How it works
Institutional claims describe a facility’s charges rather than a practitioner’s. The UB-04 uses a type-of-bill code, revenue codes that group charges by department (room and board, pharmacy, operating room and so on), occurrence and value codes, and, for inpatient stays, admission and discharge information.
Why it matters
Professional and institutional claims follow different rules, and sending the wrong format causes rejections. Some payers require the institutional format from facilities that bill Medicare on the professional format, such as ambulatory surgery centers — see ASC billing.
Example
A hospital outpatient department bills a procedure on the 837I with revenue codes and HCPCS codes; the surgeon bills the same procedure separately on an 837P.