01

Auto accident/auto liability insurance involved

Enter the date of an auto accident. Use this code to report an auto accident that involves auto liability insurance requiring proof of fault.

02

Auto or other accident/
no fault involved

Enter the date of the accident including auto or other where no-fault coverage allows insurance immediate claim settlement without proof of fault. Use this code in conjunction with occurrence codes 24, 50, or 51 to document coordination of benefits with the no-fault insurer.

03

Accident/tort liability

Enter the date of an accident (excluding automobile) resulting from a third party's action. This incident may involve a civil court action in an attempt to require payment by the third party other than no-fault liability.

Refer to: "Tort Response Form".

04

Accident/employment-related

Enter the date of an accident that allegedly relates to the patient's employment and involves compensation or employer liability.

Use this code in conjunction with occurrence codes 24, 50, or 51 to document coordination of benefits with Workers' Compensation insurance or an employer. Only services not covered by Workers' Compensation may be considered for payment by Medicaid.

05

Other accident

Enter the date of an accident not described by the above codes.

Use this code to report no other casualty related payers have been determined.

06

Crime victim

Enter the date on which a medical condition resulted from alleged criminal action.

10

Last menstrual period

Enter the date of the last menstrual period when the service is maternity-related.

11

Onset of symptoms

Indicate the date the patient first became aware of the symptoms or illness being treated.

16

Date of last therapy

Indicate the last day of therapy services for OT, PT, or speech therapy (ST).

17

Date outpatient OT plan established or last reviewed

Indicate the date a plan was established or last reviewed for occupation therapy.

24

Date other insurance denied

Enter the date of denial of coverage by a TPR.

25

Date benefits terminated by primary payer

Enter the last date for which benefits are being claimed.

27

Date home health plan of treatment was established

Enter the date the current plan of treatment was established.

29

Date outpatient PT plan established or last reviewed

Indicate the date a plan of treatment was established or last reviewed for physical therapy.

30

Date outpatient speech pathology plan established or last reviewed

Indicate the date a plan of treatment for speech pathology was established or last reviewed.

35

Date treatment started for PT

Indicate the date services were initiated for physical therapy.

44

Date treatment started for OT

Indicate when occupational therapy services were initiated.

45

Date treatment started for speech-language pathology (SLP)

Indicate when speech language pathology services were initiated.