11 NCAC 12 .1502             REQUIREMENTS FOR USE OF HCFA FORM 1450 (UB92)

(a)  Effective January 1, 1995, the HCFA Form 1450 (UB92) shall be the standard claim form for all manual billing by institutional health care providers, and the HCFA Form 1450 shall be accepted by all payors conducting business in this State.

(b)  Effective January 1, 1995, with implementation to be complete no later than April 1, 1995, the following additional information and placement location shall be required for the HCFA Form 1450 (UB92):

(1)           The provider tax I.D. number shall be located in form locator 5.

(2)           The ethnic origin code shall be located in form locator 24-30 (Condition Codes), using Code X1-X5 (see definitions as defined in the State Uniform Billing Manual) to translate the ethnic origin codes.

(c)  Effective October 1, 1995, the cause of injury code shall be located in form locator 77.  This code shall be required on all HCFA Form 1450 (UB92) claims generated by institutional health care providers for claims of inpatients and of patients treated in emergency rooms or trauma centers; and where the diagnosis includes an injury diagnosis, which means a diagnostic code in the range or 800-999 as defined in the ICD-9 coding manual.  Coding of the cause of injury shall be in accordance with the standards in the publication entitled, "Coding and Reporting of External Causes of Injury and Poisoning Recommended Coding Guidelines for ICD-9-CM", which standards are incorporated by reference into this Rule, including subsequent amendments and editions.  Copies of the publication can be obtained from the Center for Health Policy Studies, 9700 Patuxent Woods Drive, Columbia, Maryland 21046-1577, for twenty five dollars ($25.00) each.  The absence of this code may not be used to deny the payment of a claim.

(d)  Payors may require institutional health care providers to use only the following coding systems for the filing of claims for health care services:

(1)           ICD-9-CM Codes to report all diagnoses, reasons for encounters and procedures - based upon code level changes made effective October 1 of each year or other effective date designated by the HCFA.

(2)           HCPCS Level 1 and 2 Codes - based upon code level changes made effective October 1 of each year or other effective date designated by the HCFA.

(3)           CPT-4 Codes based upon code level changes made effective January 1 of each year or other effective date designated by the HCFA.

(e)  When there is no applicable HCPCS Level 1 or Level 2 Code or modifier, the payor may establish its own code or modifier.  A complete list of all codes and modifiers established by payors must be published by and available upon request from payors by January 1, 1995.

 

History Note:        Authority G.S. 58‑2‑40; 58‑3‑171;

Eff. October 1, 1994;

Amended Eff. March 1, 1995.