00431 in FHIR

Condition code

Introduced in v2.1· user· 57 values· 58 in FHIR

OID & Vocabulary Information

Table OID
2.16.840.1.113883.12.43
Codesystem OID (v1)
2.16.840.1.113883.18.19
Value Set OID
2.16.840.1.113883.21.22
Expansion
All codes from codesystem
UTG Code Table
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2
57
01
Military service related
02
Condition is employment related
03
Patient covered by insurance not reflected here
04
HMO enrollee
05
Lien has been filed
06
ESRD patient in first 18 months of entitlement covered by employer group health insurance
07
Treatment of non-terminal condition for hospice patient
08
Beneficiary would not provide information concerning other insurance coverage
09
Neither patient nor spouse is employed
10
Patient and/or spouse is employed but no EGHP exists
11
Disabled beneficiary but no LGHP
12
Payer codes.
Modified: added
12 ... 16
Payer codes.
Modified: deleted
Deprecated
13
Payer codes.
Modified: added
14
Payer codes.
Modified: added
15
Payer codes.
Modified: added
16
Payer codes.
Modified: added
18
Maiden name retained
19
Child retains mother's name
20
Beneficiary requested billing
21
Billing for Denial Notice
26
VA eligible patient chooses to receive services in a Medicare certified facility
27
Patient referred to a sole community hospital for a diagnostic laboratory test
28
Patient and/or spouse's EGHP is secondary to Medicare
29
Disabled beneficiary and/or family member's LGHP is secondary to Medicare
31
Patient is student (full time-day)
32
Patient is student (cooperative/work study program)
33
Patient is student (full time-night)
34
Patient is student (Part time)
36
General care patient in a special unit
37
Ward accommodation as patient request
38
Semi-private room not available
39
Private room medically necessary
40
Same day transfer
41
Partial hospitalization
46
Non-availability statement on file
48
Psychiatric residential treatment centers for children and adolescents
55
SNF bed not available
56
Medical appropriateness
57
SNF readmission
60
Day outlier
61
Cost outlier
62
Payer code
66
Provider does not wish cost outlier payment
67
Beneficiary elects not to use life time reserve (LTR) days
68
Beneficiary elects to use life time reserve (LTR) days
70
Self-administered EPO
71
Full care in unit
72
Self-care in unit
73
Self-care training
74
Home
75
Home - 100% reimbursement
76
Back-up in facility dialysis
77
Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment in full
78
New coverage not implemented by HMO
79
Corf services provided off-site
80
Pregnant
58 codes+1 new