UB-04 Bingo - Call List

(Print) Use this randomly generated list as your call list when playing the game. There is no need to say the BINGO column name. Place some kind of mark (like an X, a checkmark, a dot, tally mark, etc) on each cell as you announce it, to keep track. You can also cut out each item, place them in a bag and pull words from the bag.

1. Service Date _______
2. Revenue Code ________
3. Billing Provider Name _________
4. Principal Diagnosis Code _________
5. Attending Physician Name ________
6. Value Codes _______
7. Patient's Address _______
8. Patient Discharge Status ________
9. Patient's Gender _______
10. Patient Status _______
11. Medical Record Number _________
12. HCPCS/ Rates _______
13. Admission Date _________
14. Patient Control Number ________
15. Units of Service _______
16. Admission Type _________
17. Statement Covers Period __________
18. Condition Codes ________
19. Total Charges _______
20. Type of Bill _______
21. Patient's DOB _______
22. Occurence Codes ________
23. Admission Source _________
24. Patient Name _______