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