Code | Display | Definition | version introduced | Deutsch (German, de) |
01 |
Military service related |
Military service related |
2.3.1 |
|
02 |
Condition is employment related |
Condition is employment related |
2.3.1 |
|
03 |
Patient covered by insurance not reflected here |
Patient covered by insurance not reflected here |
2.3.1 |
|
04 |
HMO enrollee |
HMO enrollee |
2.3.1 |
|
05 |
Lien has been filed |
Lien has been filed |
2.3.1 |
|
06 |
ESRD patient in first 18 months of entitlement covered by employer group health insurance |
ESRD patient in first 18 months of entitlement covered by employer group health insurance |
2.3.1 |
|
07 |
Treatment of non-terminal condition for hospice patient |
Treatment of non-terminal condition for hospice patient |
2.3.1 |
|
08 |
Beneficiary would not provide information concerning other insurance coverage |
Beneficiary would not provide information concerning other insurance coverage |
2.3.1 |
|
09 |
Neither patient nor spouse is employed |
Neither patient nor spouse is employed |
2.3.1 |
|
10 |
Patient and/or spouse is employed but no EGHP exists |
Patient and/or spouse is employed but no EGHP exists |
2.3.1 |
|
11 |
Disabled beneficiary but no LGHP |
Disabled beneficiary but no LGHP |
2.3.1 |
|
12 |
Payer codes. |
Payer codes. |
2.3.1 |
|
13 |
Payer codes. |
Payer codes. |
2.3.1 |
|
14 |
Payer codes. |
Payer codes. |
2.3.1 |
|
15 |
Payer codes. |
Payer codes. |
2.3.1 |
|
16 |
Payer codes. |
Payer codes. |
2.3.1 |
|
18 |
Maiden name retained |
Maiden name retained |
2.3.1 |
|
19 |
Child retains mother's name |
Child retains mother's name |
2.3.1 |
|
20 |
Beneficiary requested billing |
Beneficiary requested billing |
2.3.1 |
|
21 |
Billing for Denial Notice |
Billing for Denial Notice |
2.3.1 |
|
26 |
VA eligible patient chooses to receive services in a medicare certified facility |
VA eligible patient chooses to receive services in a medicare certified facility |
2.3.1 |
|
27 |
Patient referred to a sole community hospital for a diagnostic laboratory test |
Patient referred to a sole community hospital for a diagnostic laboratory test |
2.3.1 |
|
28 |
Patient and/or spouse’s EGHP is secondary to Medicare |
Patient and/or spouse’s EGHP is secondary to Medicare |
2.3.1 |
|
29 |
Disabled beneficiary and/or family member’s LGHP is secondary to Medicare |
Disabled beneficiary and/or family member’s LGHP is secondary to Medicare |
2.3.1 |
|
31 |
Patient is student (full time-day) |
Patient is student (full time-day) |
2.3.1 |
|
32 |
Patient is student (cooperative/work study program) |
Patient is student (cooperative/work study program) |
2.3.1 |
|
33 |
Patient is student (full time-night) |
Patient is student (full time-night) |
2.3.1 |
|
34 |
Patient is student (Part time) |
Patient is student (Part time) |
2.3.1 |
|
36 |
General care patient in a special unit |
General care patient in a special unit |
2.3.1 |
|
37 |
Ward accommodation as patient request |
Ward accommodation as patient request |
2.3.1 |
|
38 |
Semi-private room not available |
Semi-private room not available |
2.3.1 |
|
39 |
Private room medically necessary |
Private room medically necessary |
2.3.1 |
|
40 |
Same day transfer |
Same day transfer |
2.3.1 |
|
41 |
Partial hospitalization |
Partial hospitalization |
2.3.1 |
|
46 |
Non-availability statement on file |
Non-availability statement on file |
2.3.1 |
|
48 |
Psychiatric residential treatment centers for children and adolescents |
Psychiatric residential treatment centers for children and adolescents |
2.3.1 |
|
55 |
SNF bed not available |
SNF bed not available |
2.3.1 |
|
56 |
Medical appropriateness |
Medical appropriateness |
2.3.1 |
|
57 |
SNF readmission |
SNF readmission |
2.3.1 |
|
60 |
Day outlier |
Day outlier |
2.3.1 |
|
61 |
Cost outlier |
Cost outlier |
2.3.1 |
|
62 |
Payer code |
Payer code |
2.3.1 |
|
66 |
Provider does not wish cost outlier payment |
Provider does not wish cost outlier payment |
2.3.1 |
|
67 |
Beneficiary elects not to use life time reserve (LTR) days |
Beneficiary elects not to use life time reserve (LTR) days |
2.3.1 |
|
68 |
Beneficiary elects to use life time reserve (LTR) days |
Beneficiary elects to use life time reserve (LTR) days |
2.3.1 |
|
70 |
Self-administered EPO |
Self-administered EPO |
2.3.1 |
|
71 |
Full care in unit |
Full care in unit |
2.3.1 |
|
72 |
Self-care in unit |
Self-care in unit |
2.3.1 |
|
73 |
Self-care training |
Self-care training |
2.3.1 |
|
74 |
Home |
Home |
2.3.1 |
|
75 |
Home - 100% reimbursement |
Home - 100% reimbursement |
2.3.1 |
|
76 |
Back-up in facility dialysis |
Back-up in facility dialysis |
2.3.1 |
|
77 |
Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment in full |
Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment in full |
2.3.1 |
|
78 |
New coverage not implemented by HMO |
New coverage not implemented by HMO |
2.3.1 |
|
79 |
Corf services provided off-site |
Corf services provided off-site |
2.3.1 |
|
80 |
Pregnant |
Pregnant |
2.3.1 |
schwanger |