Planned Readmission
85= Discharged to Designated Cancer Center or Children's Hospital with a Planned Readmission
86= Discharged to Home under care of organized home health service with a Planned Readmission
87= Discharged to Court/Law Enforcement with a Planned Readmission
88= discharged to a federal health care facility with a Planned Readmission
89= Discharged to swing bed (SNF) with a Planned Readmission
90= Discharged to IRF (rehab) with a Planned Readmission
91= Discharged to a Medicare certified long term care hospital with a Planned Readmission
92= Discharged to a nursing facility certified under Medicaid but not under Medicare with a Planned Readmission
93= Discharged to Psychiatric Hospital with a Planned Readmission
94= Discharged to a critical access hospital with a Planned Readmission
95= Discharged to another type of health care institution not defined elsewhere with a Planned Readmission
96-99= Reserved


RevenueCode REVENUE_CODE FL 42 Line1 - Line(x) Revenue Code 1 - Revenue Code (x) CHAR 4


RevenueCode REV_PDS FL 44 Line1 - Line(x) HCPCS/HIPPS Rate Codes for Revenue Code 1 - HCPCS/HIPPS Rate Codes for Revenue Code (x) CHAR 5 Valid Range= valid HCPCS/HIPPS codes for data year

RevenueCode HCPCS_MOD1 FL 44 Line1 - Line(x) Procedure Code Modifier 1-1 - Procedure Code Modifier 1-(x) CHAR 3


RevenueCode HCPCS_MOD2 FL 44 Line1 - Line(x) Procedure Code Modifier 2-1 - Procedure Code Modifier 2-(x) CHAR 3


RevenueCode HCPCS_MOD3 FL 44 Line1 - Line(x) Procedure Code Modifier 3-1 - Procedure Code Modifier 3-(x) CHAR 3


RevenueCode HCPCS_MOD4 FL 44 Line1 - Line(x) Procedure Code Modifier 4-1 - Procedure Code Modifier 4-(x) CHAR 3


RevenueCode REVENUE_START_DATETIME FL 45 Service Date NUM 8 Valid dates: Any date on or after 1/1/2013.
Valid range: Month= 01-12; Day= 01-31
Valid month/day ranges:
For Month 04, 06, 09, and 11, Day = 01-30
For Month 01, 03, 05, 07, 08, 10, and 12,
Day = 01-31
For Month 02, Day = 01-28 or 29


RevenueCode REV_UNT FL 46 Line1 - Line(x) Units for Revenue Code 1 - Units for Revenue Code (x) CHAR 2 Valid Range= "DA" and "UN"

RevenueCode REV_CNT FL 46 Line1 - Line(x) Unit Count for Revenue Code 1 - Unit Count for Revenue Code (x) NUM 8 Valid Range up to 99999 and must be numeric

Encounter REV_TOT FL 47 Line 23 Sum of Revenue Charges NUM 8 Valid Range: Amount >= $0

RevenueCode REV_CHG FL 47 Line1 - Line(x) Charges for Revenue Code 1 - Charges for Revenue Code (x) NUM 8 Valid Range: Amount >= $0

RevenueCode REV_NCC FL 48 Line1 - Line(x) Non-Covered Charges for Revenue Code 1 - Non-Covered Charges for Revenue Code (x) NUM 8 Valid Range: Positive or Negative Dollar amount.

Payer_PII PAYER_NAME FL 50 Line 1 Name of Expected Payer #1 CHAR 60


Payer_PII PAYER_NAME FL 50 Line 2 Name of Expected Payer #2 CHAR 35


Payer_PII PAYER_NAME FL 50 Line 3 Name of Expected Payer #3 CHAR 35


Provider NPI FL 56 NPI of Billing Provider CHAR 12


Payer RELATION FL 59 Line 1 Relationship to Insured #1 CHAR 2 Valid range=
01= Spouse
18= Self
19= Child
20= Employee
21= Unknown
39= Organ Donor
40= Cadaver Donor
53= Life Partner
G8= Other relationship




Payer RELATION FL 59 Line 2 Relationship to Insured #2 CHAR 2 Valid range=
01= Spouse
18= Self
19= Child
20= Employee
21= Unknown
39= Organ Donor
40= Cadaver Donor
53= Life Partner
G8= Other relationship


Payer RELATION FL 59 Line 3 Relationship to Insured #3 CHAR 2 Valid range=
01= Spouse
18= Self
19= Child
20= Employee
21= Unknown
39= Organ Donor
40= Cadaver Donor
53= Life Partner
G8= Other relationship


N/A N/A FL 60 Patient's Primary Insurance ID Number CHAR 30


Condition CONDITION_CODESYS_NAME FL 66 Flag for version of ICD CHAR 2 9= ICD 9
0= ICD 10


Condition DX_CHAPTER FL 67 Diagnosis Chapter #01- Diagnosis Chapter #25 CHAR 2


Condition CONDITION_CODE FL 67 pos 1-7 Diagnosis code #01 CHAR 8


Condition ORIGINAL_POA FL 67 pos8 Present on Admission Flag_DX01 - Present on Admission Flag_DX25 CHAR 2 Valid range=Y, N, U, W, 1

Condition CONDITION_CODE FL 67A-Q Diagnosis code #02- Diagnosis code #25 CHAR 8


Condition CONDITION_CODE FL 69 Admitting Diagnosis CHAR 8 ICD-9/10 Valid Code List

Condition CONDITION_CODE FL 70a Patient Reason for Visit UB1 - Patient Reason for Visit UB3 CHAR 8 ICD-9/10 Valid Code List

Condition DRG FL 71 Diagnosis Related Group CHAR 5 Valid range= 1-9999

Condition CONDITION_CODE FL 72 pos 1-7 Ecode #01- Ecode #12 CHAR 8 ICD-9/10 Valid Code List

Condition ORIGINAL_POA FL 72 pos8 Present on Admission Flag_ECODE01 - Present on Admission Flag_ECODE12 CHAR 2 Valid range=Y, N, U, W, 1

Procedure PROCEDURE_CODE FL 74 Procedure #01 CHAR 8 ICD-9/10 Valid Code List (Inpatient or Ambulatory);
Level I HCPCS codes which are also referred to as CPT codes (Ambulatory Only);


Procedure PROCEDURE_CODE FL 74 Procedure #02 - Procedure #25 CHAR 8 ICD-9/10 Valid Code List (Inpatient or Ambulatory);
Level I HCPCS codes which are also referred to as CPT codes (Ambulatory Only);


Procedure PROCEDURE_START_DATETIME FL 74 Date of Procedure #01 NUM 8 Valid range: Month= 1-12; Day= 1-31
Valid Range = YYYY = survey year to survey year minus 1
Valid month/day ranges:
For Month 04, 06, 09, and 11, Day = 01-30
For Month 01, 03, 05, 07, 08, 10, and 12,
Day = 01-31
For Month 02, Day = 01-28 or 29


Procedure PROCEDURE_START_DATETIME FL 74 Date of Procedure #02 - Date of Procedure #25 NUM 8 Valid range: Month= 1-12; Day= 1-31
Valid Range = YYYY = survey year to survey year minus 1
Valid month/day ranges:
For Month 04, 06, 09, and 11, Day = 01-30
For Month 01, 03, 05, 07, 08, 10, and 12,
Day = 01-31
For Month 02, Day = 01-28 or 29


N/A N/A FL 74 Procedure Chapter #01- Procedure Chapter #25 CHAR 2


Provider NPI FL 76 NPI for Attending Physician CHAR 12


Provider NPI FL 77 NPI for Operating Physician CHAR 12


Patient Array PATIENT_ETHNICITY FL 81 Patient Ethnicity CHAR 35


Patient Array PATIENT_RACE FL 81 Patient Race CHAR 12


Patient Array MARITAL_STATUS FL 81 Patient Marital Status CHAR 8 A= Common Law
B= Registered Domestic Partner
C= Not Applicable
D= Divorced
I= Single
K= Unknown
M= Married
R= Unreported
S= Separated
U= Unmarried (Single or Divorced or Widowed)
W= Widowed


Payer PAYER_CODE FL 81 Expected Source of Payment2 CHAR 2 Valid range= 09-15;16;AM, BL, CH, CI, DS, HM, LI,LM, MA,MB, MC, OF, TV, VA,WC, ZZ

Payer PAYER_CODE FL 81 Expected Source of Payment3 CHAR 2 Valid range= 09-15;16;AM, BL, CH, CI, DS, HM, LI,LM, MA,MB, MC, OF, TV, VA,WC, ZZ

Payer PAYER_CODE FL 81 Typology for Expected Payer #1 CHAR 6


Payer PAYER_CODE FL 81 Typology for Expected Payer #2 CHAR 6


Payer PAYER_CODE FL 81 Typology for Expected Payer #3 CHAR 6


Payer PAYER_CODE FL 81 x12 only Expected Source of Payment1 CHAR 2 09= Self-pay
10= Central certification
11= Other non-federal programs
12= Preferred provided organization (PPO)
13= Point of Service (POS)
14= Exclusive provider organization (EPO)
15= Indemnity insurance
16= Health maintenance organization (HMO) Medicare risk
AM= Automobile medical
BL= Blue cross/Blue shield
CH= Champus
CI= Commercial Insurance Co.
DS= Disability
HM= Health Maintenance Organization
LI= Liability
LM= Liability medical
MA= Medicare Part A
MB= Medicare Part B
MC= Medicaid
OF= Other Federal Programs
TV= Title V
VA= Veteran Administration Plan
WC= Workers' Compensation Health Claim
ZZ= Mutually defined, unknown


Patient_PII PATIENT_SSN X12 only Patient Social Security Number CHAR 12


Encounter TOTALICU_FLAG
Flag for all ICU( CCU, NICU, and Adult ICU) Revenue Codes NUM 2 1=Yes
2=No


Encounter TOTALICU_LOS
Length of Stay in the ICU, CCU or NICU for each record NUM 3 ≥ 0

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