Helpful Tips on hospital billing and coding

Helpful Tips

• Diagnosis Codes: When reporting diagnosis codes a decimal point must not be submitted as the decimal point is implied.

• Single Date: Under 5010, a date range must be supplied and a single date is no longer permitted

• Admission Date: The admission date and hour only are allowed on inpatient claims and cannot be sent on outpatient claims.

• Special Days: 5010 has deleted the ‘Claim Quantity’ segment which contained the total covered days, non-covered days, coinsurance days and the lifetime reserve days. These days will now be sent in the Value information segment. The four valid values are:

o 80 - Covered days

o 81 - Non Covered days

o 82 - Coinsurance Days

o 83 - Lifetime Reserve Days


• Service Facility Location Name: Required when the location of health care service is different than the billing provider. The Service Facility must be a non-person and must contain a valid 9-digit postal code or zip code.

• Outpatient Services “Priority Type of Admission or Visit” and “Point of Origin for Admission or Visit”: Required for outpatient services submitted via paper or electronically for all bill types except 14X (Hospital laboratory Services provided to non-patients [OP/6]).

• National Drug Code (NDC): Drug quantity information is now required when an NDC is submitted.

o As an NDC unit of measurement, milligrams (ME) has been added. However Florida Blue does not recognize the ME unit of measure. Refer to the Billing Drug Services on a Professional claim section below