Form Locators 16-30

75.2 - Form Locators 16-30 (Rev. 1973, Issued: 05-21-10, Effective: 09-01-10, Implementation: 09-01-10) FL 16 - Discharge Hour Not Required. FL 17 - Patient Discharge Status Required. (For all Part A inpatient, SNF, hospice, home health agency (HHA) and outpatient hospital services.) This code indicates the patient’s discharge status as of the “Through” date of the billing period (FL 6). Codes used for Medicare claims are available from Medicare contractors. Codes are also available from the NUBC (www.nubc.org) via the NUBC’s Official UB-04 Data Specifications Manual. FLs 18 - 28 - Condition Codes Situational. The provider enters the corresponding code (in numerical order) to describe any of the following conditions or events that apply to this billing period. Codes used for Medicare claims are available from Medicare contractors. Codes are also available from the NUBC (www.nubc.org) via the NUBC’s Official UB-04 Data Specifications Manual. FL 29 - Accident State Not used. Data entered will be ignored. FL 30 - (Untitled) Not used. Data entered will be ignored.