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UB-04: Is box 70 the same diagnosis as box 69?

Patient Financial Services Weekly Advisor, April 6, 2007

Q: Could you please verify that box 70 is the same diagnosis as box 69? Also, what is box 81 a, b, c, and d? And what is the "qual" on boxes 76-79?

A: The value submitted in 70 is at times the same as what is put in box 69. But that should not be set as a default. Box 69 is the diagnosis used to indicate the reason for the admission, while 70 is used to indicate, for an unscheduled outpatient visit, what the patient indicated as their reason for visit to the provider.

Form locator 81 is the code-code area-to allow for additional data elements to be reported. It's described in the manual in detail. For example, the taxonomy code that hospital providers are required to report to Medicare A. Other usages have been identified in the manual, and future usages will most likely be identified.

The qualifiers in 76-79 identify the values being sent to identify the physician.

Editor's note: Jim Whicker, director of electronic commerce/EDI and accounts receivable management at Intermountain Healthcare in Salt Lake City, UT, answered this question.

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