Form 57.800 Billing Code Data
[NCEZID] The National Healthcare Safety Network (NHSN)
Billing Code Data (UB-04) CSV Template.xlsx
Billing Code Data: 837I Upload
OMB: 0920-0666
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Overview
ENCOUNTER
PATIENT
CONDITION
PROCEDURE
REVENUE
Sheet 1: ENCOUNTER
| NHSN_ORGID |
ENCOUNTER_ID |
PT_CONTROL_NUM |
PRESENT_ON_ADM |
ADM_DIAG |
TYPE_BILL |
STMT_FROM_DATE |
STMT_THRU_DATE |
ADM_DATE |
ADM_HOUR |
ADM_TYPE |
POINT_ORIGIN_CODE |
DIS_DATE |
DIS_HOUR |
DIS_DISP_CODE |
COND_CODE |
PAYER_NAME_1 |
HLTH_PLAN_ID_NUM_1 |
PAYER_NAME_2 |
HLTH_PLAN_ID_NUM_2 |
PAYER_NAME_3 |
HLTH_PLAN_ID_NUM_3 |
Sheet 2: PATIENT
| NHSN_ORGID |
PT_MRN |
PT_CONTROL_NUM |
PT_NAME_FIRST |
PT_NAME_MIDDLE |
PT_NAME_LAST |
PT_SSN |
PT_ETHNICITY |
PT_RACE |
MARITAL_STATUS |
PT_ADDRESS |
PT_ADDRESS_CITY |
PT_ADDRESS_STATE |
PT_ADDRESS_ZIP |
PT_DOB |
PT_SEXATBIRTH |
Sheet 3: CONDITION
| NHSN_ORGID |
PT_CONTROL_NUM |
CODE_SYS_NAME |
DIAGN_TYPE |
PRESENT_ON_ADM |
DIAG_CODE |
Sheet 4: PROCEDURE
| NHSN_ORGID |
PT_CONTROL_NUM |
PROC_START_DATE |
PROC_CODE |
PROC_CODE_ORDER |
Sheet 5: REVENUE
| NHSN_ORGID |
PT_CONTROL_NUM |
REV_SER_DATE |
REV CODE |
HCPCS_MOD_1 |
HCPCS_MOD_2 |
HCPCS_MOD_3 |
HCPCS_MOD_4 |
CPT_HCPCS |
| File Type | application/vnd.openxmlformats-officedocument.spreadsheetml.sheet |
| File Modified | 0000-00-00 |
| File Created | 0000-00-00 |