BILLING AND CODING INFORMATION FOR HOSPITAL …

63 TREA TMENT AUTHORIA TION CODES 6 STATEMENT COVERS PERIOD 9 PATIENT ADDRESS 17 STAT ATE DX REASON DX 71PPS CODE QUAL LAST LAST National Uniform NUBC Billing Committee OCCURRENCE QUAL QUAL QUAL CODE DATE A B C A B C A B C A B C A B C a b a b Revenue Code (Box 42)1 Enter the appropriate revenue code for each line item based on hospital billing ... ................
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