CLM_RLT_OCRNC_TB Claim Related Occurrence Table 01 THRU 09 = Accident 10 THRU 19 = Medical condition 20 THRU 39 = Insurance related 40 THRU 69 = Service related A1-A3 = Miscellaneous =========================================== 01 = Auto accident - The date of an auto accident. 02 = No-fault insurance involved, including auto accident/other - The date of an accident where the state has applicable no-fault liability laws, (i.e., legal basis for settlement without admission or proof of guilt). 03 = Accident/tort liability - The date of an accident resulting from a third party's action that may involve a civil court process in an attempt to require payment by the third party, other than no-fault liability. 04 = Accident/employment related - The date of an accident relating to the patient's employment. 05 = Other accident - The date of an accident not described by the codes 01 thru 04. 06 = Crime victim - Code indicating the date on which a medical condition resulted from alleged criminal action committed by one or more parties. 07 = Reserved for national assignment. 08 = Reserved for national assignment. 11 = Onset of symptoms/illness - The date the patient first became aware of symptoms/illness. 12 = Date of onset for a chronically dependent individual - Code indicates the date the patient/bene became a chronically dependent individual. 13 = Reserved for national assignment. 14 = Reserved for national assignment. 15 = Reserved for national assignment. 16 = Reserved for national assignment. 17 = Date outpatient occupational therapy plan established or last reviewed - Code indicating the date an occupational therapy plan was established or last reviewed (eff 3/93) 18 = Date of retirement (patient/bene) - Code indicates the date of retirement for the patient/bene. 19 = Date of retirement spouse - Code indicates the date of retirement for the patient's spouse. 20 = Guarantee of payment began - The date on which the provider began claiming Medicare payment under the guarantee of payment provision. 21 = UR notice received - Code indicating the date of receipt by the hospital & SNF of the UR committee's finding that the admission or future stay was not medically necessary. 22 = Active care ended - The date on which a covered level of care ended in a SNF or general hospital, or date active care ended in a psychiatric or tuberculosis hospital or date on which patient was released on a trial basis from a residential facility. Code is not required if code "21" is used. 23 = Cancellation of Hospice benefits - The date the RHHI cancelled the hospice benefit. (eff. 10/00). NOTE: this will be different than the revocation of the hospice benefit by beneficiaries. Benefits exhausted - The last date for which benefits can be paid. (term 9/30/93; replaced by code A3) 24 = Date insurance denied - The date the insurer's denial of coverage was received by a higher priority payer. 25 = Date benefits terminated by primary payer - The date on which coverage (including worker's compensation benefits or no-fault coverage) is no longer available to the patient. 26 = Date skilled nursing facility (SNF) bed available - The date on which a SNF bed became available to a hospital inpatient who required only SNF level of care. 27 = Date of Hospice Certification or Re-Certification -- code indicates the date of certification or recertification of the hospice benefit period, beginning with the first two initial benefit periods of 90 days each and the subsequent 60-day benefit periods. (eff. 9/01) 27 = Date home health plan established or last reviewed - Code indicating the date a home health plan of treatment was established or last reviewed. (Obsolete) not used by hospital unless owner of facility 28 = Date comprehensive outpatient rehabilitation plan established or last reviewed - Code indicating the date a comprehensive outpatient rehabilitation plan was established or last reviewed. not used by hospital unless owner of facility 29 = Date OPT plan established or last reviewed - the date a plan of treatment was established for outpatient physical therapy. Not used by hospital unless owner of facility 30 = Date speech pathology plan treatment established or last reviewed - The date a speech pathology plan of treatment was established or last reviewed. Not used by hospital unless owner of facility 31 = Date bene notified of intent to bill (accommodations) - The date of the notice provided to the patient by the hospital stating that he no longer required a covered level of IP care. 32 = Date bene notified of intent to bill (procedures or treatment) - The date of the notice provided to the patient by the hospital stating requested care (diagnostic procedures or treatments) is not considered reasonable or necessary. 33 = First day of the Medicare coordination period for ESRD bene - During which Medicare benefits are secondary to benefits payable under an EGHP. Required only for ESRD beneficiaries. 34 = Date of election of extended care facilities - The date the guest elected to receive extended care services (used by Religious Nonmedical Health Care Institutions only). 35 = Date treatment started for physical therapy - Code indicates the date services were initiated by the billing provider for physical therapy. 36 = Date of discharge for the IP hospital stay when patient received a transplant procedure - Hospital is billing for immunosuppressive drugs. 37 = The date of discharge for the IP hospital stay when patient received a noncovered transplant procedure - Hospital is billing for immunosuppresive drugs. 38 = Date treatment started for home IV therapy - Date the patient was first treated in his home for IV therapy. 39 = Date discharged on a continuous course of IV therapy - Date the patient was discharged from the hospital on a continuous course of IV therapy. 40 = Scheduled date of admission - The date on which a patient will be admitted as an inpatient to the hospital. (This code may only be used on an outpatient claim.) 41 = Date of First Test for Pre-admission Testing - The date on which the first outpatient diagnostic test was performed as part of a pre-admission testing (PAT) program. This code may only be used if a date of admission was scheduled prior to the administration of the test(s). (eff. 10/01) 42 = Date of discharge/termination of hospice care - for the final bill for hospice care. Eff 5/93, definition revised to apply only to date patient revoked hospice election. 43 = Scheduled Date of Canceled Surgery - date which ambulatory surgery was scheduled. (eff. 9/01) 44 = Date treatment started for occupational therapy - Code indicates the date services were initiated by the billing provider for occupational therapy. 45 = Date treatment started for speech therapy - Code indicates the date services were initiated by the billing provider for speech therapy. 46 = Date treatment started for cardiac rehabilitation - Code indicates the date services were initiated by the billing provider for cardiac rehabilitation. 47 = Date Cost Outlier Status Begins - code indicates that this is the first day the cost outlier threshold is reached. For Medicare purposes, a bene must have regular coinsurance and/or lifetime reserve days available beginning on this date to allow coverage of additional daily charges for the purpose of making cost outlier payments. (eff. 9/01) 48 = Payer code - Code reserved for internal use only by third party payers. HCFA assigns as needed for your use. Providers will not report it. 49 = Payer code - Code reserved for internal use only by third party payers. HCFA assigns as needed for your use. Providers will not report it. 50 - 69 = Reserved for state assignment A1 = Birthdate, Insured A - The birthdate of the individual in whose name the insurance is carried. (Eff 10/93) A2 = Effective date, Insured A policy - A code indicating the first date insurance is in force. (eff 10/93) A3 = Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer A. (eff 10/93) B1 = Birthdate, Insured B - The birthdate of the individual in whose name the insurance is carried. (eff 10/93) B2 = Effective date, Insured B policy - A code indicating the first date insurance is in force. (eff 10/93) B3 = Benefits exhausted - code indicating the last date for which benefits are available and after which no payment can be made to payer B. (eff 10/93) C1 = Birthdate, Insured C - The birthdate of the individual in whose name the insurance is carried. (eff 10/93) C2 = Effective date, Insured C policy - A code indicating the first date insurance is in force. (eff 10/93) C3 = Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer C. (eff 10/93)