What are some common field descriptions found on a UB-04 form?

What are some common field descriptions found on a UB-04 form?

The UB-04 form is a critical document used in healthcare for billing and claims submission. It contains various field descriptions, each serving a specific purpose. Here are some common field ub-04 form field descriptions:

Patient Information

This section includes fields for the patient’s name, date of birth, gender, and address. Accuracy in this section is crucial to ensure proper identification and billing.

Provider Information

Fields in this section capture details about the healthcare facility or provider, including their name, address, and National Provider Identifier (NPI) number.

Admission and Discharge Dates

These fields record the date of the patient’s admission to and discharge from the healthcare facility, which is vital for determining the length of stay and billing accordingly.

Diagnosis Codes (ICD-10)

These codes describe the patient’s diagnosis or reason for treatment. Proper coding is essential for insurance reimbursement and medical necessity.

Procedure Codes (CPT/HCPCS)

This section lists the medical procedures, services, or treatments provided to the patient. Correct coding is essential for accurate billing and reimbursement.

Revenue Codes

Revenue codes categorize services provided by the healthcare facility, helping insurance companies understand the nature of the charges.

Total Charges

This field summarizes the total charges incurred during the patient’s stay or visit. It includes all services, procedures, and supplies provided.

Payer Information

Fields in this section capture details about the patient’s insurance company, including policy numbers and contact information.

Provider NPI and Taxonomy Code

These fields specify the healthcare provider’s NPI and the associated taxonomy code, ensuring proper identification for billing purposes.


The remarks section allows providers to include additional information or explanations related to the services rendered or billing details.

Point of Origin for Admission or Visit Codes 

These codes on the UB-04 form specify where the patient’s condition originated or where the admission took place, such as the emergency room or another healthcare facility.

Occurrence Codes and Dates 

Occurrence codes on the UB-04 form are used to provide additional information about specific events related to the patient’s care, such as the start date of a particular symptom or condition.

Condition Codes  

Condition codes convey important details about the patient’s condition or circumstances, such as whether the admission is related to employment or an accident.

Value Codes and Amounts 

Value codes on the UB-04 form indicate specific monetary values related to charges, payments, or adjustments. Ensuring accurate value code entry is vital for proper reimbursement.

Accommodation Codes 

These codes describe the type of accommodation the patient received during their stay, such as a private room or semi-private room. Proper coding impacts billing and reimbursement.

National Drug Codes (NDC) 

If medications are administered during the patient’s stay, the UB-04 form may include NDCs, which are used to report the specific drugs administered. Accurate coding is vital for billing and tracking pharmaceutical costs.


Ambulance Transportation Codes 

For patients transported via ambulance, the UB-04 form includes codes for reporting the mode of transportation and the mileage involved. Precise coding ensures accurate billing to payers.

External Cause of Injury Codes

These codes provide details about the external cause of an injury or condition, helping to determine liability and facilitate proper billing in cases of accidents or injuries.

Signature and Date Fields 

UB-04 forms require signatures from the patient, provider, or authorized personnel, along with corresponding dates. Ensuring these signatures are obtained and dates are accurate is essential for compliance.

Attachment Control Numbers 

In cases where additional documentation is required to support a claim, attachment control numbers are used to link the UB-04 form to the necessary documentation.

Frequently Answers Questions

  1. What is a UB-04 form, and why is it used in healthcare billing?

A UB-04 form is a standardized billing form used in healthcare to submit claims for services rendered to patients. It ensures uniformity in billing and is widely accepted by insurance companies.

  1. Why are accurate UB-04 form field descriptions essential for healthcare billing?

Accurate field descriptions ensure that claims are properly coded and documented, reducing the likelihood of claim denials and facilitating timely reimbursement.

  1. How can medical billing companies assist in handling UB-04 forms?

Best Medical billing companies specialize in understanding UB-04 forms, ensuring that field descriptions are accurately completed, coding is correct, and claims are processed efficiently.

  1. Are there specific guidelines for completing UB-04 forms correctly?

Yes, there are guidelines provided by the National Uniform Billing Committee (NUBC) and healthcare insurers that must be followed to ensure accurate completion of UB-04 forms.

  1. What happens if there are errors in UB-04 form field descriptions?

Errors can lead to claim denials, delayed reimbursement, and potential compliance issues. It’s crucial to identify and correct errors promptly.

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