Most important medical service performed, usually for treatment, that is related to the chief diagnosis responsible for the admission of the patient to the hospital.

1. ICD-9-CM procedure code for the most important medical service performed, usually for treatment, which is related to the chief diagnosis responsible for the admission of the patient to the hospital. If there are two procedures that are principal, then the one most related to the principal diagnosis should be the principal procedure. 2. When completing the Uniform Bill (UB-04) paper or electronic claim form, the principal procedure code should appear in Field 67. The electronic version requires an eight-character date listing year, month, and day (20XX0425).

The evaluation of a provider request for a specific service to determine the medical necessity and appropriateness of the care requested for a patient. Also called prior authorization in some states.

Group of figures assigned by a managed care plan or insurance program to a specific case after prior approval or precertification for treatment is completed.

Insurance of an individual before the effective date of another policy and the subscriber has a different identification number.

Insurance coverage of an individual who was covered under a previous employer and is now to be covered with the same insurance company under a new employer.

The “from” and “through” dates of a patient’s stay in a hospital, skilled nursing facility (SNF), or nursing home that ended within 60 days of the current hospital or SNF admission.

1. Confidentiality. 2. Free from observation such as closed doors, drawn curtains around a hospital bed. 3. Under the Health Insurance Portability and Accountability Act (HIPAA), use and disclosure of protected health information is permissible for treatment, payment, or health care operations (TPO).

Federal legislation that became effective on September 27, 1975, and established an individual’s right to review his or her medical records maintained by a federal medical care facility such as a VA medical center or U.S. Public Health Service facility and to contest inaccuracies in such records. This act also began to limit government use of the Social Security number. Some federal agencies or federally funded institutions may be regulated by both the Privacy Act and the HIPAA standards. Such entities are required to comply with both sets of regulations. Although the HIPAA standards generally provide more restrictive regulations, entities are advised to revise their policies and procedures to comply with both the HIPAA standards and the Privacy Act.