Billing Code Data Dictionary

Table	UB-04 Form Locator (FL)	Variable Name	Field Name	Instructions for Data Collection	Values	Format	Length
Encounter	12	ADM_DATE	Admit Date (MMDDYY)	Enter the date that the patient was admitted for inpatient care using a six-digit format (MMDDYY).	Valid range: Month= 1-12; 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 For Year: include two-digit year	N	6
Encounter	69	ADM_DIAG	Admitting Diagnosis Codes	Enter the approriate diagnosis code(s) that describes the patient's admitting condition for this encounter.	ICD-9/10 Valid Code List (Inpatient or Ambulatory)	AN	8
Encounter	13	ADM_HR	Admit Hour	Enter the appropriate two-digit admission time referring to the hour during which the patient was admitted for inpatient care.	00-23	AN	2
Encounter	14	ADM_TYPE	Admit Type	Enter the appropriate two-digit type of visit priority code for the admission/visit.	1= Emergency 2= Urgent 3= Elective 4= Newborn 5= Trauma 6-8 Reserved 9= information not available	AN	1
Encounter	18-28	COND_CODE	Condition Codes	Enter the appropriate two-digit condition code or to describe any of the conditions or events that apply to the billing period if applicable to the patient’s condition.	Two-digit codes from the NUBC’s Official UB-04 Data Specifications Manual	AN	2
Revenue	44	CPT_HCPCS	HCPCS/RATES/HIPPS CODE	Enter the applicable HCPCS (CPT)/HIPPS rate code for the service line item if the claim was for ancillary outpatient services and accommodation rates.	Five-digit code from the current AMA CPT code list	AN	5
Condition	67A-Q	DIAG_CODE	Diagnosis Code	Enter the approriate diagnosis code(s) to describe any health condition(s) identified/treated/observed during this encounter.	ICD-9/10 Valid Code List (Inpatient or Ambulatory)	AN	8
Condition	66	DIAG_CODE_SYS_NAME	Diagnosis and Procedure Code Qualifier	Enter the required value of “9” or only for the special conditions enter a “0”. Note: “0” is allowed if ICD-10 is named as an allowable code set under HIPAA.	0=ICD10 9=ICD9	N	1
Condition	67A-Q	DIAG_TYPE	Diagnosis Type	Identify the diagnois using the following diagnosis types: Admitting Diagnosis - the condition identified by the physician at the time of the patient’s admission requiring hospitalization. Other Diagnoses - other condition(s) coexist or develop(s) subsequently during the patient’s treatment. Patient’s Reason for Visit - the condition the patient reports as the reason for their visit. Principal Diagnosis - the condition established after study to be chiefly responsible for this encounter. Reason for Visit - (up to three (3) diagnoses) May enter up to 23 total diagnosis codes.	ADM_DIAG = Admitting Diagnosis DIAG = Other Diagnoses PT_REASON = Patient’s Reason for Visit PRIN_ DIAG = Principal Diagnosis REASON_VISIT = Reason for Visit	AN	8
Encounter	N/A	DIS_DATE	Patient's Discharge Date	Not include on UB04 form	Valid range: Month= 1-12; 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 For Year: include two-digit year	N	6
Encounter	17	DISC_DISP_CODE	Patient's Discharge Status (Disposition) Code	Enter the appropriate two-digit code indicating the patient’s discharge status.	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	AN	2
Encounter	16	DISC_HOUR	Discharge Hour	Enter the appropriate two-digit admission time referring to the hour during which the patient was admitted for inpatient care.	00-23	AN	2
Encounter	N/A	ENCOUNTER_ID	Encounter Identificiation	Unique identifier for each patient encounter, assigned by NHSN.	As assigned by NHSN	AN	????
Revenue	44	HCPCS_MOD_1, 2,3,4	CPT (Level I HCPCS) and Level II HCPCS Modifiers	Up to four modifiers, two characters each. Various CPT (Level I HCPCS) and Level II HCPCS codes may require the use of modifiers to improve the accuracy of coding. Hospitals should not report a separate HCPCS (five-digit code) instead of the modifier. When appropriate, report a modifier based on the CPT (Level I HCPCS) and Level II HCPCS.	CPT (Level I HCPCS) and Level II HCPCS Modifiers based on the current AMA publication.	AN	2
Encounter	51	HLTH_PLAN_ID_NUM_1, 2, 3	Health Plan Identification Number	Enter the number used by the primary (51a) health plan to identify itself. Enter a secondary (51b) or tertiary (51c) health plan, if applicable.	Report the national health plan identifier when one is established; otherwise report the “number” Medicare has assigned.	AN	15
Patient	81	MARITAL_STATUS	Patient's Marital Status	Enter the marital status of the patient at the time of admission.	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	AN	1
Encounter	N/A	NHSN_ORGID	NHSN Facility ID	The NHSN-assigned facility ID when enrolled in NHSN.	must be >= 10000 must be <= 99999	N	5
Encounter	50	PAYER_ID_PRIMARY, SECONDARY, TERTIARY	Payer identification	Enter the health plan that the provider might expect some payment from for the claim - Primary, Secondary, Tertiary	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	AN	23
Encounter	15	POINT_ORIGIN_CODE	Point of Orgin Code	Enter the code indicating the source of the referral for this admission or visit	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	AN	1
Condition	67pos 8	PRESENT_ON_ADM	Present on Admission	Enter the diagnosis code of the condition that was present when the patient was admitted.	ICD-9/10 Valid Code List (Inpatient or Ambulatory)	AN	8
	74	PROC_CODE	Procedure Code	Enter the procedure code(s) to describe any procedure(s) performed during this encounter.	ICD-9/10 Valid Code List (Inpatient or Ambulatory); Level I HCPCS codes which are also referred to as CPT codes (Ambulatory Only);	AN	8
Procedure	N/A	PROC_CODE_ORDER	Procedure Code Order	Enter the number that corresponds to the procedure to indicate the order in which the procedure was preformed.	1,2,3…..
Procedure	66	PROC_CODE_SYSTEM_NAME	Procedure Code Qualifier	Enter the required value of “9” or only for the special conditions enter a “0”. Note: “0” is allowed if ICD-10 is named as an allowable code set under HIPAA.	0=ICD10 9=ICD9	AN	1
	74	PROC_START_DATE	Procedure Start Date	Enter the date that the procedure was performed.	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 For Year: include two-digit year
Patient	09a	PT_ADDRESS	Patient's Mailing Address	Required. The patient’s mailing address, including street number and name, post office box number or RFD.	As patient reports	AN	40
Patient	09b	PT_ADDRESS_CITY	Patient's City	Required. The patient’s city.	As patient reports	AN	30
Patient	09c	PT_ADDRESS_STATE	Patient's State	Required. The patient’s State.	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	AN	2
Patient	09d	PT_ADDRESS_ZIP	Patient's Zipcode	Required. The patient’s ZIP Code.	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)	AN	9
Encounter	3a	PT_CONTROL_NUM	Patient's Control Number	Enter the patient’s unique alphanumeric control number assigned to the patient by the facility. This number is unique for every encounter.	Assigned by facility	AN	24/50
Patient	10	PT_DOB	Patient's Date of Birth	Required. The patient's month, day, and year of birth (MMDDCCYY) of patient. If full birth date is unknown, indicate zeros for all eight digits.	Valid range: Month= 1-12; 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 For Year: include four-digit year	N	8
Patient	81	PT_ETHNICITY	Patient's Ethnicity	Patient's Ethnicity	Hispanic or Latino Not Hispanic or Not Latino Decline to respond Unknown
Patient	3b	PT_MRN	Patient's Medical Record Number	The number assigned to the patient’s medical/health record by the provider (not FL3a).	Assigned by facility
Patient	8a	PT_NAME_FIRST	Patient's First Name	Required. The patient’s first name.	As reported by patient	AN	19
Patient	8b	PT_NAME_LAST	Patient's Last Name	Required. The patient’s last name.	As reported by patient	AN	29
Patient		PT_NAME_MIDDLE	Patient's Middle Name	Required. The patient’s middle name.	As reported by patient
Patient	81	PT_RACE	Patient's Race	Patient's Race.	1002-5 = American Indian or Alaska Native 2028-9 = Asian 2054-5 = Black or African American 2118-8 = Middle Eastern or North African 2076-8 = Native Hawaiian or Other Pacific Islander 2106-3 = White DEC = Decline to respond UNK = Unknown	AN	6
Patient	11	PT_SEXATBIRTH	Patient's Sex Assigned at Birth	Required. The patient’s sex as recorded at admission, outpatient service, or start of care.	F = Female M = Male UNK = Unknown	AN	3
Patient		PT_SSN	Patient's Social Security Number		As reported by patient	N	12	`
Revenue	42	REV_CODE	Revenue Code 1-23	Enter the applicable Revenue Code for the services rendered	Four-digit codes from the NUBC’s Official UB-04 Data Specifications Manual	N	4
Revenue	45	REV_SER_DATE	Revenue Service Date	Enter the applicable six-digit format (MMDDYY) for the service line item if the claim was for outpatient services, SNF\PPS assessment date, or needed to report the creation date for line 23.	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 For Year: include two-digit year	N	6
Encounter	6	STMT_FROM_DATE	Statement From Date	The beginning service dates of the period included on the bill included on the bill using a six-digit date format (MMDDYY).	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 For Year: include two-digit year	N	6
Encounter	6	STMT_THRU_DATE	Statement Through Date	The ending service dates of the period included on the bill included on the bill using a six-digit date format (MMDDYY).	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 For Year: include two-digit year	N	6
Encounter	4	TYPE_BILL	Type of Bill	This four-digit alphanumeric code gives three specific pieces of information after a leading zero. CMS will ignore the leading zero. CMS will continue to process three specific pieces of information. The second digit identifies the type of facility. The third classifies the type of care. The fourth indicates the sequence of this bill in this particular episode of care. It is referred to as a “frequency” code.	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	AN	4