UB04 Field 70: Patient's Reason for Visit Code

The Patient’s Reason for Visit Code is reported in Box 70 of the UB-04 claim form. This field is used to indicate the patient’s chief complaint or reason for seeking healthcare services, typically for outpatient visits. The field is structured with subfields 70a through 70q, allowing up to 17 diagnosis codes to describe the patient’s reason for visit.

The purpose of this field is to provide payers with the patient’s primary reason for the visit, which may differ from the formal admission or principal diagnosis. While optional, accurate completion can improve claims processing efficiency and reduce denials.

However, some commercial payers or state-specific regulations may mandate its use for certain claim types. Providers should verify payer-specific requirements. The field supports up to 17 diagnosis codes (70a–70q), and codes must be entered in the same format as the rest of the claim (ICD-10-CM for dates of service on or after October 1, 2015).

When coding, ensure the reason for visit codes align with the patient’s documented chief complaint in the medical record. Do not use this field to repeat the principal diagnosis unless it is identical to the presenting reason. Misuse can lead to claim rejections or audits.

Step-by-Step Claim Example

Consider a patient presenting to the emergency department with acute onset of severe headache. The following steps illustrate how to populate Field 70 on the UB-04:

1. Identify the chief complaint: The triage note records “severe headache” (ICD-10-CM R51). Additional symptoms include nausea (R11.2) and photophobia (H53.14).
2. Determine code priority: Use the primary reason for visit as the most specific code that describes the presenting symptom. In this case, R51.9 (Headache, unspecified) is appropriate, but if documented, use a more specific code like G44.1 (Vascular headache, not elsewhere classified) if migraine suspected.
3. Populate Field 70a: Enter the primary reason code (e.g., R51). Subfield 70a corresponds to the first reason.
4. Add secondary reasons: Use subfields 70b and 70c for nausea (R11.2) and photophobia (H53.14) if they are relevant to the visit and documented.
5. Format the claim: On the UB-04 paper form, write the codes in the 70a–70q boxes. For electronic submissions, map the data to the appropriate loop (e.g., 2300 in 837I). Ensure no more than 17 codes are reported.
6. Cross-check with diagnosis fields: If the patient is later admitted (inpatient), Field 69 (Admitting Diagnosis) would also be R51, but Field 70 remains the chief complaint. If the patient is discharged home from the ED, Field 67 (Principal Diagnosis) might be G44.1 (Migraine), while Field 70 still shows R51.

This example demonstrates the distinction: Field 70 captures the reason for the visit (headache), while other fields hold the ultimate diagnosis. Accuracy ensures proper payment and utilization review.

Common Mistakes & Audit Red Flags

Several errors can lead to claim denials or audits when completing Field 70:

• Using the same code as Principal Diagnosis (Field 67): When the chief complaint and principal diagnosis are identical, some payers question medical necessity. For instance, reporting “R07.9 (Chest pain)” in both Field 70 and Field 67 for a patient stable enough for discharge may raise red flags.
• Omitting Field 70 when required: Some commercial payers mandate this field for outpatient ED claims. Failure to include it can result in denied claims or requests for additional documentation.
• Exceeding 17 codes: Field 70 only supports up to 17 codes (70a–70q). Reporting more than 17 reason codes will cause claim rejection.
• Using outdated code sets: The field must use ICD-10-CM codes for dates of service after October 1, 2015. Using ICD-9 codes (or external cause codes like E-codes in Field 72) in Field 70 is incorrect.
• Inconsistent documentation: If the medical record does not support the reason for visit code reported (e.g., coding “F41.1 (Generalized anxiety disorder)” when the note only mentions “stress”), auditors may flag the claim for upcoding.
• Ignoring payer-specific edits: For example, some payers require Field 70 to be populated for all outpatient visits, while others consider it optional. Check your specific payer contract.

Auditors often review Field 70 against other fields (e.g., 67, 69) to verify consistency. If Field 70 shows a minor complaint (e.g., “R21 (Rash)”) but Field 74 shows a major procedure (e.g., cardiac catheterization), the claim may be flagged for medical necessity review. Always ensure the reason for visit aligns with the overall treatment provided.

To minimize risks, train staff to map chief complaints correctly, validate codes against payer requirements, and perform internal audits of Field 70 usage.

Related Codes/Fields

Field/Code	Description	Relationship to Field 70
Field 67	Principal Diagnosis Code	Final diagnosis after evaluation—may differ from reason for visit.
Field 69	Admitting Diagnosis	For inpatient stays—similar to Field 70 but focuses on admission reason.
Field 72 (a–c)	External Cause of Injury Code	Used for injury-related visits; Field 70 captures the symptom (e.g., “pain”), Field 72 captures the cause (e.g., “fall”).
Field 66	Diagnosis Code Qualifier	Indicates ICD version (e.g., “10” for ICD-10); applies to Field 70 codes.
ICD-10-CM Codes	Diagnosis Codes	Provide specificity; Field 70 must use the same version as other diagnosis fields.

^[1] provides the official state-level guidance, but providers should consult their specific payer contracts for any unique requirements.

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References

[1] Maryland Medicaid — FL 70 — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf