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Data Element Name:  Inpatient Ancillary Total Charges
Format-Length:  N - 10 Required For:  IP
Effective Date:  1/1/94 Revision Date:  June 1998

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2400 SV203 782 Inpatient Ancillary Total Charges

Paper Form Locator Code Qualifier
Institutional - UB-04 47 N/A

Definition:

The charges for Inpatient ancillary services incurred by the patient during the billing period.

Codes and Values:

  1. The amount must be entered in dollars and cents.

    Example:  $125.24 would be entered as: 125.24

Edit Applications:

  1. If Inpatient Ancillary Revenue Codes 0001 through 0099 are reported, any associated charges are NOT included in Inpatient Ancillary Total Charges.

  2. Inpatient Ancillary Total Charges must be equal to or greater than the corresponding Inpatient Ancillary Total Non-Covered Charges.

  3. If Inpatient Ancillary Total Charges are reported, the associated Inpatient Ancillary Revenue Code and Inpatient Ancillary Total Non-Covered Charges must also be reported.

  4. SPARCS allows a maximum of 200 Ancillaries.
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