Situational Rule for this data element states:“Required when claim involves outpatient visits.”
Please confirm that Patient’s Reason for Visit is not required on ALL outpatient claims, but rather on certain outpatient claims as directed by the NUBC billing manual.
You are correct. The NUBC billing manual including any exceptions identified within the manual outlines under what circumstances the patient's reason for visit (005010X223A2, Loop ID 2300, HI Segment) is required on an outpatient claim under the instructions for Form Locator 70a-c (Patient's reason for visit) and Form Locator 04 (Type of Bill). The determination of Inpatient vs Outpatient designation as defined by the NUBC Manual is clarified in the front matter in Section 1.5 and 1.12.6.