Diagnosis-Related Group (DRG) 470 Dates of Service vs Dates of Procedure Reporting
Palmetto GBA is seeing an influx in providers incorrectly reporting date of admission where date of procedure is required on UB-04 forms. When procedures aren't performed on date of admission, providers should be entering the actual date of procedure in Box 74.
When completing your UB-04 form, be sure to accurately complete these sections. It is important that these claims be correct; payment is affected and providers will be paid at a lesser rate once the Diagnosis-Related Group (DRG) is changed if correct dates are not billed. If audited by any review contractor (Zone Program Integrity Contractor (ZPIC), Recovery Audit Contractor (RAC), Medicare Administrative Contractor (MAC), or Comprehensive Error Rate Testing (CERT)) these claims would be considered billed in error.
Inpatient Date of Service Reporting
For all inpatient claims (including acute general hospital, psychiatric hospital, rehabilitation hospital, long-term care hospital and skilled nursing facility), the date(s) of service is reported in form locator (FL) 6, Statement Covers Period, of the UB-04 claim form or its electronic equivalent.
Each inpatient claim contains the Statement Covers Period ("from" and "through" dates) to identify the span of service dates included in a particular bill.
- The "from" date is the earliest date of service on the bill
- The "through" date equals the date the patient was discharged from the facility or remains a patient of the facility (discharge status code 30)
Note: Use the benefits exhaust date to substitute for the discharge date on both Inpatient Psychiatric Facility and Long Term Care Hospital (LTCH) PPS claims when present.
The Admission Date (FL 12) is the date the patient was admitted as an inpatient to the facility (or indicates the start of care date for home health and hospice). It is reported on all inpatient claims regardless of whether it is an initial, interim or final bill. The admission date and "from" dates are not required to match.
For all inpatient claims, the Principal Procedure Code/Date is reported in form locator (FL) 74, Principle Procedure Code/Date, of the UB-04 claim form or its electronic equivalent.
Box 6 — Statement Covers Period: Covers admission date until discharge date. Enter beginning and ending service dates of the period included on the bill using a six-digit date format (MMDDYY). For example, 010118.
Box 12 — Admission Date: Enter date that patient was admitted using a six-digit format (MMDDYY). Note: required on all inpatient claims.
* Situational field
Box 74 — Principal Procedure Code/Date: Enter principal procedure code and date using a six-digit format (MMDDYY) if patient has undergone an inpatient procedure. Note: required on inpatient claims.
* Situational field
** For inpatient admissions with procedures scheduled other than date of admission, please be sure to enter correct date of procedure.