PatientDischargeStatus________PrincipalDiagnosisCode_________Units ofService_______AttendingPhysicianName________AdmissionType_________StatementCoversPeriod__________Type ofBill_______AdmissionDate_________PatientControlNumber________AdmissionSource_________Patient'sGender_______ValueCodes_______MedicalRecordNumber_________ConditionCodes________HCPCS/Rates_______Patient'sAddress_______TotalCharges_______BillingProviderName_________OccurenceCodes________PatientStatus_______Patient'sDOB_______RevenueCode________ServiceDate_______PatientName_______PatientDischargeStatus________PrincipalDiagnosisCode_________Units ofService_______AttendingPhysicianName________AdmissionType_________StatementCoversPeriod__________Type ofBill_______AdmissionDate_________PatientControlNumber________AdmissionSource_________Patient'sGender_______ValueCodes_______MedicalRecordNumber_________ConditionCodes________HCPCS/Rates_______Patient'sAddress_______TotalCharges_______BillingProviderName_________OccurenceCodes________PatientStatus_______Patient'sDOB_______RevenueCode________ServiceDate_______PatientName_______

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.


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