How to bill Observation care on UB 04 – Locator 46
• Report inpatient services with appropriate revenue and HCPCS codes
• Report the number of observation hours in Field Locator 46
Observation Following ER
Bill observation services that are a result of an emergency department visit on the same UB-04 form.
Observation Following SDC
Bill observation services that are a result of an outpatient surgical procedure (SDC) on the same UB-04 form.
Inpatient Following Observation
• Bill observation services that convert to an inpatient admission on the same UB-04 form as the inpatient admission.
• Enter the inpatient admission date in Form Locator 6 (statement covers period) as the beginning (from) date of the UB-04 form. Do not include the observation date within the statement covers period date range; this will cause the claim to deny as billed incorrectly because the number of admission days will not equal the number of days indicated by the statement covers period.
• Enter the date on which the patient was admitted for inpatient services or other start of care in Field Locator 12.
• Enter the time at which the patient was admitted for inpatient services or other start of care in Field Locator 13; hours are entered in two-digit military time (e.g., use 14 for 2:00 p.m.).
Per Diem Facilities
Bill observation services that convert to an inpatient admission after midnight of the observation day with the date of the observation service in Field Locator 45 and the number of hours in Field Locator 46.
Observation with Ancillary Services
Bill outpatient ancillary services received during an observation stay using appropriate revenue codes and HCPCS codes on the same UB-04 form as the observation services.
Observation with Radiological Procedures
Bill observation services used in conjunction with radiological procedures (i.e., CAT scan, MRI, ultrasound) on the same UB-04 form as the radiological procedure.
Observation with Diagnostic Procedures
Bill observation services used in conjunction with diagnostic procedures on the same UB-04 form as the diagnostic services.
OI Denial Review Request
• Submit OI denial reviews as a Corrected Claim Appeal along with a completed Provider Claim Appeal Form.
• Submit as an outpatient claim and include only the observation room charges. All other outpatient charges that are submitted on the claim with the observation date of service will be denied.
• Report inpatient services with appropriate revenue and HCPCS codes
• Report the number of observation hours in Field Locator 46
Observation Following ER
Bill observation services that are a result of an emergency department visit on the same UB-04 form.
Observation Following SDC
Bill observation services that are a result of an outpatient surgical procedure (SDC) on the same UB-04 form.
Inpatient Following Observation
• Bill observation services that convert to an inpatient admission on the same UB-04 form as the inpatient admission.
• Enter the inpatient admission date in Form Locator 6 (statement covers period) as the beginning (from) date of the UB-04 form. Do not include the observation date within the statement covers period date range; this will cause the claim to deny as billed incorrectly because the number of admission days will not equal the number of days indicated by the statement covers period.
• Enter the date on which the patient was admitted for inpatient services or other start of care in Field Locator 12.
• Enter the time at which the patient was admitted for inpatient services or other start of care in Field Locator 13; hours are entered in two-digit military time (e.g., use 14 for 2:00 p.m.).
Per Diem Facilities
Bill observation services that convert to an inpatient admission after midnight of the observation day with the date of the observation service in Field Locator 45 and the number of hours in Field Locator 46.
Observation with Ancillary Services
Bill outpatient ancillary services received during an observation stay using appropriate revenue codes and HCPCS codes on the same UB-04 form as the observation services.
Observation with Radiological Procedures
Bill observation services used in conjunction with radiological procedures (i.e., CAT scan, MRI, ultrasound) on the same UB-04 form as the radiological procedure.
Observation with Diagnostic Procedures
Bill observation services used in conjunction with diagnostic procedures on the same UB-04 form as the diagnostic services.
OI Denial Review Request
• Submit OI denial reviews as a Corrected Claim Appeal along with a completed Provider Claim Appeal Form.
• Submit as an outpatient claim and include only the observation room charges. All other outpatient charges that are submitted on the claim with the observation date of service will be denied.