Disapprove. The data element is already situational for certain outpatient claims. Future versions of the TR3 clarify the situational usage note.
The determination of Inpatient vs. Outpatient designation as defined by the NUBC Manual is documented in the front matter in Section 1.5 and 1.12.6 of the TR3. In addition, ASC X12 has issued an RFI (1256) that clarifies that Patient’s Reason for Visit is not required on ALL outpatient claims, but rather on certain outpatient claims as directed by the NUBC billing manual:
Not required on any claim except for 013x, 085x and 078x when:
a) Priority (Type) of Admission/Visit Codes
1,2, or 5 are reported
b) Revenue Codes 045x, 0516, 0526, or 0762 are reported.
May be reported on all other 013x, 078x and 085x types of bills at submitter’s discretion when this information provides additional information to support medical necessity.