Author Topic: UB04 Form Completion  (Read 1178 times)


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UB04 Form Completion
« on: January 25, 2010, 02:25:12 PM »
My client is billing Med A for CPT 76775 Retroperitoneal: Limited  They bill the facility for the technical and bill Medicare FL for the professional component.
Because they are a mobile imaging group, they have registered technicians and a group NPI.  They do not have and are not required to have individual NPI's.
They travel to the patients who are at home, in a rehab, in a skilled nursing facility, etc. 

My question is how do I complete on the UB04 form box 76, 77, 78 for Attending, Operating, Other?  These fields require individual NPI's.

SECOND question - because my clients visit the patient, there are no admitting dx appropriate for the performed, billed procedure.  How do I specify that the claim is only for the read and do I reenter the same ICD 9 codes from box 66, 69, 70, 74? 
Thanks -


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Re: UB04 Form Completion
« Reply #1 on: January 26, 2010, 07:21:01 AM »
I ran into this once, where the facility did not have any individual NPI's associated with it.  In the case I had, we entered the group NPI in 76 (77 & 78 were blank).  However, that was very unusual.  I would check with one of your major carriers to see if they want the group NPI or if they want the NPI of the provider ordering the test.

As for the diagnosis, I would enter the ordering dx for the admitting dx.

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