Uniform Billing, Version 04 (UB-04) Certification Practice Test

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

Form Locator 31-34 Form Locator 14 Form Locator 30 Form Locator 35-36

Correct Answer:

Form Locator 35-36

Explanation:

Occurrence data on UB-04 is used to identify events that happen during the stay and, when those events span a range of dates, both the code and the start/end dates must be reported together. The Form Locators designated for reporting an occurrence span—together with its corresponding dates—are the ones you use when there is an event that begins and ends in the hospitalization period. You fill these fields only if such an event exists; if there’s no span to report, these fields are left blank. This placement is specifically for capturing span information in a single place so payers can accurately interpret the duration and nature of the event. Other form locators cover different data elements, so they don’t serve this purpose.

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