UB04 Code-Code Field/Qualifiers Code P5: External Cause of Injury Code

Overview

Code P5 is a qualifier code used in field 81CC of the UB‑04 claim form to indicate an External Cause of Injury Code. The MassHealth Billing Guide for the UB‑04 (February 2021) does not provide specific instructions for this code, but it outlines general requirements for completing the UB‑04 claim form, including that all entries must be complete, accurate, and legible, and that providers must use black ink only ^[1]. The guide also states that up to 22 revenue codes and associated charges may be entered on each UB‑04 claim form ^[1]. For claims that exceed 22 lines, an electronic claim must be submitted ^[1].

When to Use

The MassHealth Billing Guide for the UB‑04 does not specify when to use code P5. However, based on the general instructions for completing the UB‑04 claim form, providers must enter all required information as applicable, repeating if necessary, and must not use ditto marks or words such as “same as above” ^[1]. When a required entry is a date, it must be entered in MMDDYY or MMDDYYYY format ^[1]. Providers should consult the official UB‑04 data specifications or their payer’s billing instructions to determine the appropriate use of code P5, as the MassHealth guide does not address this specific qualifier.

Step-by-Step Claim Example

The MassHealth Billing Guide for the UB‑04 does not provide an example for code P5. In general, when completing the UB‑04 claim form, providers must type or print all applicable information on the claim form, using black ink only, and ensure all entries are complete, accurate, and legible ^[1]. For each claim line, enter all required information as applicable, repeating if necessary ^[1]. Attach any necessary reports or required forms to the claim form ^[1]. Because the guide does not detail the use of code P5, providers should refer to the official UB‑04 manual or their payer’s specific coding guidelines for a step‑by‑step example.

Common Mistakes & Audit Red Flags

The MassHealth Billing Guide for the UB‑04 does not list common mistakes or audit red flags specific to code P5. However, general errors that may apply to any UB‑04 field include:

• Using ditto marks or “same as above” instead of repeating required information ^[1].
• Entering dates in an incorrect format (not MMDDYY or MMDDYYYY) ^[1].
• Submitting claims with more than 22 revenue code lines on a paper form when an electronic claim is required ^[1].
• Failing to attach necessary reports or forms ^[1].

Providers should ensure that any use of code P5 follows the payer’s specific requirements to avoid claim rejections or audits.

Related Codes/Fields

Field/Code	Description	Source
Field 81CC	Occurrence Code (two‑character qualifier) – used for codes such as P5 (External Cause of Injury Code)	Not specified in the MassHealth guide
Code P5	External Cause of Injury Code	Not specified in the MassHealth guide
Field 81	Occurrence Code (general)	Not specified in the MassHealth guide
Field 82	Occurrence State	Not specified in the MassHealth guide

Note: The MassHealth Billing Guide for the UB‑04 (February 2021) does not provide a list of related codes or fields for code P5. The table above is based on standard UB‑04 form definitions, which are not included in the provided source.

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References

[1] MassHealth Billing Guide for the UB‑04 (February 2021), p. 2 — https://www.mass.gov/doc/ub-04-billing-guide-0/download