UB04 PPS Code Code 03: APC (Ambulatory Payment Classification)

Overview

However, the provided source material from Maryland Medicaid does not contain any information about PPS codes, APC, or Field 71. Instead, the source discusses Field Locator 13 (Admission Hour) and Field Locator 14 (Priority of Visit). In that context, the code “03” is used as an admission hour indicator, not as a PPS code. ^[1]

The absence of APC‑related content in the only supplied source means that the following sections must rely on the source’s actual content, which describes admission hour coding for code 03. This article will therefore explain the use of code 03 in the admission hour field (FL13), as that is the sole reference available.

When to Use

The provided source states that code 03 should be entered in Field Locator 13 (Admission Hour) to indicate the time period 03:00‑03:59. This code is used for both inpatient and outpatient claims. Per the source: “Enter the code for the hour during which the patient was admitted for inpatient or outpatient care.” ^[1]

• Use code 03 when the patient’s admission time falls anywhere between 3:00 AM and 3:59 AM.
• The code is required on all inpatient claims except bill type 21x (intermediate care facilities). It is optional for outpatient billing.
• Nursing facilities should use the date of admission for the first month of billing only, and the admission hour code for that date.

The source does not provide any guidance on when to use code 03 in the PPS field (Field 71). Therefore, for APC billing purposes, providers should consult other authoritative resources not included here.

Step-by-Step Claim Example

Because the source only addresses the admission hour code, the following example demonstrates how to apply code 03 in Field Locator 13, not in Field 71.

Scenario: A patient is admitted to a general acute care hospital on March 15, 2024, at 3:20 AM.

1. Field Locator 12 (Admission Date): Enter 03/15/2024.
2. Field Locator 13 (Admission Hour): Enter 03 (since the admission time falls between 03:00 and 03:59).
3. Field Locator 14 (Priority of Visit): For inpatient billing, enter the appropriate priority code. The source provides code 1 for Emergency if “the patient requires immediate medical intervention”.

The source does not describe Field 71 (PPS Code). For a claim that includes APC‑based payment, the correct PPS code 03 should be entered in Field 71, but no example or instruction is available from the provided text.

Common Mistakes & Audit Red Flags

The source does not mention APC‑specific errors. However, for admission hour code 03, common mistakes include:

• Using a two‑digit code that does not match the actual time of admission. For a 3:20 AM admission, only code 03 is correct; code 04 would be an audit red flag.
• Omitting the admission hour on required inpatient claims (bill types other than 21x). The source states the hour “is required on all inpatient claims except for bill type 21x.” ^[1]
• For outpatient billing, leaving the field blank may be acceptable, but inconsistency between the admission date and hour code could trigger review.

Without source coverage of APC, auditors will look for the correct APC code 03 in Field 71. Any misalignment between the procedure/service rendered and the APC code could result in claim denial. Providers should refer to Medicare or state‑specific PPS coding manuals.

Related Codes/Fields

The following table lists related fields and codes mentioned in the source, along with the APC code 03 (not covered by the source).

Field / Code	Description	Source Reference
FL13 Code 03	Admission hour 03:00‑03:59 (time code)	[1]
FL14 Code 1	Priority of Visit: Emergency	[1]
FL71 Code 03 (APC)	Ambulatory Payment Classification (not in source)	No source provided

Note: The source only contains information about FL13 and FL14 codes. The APC code 03 row is included for completeness but is not supported by the given text.

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References

[1] Maryland Medicaid (Code 03) — https://health.maryland.gov/mmcp/provider/Documents/ffs-billing/UB04-Hospital-Billing-Instructions%20%281%29.pdf