Billing Code Data 837I upload-Data Elements_final.xlsx

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