Hospital Billing 2nd Edition by Susan Magovern,Jean Jurek

Exercise 3

Answer the following questions based on the top portion of the UB-04 form shown here. Appendix A contains a table of occurrence codes for quick reference.

a.Based on the TOB (0133), is this the first physical therapy claim for the patient for this condition?______
b.Has the patient finished treatment? Explain.________________
c.Do the dates of service in FL 45, lines 1-7, correspond with the dates reported in FL 6 (Statement Covers Period)?__________
d.Based on the data in FLs 31-33, when was the patient evaluated for physical therapy treatment?______
e. When did the patient begin receiving treatment?______________________
f. How many treatments are being reported on this claim?_____________
g. Value code 50 in FL 39 is used to report the number of physical therapy visits from the onset of treatment through this billing period.How many treatments did the patient receive in February?________
h. When did the patient first become aware of the symptoms that are being treated?__________________