CMS Pub. 100-04, ch. 3, § 190.10.1

Effective with cost reporting periods beginning on or after January 1, 2005, the following

claim preparation requirements apply to IPFs:

• Type of Bill (TOB) is 11X;

• Medicare provider number ranges for IPFs are from xx-4000 - xx-4499, xx-Sxxx, and xx-Mxxx; (NOTE: Implementation of NPI will change this.)

• The IPF must correctly code diagnoses for the principal diagnosis, and up to

twenty four additional diagnoses, if applicable;

• The IPF must correctly code one principal procedure and up to twenty four

additional procedures performed during the stay;

• The IPF must also code age, sex, and patient (discharge) status of the patient

on the claim, using standard inpatient coding rules; and

• An IPF distinct part must code source of admission code "D" on incoming

transfers from the acute care area of the same hospital to avoid overpayment of

the emergency department adjustment when the acute area has billed or will be

billing for covered services for the same inpatient admission.

Other general requirements for processing Medicare Part A inpatient claims described in

Chapter 25 of this manual apply.

CMS' hospital inpatient GROUPER applicable to the discharge date (or effective

December 3, 2007, benefits exhaust date, if present) on the claim will determine the

DRG/MS-DRG assignment.