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 when MC094 = 002 and MC036 = Report the primary ICD CM ICD-CM External External Code 11, 18, 21, procedure code when appropriate. Primary Source 8 - ICD Primary 28, 41, 65, MC 59 10/30/14 varchar[7] Repeat this code on all lines of the 55% A2 Procedure Source 8 Procedure Procedure Code 66, 84, 86 inpatient claim. Do not code decimal Code - Text Codes or 89 (type point. of bill indicates an inpatient visit) 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 claim 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 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 Claim line units of Report the of services / units MC 62 Quantity 11/8/12 Counter All 98% A1 - Integer service performed.
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 10/30/14 External Source 8 - Text External Code Source 8 - 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 MC036 = 11, 18, 21, 28, 41, 65, 66, 84, 86 or 89 (type of bill indicates an inpatient visit) 55% 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 claim line in CCYYMMDD Format. All 98% A0 MC 61 Date of Service - To 11/8/12 Full Date - Integer Century Year 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 Claim line units of service Report the of services / units performed. All 98% A1
apcd-medical-claim-file-submission-guide.docx