Tuesday, February 18, 2020

Occurrence code, special program indicator list

OCCURRENCE CODE/DATE ( Form Field 31a - 34B) – Enter the applicable code and associated date to identify significant events relating to this bill that may affect processing. Dates are entered in an MMDDYY format. A maximum of eight codes and associated dates can be entered.

Required, if applicable.

The IHCP uses the following occurrence codes:

Occurrence Codes Code Description

01 Auto accident
02 No-fault insurance involved – Including auto accident or other
03 Accident or tort liability
04 Accident or employment related
05 Other accident
06 Crime victim
25 Date benefits terminated by primary payer
27 Date home health plan established or last reviewed
42 Date of discharge – This code is used to show the date of live discharge from the
hospital confinement being billed, from a long-term care facility, or from home health
care or hospice, as appropriate.
52 Certification/recertification date – This code is used to show that an initial examination
or initial evaluation is being billed in a hospital setting. This code bypasses certain PA
editing. Details can be found in the applicable sections of the IAC.
55 Date of death – This code is used to show the date of death.
73 Benefit eligibility – This code is used to bill for home health overhead – One per day.

Special Program Indicators

A0 Special Zip Code Reporting-Ambulance
A3 Special Federal Funding
A5 Disability
A6 PPV/Medicare Pneumococcal Pneumococcal/Influenza
A7 Induced Abortion - Danger to Life
A9 Second Opinion Surgery
AA Abortion performed due to Rape
AB Abortion performed due to Incest
AC Abortion performed due to serious fetal genetic defect, deformity, abnormality
AD Abortion performed due to life endangering condition
AE Abortion performed due to physical health of mother that is not life endangering
AF Abortion performed due to emotional/psychological health of mother
AG Abortion performed due to social economic reasons
AH Elective abortion
AI Sterilization
AJ Payer responsible for Co-payment
AK Air ambulance required
AL Specialized treatment/bed unavailable
AM Non-emergency Medically Necessary Stretcher Transport Required
AN Preadmission Screening Not Required
AO-AZ Reserved for National Assignment
B0 Medicare coordinated care demonstration program
B1 Beneficiary is ineligible for demonstration program
B2 Ambulance-CAH exempt from fee schedule if not exempt CAH don’t use B2
B3 Pregnancy indicator
B4 Admission Unrelated to Discharge - Admission unrelated to discharge on same day. This code is
for discharges starting on January 1, 2004. Effective January 1, 2005
BP Gulf Oil Spill Related, all services on claim
DR Disaster Related
G0 Distinct Medical visit - multiple medical visits occurred same day in same revenue center - Report this code when multiple medical visits occurred on the same day in the same revenue center. The visits were distinct and constituted independent visits. An example of such a situation would be a beneficiary going to the emergency room twice on the same day, in the morning for a broken arm and later for chest pain. Proper reporting of Condition Code G0 (zero) allows for payment under OPPS in this situation. The OCE contains an edit that will reject multiple medical visits on the same day with the same revenue code without the presence of Condition Code G0 (zero).

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