Which Form Locator holds Occurrence Codes and Dates and is required, if applicable?

• A. Form Locator 18-28
• B. Form Locator 35-36
• C. Form Locator 29
• D. Form Locator 31-34

Answer: (D)

Occurrence information on the UB-04 is captured in a specific group of form locators that are reserved for events that can affect billing. These fields are located in the set that runs through four consecutive locators, and they are used to report up to four occurrence code/date pairs. Each pair consists of an event code (the reason or type of occurrence) and the date it occurred. They must be filled in if there are any applicable events to report (for example, admission or discharge events); if no such events exist, these fields are left blank.

Putting an occurrence code with its corresponding date helps the payer understand when key events happened during the patient’s stay, which can influence payment and adjudication. The other form locator ranges hold different data elements, so they aren’t used for these occurrence codes and dates.