QTY

Claim Quantity

Pos: 240	Max: 4
Detail - Optional
Loop: 2300	Elements: 3

Ref

Id

Element Name

Req

Type

Min/Max

Usage

QTY01

673

Quantity Qualifier
Description: Code specifying the type of quantity

M

ID

2/2

Required

Code

Name

CA

Covered - Actual

Description: Days covered on this service

UB-92 Ref. [UB-Name]:

7 [Covered Days]

EMC v.6.0 Reference:

Record Type 30 Field No. 20 (Sequence 01-03)

CD

Co-insured - Actual

UB-92 Ref. [UB-Name]:

9 [Coinsurance Days]

EMC v.6.0 Reference:

Record Type 30 Field No. 22 (Sequence 01-03)

LA

Life-time Reserve - Actual

Description: Medicare hospital insurance includes extra hospital days to be used if the patient has a long illness and is required to stay in the hospital over a specified number of days; this is the actual number of days in reserve

UB-92 Ref. [UB-Name]:

10 [Lifetime Reserve Days]

EMC v.6.0 Reference:

Record Type 30 Field No. 23 (Sequence 01-03)

NA

Number of Non-covered Days

UB-92 Ref. [UB-Name]:

8 [Non-Covered Days]

EMC v.6.0 Reference:

Record Type 30 Field No. 21

QTY02

380

Quantity
Description: Numeric value of quantity
Industry: Claim Days Count

C

R

1/15

Required

QTY03

C001

Composite Unit of Measure
Description: To identify a composite unit of measure(See Figures Appendix for examples of use)

O

Comp

Required

355

Unit or Basis for Measurement Code
Description: Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken

M

ID

2/2

Required

Code

Name

DA

Days

1.

R0204 - At least one of QTY02,QTY04 is required

2.

E0204 - Only one of QTY02,QTY04 may be presented

1.

QTY04 is used when the quantity is non-numeric.

Notes:

1. Use the Quantity segment at the claim level Loop ID-2300 to transmit quantities that apply to the entire claim.
2. Required on Inpatient claims or encounters when covered, co-insured, life-time reserved or non-covered days are being reported.

Example:

QTY*LA*20*DA~