BLI Billable information

To provide billable information for a claim or encounter.

Position: 010 · Element: 5004 · Name: Monetary amount · Type: Numeric (N) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: 3

To specify a monetary amount.

020 E029 Diagnosis Composite (composite) Conditional 9

Position: 010 · Element: 7135 · Name: Product identifier · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 35 · Repeat: -

To identify a product.

Position: 020 · Element: 9623 · Name: Diagnosis type code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: -

Code specifying the type of diagnosis.

Position: 030 · Element: 1131 · Name: Code list identification code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 17 · Repeat: -

Code identifying a user or association maintained code list.

1 The codes for this data element are provided by the code list responsible agency defined in data element 3055.

030 E507 Date/time/period Composite (composite) Conditional 9

Position: 010 · Element: 2005 · Name: Date or time or period function code qualifier · Type: String (AN) · Requirement: Mandatory · Min: 1 · Max: 3 · Repeat: -

Code qualifying the function of a date, time or period.

Position: 020 · Element: 2380 · Name: Date or time or period text · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: -

The value of a date, a date and time, a time or of a period in a specified representation.

Position: 030 · Element: 2379 · Name: Date or time or period format code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: -

Code specifying the representation of a date, time or period.

Position: 040 · Element: 7402 · Name: Object identifier · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 35 · Repeat: 5

Code specifying the unique identity of an object.

Position: 050 · Element: 9607 · Name: Yes or no indicator code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: 3

Code specifying either a yes or no.

060 E028 Related cause Composite (composite) Conditional 9

Position: 010 · Element: 9625 · Name: Related cause code · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 3 · Repeat: -

Code specifying a related cause.

Position: 020 · Element: 2000 · Name: Date · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 14 · Repeat: -

To specify a date.

Position: 030 · Element: 3229 · Name: Country subdivision identifier · Type: String (AN) · Requirement: Conditional · Min: 1 · Max: 9 · Repeat: -

To identify a country subdivision, such as state, canton, county, prefecture.

1 Recommended use ISO 3166-2. If not applicable, use appropriate code set defined by appropriate national authority.