Required when MC094 = 001 or 002 and any of the following MC039 Lookup International Report the that defines whether ICD thru MC 11/8/12 Table - tlkpICDIndicator int[1] Classification of the diagnoses on claim are ICD9 or 100% B 07 Indicator MC053, Integer Diseases version ICD10. EXAMPLE: 9 = ICD9 MC058, MC083 thru MC088, MC142 thru MC153 is populated Value Description 9 ICD-9 0 ICD-10 External Report a valid Procedure modifier Procedure External Code Code HCPCS / CPT when a modifier clarifies / improves MC Modifier - 11/8/12 Source 9 - char[2] All 0% C Source 9 Code Modifier the reporting accuracy of the 3 Modifiers - Text associated procedure code (MC055). External Report a valid Procedure modifier Procedure External Code Code HCPCS / CPT when a modifier clarifies / improves MC Modifier - 11/8/12 Source 9 - char[2] All 0% C Source 9 Code Modifier the reporting accuracy of the 4 Modifiers - Text associated procedure code (MC055). Report the date the was Claim Century Year processed by the carrier / submitter Full Date Processed MC Processed 11/8/12 Day - int[8] in CCYYMMDD Format. This date All 98% A2 - Integer Date Date CCYYMMDD can be equal to Paid Date, but cannot be after Paid Date.
MC ICD Indicator 11/8/12 Lookup Table - Integer tlkpICDIndicator int[1] International Classification of Diseases version Report the that defines whether the diagnoses on claim are ICD9 or ICD10. EXAMPLE: 9 = ICD9 Required when MC094 = 001 or 002 and any of the following MC039 thru MC053, MC058, MC083 thru MC088, MC142 thru MC153 is populated 100% B Value Description 9 ICD-9 0 ICD-10 MC Procedure Modifier - 3 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 0% C MC Procedure Modifier - 4 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 0% C MC Claim Processed Date 11/8/12 Full Date - Integer Century Year Day - CCYYMMDD int[8] Processed Date Report the date the was processed by the carrier / submitter in CCYYMMDD Format. This date can be equal to Paid Date, but cannot be after Paid Date. All 98% A2 07
v5-apcd-medical-claim-file-submission-guide-FINAL.docx