Medical Billing Types & the Codes Used for Them

medical-billing-company-software_picThe subject keeps coming up, so I decided to create a bill type list and post it for easy reference.

This is NOT INTENDED to be a comprehensive explanation of all the bill types.

That is beyond the scope of this post and beyond even our own desire, here. We just wanted to make a little “cheat sheet” of sorts.

What follows is an edited version, a précis if you will, of this post, by Joy Hicks, to which we are indebted for its simplicity…

Medical billing uses three-digit codes on a claim form to describe the type of bill a provider is submitting to a payor. Each digit has a specific purpose and is required on all UB-04 claims (entered in field locator 4, if you must know).

The First Digit

The first digit refers to the type of provider facility submitting the claim.
1 – Hospital
2 – Skilled Nursing
3 – Home Health
4 – Religious Nonmedical Health Care Facility (Hospital)
5 – Religious Nonmedical Health Care Facility (Extended Care)
7 – Clinic
8 – Specialty Facility, Hospital ASC Surgery

The Second Digit

The second digit refers to the bill “classification” (except for clinics and special facilities, see below).

If the first digit is number 1 – 5, then the second digit designates the “level” of care provided:
1 – Inpatient (Medicare Part A)
2 – Inpatient (Medicare Part B)
3 – Outpatient
4 – Other (Medicare Part B)
5 – Level I Intermediate Care
6 – Level II Intermediate Care
7 – Subacute Inpatient (for use with Revenue Code 019X)
8 – Swing Bed

For Clinics Only – the first digit must be 7 – the second digit designates the “type” of Clinic:
1 – Rural Health Clinic
2 – Hospital Based or Independent Renal Dialysis Facility
3 – Federally Qualified Health Center (FQHC), Free Standing Provider-Based
4 – Other Rehabilitation Facility (ORF)
5 – Comprehensive Outpatient Rehabilitation Facility (CORF)
6 – Community Mental Health Center (CMHC)

For Special Facilities Only – the first digit must be 8 – the second digit designates the “type” of Special Facility:
1 – Nonhospital Based Hospice
2 – Hospital Based Hospice
3 – Ambulatory Surgical Center Services to Hospital Patients
4 – Other Rehabilitation Facility (ORF)
5 – Comprehensive Outpatient Rehabilitation Facility (CORF)
6 – Community Mental Health Center (CMHC)

Third Digit

In all cases from above, the third digit refers to the “timing” or “frequency” of the claim:
0 – Nonpayment or Zero Claims
1 – Admit Through Discharge Claim
2 – Interim (First Claim)
3 – Interim (Continuing Claims)
4 – Interim (Last Claim)
5 – Late Charge Only
7 – Replacement of Prior Claim or Corrected Claim
8 – Void or Cancel of a Prior Claim
9 – Final Claim for a Home Health PPS Episode

Examples of Bill Types

Bill Type 111 represents a Hospital Inpatient Claim indicating that the claim period covers admit through the patients discharge.

Bill Type 117 represents a Hospital Inpatient Replacement or Corrected claim to a previously submitted hospital inpatient claim that has paid in order for the payer to reprocess the claim.

Bill Type 138 represents a Hospital Outpatient Void or Cancel of a Prior claim to a previously submitted hospital outpatient claim that has paid in order for the payer to recoup the payment made.

Bill Type 831 represents a Hospital Outpatient Surgery performed in an Ambulatory Surgical Center. For an outpatient surgery performed in a Hospital, the type of bill would be 131 instead of 831.

 

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