Medical Billing - FA0 Record Fields 7 Through 17

By: Michael Russell

The FA0 record is the longest record in the NSF 3.01 specifications. We pick up our review of the FA0 fields with number 7.

FA0 field 7, positions 56 - 57, is the place of service field. This is a 2 digit code that tells the carrier where the place of service was that the procedure or sale took place, such as home, hospital, facility, etc. Consult your handbook for a list of valid codes.

FA0 field 8, positions 58 - 59, is the type of service field. This is also a 2 digit code that tells the carrier the type of service for this item being billed. Common codes are 01 for purchase and 02 for rental.

FA0 field 9, positions 60 - 64, is the procedure code. Every item or procedure that is billed has a code that goes with it. These codes can be downloaded into the software from the carrier sites to be matched up with the corresponding item. This way, whenever an item is entered into the system, the corresponding code automatically is filled in. This code must be transmitted to the carrier or the item will not be paid.

FA0 fields 10, 11, 12, positions 65 - 70, are the procedure modifier fields. An article on modifiers alone can be written, but for the purpose of this article on medical billing, we'll keep this description short. Every item that is billed has what is called a two character modifier code such as KH. These modifiers can either be static, in the case of a purchase item, or variable, in the case of a rental item, where when a certain month comes, the modifier itself changes from one to another. This will be covered more thoroughly in a future article. For now, what you need to know is that the right modifier must be transmitted for that particular item and month or the claim will not be paid.

FA0 field 13, positions 71 - 77, is the line item charge amount. Here is where things get a little tricky. In the real world, not everything is billed in whole dollar amounts. Many items are billed in dollars and cents. However, when sending medical claims, no decimal points are sent in the claim. So a bill of $12,345.67 would be sent as 1234567. The decimal is not sent but is implied that the last two digits are pennies. If decimals are transmitted, the claim will not be paid, as the decimal will be treated as an invalid character.

FA0 fields 14 - 17, positions 78 - 81, are the diagnosis pointer fields. This is more for technical reasons and does not exist in paper claims. These fields need to be filled in to designate how many diagnosis codes have been filled in for the claim. So if all four diagnosis codes have been used then these one position fields would be filled in 1,2,3,4, without the commas. These fields must be filled in for each diagnosis code.

In the next installment in this series on medical billing of FA0 records, we'll continue with field number 18.

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Michael Russell
Your Independent guide to Medical Billing
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