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Data Element Name:  Principal Procedure Code
Format-Length:  A/N - 7 Required For:  IP
Effective Date:  1/1/94 Revision Date:  January 2008

NOTE: This is a composite data element, for mapping guidelines refer to the Inpatient 837 Addendum.

National Standard Mapping:

Electronic - 837I

X12 Loop

Ref. Des.

Data Element

Code

Description
Version 4050R 2300 HI01-1 1270 BR Procedure Code Qualifier
HI01-2 1271 Principal Procedure Code

Paper Form Locator Code Qualifier
Institutional - UB-04 74 N/A

Definition:

All significant procedures are to be reported: the Principal Procedure here and other significant procedures in Other Procedure Code 1-14.

A significant procedure is one that is surgical in nature, carries a procedural risk, carries an anesthetic risk, or requires specialized training. Surgery includes incision, excision, amputation, introduction, endoscopy, repair, destruction, suture, and manipulation.

When more than one procedure is reported, the principal procedure is to be designated. In determining which of several procedures is principal, the following criteria apply:

The principal procedure is one that is performed for definitive treatment rather than one performed for diagnostic or exploratory purposes, or was necessary to take care of a complication. If there appear to be two procedures that are principal, then the one most related to the Principal/Primary diagnosis should be selected as the principal procedure.

Codes and Values:

  1. Must be entered exactly as shown in the ICD-9-CM coding reference.

  2. If this field is not applicable it must be blank.

Example: HI*BR:3614:D8:20060413~

Edit Applications:

  1. If the Principal Procedure Code is entered, the Operating/Emergency Department Physician 2 State License Number and Principal Procedure Date must also be reported.

  2. Edits pertaining to ICD-9-CM codes are validated on the basis of the Statement-Covers-Thru Date and Expected Principal Reimbursement depending on conditions described in Appendix N, which include sex-specific procedure code conditions.

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