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Fields 10 a - 10 c - Is Patient’s Condition Related To:
Posted by Dan Perrine, Last modified by Dan Perrine on 28 March 2018 06:52 AM

This information indicates whether the patient’s illness or injury is related to employment, auto accident, or other accident. “Employment (current or previous)” would indicate that the condition is related to the patient’s job or workplace. “Auto accident” would indicate that the condition is the result of an automobile accident. “Other accident” would indicate that the condition is the result of any other type of accident.

INSTRUCTIONS: When appropriate, enter an X in the correct box to indicate whether one or more of the services described in Item Number 24 are for a condition or injury that occurred on the job or as a result of an automobile or other accident. Only one box on each line can be marked.

The state postal code where the accident occurred must be reported if “YES” is marked in 10b for “Auto Accident.” Any item marked “YES” indicates there may be other applicable insurance coverage that would be primary, such as automobile liability insurance. Primary insurance information must then be shown in Item Number 11.

MEDICARE - Check "YES" or "NO" to indicate whether employment, auto liability, or other accident involvement applies to one or more of the services described in item 24. Enter the State postal code. Any item checked "YES" indicates there may be other insurance primary to Medicare. Identify primary insurance information in item 11.

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