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Data Element Name:  Occurrence Information - Accident Related Codes and Dates
Format-Length:  A/N - 2 Required For:  AS, ED, IP
Effective Date:  1/1/94 Revision Date:  September 2003

NOTE: This is a composite data element. Up to 12 Occurrence Codes can be reported. For mapping guidelines refer to the Inpatient and Outpatient 837 Addenda.

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2300 HI01-1 1270 BH Occurrence Qualifier
HI01-2 1271 Occurrence Code
HI01-3 1250 D8 Date Format (CCYYMMDD)
HI01-4 1251 Occurrence Date

Paper Form Locator Code Qualifier
Institutional - UB-04 31-34 N/A

Definition:

The code and associated date defining a significant event relating to this bill that may affect payer processing.

The code which identifies the specific type of accident suffered by the patient and the corresponding date.

Codes and Values:

  1. Enter ONE of the following values in the Associated Occurrence Code Field:

    01 = Auto Accident

    02 = No-Fault Insurance Involved - Including Auto Accident/Other

    03 = Accident/Tort Liability

    04 = Accident/Employment Related

    05 = Other Accident

    06 = Crime Victim

  2. Enter the associated Date in the corresponding Occurrence Code Date Field in CCYYMMDD format.

  3. The Dates must be valid in accordance with the Date Edit Validation Table in Appendix A.

Edit Applications:

  1. If an Occurrence Code is entered, then a valid Occurrence Date must also be reported.
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