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| Data Element Name: Outpatient Ancillary Services Information Group Definition | |||
| SPARCS Data Element Number: 41 - 46 | |||
| Record Positions: 662 - 1321 | Format-Length: A/N - 660 | ||
| Effective Date: 1/1/2003 | Revision Date: January 2003 | ||
Definition:
The following block of data represents ancillary information reported on the bill in one to twenty occurrences. The codes were entered in ascending numerical order with common ancillary codes grouped where possible.
If more than fifteen Ancillary Service Codes were reported for a patient stay, overflow records were used to record this data. See Record Sequence Number (Data Element 7) and Record Sequence Count (Data elements 8).
It is necessary to report at least one Outpatient Ancillary with each claim. There must have been at least one total and non-covered charge for all ancillary codes reported except for the 036x, 049x, or 045x categories. For these exceptions the total and non-covered charges may have been rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each claim.
| Data Element Number |
Data Element Name |
Occurrence |
Record Positions |
| 41 | Ancillary Revenue Code | 1 | 662 - 665 |
| 2 | 695 - 698 | ||
| 3 | 728 - 731 | ||
| 4 | 761 - 764 | ||
| 5 | 794 - 797 | ||
| 6 | 827 - 830 | ||
| 7 | 860 - 863 | ||
| 8 | 893 - 896 | ||
| 9 | 926 - 929 | ||
| 10 | 959 - 962 | ||
| 11 | 992 - 995 | ||
| 12 | 1,025 - 1,028 | ||
| 13 | 1,058 - 1,061 | ||
| 14 | 1,091 - 1,094 | ||
| 15 | 1,124 - 1,127 | ||
| 16 | 1,157 - 1,160 | ||
| 17 | 1,190 - 1,193 | ||
| 18 | 1,223 - 1,226 | ||
| 19 | 1,256 - 1,259 | ||
| 20 | 1,289 - 1,292 |
||
| 42 | Procedure Code-CPT4/HCPCS | 1 | 666 - 670 |
| 2 | 699 - 703 | ||
| 3 | 732 - 736 | ||
| 4 | 765 - 769 | ||
| 5 | 798 - 802 | ||
| 6 | 831 - 835 | ||
| 7 | 864 - 868 | ||
| 8 | 897 - 901 | ||
| 9 | 930 - 934 | ||
| 10 | 963 - 967 | ||
| 11 | 996 - 1,000 | ||
| 12 | 1,029 - 1,033 | ||
| 13 | 1,062 - 1,066 | ||
| 14 | 1,095 - 1,099 | ||
| 15 | 1,128 - 1,132 | ||
| 16 | 1,161 - 1,165 | ||
| 17 | 1,194 - 1,198 | ||
| 18 | 1,227 - 1,231 | ||
| 19 | 1,260 - 1,264 | ||
| 20 | 1,293 - 1,297 |
||
| 43 | Modifier 1 | 1 | 671 - 672 |
| 2 | 704 - 705 | ||
| 3 | 737 - 738 | ||
| 4 | 770 - 771 | ||
| 5 | 803 - 804 | ||
| 6 | 836 - 837 | ||
| 7 | 869 - 870 | ||
| 8 | 902 - 903 | ||
| 9 | 935 - 936 | ||
| 10 | 968 - 969 | ||
| 11 | 1,001 - 1,002 | ||
| 12 | 1,034 - 1,035 | ||
| 13 | 1,067 - 1,068 | ||
| 14 | 1,100 - 1,101 | ||
| 15 | 1,133 - 1,134 | ||
| 16 | 1,166 - 1,167 | ||
| 17 | 1,199 - 1,200 | ||
| 18 | 1,232 - 1,233 | ||
| 19 | 1,265 - 1,266 | ||
| 20 | 1,298 - 1,299 |
||
| 44 | Modifier 2 | 1 | 673 - 674 |
| 2 | 706 - 707 | ||
| 3 | 739 - 740 | ||
| 4 | 772 - 773 | ||
| 5 | 805 - 806 | ||
| 6 | 838 - 839 | ||
| 7 | 871 - 872 | ||
| 8 | 904 - 905 | ||
| 9 | 937 - 938 | ||
| 10 | 970 - 971 | ||
| 11 | 1,003 - 1,004 | ||
| 12 | 1,036 - 1,037 | ||
| 13 | 1,069 - 1,070 | ||
| 14 | 1,102 - 1,103 | ||
| 15 | 1,135 - 1,136 | ||
| 16 | 1,168 - 1,169 | ||
| 17 | 1,201 - 1,202 | ||
| 18 | 1,234 - 1,235 | ||
| 19 | 1,267 - 1,268 | ||
| 20 | 1,300 - 1,301 |
||
| 45 | Ancillary Total Charge | 1 | 675 - 684 |
| 2 | 708 - 717 | ||
| 3 | 741 - 750 | ||
| 4 | 774 - 783 | ||
| 5 | 807 - 816 | ||
| 6 | 840 - 849 | ||
| 7 | 873 - 882 | ||
| 8 | 906 - 915 | ||
| 9 | 939 - 948 | ||
| 10 | 972 - 981 | ||
| 11 | 1,005 - 1,014 | ||
| 12 | 1,038 - 1,047 | ||
| 13 | 1,071 - 1,080 | ||
| 14 | 1,104 - 1,113 | ||
| 15 | 1,137 - 1,146 | ||
| 16 | 1,170 - 1,179 | ||
| 17 | 1,203 - 1,212 | ||
| 18 | 1,236 - 1,245 | ||
| 19 | 1,269 - 1,278 | ||
| 20 | 1,302 - 1,311 |
||
| 46 | Ancillary Total Non-Covered Charge | 1 | 685 - 694 |
| 2 | 718 - 727 | ||
| 3 | 751 - 760 | ||
| 4 | 784 - 793 | ||
| 5 | 817 - 826 | ||
| 6 | 850 - 859 | ||
| 7 | 883 - 892 | ||
| 8 | 916 - 925 | ||
| 9 | 949 - 958 | ||
| 10 | 982 - 991 | ||
| 11 | 1,015 - 1,024 | ||
| 12 | 1,048 - 1,057 | ||
| 13 | 1,081 - 1,090 | ||
| 14 | 1,114 - 1,123 | ||
| 15 | 1,147 - 1,156 | ||
| 16 | 1,180 - 1,189 | ||
| 17 | 1,213 - 1,222 | ||
| 18 | 1,246 - 1,255 | ||
| 19 | 1,279 - 1,288 | ||
| 20 | 1,312 - 1,321 | ||
