External External Code Procedure Code HCPCS / CPT Report a valid Procedure code for the MC 56 11/8/12 Source 9 - All 98% A1 Code Source 9 Code claim line as defined by MC130. CPTs & HCPCS - Text External Report a valid Procedure modifier Procedure External Code Code HCPCS / CPT when a modifier clarifies / improves MC 57 Modifier - 11/8/12 Source 9 - char[2] All 20% B Source 9 Code Modifier the reporting accuracy of the 1 Modifiers - Text associated procedure code (MC055). External Report a valid Procedure modifier Procedure External Code Code / CPT Code when a modifier clarifies / improves MC 58 Modifier - 11/8/12 Source 9 - char[2] All 3% B Source 9 Modifier the reporting accuracy of the 2 Modifiers - Text associated procedure code (MC055). Required External Code Report the primary ICD CM ICD-CM External when Source 8 - procedure code when appropriate. Primary Codes ICD Primary MC094 = MC 59 11/8/12 ICDCM varchar[7] Repeat this code on all lines of the 98% A2 Procedure Source 8 Procedure Code 002 and Procedure inpatient claim. Do not code decimal Code - Text MC039 is Codes point. populated Date of Century Year Full Date Report the date of service for the MC 60 Service - 6/24/10 Month Day - int[8] Date of Service All 98% A0 - Integer line in CCYYMMDD Format. From CCYYMMDD Report the end service date for the claim line in CCYYMMDD Format. Date of Century Year For inpatient claims, the room and Full Date MC 61 Service - 11/8/12 Month Day - int[8] Date of Service board line may or may not be equal All 98% A0 - Integer To CCYYMMDD to the discharge date. Procedures delivered during a visit should indicate which date they occurred. Quantity line units of Report the count of services / units MC 62 Quantity 11/8/12 Counter All 98% A1 - Integer service performed.
MC 56 Procedure Code 11/8/12 External Code Source 9 - Text External Code Source 9 - CPTs & HCPCS HCPCS / CPT Code Report a valid Procedure code for the claim line as defined by MC130. All 98% A1 MC 57 Procedure Modifier - 1 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] HCPCS / CPT Code Modifier Report a valid Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (MC055). All 20% B MC 58 Procedure Modifier - 2 11/8/12 External Code Source 9 - Text External Code Source 9 - Modifiers char[2] / CPT Code Modifier Report a valid Procedure modifier when a modifier clarifies / improves the reporting accuracy of the associated procedure code (MC055). All 3% B MC 59 ICD-CM Primary Procedure Code 11/8/12 External Codes Source 8 - Text External Code Source 8 - ICDCM Procedure Codes varchar[7] ICD Primary Procedure Code Report the primary ICD CM procedure code when appropriate. Repeat this code on all lines of the inpatient claim. Do not code decimal point. Required when MC094 = 002 and MC039 is populated 98% A2 MC 60 Date of Service - From 6/24/10 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Date of Service Report the date of service for the line in CCYYMMDD Format. All 98% A0 MC 61 Date of Service - To 11/8/12 Full Date - Integer Century Year Month Day - CCYYMMDD int[8] Date of Service Report the end service date for the claim line in CCYYMMDD Format. For inpatient claims, the room and board line may or may not be equal to the discharge date. Procedures delivered during a visit should indicate which date they occurred. All 98% A0 MC 62 Quantity 11/8/12 Quantity - Integer Counter line units of service Report the count of services / units performed. All 98% A1