Global: ^IBT(356.22

FileMan FileNo	FileMan Filename	Package
356.22	HCS REVIEW TRANSMISSION	Integrated Billing

Package	Total	Routines
Integrated Billing	26	IBTRH1 IBTRH2 IBTRH2A IBTRH3 IBTRH3A IBTRH5 IBTRH5B IBTRH5C IBTRH5D IBTRH5E IBTRH5F IBTRH5G IBTRH5H IBTRH5I IBTRH5J IBTRH5K IBTRH6 IBTRH7 IBTRH8 IBTRH8A IBTRHDE IBTRHLI2 IBTRHLI3 IBTRHLO IBTRHLO1 IBTUTL

Package	Total	FileMan Files
Integrated Billing	1	HCS REVIEW TRANSMISSION(#356.22)[.13, .14]

Package	Total	FileMan Files
Integrated Billing	38	REVENUE CODE(#399.2)[#356.2216(2.06)] INSURANCE COMPANY(#36)[#356.2215(.02)] IB NON/OTHER VA BILLING PROVIDER(#355.93)[#356.2213(.03), #356.22168(.03)] PLACE OF SERVICE(#353.1)[2.05, #356.2216(.05)] X12 271 SERVICE TYPE(#365.013)[2.03, #356.2216(.03)] X12 271 TIME PERIOD QUALIFIER(#365.015)[4.05, #356.2216(5.05)] X12 271 QUANTITY QUALIFIER(#365.016)[4.01, #356.2216(5.01)] X12 271 ERROR CONDITION(#365.017)[#356.22101(.04)] X12 271 ERROR ACTION(#365.018)[#356.22101(.05)] X12 271 CONTACT QUALIFIER(#365.021)[19.01, 19.02, 19.03, #356.2213(.07), #356.2213(.08), #356.2213(.09), #356.22168(.07), #356.22168(.08), #356.22168(.09)] X12 271 ENTITY IDENTIFIER CODE(#365.022)[#356.2213(.01), #356.2213(4.02), #356.22168(.01), #356.22168(4.02)] X12 271 IDENTIFICATION QUALIFIER(#365.023)[#356.2213(4.08), #356.22168(4.08)] X12 271 DELIVERY FREQUENCY CODE(#365.025)[4.07, #356.2216(5.07)] X12 271 LOOP ID(#365.027)[#356.22101(.02), #356.22105(.02), #356.2213(.04), #356.2213(4.01), #356.22168(.04), #356.22168(4.01)] X12 278 REQUEST CATEGORY(#356.001)[2.01, #356.2216(.15)] X12 278 CERTIFICATION TYPE CODE(#356.002)[2.02, #356.2216(.02)] X12 278 CURRENT HEALTH CONDITION CODE(#356.003)[2.14] X12 278 PROGNOSIS CODE(#356.004)[2.15] X12 278 DELAY REASON CODE(#356.005)[2.17] X12 278 DIAGNOSIS TYPE(#356.006)[#356.22107(.02), #356.223(.01), #356.2316(.02)] X12 278 DELIVERY PATTERN TIME CODE(#356.007)[4.08, #356.2216(5.08)] X12 278 CONDITION CODE(#356.008)[4.1, 4.11, 4.12, 4.13, 4.14, 5.02, 5.03, 5.04, 5.05, 5.06, 5.08, 5.09, 5.1, 5.11, 5.12, 5.14, 5.15, 5.16, 5.17, 5.18, 6.02, 6.03, 6.04, 6.05, 6.06, 6.08, 6.09, 6.1, 6.11, 6.12, 6.14, 6.15, 6.16, 6.17, 6.18] X12 278 ADMISSION SOURCE(#356.009)[7.02] X12 278 PATIENT STATUS(#356.01)[7.03] X12 278 NURSING HOME RESIDENTIAL STATUS(#356.011)[7.04, #356.2216(2.08)] X12 278 SUBLUXATION LEVEL CODE(#356.012)[7.07, 7.08] X12 278 OXYGEN EQUIPMENT TYPE(#356.013)[8.01, 8.02, 8.03] X12 278 OXYGEN TEST CONDITION(#356.014)[9.03] X12 278 OXYGEN TEST FINDINGS(#356.015)[9.04, 9.05, 9.06] X12 278 OXYGEN DELIVERY SYSTEM CODE(#356.016)[9.08] X12 278 PATIENT LOCATION(#356.017)[10.13] X12 278 REPORT TYPE CODE(#356.018)[#356.2211(.01), #356.22166(.01)] X12 278 NURSING HOME LEVEL OF CARE(#356.019)[#356.2216(2.09)] X12 278 CERTIFICATION ACTION CODES(#356.02)[103.01, #356.2216(11.01)] X12 278 HCS DECISION REASON CODES(#356.021)[103.03, #356.2215(.03), #356.2215(.04), #356.2215(.05), #356.2215(.06), #356.2216(11.03)] X12 278 DENTAL NUMBERING SYSTEM(#356.022)[#356.22164(.01)] HCSR WORKLIST DELETE REASON CODE(#356.023)[.25] HCS REVIEW TRANSMISSION(#356.22)[.13, .14]
DRG Grouper	3	DRG(#80.2)[#356.223(.02)] ICD OPERATION/PROCEDURE(#80.1)[10.07, #356.2216(1.02), #356.2216(1.03)] ICD DIAGNOSIS(#80)[#356.223(.02)]
Kernel	3	INSTITUTION(#4)[#356.2213(.03), #356.22168(.03)] STATE(#5)[2.11, #356.2213(5.03), #356.2214(.06), #356.22168(5.03)] NEW PERSON(#200)[.09, .11, .24, #356.221(.02), #356.2213(.03), #356.22168(.03)]
CPT HCPCS Codes	2	CPT MODIFIER(#81.3)[#356.2216(1.04), #356.2216(1.05), #356.2216(1.06), #356.2216(1.07)] CPT(#81)[10.07, #356.2216(1.02), #356.2216(1.03)]
Registration	2	WARD LOCATION(#42)[.05] PATIENT(#2)[.02]
Health Level Seven	1	COUNTRY CODE(#779.004)[2.12, #356.2213(5.05), #356.22168(5.05)]
Lab Service	1	LAB LOINC(#95.3)[#356.223(.02)]
Scheduling	1	HOSPITAL LOCATION(#44)[.06]

Fields, Total: 178

Field #	Name	Loc	Type	Details
.01	DATE ENTERED	0;1	DATE	**********************REQUIRED FIELD********************** INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date and time, no range limit on date.` DESCRIPTION: `The date and time of when the entry was added to the file.` CROSS-REFERENCE: `356.22^B` `1)= S ^IBT(356.22,"B",$E(X,1,30),DA)=""` `2)= K ^IBT(356.22,"B",$E(X,1,30),DA)` RECORD INDEXES: `AD (#459)`
.02	PATIENT	0;2	POINTER TO PATIENT FILE (#2)	PATIENT(#2) LAST EDITED: `JAN 05, 2015` HELP-PROMPT: `Enter a valid Patient.` DESCRIPTION: `The Patient of this transmission entry.` RECORD INDEXES: `D (#470), E (#1215)`
.03	INSURANCE POLICY	0;3	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>9999999)!(X<1)!(X?.E1"."1.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 1 and 9999999, 0 decimal digits.` DESCRIPTION: `This field contains the IEN of the PATIENT INSURANCE multiple (file 2, sub-file .312) this entry is for.` RECORD INDEXES: `E (#1215)`
.04	INPATIENT / OUTPATIENT	0;4	SET	'I' FOR INPATIENT; 'O' FOR OUTPATIENT; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Patient Status.` DESCRIPTION: `The status of the patient - inpatient or outpatient.` RECORD INDEXES: `E (#1215)`
.05	WARD	0;5	POINTER TO WARD LOCATION FILE (#42)	WARD LOCATION(#42) LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ward location.` DESCRIPTION: `The Ward location for inpatients, null for outpatients.`
.06	CLINIC	0;6	POINTER TO HOSPITAL LOCATION FILE (#44)	HOSPITAL LOCATION(#44) LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Clinic.` DESCRIPTION: `The Clinic for outpatients, null for inpatients.`
.07	EVENT DATE	0;7	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>17!($L(X)<1) X` LAST EDITED: `JUL 01, 2014` HELP-PROMPT: `Answer must be 1-17 characters in length.` DESCRIPTION: `Date of the event for this entry. Contains admission date/time (internal FM format) for inpatients or appointment date/time (internal FM format) for outpatients. Can contain date range in [internal FM date/time]-[internal` `FM date/time] format.` RECORD INDEXES: `D (#470)`
.08	STATUS	0;8	SET	'01' FOR IN PROGRESS; '02' FOR AWAITING RESPONSE; '03' FOR UNABLE TO SEND; '04' FOR NEGATIVE RESPONSE RECEIVED; '05' FOR POSITIVE RESPONSE RECEIVED; '06' FOR MANUALLY REMOVED; '07' FOR PENDING RESPONSE RECEIVED; '08' FOR FLAGGED FOR NEXT REVIEW; '0' FOR INITIAL ENTRY; '09' FOR 215 INQ SENT; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Status Code.` DESCRIPTION: `The code describing current status of the entry.` RECORD INDEXES: `AD (#459)`
.09	MARKED 'IN PROGRESS' BY	0;9	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid user.` DESCRIPTION: `The User who marked this entry as "in progress".`
.1	DATE MARKED 'IN PROGRESS'	0;10	DATE	INPUT TRANSFORM: `S %DT="ESTR" D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 07, 2015` HELP-PROMPT: `Enter a valid date and time, no range limit on date.` DESCRIPTION: `The Date/time this entry was marked as 'in progress'.`
.11	REQUESTED BY	0;11	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid User.` DESCRIPTION: `The name of the person who will be the Contact for any UMO questions.`
.12	MESSAGE CONTROL ID	0;12	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>20!($L(X)<1) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Answer must be 1-20 characters in length.` DESCRIPTION: `This is the HL7 message control number that is generated at the time the HL7 message is created and placed in the outgoing HL7 message queue.` CROSS-REFERENCE: `356.22^C` `1)= S ^IBT(356.22,"C",$E(X,1,30),DA)=""` `2)= K ^IBT(356.22,"C",$E(X,1,30),DA)` `3)= This index is used to link the response message to the original request or inquiry.` `This cross reference is used to link the response messages with the corresponding request/inquiry messages.`
.13	INQUIRY	0;13	POINTER TO HCS REVIEW TRANSMISSION FILE (#356.22)	HCS REVIEW TRANSMISSION(#356.22) LAST EDITED: `MAY 05, 2014` HELP-PROMPT: `Select the inquiry this response corresponds to.` DESCRIPTION: `This field contains the pointer to the 278 inquiry this response corresponds to. If this entry is an inquiry, this field should be blank.`
.14	RESPONSE	0;14	POINTER TO HCS REVIEW TRANSMISSION FILE (#356.22)	HCS REVIEW TRANSMISSION(#356.22) LAST EDITED: `MAY 05, 2014` HELP-PROMPT: `Select the response for this inquiry.` DESCRIPTION: `This field contains the pointer to the 278 response for this inquiry.`
.15	TRANSMISSION DATE/TIME	0;15	DATE	INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:X<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid date and time, no range on date.` DESCRIPTION: `This is the date and time response was received (if this entry is a response) or inquiry was sent out (if this entry is an inquiry).` CROSS-REFERENCE: `356.22^AC` `1)= S ^IBT(356.22,"AC",$E(X,1,30),DA)=""` `2)= K ^IBT(356.22,"AC",$E(X,1,30),DA)` `Used to find HCS REVIEW TRANSMISSION entries by the date/time they were transmitted.`
.16	SOURCE	0;16	DATE	INPUT TRANSFORM: `S %DT="ETXR" D ^%DT S X=Y K:X<1 X` LAST EDITED: `DEC 30, 2014` HELP-PROMPT: `Enter the date/time of the entry's associated appointment or the date of the entry's associated admission.` DESCRIPTION: `If the source of the event is an appointment, this is internal FileMan date/time of the appointment. If the source of the event is an admission, this is the internal FileMan date of the admission.` RECORD INDEXES: `E (#1215)`
.17	TICKLER	0;17	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>12!($L(X)<1) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'D' to delay review until time of discharge or enter a valid date.` DESCRIPTION: `A value of 'D' will prevent this entry from being shown on the HCSR worklist until the admission related to the entry has been discharged. The 'D' option is only valid for entries with an Input/Output value of 'I'.` `Otherwise this is an internal FileMan date and the entry will begin to appear on the worklist on this date.`
.18	FROM RESPONSE	0;18	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>1)!(X<1)!(X?.E1"."1.N) X` LAST EDITED: `DEC 18, 2014` HELP-PROMPT: `Enter 1 if the entry was created from the Response Worklist.` DESCRIPTION: `If the entry was created from the Response Worklist, the value of this field is 1.`
.19	215 TRIGGERED	0;19	SET	'0' FOR NO; '1' FOR YES; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 1 if a 215 transaction has been generated for this entry or 0 otherwise.` DESCRIPTION: `A flag that determines if a 278X215 Inquiry transaction has been generated for this entry. This 215 version of the 278 transaction could have been generated manually or via the auto-trigger controlled by the IB SITE` `PARAMETERS definition for auto trigger of 215 for appointments or admissions.`
.2	TRANSACTION TYPE	0;20	SET	'0' FOR X12 217 TRANSACTION; '1' FOR X12 215 TRANSACTION; '2' FOR X12 RESPONSE MESSAGE; LAST EDITED: `DEC 18, 2014` HELP-PROMPT: `Enter 0 if the entry is a 217 transaction, 1 if the entry is a 215 transaction or 2 if the entry is an X12 Response.` DESCRIPTION: `This field value identifies the entry as either an X12 278X217 transaction, or an X12 278X215 transaction, or an X12 278 response.`
.21	RESPONSE STATUS	0;21	SET	'0' FOR Not In-Progress; '1' FOR In Progress; LAST EDITED: `DEC 18, 2014` HELP-PROMPT: `Enter 1 to Mark the Response Entry as In progress or 0 to remove the In Progress mark.` DESCRIPTION: `This field is set to 1 when a user marks the Response on the Response Worklist as In-Progress. It is set to 0 when a user removes the In-Progress mark.`
.22	DELETED RESPONSE	0;22	SET	'1' FOR DELETED; LAST EDITED: `FEB 18, 2015` HELP-PROMPT: `Enter 1 to manually remove this response from the Response Worklist.` DESCRIPTION: `Determines if a response entry was manually removed from the Response Worklist and should not be displayed.`
.23	DATE MANUALLY REMOVED	0;23	DATE	INPUT TRANSFORM: `S %DT="ESTXR" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `OCT 29, 2015` HELP-PROMPT: `Enter the date/time the entry was manually removed (No range limit on date).` DESCRIPTION: `The timestamp of when an entry was manually removed from the worklist. A manually removed entry will no longer appear on the HCSR Worklist or the HCSR Response Worklist.` CROSS-REFERENCE: `356.22^F` `1)= S ^IBT(356.22,"F",$E(X,1,30),DA)=""` `2)= K ^IBT(356.22,"F",$E(X,1,30),DA)` `This cross reference will be used for the generation of the 278 Deletion Disposition Report.`
.24	MANUALLY REMOVED BY	0;24	POINTER TO NEW PERSON FILE (#200)	NEW PERSON(#200) LAST EDITED: `FEB 18, 2015` HELP-PROMPT: `Enter a valid user.` DESCRIPTION: `The user who manually removed an entry from the HCSR Worklist or the HCSR Response Worklist.`
.25	DELETE REASON	0;25	POINTER TO HCSR WORKLIST DELETE REASON CODE FILE (#356.023)	HCSR WORKLIST DELETE REASON CODE(#356.023) LAST EDITED: `MAY 15, 2015` HELP-PROMPT: `Enter one of the Delete Reason Codes on file.` DESCRIPTION: `The Delete Reason Code is the reason for which the 278 request or inquiry was removed from the HCSR Worklist.`
.26	MANUAL 215	0;26	SET	'0' FOR NOT A MANUAL 215; '1' FOR MANUAL 215; LAST EDITED: `SEP 21, 2015` HELP-PROMPT: `Set value to 0 for 'non-manual' 278x215 or 1 for 'manual' 278x215 generation.` DESCRIPTION: `This flag is set automatically when a 278x215 Authorization Inquiry is generated manually.`
.27	REQ FROM RESP	0;27	SET	'0' FOR NO REQUEST CREATED FROM RESPONSE; '1' FOR REQUEST CREATED FROM THIS RESPONSE; LAST EDITED: `DEC 09, 2015` HELP-PROMPT: `Select 1 if this 278 Response message has had a 278 Request generated from it. Otherwise, enter 0 to indicate no 278 Request message has been generated from this 278 Response message.` DESCRIPTION: `This field indicates whether a request message was created from this response message. This is required in order to prevent duplicate requests being generated from one response message.`
1	COMMENTS	1;0	DATE Multiple #356.221	356.221 DESCRIPTION: `User comments for this entry.`
2.01	REQUEST CATEGORY	2;1	POINTER TO X12 278 REQUEST CATEGORY FILE (#356.001)	X12 278 REQUEST CATEGORY(#356.001) INPUT TRANSFORM: `S DIC("S")="I $$REQCAT^IBTRH5C()" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` OUTPUT TRANSFORM: `REQUEST CATEGORY:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Request Type for this Patient Event review.` DESCRIPTION: `The Request Type for this Patient Event review that is being submitted for approval (e.g. Admission Review, Health Services Review, Individual or Specialty Care Review).` SCREEN: `S DIC("S")="I $$REQCAT^IBTRH5C()"` EXPLANATION: `Only allows Request Category that are valid for the status of the entry.`
2.02	CERTIFICATION TYPE CODE	2;2	POINTER TO X12 278 CERTIFICATION TYPE CODE FILE (#356.002)	X12 278 CERTIFICATION TYPE CODE(#356.002) INPUT TRANSFORM: `S DIC("S")="I $$CERTCD^IBTRH5C()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CERTIFICATION TYPE CODE:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Certification Type Code.` DESCRIPTION: `This is Certification Type of the HCSR Transmission entry.` SCREEN: `S DIC("S")="I $$CERTCD^IBTRH5C()"` EXPLANATION: `If a 278 Request is being created from a Response, 'I' is not a valid selection.`
2.03	SERVICE TYPE CODE	2;3	POINTER TO X12 271 SERVICE TYPE FILE (#365.013)	X12 271 SERVICE TYPE(#365.013) INPUT TRANSFORM: `S DIC("S")="I $$SVCTYPE^IBTRH5I()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `SERVICE TYPE CODE:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Service Type.` DESCRIPTION: `The Service Type field is REQUIRED unless you plan to enter Service Detail information.` SCREEN: `S DIC("S")="I $$SVCTYPE^IBTRH5I()"` EXPLANATION: `Select a valid Service Type`
2.04	FACILITY TYPE QUALIFIER	2;4	SET	'A' FOR Uniform Billing Claim Form Bill Type; 'B' FOR Place of Service Codes for Professional or Dental Services; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Service Location Qualifier code.` DESCRIPTION: `The Service Location Qualifier field is REQUIRED unless you plan to enter Service Detail information.`
2.05	FACILITY TYPE	2;5	POINTER TO PLACE OF SERVICE FILE (#353.1)	PLACE OF SERVICE(#353.1) OUTPUT TRANSFORM: `FACILITY TYPE:NAME` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Service Location.` DESCRIPTION: `Select the Service Location where this patient event will be performed.`
2.06	LOCATION OF CARE	2;6	SET	'1' FOR Hospital - Inpt or Opt (includes clinics); '2' FOR Skilled Nursing (NHCU); '3' FOR Home Health Agency; '7' FOR Clinic (only independent/satellite); '8' FOR Spec. Facility Hosp/Amb Surg Ctr; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Location of Care.` DESCRIPTION: `This is location of care code for the 278 inquiry. This field is only populated if the FACILITY TYPE QUALIFIER field is set to A.`
2.07	BILL CLASSIFICATION	2;7	SET	'8' FOR Swingbed; '1' FOR Inpatient (Medicare-A); '2' FOR Humanit. Emerg. (Inpatient/Medicare-B); '3' FOR Outpatient; '4' FOR Humanit. Emerg. (Outpatient/ESRD); LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Bill Classification code.` DESCRIPTION: `This is Bill Classification code for the 278 inquiry. This field is only populated if the FACILITY TYPE QUALIFIER field is set to A.`
2.08	RELATED CAUSES #1	2;8	SET	'AA' FOR Auto Accident; 'AP' FOR Another Party Responsible; 'EM' FOR Employment; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Related Cause. The entered Related Cause must not already be present in Related Causes #2 or #3.` DESCRIPTION: `Select a cause related to this patient care event.` SCREEN: `S DIC("S")="I $$RCAUSE^IBTRH5A(2.08)"` EXPLANATION: `Only allows Related Causes that are not already present in in Related Causes #2 or #3.`
2.09	RELATED CAUSES #2	2;9	SET	'AP' FOR Another Party Responsible; 'EM' FOR Employment; LAST EDITED: `JAN 27, 2015` HELP-PROMPT: `Enter a valid Related Cause. The entered Related Cause must not already be present in Related Causes #1 or #3.` DESCRIPTION: `Select a cause related to this patient care event.` SCREEN: `S DIC("S")="I $$RCAUSE^IBTRH5A(2.09)"` EXPLANATION: `Only allows Related Causes that are not already present in in Related Causes #1 or #3.`
2.1	RELATED CAUSES #3	2;10	SET	'AP' FOR Another Party Responsible; 'EM' FOR Employment; LAST EDITED: `JAN 27, 2015` HELP-PROMPT: `Enter a valid Related Cause. The entered Related Cause must not already be present in Related Causes #1 or #2.` DESCRIPTION: `Select a cause related to this patient care event.` SCREEN: `S DIC("S")="I $$RCAUSE^IBTRH5A(2.1)"` EXPLANATION: `Only allows Related Causes that are not already present in in Related Causes #1 or #2.`
2.11	STATE	2;11	POINTER TO STATE FILE (#5)	STATE(#5) LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid state.` DESCRIPTION: `The state in which the auto accident occurred. This is REQUIRED if the accident occurred out of this state.`
2.12	COUNTRY	2;12	POINTER TO COUNTRY CODE FILE (#779.004)	COUNTRY CODE(#779.004) OUTPUT TRANSFORM: `COUNTRY:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid country.` DESCRIPTION: `The country in which the auto accident occurred if outside the US.`
2.13	LEVEL OF SERVICE	2;13	SET	'03' FOR Emergency; 'E' FOR Elective; 'U' FOR Urgent; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Level of Service.` DESCRIPTION: `The Level of Service if care is other than Routine. This is REQUIRED if this request is an Appeal.`
2.14	CURRENT HEALTH CONDITION	2;14	POINTER TO X12 278 CURRENT HEALTH CONDITION CODE FILE (#356.003)	X12 278 CURRENT HEALTH CONDITION CODE(#356.003) OUTPUT TRANSFORM: `CURRENT HEALTH CONDITION:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter an optional Health Condition Code.` DESCRIPTION: `The Health Condition Code is only entered if it is a factor in choosing services that are not typical for the patient's diagnoses.`
2.15	PROGNOSIS CODE	2;15	POINTER TO X12 278 PROGNOSIS CODE FILE (#356.004)	X12 278 PROGNOSIS CODE(#356.004) OUTPUT TRANSFORM: `PROGNOSIS CODE:DESCRIPTION` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter an optional Prognosis Code.` DESCRIPTION: `The Prognosis Code is only entered if it is a factor in choosing services that are not typical for the patient's diagnoses.`
2.16	RELEASE OF INFORMATION CODE	2;16	SET	'M' FOR Prov has Limited or Restricted Ability to Release Data Related to Clm; 'Y' FOR Prov has a Signed Statement Permitting Release of Medical Billing Data; LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter a valid ROI code.` DESCRIPTION: `The ROI code which determines how information of this patient event will be released.`
2.17	DELAY REASON	2;17	POINTER TO X12 278 DELAY REASON CODE FILE (#356.005)	X12 278 DELAY REASON CODE(#356.005) OUTPUT TRANSFORM: `DELAY REASON:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Delay Reason.` DESCRIPTION: `The Delay Reason code. This information is REQUIRED if this request is outside of the normal timeframe for this UMO.`
2.18	ACCIDENT DATE	2;18	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter a valid date (no range limit).` DESCRIPTION: `Enter the date on which the accident occurred.`
2.19	LAST MENSTRUAL PERIOD DATE	2;19	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter a valid date (no range limit).` DESCRIPTION: `The Date of Last Menstrual Period if this request is related to pregnancy.`
2.2	ESTIMATED DOB	2;20	DATE	INPUT TRANSFORM: `S %DT="E" D ^%DT S X=Y K:X<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid estimated date of birth.` DESCRIPTION: `The Estimated Date of Birth if this request is related to an estimated date of birth (due date).`
2.21	ILLNESS DATE	2;21	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `APR 08, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date when the current symptoms or illness first began.`
2.22	DISCHARGE DATE	2;22	DATE	INPUT TRANSFORM: `S %DT="ESTX" D ^%DT S X=Y K:X<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid date and optional time of discharge for this patient.` DESCRIPTION: `The patient discharge date/time for the 278 inquiry. Time is optional.`
2.23	CERTIFICATION ISSUE DATE	2;23	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Certification Issue Date.` DESCRIPTION: `The Certification Issue Date for this authorization.`
2.24	CERTIFICATION EXPIRATION DATE	2;24	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Certification Expiration Date.` DESCRIPTION: `The authorization expiration date.`
2.25	CERTIFICATION EFFECTIVE DATE	2;25	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Certification Effective Date.` DESCRIPTION: `The Certification Effective Date for the authorization provided.`
2.26	CERT EFFECTIVE THRU DATE	2;26	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date for which the authorization is still in effect.`
3	PATIENT DIAGNOSIS	3;0	POINTER Multiple #356.223	356.223 DESCRIPTION: `This multiple contains patient diagnosis codes for 278 inquiry.`
4.01	HCSD QUANTITY QUALIFIER	4;1	POINTER TO X12 271 QUANTITY QUALIFIER FILE (#365.016)	X12 271 QUANTITY QUALIFIER(#365.016) INPUT TRANSFORM: `S DIC("S")="I $$HCSDQQ^IBTRH5H()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `HCSD QUANTITY QUALIFIER:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Service Quantity Qualifier.` DESCRIPTION: `If the Certification Type is 4 - Extension, this is the number of additional visits. If the Certification Type is S - Revised, it is the new total.` SCREEN: `S DIC("S")="I $$HCSDQQ^IBTRH5H()"` EXPLANATION: `Enter a valid Quantity Qualifier code.`
4.02	HCSD SERVICE UNIT COUNT	4;2	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `The service unit count for the Health Care Services Delivery segment of the 278 inquiry.`
4.03	HCSD UNITS OF MEASUREMENT	4;3	SET	'DA' FOR Days; 'MO' FOR Months; 'WK' FOR Weeks; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Units of Measurement code.` DESCRIPTION: `The Unit of Measurement for the Sample Selection Modulus.`
4.04	HCSD SAMPLE SELECTION MODULUS	4;4	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999)!(X<0)!(X?.E1"."3.N) X` LAST EDITED: `NOV 19, 2014` HELP-PROMPT: `Type a number between 0 and 999, 2 decimal digits.` DESCRIPTION: `Enter a number with up to 2 decimal points that represents the sampling frequency in terms of the Unit of Measurement (e.g. 1.5 weeks).`
4.05	HCSD TIME PERIOD QUALIFIER	4;5	POINTER TO X12 271 TIME PERIOD QUALIFIER FILE (#365.015)	X12 271 TIME PERIOD QUALIFIER(#365.015) INPUT TRANSFORM: `S DIC("S")="I $$TIMEPDQ^IBTRH5I()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `HCSD TIME PERIOD QUALIFIER:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Time Period Qualifier.` DESCRIPTION: `The Time Period Qualifier for the Period Count when patient events must be rendered within a specific time frame.` SCREEN: `S DIC("S")="I $$TIMEPDQ^IBTRH5I()"` EXPLANATION: `Select a valid Time Period Qualifier`
4.06	HCSD PERIOD COUNT	4;6	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 1 and 999, 0 decimal digits.` DESCRIPTION: `Enter a whole number between 1 and 999 when patient events must be rendered within a specific time frame.`
4.07	HCSD DELIVERY FREQUENCY	4;7	POINTER TO X12 271 DELIVERY FREQUENCY CODE FILE (#365.025)	X12 271 DELIVERY FREQUENCY CODE(#365.025) INPUT TRANSFORM: `S DIC("S")="I $$HCSDFC^IBTRH5H()" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 14, 2015` HELP-PROMPT: `Enter a valid Delivery Frequency Code.` DESCRIPTION: `The Delivery Frequency Code when patient events must be rendered within a specific time frame.` SCREEN: `S DIC("S")="I $$HCSDFC^IBTRH5H()"` EXPLANATION: `The code identify a specific calendar delivery pattern.`
4.08	HCSD DELIVERY TIME PATTERN	4;8	POINTER TO X12 278 DELIVERY PATTERN TIME CODE FILE (#356.007)	X12 278 DELIVERY PATTERN TIME CODE(#356.007) OUTPUT TRANSFORM: `HCSD DELIVERY TIME PATTERN:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter an optional Delivery Pattern Time Code.` DESCRIPTION: `The optional Delivery Pattern Time Code of when the services will be provided.`
4.09	AMBULANCE CERT. CONDITION	4;9	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if the Ambulance Cert. Condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Ambulance Certification Condition(s).`
4.1	AMBULANCE CONDITION #1	4;10	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.1)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `AMBULANCE CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ambulance Certification Code. The entered code must not already be present in Ambulance Conditions #2, #3, #4 or #5.` DESCRIPTION: `The first of 5 possible Ambulance Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.1)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Ambulance Certification.`
4.11	AMBULANCE CONDITION #2	4;11	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.11)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `AMBULANCE CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ambulance Certification Code. The entered code must not already be present in Ambulance Conditions #1, #3, #4 or #5.` DESCRIPTION: `The second of 5 possible Ambulance Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.11)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Ambulance Certification.`
4.12	AMBULANCE CONDITION #3	4;12	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.12)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `AMBULANCE CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ambulance Certification Code. The entered code must not already be present in Ambulance Conditions #1, #2, #4 or #5.` DESCRIPTION: `The third of 5 possible Ambulance Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.12)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Ambulance Certification.`
4.13	AMBULANCE CONDITION #4	4;13	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.13)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `AMBULANCE CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ambulance Certification Code. The entered code must not already be present in Ambulance Conditions #1, #2, #3 or #5.` DESCRIPTION: `The fourth of 5 possible Ambulance Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.13)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Ambulance Certification.`
4.14	AMBULANCE CONDITION #5	4;14	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.14)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `AMBULANCE CONDITION #5:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Ambulance Certification Code. The entered code must not already be present in Ambulance Conditions #1, #2, #3 or #4.` DESCRIPTION: `The fifth of 5 possible Ambulance Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(4.14)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Ambulance Certification.`
5.01	CHIROPRACTIC CERT. CONDITION	5;1	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if Chiropractic Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Chiropractic Certification Condition(s).`
5.02	CHIROPRACTIC CONDITION #1	5;2	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.02)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CHIROPRACTIC CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Chiropracatic Certification Condition. The entered code must not already be present in Chiropractic Conditions #2, #3, #4 or #5.` DESCRIPTION: `The first of 5 possible Chiropractic Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.02)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Chiropractic Certification.`
5.03	CHIROPRACTIC CONDITION #2	5;3	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.03)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CHIROPRACTIC CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Chiropractic Certification Condition. The entered code must not already be present in Chiropractic Conditions #1, #3, #4 or #5.` DESCRIPTION: `The Second of 5 possible Chiropractic Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.03)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Chiropractic Certification.`
5.04	CHIROPRACTIC CONDITION #3	5;4	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.04)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CHIROPRACTIC CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Chiropractic Certification Condition. The entered code must not already be present in Chiropractic Conditions #1, #2, #4 or #5.` DESCRIPTION: `The third of 5 possible Chiropractic Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.04)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Chiropractic Certification.`
5.05	CHIROPRACTIC CONDITION #4	5;5	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.05)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CHIROPRACTIC CONDITION #5:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Chiropractic Certification Condition. The entered code must not already be present in Chiropractic Conditions #1, #2, #3 or #5.` DESCRIPTION: `The fourth of 5 possible Chiropractic Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.05)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Chiropractic Certification.`
5.06	CHIROPRACTIC CONDITION #5	5;6	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.06)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` OUTPUT TRANSFORM: `CHIROPRACTIC CONDITION #1:DESCRIPTION` LAST EDITED: `APR 08, 2015` HELP-PROMPT: `Enter a valid Chiropractic Certification Condition. The entered code must not already be present in Chiropractic Conditions #1, #2, #3 or #4.` DESCRIPTION: `The fifth of 5 possible Chiropractic Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.06)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Chiropractic Certification.`
5.07	DME CERT. CONDITION	5;7	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if the DME Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Durable Medical Equipment (DME) Certification Condition(s).`
5.08	DME CONDITION #1	5;8	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.08)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` OUTPUT TRANSFORM: `DME CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid DME Certification Condition. The entered code must not already be present in DME Conditions #2, #3, #4 or #5.` DESCRIPTION: `The first of 5 possible DME Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.08)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for DME Certification.`
5.09	DME CONDITION #2	5;9	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.09)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `DME CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid DME Certification Condition. The entered code must not already be present in DME Conditions #1, #3, #4 or #5.` DESCRIPTION: `The second of 5 possible DME Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.09)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for DME Certification.`
5.1	DME CONDITION #3	5;10	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.1)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `DME CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid DME Certification Condition. The entered code must not already be present in DME Conditions #1, #2, #4 or #5.` DESCRIPTION: `The third of 5 possible DME Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.1)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for DME Certification.`
5.11	DME CONDITION #4	5;11	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.11)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `DME CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid DME Certification Condition. The entered code must not already be present in DME Certification Conditions #1, #2, #3 or #5.` DESCRIPTION: `The fourth of 5 possible DME Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.11)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for DME Certification.`
5.12	DME CONDITION #5	5;12	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.12)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `DME CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid DME Certification Condition. The entered code must not already be present in DME Conditions #1, #2, #3 or #4.` DESCRIPTION: `The fifth of 5 possible DME Certification Conditions.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.12)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for DME Certification.`
5.13	OXYGEN CERT. CONDITION	5;13	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter 'Y' if Oxygen Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Oxygen Therapy Certification condition(s).`
5.14	OXYGEN CONDITION #1	5;14	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.14)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Certification Condition. The entered code must not already be present in Oxygen Conditions #2, #3, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the need for Oxygen Therapy. You can enter up to five Condition codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.14)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Oxygen Certification.`
5.15	OXYGEN CONDITION #2	5;15	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.15)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Certification Condition. The entered code must not already be present in Oxygen Conditions #1, #3, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the need for Oxygen Therapy. You can enter up to five Condition codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.15)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Oxygen Certification.`
5.16	OXYGEN CONDITION #3	5;16	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.16)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Certification Condition. The entered code must not already be present in Oxygen Conditions #1, #2, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the need for Oxygen Therapy. You can enter up to five Condition codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.16)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Oxygen Certification.`
5.17	OXYGEN CONDITION #4	5;17	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.17)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Certification Condition. The entered code must not already be present in Oxygen Conditions #1, #2, #3 or #5.` DESCRIPTION: `The Cerfication Condition code that describes the need for Oxygen Therapy. You can enter up to five Condition codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.17)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Oxygen Certification.`
5.18	OXYGEN CONDITION #5	5;18	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.18)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN CONDITION #5:DESCRIPTION` LAST EDITED: `FEB 18, 2015` HELP-PROMPT: `Enter a valid Oxygen Certification Condition. The entered code must not already be present in Oxygen Conditions #1, #2, #3 or #4.` DESCRIPTION: `The Certification Condition code that describes the need for Oxygen Therapy. You can enter up to five Condition codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(5.18)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Oxygen Certification.`
6.01	FUNCT. LIMIT CERT. CONDITION	6;1	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if the Funct. Limit Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Functional Limitation Certification Condition(s).`
6.02	FUNCT. LIMIT CONDITION #1	6;2	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.02)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `FUNCT. LIMIT CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Funct. Limit Certification Condition. The entered code must not already be present in Funct Limit Conditions #2, #3, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the patient's Functional Limitations. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.02)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Functional Limits Certification.`
6.03	FUNCT. LIMIT CONDITION #2	6;3	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.03)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `FUNCT. LIMIT CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Funct. Limit Certification Condition. The entered code must not already be present in Funct. Limit Conditions #1, #3, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the patient's Functional Limitations. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.03)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Functional Limits Certification.`
6.04	FUNCT. LIMIT CONDITION #3	6;4	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.04)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `FUNCT. LIMIT CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Funct. Limit Certification Condition. The entered code must not already be present in Funct. Limit Conditions #1, #2, #4 or #5.` DESCRIPTION: `The Certification Condition code that describes the patient's Functional Limitations. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.04)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Functional Limits Certification.`
6.05	FUNCT. LIMIT CONDITION #4	6;5	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.05)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `FUNCT. LIMIT CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Funct. Limit Certification Condition. The entered code must not already be present in Funct. Limit Conditions #1, #2, #3 or #5.` DESCRIPTION: `The Certification Condition code that describes the patient's Functional Limitations. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.05)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Functional Limits Certification.`
6.06	FUNCT. LIMIT CONDITION #5	6;6	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.06)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `FUNCT. LIMIT CONDITION #5:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Funct. Limit Certification Condition. The entered code must not already be present in Funct. Limit Conditions #1, #2, #3 or #4.` DESCRIPTION: `The Certification Condition code that describes the patient's Functional Limitations. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.06)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Functional Limits Certification.`
6.07	ACTIVITIES CERT. CONDITION	6;7	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if the Activities Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Activities permitted certification condition(s).`
6.08	ACTIVITIES CONDITION #1	6;8	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.08)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `ACTIVITIES CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Activities Certifcation Condition. The entered code must not already be present in Activities Condditons #2, #3, #4 or #5.` DESCRIPTION: `The Certification Condition Code that represents the defined patient activities permitted. You can enter up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.08)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Activities Certification.`
6.09	ACTIVITIES CONDITION #2	6;9	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.09)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `ACTIVITIES CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Activities Certification Condition. The entered code must not already be present in Activities Conditions #1, #3, #4 or #5.` DESCRIPTION: `The Certification Condition Code that represents the defined patient activities permitted. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.09)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Activities Certification.`
6.1	ACTIVITIES CONDITION #3	6;10	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.1)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `ACTIVITIES CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Activities Certifiction Condition. The entered code must not already be present in Activities Conditions #1, #2, #4 or #5.` DESCRIPTION: `The Certification Condition Code that represents the defined patient activities permitted. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.1)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Activities Certification.`
6.11	ACTIVITIES CONDITION #4	6;11	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.11)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `ACTIVITIES CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Activities Certification Condition. The entered code must not already be present in Activities Conditions #1, #2, #3 or #5.` DESCRIPTION: `The Certification Condition Code that represents the defined patient activities permitted. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.11)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Activities Certification.`
6.12	ACTIVITIES CONDITION #5	6;12	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.12)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `ACTIVITIES CONDITION #5:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Activities Certification Condition. The entered code must not already be present in Activities Conditions #1, #2, #3 or #4.` DESCRIPTION: `The Certification Condition Code that represents the defined patient activities permitted. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.12)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Activities Certification.`
6.13	MENTAL STATUS CERT. CONDITION	6;13	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter 'Y' if the Mental Status Cert. condition exists, or 'N' otherwise.` DESCRIPTION: `This field indicates existence of Mental Status Certification Condition(s).`
6.14	MENTAL STATUS CONDITION #1	6;14	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.14)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `MENTAL STATUS CONDITION #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Mental Status Certification Condition. The entered code must not already be present in Mental Status Conditions #2, #3, #4 or #5.` DESCRIPTION: `The Certification Condition Code that represents the patient's mental status. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.14)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Mental Status Certification.`
6.15	MENTAL STATUS CONDITION #2	6;15	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.15)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `MENTAL STATUS CONDITION #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Mental Status Certification Condition. The entered code must not already be present in Mental Status Conditions #1, #3, #4 or #5.` DESCRIPTION: `The Certificaton Condition Code that represents the patient's mental status. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.15)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Mental Status Certification.`
6.16	MENTAL STATUS CONDITION #3	6;16	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.16)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `MENTAL STATUS CONDITION #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Mental Status Certification Condition. The entered code must not already be present in Mental Status Conditions #1, #2, #4 or #5.` DESCRIPTION: `The Certification Condition Code that represents the patient's mental status. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.16)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Mental Status Certification.`
6.17	MENTAL STATUS CONDITION #4	6;17	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.17)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `MENTAL STATUS CONDITION #4:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Mental Status Certification Condition. The entered code must not already be present in Mental Status Conditions #1, #2, #3 or #5.` DESCRIPTION: `The Certification Condition Code that represents the patient's mental status. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.17)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Mental Status Certification.`
6.18	MENTAL STATUS CONDITION #5	6;18	POINTER TO X12 278 CONDITION CODE FILE (#356.008)	X12 278 CONDITION CODE(#356.008) INPUT TRANSFORM: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.18)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `MENTAL STATUS CONDITION #5:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Mental Status Certification Condition. The entered code must not already be present in Mental Status Conditions #1, #2, #3 or #4.` DESCRIPTION: `The Certification Condition Code that represents the patient's mental status. You can add up to five Condition Codes.` SCREEN: `S DIC("S")="I $$CERTCOND^IBTRH5A(6.18)"` EXPLANATION: `Only allows X12 278 Condition Codes that are valid for Mental Status Certification.`
7.01	ADMISSION TYPE	7;1	SET	'1' FOR Emergency; '2' FOR Urgent; '3' FOR Elective; '4' FOR Newborn; '5' FOR Trauma; '9' FOR Information not available; LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter an optional Admission Type.` DESCRIPTION: `The optional Admission Type that describes the type of inpatient admission.`
7.02	ADMISSION SOURCE	7;2	POINTER TO X12 278 ADMISSION SOURCE FILE (#356.009)	X12 278 ADMISSION SOURCE(#356.009) OUTPUT TRANSFORM: `ADMISSION SOURCE:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter an optional Admission Source.` DESCRIPTION: `The an optional Admission Source that decribes the source of the inpatient admission.`
7.03	PATIENT STATUS	7;3	POINTER TO X12 278 PATIENT STATUS FILE (#356.01)	X12 278 PATIENT STATUS(#356.01) OUTPUT TRANSFORM: `PATIENT STATUS:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter an optional Patient Status.` DESCRIPTION: `The optional Patient Status which describes the current status of the patient.`
7.04	NURSING HOME STATUS	7;4	POINTER TO X12 278 NURSING HOME RESIDENTIAL STATUS FILE (#356.011)	X12 278 NURSING HOME RESIDENTIAL STATUS(#356.011) OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a REQUIRED Nursing Home (SNF) Residential status.` DESCRIPTION: `The Nursing Home (SNF) Residential status is required when the patient is currently in or eligible for a nursing home.`
7.05	TREATMENT SERIES NUMBER	7;5	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 21, 2014` HELP-PROMPT: `Type a number between 0 and 999999999, 0 decimal digits.` DESCRIPTION: `Enter a 1-9 digit whole number. This is REQUIRED when requesting certification for a specific number in a series of treatments.`
7.06	TREATMENT COUNT	7;6	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 21, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a 1-15 digit number. This is REQUIRED when requesting certification for a specific number in a series of treatments.`
7.07	SUBLUXATION LEVEL CODE #1	7;7	POINTER TO X12 278 SUBLUXATION LEVEL CODE FILE (#356.012)	X12 278 SUBLUXATION LEVEL CODE(#356.012) OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter a valid Subluxation Level Code.` DESCRIPTION: `The Subluxation Level code is REQUIRED if the treatment includes subluxation.`
7.08	SUBLUXATION LEVEL CODE #2	7;8	POINTER TO X12 278 SUBLUXATION LEVEL CODE FILE (#356.012)	X12 278 SUBLUXATION LEVEL CODE(#356.012) OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter a valid Subluxation Level Code.` DESCRIPTION: `The Subluxation Level code is REQUIRED if treatment includes subluxation.`
7.09	PATIENT CONDITION CODE	7;9	SET	'A' FOR Acute Condition; 'C' FOR Chronic Condition; 'D' FOR Non-acute Condition; 'E' FOR Non-Life Threatening; 'F' FOR Routine; 'G' FOR Symptomatic; 'M' FOR Acute Manifestation of a Chronic Condition; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Patient Condition code.` DESCRIPTION: `The REQUIRED code that describes the current condition of the patient.`
7.1	COMPLICATION INDICATOR	7;10	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter Y to indicate the existence of complications or N otherwise.` DESCRIPTION: `Determines whether or not complications indicators exist.`
7.11	PAT. COND. DESCRIPTION LINE 1	7;11	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `NOV 21, 2014` HELP-PROMPT: `Answer must be 1-80 characters in length.` DESCRIPTION: `Enter a 1-80 character, free text description of the patient's condition.`
7.12	PAT. COND. DESCRIPTION LINE 2	7;12	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `NOV 21, 2014` HELP-PROMPT: `Answer must be 1-80 characters in length.` DESCRIPTION: `Enter a 1-80 character, free text description of the patient's condition.`
7.13	X-RAY AVAILABLE?	7;13	SET	'N' FOR No; 'Y' FOR Yes; LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Enter Y to indicate that there are related X-Rays available or N otherwise..` DESCRIPTION: `Determines wheter or not related X-Rays are available.`
8.01	OXYGEN EQUIPMENT TYPE #1	8;1	POINTER TO X12 278 OXYGEN EQUIPMENT TYPE FILE (#356.013)	X12 278 OXYGEN EQUIPMENT TYPE(#356.013) INPUT TRANSFORM: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.01)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN EQUIPMENT TYPE #1:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Equipment type. The entered code must not already be present in Oxygen Equipment Types #2 or #3.` DESCRIPTION: `Select the type of Oxygen Equipment. You can enter up to three Oxygen Equipment Types.` SCREEN: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.01)"` EXPLANATION: `Only allows Oxygen Equipment Types that are not already present in in Oxygen Equipment Types #2 or #3.`
8.02	OXYGEN EQUIPMENT TYPE #2	8;2	POINTER TO X12 278 OXYGEN EQUIPMENT TYPE FILE (#356.013)	X12 278 OXYGEN EQUIPMENT TYPE(#356.013) INPUT TRANSFORM: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.02)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN EQUIPMENT TYPE #2:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Equipment Type. The entered code must not already be present in Oxygen Equipment Types #1 or #3.` DESCRIPTION: `Select the type of Oxygen Equipment. You can enter up to three Oxygen Equipment Types.` SCREEN: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.02)"` EXPLANATION: `Only allows Oxygen Equipment Types that are not already present in in Oxygen Equipment Types #1 or #3.`
8.03	OXYGEN EQUIPMENT TYPE #3	8;3	POINTER TO X12 278 OXYGEN EQUIPMENT TYPE FILE (#356.013)	X12 278 OXYGEN EQUIPMENT TYPE(#356.013) INPUT TRANSFORM: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.03)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `OXYGEN EQUIPMENT TYPE #3:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Equipment Type. The entered code must not already be present in Oxygen Equipment Types #1 or #2.` DESCRIPTION: `Select the type of Oxygen Equipment. You can enter up to three Oxygen Equipment Types.` SCREEN: `S DIC("S")="I $$OXYTTYPE^IBTRH5B(8.03)"` EXPLANATION: `Only allows Oxygen Equipment Types that are not already present in in Oxygen Equipment Types #1 or #2.`
8.04	OXYGEN EQUIPMENT REASON	8;4	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Answer must be 1-80 characters in length.` DESCRIPTION: `Enter an optional 1-80 character, free text description of why the oxygen equipment is needed.`
8.05	OXYGEN FLOW RATE	8;5	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."3.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 2 decimal digits.` DESCRIPTION: `Enter a numeric value representing the Oxygen Flow rate in liters/minute.`
8.06	DAILY OXYGEN USE COUNT	8;6	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 24, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a numeric value representing the number of times per day that the patient must use oxygen.`
8.07	OXYGEN USE PERIOD HOUR COUNT	8;7	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 24, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a numeric value representing the number of hours per period of oxygen use.`
8.08	RESPIRATORY THERAPIST ORDER	8;8	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `NOV 24, 2014` HELP-PROMPT: `Answer must be 1-80 characters in length.` DESCRIPTION: `Enter a 1-80 character, free text description of special orders for the Respiratory Therapist.`
9.01	ARTERIAL BLOOD GAS QUANTITY	9;1	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 24, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a numerical value representing Arterial Blood Gas Quantity.`
9.02	OXYGEN SATURATION QUANTITY	9;2	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `NOV 24, 2014` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a numerical value representing Oxygen Saturation Quantity.`
9.03	OXYGEN TEST CONDITION	9;3	POINTER TO X12 278 OXYGEN TEST CONDITION FILE (#356.014)	X12 278 OXYGEN TEST CONDITION(#356.014) OUTPUT TRANSFORM: `OXYGEN TEST CONDITION:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Test Condition.` DESCRIPTION: `The conditions under which the patient was tested.`
9.04	OXYGEN TEST FINDINGS #1	9;4	POINTER TO X12 278 OXYGEN TEST FINDINGS FILE (#356.015)	X12 278 OXYGEN TEST FINDINGS(#356.015) INPUT TRANSFORM: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.04)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 22, 2015` HELP-PROMPT: `Enter a valid Oxygen Test Findings. The entered code must not already be present in Oxygen Test Findings #2 or #3.` DESCRIPTION: `The patient's Oxygen Test Findings. You can enter up to three findings.` SCREEN: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.04)"` EXPLANATION: `Only allows Oxygen Test Finding Codes that are not already present in Oxygen Test Findings #2 or #3.`
9.05	OXYGEN TEST FINDINGS #2	9;5	POINTER TO X12 278 OXYGEN TEST FINDINGS FILE (#356.015)	X12 278 OXYGEN TEST FINDINGS(#356.015) INPUT TRANSFORM: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.05)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 12, 2015` HELP-PROMPT: `Enter a valid Oxygen Test Findings. The entered code must not already be present in Oxygen Test Findings #1 or #3.` DESCRIPTION: `The patient's Oxygen Test Findings. You can enter up to three findings.` SCREEN: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.05)"` EXPLANATION: `Only allows Oxygen Test Finding Codes that are not already present in Oxygen Test Findings #1 or #3.`
9.06	OXYGEN TEST FINDINGS #3	9;6	POINTER TO X12 278 OXYGEN TEST FINDINGS FILE (#356.015)	X12 278 OXYGEN TEST FINDINGS(#356.015) INPUT TRANSFORM: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.06)" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X` OUTPUT TRANSFORM: `NOT EXECUTABLE!! -- SPECIFIER NEEDS AN "O"!` LAST EDITED: `JAN 22, 2015` HELP-PROMPT: `Enter a valid Oxygen Test Findings. The entered code must not already be present in Oxygen Test Findings #1 or #2.` DESCRIPTION: `The patient's Oxygen Test Findings. You can enter up to three findings.` SCREEN: `S DIC("S")="I $$OXYTFIND^IBTRH5B(9.06)"` EXPLANATION: `Only allows Oxygen Test Finding Codes that are not already present in Oxygen Test Findings #1 or #2.`
9.07	PORTABLE OXYGEN SYSTEM FLOW	9;7	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `JAN 06, 2015` HELP-PROMPT: `Type a number between 0 and 999999999999999, 0 decimal digits.` DESCRIPTION: `Enter a numeric value representing the Flow Rate for portable oxygen in liter/minute.`
9.08	OXYGEN DELIVERY SYSTEM	9;8	POINTER TO X12 278 OXYGEN DELIVERY SYSTEM CODE FILE (#356.016)	X12 278 OXYGEN DELIVERY SYSTEM CODE(#356.016) OUTPUT TRANSFORM: `OXYGEN DELIVERY SYSTEM:DESCRIPTION` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a valid Oxygen Delivery System Code.` DESCRIPTION: `The prescribed form of Oxygen Delivery.`
10.01	HOME HEALTH START DATE	10;1	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date when the home health, private duty or nursing agency services started.`
10.02	HOME HEALTH CERT. START	10;2	DATE	INPUT TRANSFORM: `N %DT S %DT="EX" S:+$P($G(^IBT(356.22,DA,10)),U,3) %DT(0)=-$P($G(^IBT(356.22,DA,10)),U,3) D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date when home health care will start.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `^^TRIGGER^356.22^10.03` `1)= Q` `2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBT(356.22,D0,10)):^(10),1:"") S X=$P(Y(1),U,2)="" I X S X=DIV S Y(1)=$S($D(^IBT(356.22,D0,10)):^(10),1:"") S X=$P(Y(1),U,3),X=X S DIU=X K Y S X="" X ^DD(356.22,10.0` `2,1,1,2.4)` `2.4)= S DIH=$G(^IBT(356.22,DIV(0),10)),DIV=X S $P(^(10),U,3)=DIV,DIH=356.22,DIG=10.03 D ^DICR` `CREATE VALUE)= NO EFFECT` `DELETE CONDITION)= HOME HEALTH CERT. START=""` `DELETE VALUE)= @` `FIELD)= #10.03`
10.03	HOME HEALTH CERT. END	10;3	DATE	INPUT TRANSFORM: `N %DT S %DT="EX",%DT(0)=$G(DG("10;2")) S:%DT(0)="" %DT(0)=$P($G(^IBT(356.22,DA,10)),U,2) D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The Date when home health care will end.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` `TRIGGERED by the HOME HEALTH CERT. START field of the HCS REVIEW TRANSMISSION File`
10.04	COVERED BY MEDICARE?	10;4	SET	'W' FOR Not applicable; 'Y' FOR Yes; 'N' FOR No; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Medicare Coverage Indicator Code.` DESCRIPTION: `The Medicare coverage indicator for the 278 inquiry.`
10.05	SURGERY DATE	10;5	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date on which surgery was performed. This date should be entered if there was a surgery related to this home health care.`
10.06	SURGICAL PROCEDURE CODE TYPE	10;6	SET	'HC' FOR CPT/HCPCS; 'ID' FOR ICD-9-CM; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Procedure Coding Method.` DESCRIPTION: `The Procedure Coding Method for the related surgical procedures.`
10.07	SURGICAL PROCEDURE CODE	10;7	VARIABLE POINTER	CPT(#81) ICD OPERATION/PROCEDURE(#80.1) EXPLANATION: `Restricts look-ups based on the Procedure Code Type.` `SCREEN ON FILE 80.1: S DIC("S")="I $$PROC^IBTRH5B(10.07)"` EXPLANATION: `Restricts look-ups based upon the Procedure Code Type.` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a Surgical Procedure.` DESCRIPTION: `The Surgical Procedure associated with this home health care.`
10.08	PHYSICIAN ORDER DATE	10;8	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date on which the physician issued verbal orders for the start of home health care.`
10.09	LAST VISIT DATE	10;9	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date on which the patient was last seen by the physician.`
10.1	PHYSICIAN CONTACT DATE	10;10	DATE	INPUT TRANSFORM: `S %DT="EX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The date on which the physician was last contacted by the home health services provider.`
10.11	LAST ADMISSION START DATE	10;11	DATE	INPUT TRANSFORM: `N %DT S %DT="EX" S:+$P($G(^IBT(356.22,DA,10)),U,12) %DT(0)=-$P($G(^IBT(356.22,DA,10)),U,12) D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The Start Date of the last inpatient admission.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` CROSS-REFERENCE: `^^TRIGGER^356.22^10.12` `1)= Q` `2)= K DIV S DIV=X,D0=DA,DIV(0)=D0 S Y(0)=X S Y(1)=$S($D(^IBT(356.22,D0,10)):^(10),1:"") S X=$P(Y(1),U,11)="" I X S X=DIV S Y(1)=$S($D(^IBT(356.22,D0,10)):^(10),1:"") S X=$P(Y(1),U,12),X=X S DIU=X K Y S X="" X ^DD(356.22,10` `.11,1,1,2.4)` `2.4)= S DIH=$G(^IBT(356.22,DIV(0),10)),DIV=X S $P(^(10),U,12)=DIV,DIH=356.22,DIG=10.12 D ^DICR` `CREATE VALUE)= NO EFFECT` `DELETE CONDITION)= LAST ADMISSION START DATE=""` `DELETE VALUE)= @` `FIELD)= #10.12`
10.12	LAST ADMISSION END DATE	10;12	DATE	INPUT TRANSFORM: `N %DT S %DT="EX",%DT(0)=$G(DG("10;11")) S:%DT(0)="" %DT(0)=$P($G(^IBT(356.22,DA,10)),U,11) D ^%DT S X=Y K:X<1 X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid date.` DESCRIPTION: `The End Date of the last inpatient admission.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER` `TRIGGERED by the LAST ADMISSION START DATE field of the HCS REVIEW TRANSMISSION File`
10.13	PATIENT LOCATION	10;13	POINTER TO X12 278 PATIENT LOCATION FILE (#356.017)	X12 278 PATIENT LOCATION(#356.017) OUTPUT TRANSFORM: `PATIENT LOCATION:DESCRIPTION` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Facility Type.` DESCRIPTION: `The Facility Type that represents the location of the patient's last inpatient admission.`
11	ATTACHMENTS	11;0	POINTER Multiple #356.2211	356.2211 DESCRIPTION: `This multiple contains additional patient information (attachments) for patient event level.`
12	MESSAGE TEXT	12;0	WORD-PROCESSING #356.2212	DESCRIPTION: `This is a free form message for 278 inquiry.` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Enter a free form message of up to 264 characters.`
13	PATIENT EVENT PROVIDER	13;0	POINTER Multiple #356.2213	356.2213 DESCRIPTION: `This multiple holds data related to patient event providers for 278 inquiry.`
14	PATIENT EVENT TRANSPORT	14;0	SET Multiple #356.2214	356.2214 DESCRIPTION: `This multiple holds data related to patient event transport information for 278 inquiry.`
15	OTHER UMO	15;0	SET Multiple #356.2215	356.2215 DESCRIPTION: `This multiple holds data related to patient event other UMO for 278 inquiry.`
16	SERVICE LINE	16;0	Multiple #356.2216	356.2216 DESCRIPTION: `This multiple holds data related to each service line.`
17.01	PREV. AUTHORIZATION #	17;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>50!($L(X)<1) X` LAST EDITED: `NOV 18, 2014` HELP-PROMPT: `Answer must be 1-50 characters in length.` DESCRIPTION: `Enter the previous Authorization Number from the UMO that is associated with this patient event.`
17.02	PREV. ADMIN. REFERENCE #	17;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>50!($L(X)<1) X` LAST EDITED: `NOV 18, 2014` HELP-PROMPT: `Answer must be 1-50 characters in length.` DESCRIPTION: `Enter the previous Administrative Reference Number from the UMO that is associated with this patient event.`
18.01	WEIGHT UNITS	18;1	SET	'KG' FOR KILOGRAM; 'LB' FOR POUND; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter the Unit of Measurement Code for Weight (CR101).` DESCRIPTION: `THE code specifying the units in which a value is being expressed, or manner in which a measurement has been taken. (CR101)` TECHNICAL DESCR: `Required when CR102 (Patient Weight) is present.`
18.02	PATIENT WEIGHT	18;2	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>9999999999)!(X<1)!(X?.E1"."1N.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 1 and 9999999999, 0 decimal digits.` DESCRIPTION: `Enter the patient's weight in pounds.` TECHNICAL DESCR: `Required when patient weight information is needed to justify the medical necessity of the level of ambulance services.`
18.03	AMBULANCE TRANSPORT CODE	18;3	SET	'I' FOR INITIAL TRIP; 'R' FOR RETURN TRIP; 'T' FOR TRANSFER TRIP; 'X' FOR ROUND TRIP; LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Enter a valid Ambulance Transportation Code.` DESCRIPTION: `The type of ambulance transportation trip.`
18.04	AMBULANCE TRANSPORT REASON	18;4	SET	'A' FOR NEAREST FACILITY; 'B' FOR PREFERRED PHYSICIAN; 'C' FOR NEARNESS OF FAMILY; 'D' FOR SPECIALIST OR SPECIAL EQUIP.; 'E' FOR REHABILITATION FACILITY; 'F' FOR RESIDENTIAL FACILITY; LAST EDITED: `NOV 19, 2014` HELP-PROMPT: `Select the most appropriate Ambulance Transport Reason.` DESCRIPTION: `Enter a code here to indicate the reason why the patient was transported to a particular location.` TECHNICAL DESCR: `Required when ambulance transport reason is required to determine medical necessity.`
18.05	DISTANCE UNITS	18;5	SET	'DH' FOR MILES; 'DK' FOR KILOMETERS; LAST EDITED: `MAY 09, 2014` HELP-PROMPT: `Enter the Unit of Measurement Code for Transport (CR105).` DESCRIPTION: `This field indicates the units of the value expressed in the field Transport Distance.` TECHNICAL DESCR: `Required when distance of transportation is known.`
18.06	TRANSPORT DISTANCE	18;6	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999999999999999)!(X<1)!(X?.E1"."1N.N) X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Type a number between 1 and 999999999999999, 0 decimal digits.` DESCRIPTION: `This field represents the distance the patient was transported.` TECHNICAL DESCR: `Required when distance of transportation is known.`
18.09	ROUND TRIP PURPOSE DESCRIPTION	18;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `NOV 19, 2014` HELP-PROMPT: `Enter a 1-80 character, free text description.` DESCRIPTION: `The text entered here should explain why a round trip was needed. This field is REQUIRED when the Transport Code is Round Trip.` TECHNICAL DESCR: `Required when CR103 (Ambulance Transport Code) equals 'X Round Trip'.`
18.1	STRETCHER PURPOSE DESCRIPTION	18;10	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>80!($L(X)<1) X` LAST EDITED: `NOV 19, 2014` HELP-PROMPT: `Enter a 1-80 character, free text description.` DESCRIPTION: `The text entered here should explain why a stretcher was needed.` TECHNICAL DESCR: `Required when CR103 (Ambulance Transport Code) equals 'X Round Trip'.`
19	UMO CONTACT NAME	19;1	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>60!($L(X)<1) X` LAST EDITED: `JAN 02, 2015` HELP-PROMPT: `Answer must be 1-60 characters in length.` DESCRIPTION: `The name of the UMO contact person.`
19.01	COMMUNICATION NO. QUALIFIER-1	19;2	POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)	X12 271 CONTACT QUALIFIER(#365.021) INPUT TRANSFORM: `S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Select a Communication Qualifier.` DESCRIPTION: `The value entered here identifies the type of number entered in the field Contact Communication Number-1.` SCREEN: `S DIC("S")="I $$COMQUAL^IBTRH5I()"` EXPLANATION: `To only select valid Communication Qualifiers.`
19.02	COMMUNICATION NO. QUALIFIER-2	19;3	POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)	X12 271 CONTACT QUALIFIER(#365.021) INPUT TRANSFORM: `S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Select a Communication Qualifier.` DESCRIPTION: `The value entered here identifies the type of number entered in the field Contact Communication Number-2.` SCREEN: `S DIC("S")="I $$COMQUAL^IBTRH5I()"` EXPLANATION: `To screen for valid Communication Qualifiers.`
19.03	COMMUNICATION NO. QUALIFIER-3	19;4	POINTER TO X12 271 CONTACT QUALIFIER FILE (#365.021)	X12 271 CONTACT QUALIFIER(#365.021) INPUT TRANSFORM: `S DIC("S")="I $$COMQUAL^IBTRH5I()" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X` LAST EDITED: `DEC 31, 2014` HELP-PROMPT: `Select a Communication Qualifier.` DESCRIPTION: `The value entered here identifies the type of number entered in the field Contact Communication Number-3.` SCREEN: `S DIC("S")="I $$COMQUAL^IBTRH5I()"` EXPLANATION: `To screen for valid Communication Qualifiers.`
20	CONTACT COMMUNICATION NUMBER-1	20;1	FREE TEXT	INPUT TRANSFORM: `K:'$$CONTPH^IBTRH5C(20) X` LAST EDITED: `FEB 04, 2015` HELP-PROMPT: `Enter a valid Phone Number, Email or Phone Number Extension.` DESCRIPTION: `This is a 10 digit phone/FAX number (format: nnnnnnnnnn or nnn-nnn-nnnn) or an email/URL address.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
21	CONTACT COMMUNICATION NUMBER-2	21;1	FREE TEXT	INPUT TRANSFORM: `K:'$$CONTPH^IBTRH5C(21) X` LAST EDITED: `FEB 04, 2015` HELP-PROMPT: `Enter a valid Phone Number, Email or Phone Number Extension.` DESCRIPTION: `This is a 10 digit phone/FAX number (format: nnnnnnnnnn or nnn-nnn-nnnn) or an email/URL address.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
22	CONTACT COMMUNICATION NUMBER-3	22;1	FREE TEXT	INPUT TRANSFORM: `K:'$$CONTPH^IBTRH5C(22) X` LAST EDITED: `FEB 04, 2015` HELP-PROMPT: `Enter a valid Phone Number, Email or Phone Number Extension.` DESCRIPTION: `This is a 10 digit phone/FAX number (format: nnnnnnnnnn or nnn-nnn-nnnn) or an email/URL address.` NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
23	DELETE REASON NOTE	23;0	WORD-PROCESSING #356.2223	DESCRIPTION: `This note is available to provide additional information pertaining to the removal of a 278 Request(217) or Inquiry(215) from the HCSR Worklist.` LAST EDITED: `MAY 15, 2015` HELP-PROMPT: `Please enter a note to describe the reason for removal from the HCSR Worklist.` DESCRIPTION: `This is the word processing note field for the Delete Reason.`
101	AAA SEGMENTS	101;0	Multiple #356.22101	356.22101 DESCRIPTION: `This multiple contains AAA segments data from 278 response.`
103.01	CERTIFICATION ACTION CODE	103;1	POINTER TO X12 278 CERTIFICATION ACTION CODES FILE (#356.02)	X12 278 CERTIFICATION ACTION CODES(#356.02) LAST EDITED: `NOV 13, 2014` HELP-PROMPT: `Answer must be a valid X12 278 Certification Action Code.` DESCRIPTION: `Code indicating type of action.`
103.02	REVIEW IDENTIFICATION NUMBER	103;2	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>50!($L(X)<1) X` LAST EDITED: `JUL 07, 2014` HELP-PROMPT: `Answer must be 1-50 characters in length.` DESCRIPTION: `Reference information as defined for a particular Transaction Set or as specified by the Reference Identification Qualifier.` TECHNICAL DESCR: `HCR02 is the number assigned by the information source to this review outcome. Required when HCR02 equals A1, A2 or A6.`
103.03	REVIEW DECISION REASON CODE	103;3	POINTER TO X12 278 HCS DECISION REASON CODES FILE (#356.021)	X12 278 HCS DECISION REASON CODES(#356.021) LAST EDITED: `DEC 10, 2014` HELP-PROMPT: `Answer must be a valid X12 278 HCS Decision Reason Code.` DESCRIPTION: `Code indicating a code from a specific industry code list.` TECHNICAL DESCR: `HCR03 is the code assigned by the information source to identify the reason for the health care service review outcome indicated in HCR01. See Code Source 886. Required when HCR01 equals A3 or A4.`
103.04	SECOND SURGICAL OPINION FLAG	103;4	SET	'Y' FOR YES; 'N' FOR NO; LAST EDITED: `SEP 24, 2014` HELP-PROMPT: `Enter 'YES' if second surgical opinion is required, 'NO' otherwise.` DESCRIPTION: `This field should be set to 'YES' if second surgical opinion is required.` TECHNICAL DESCR: `HCR04 is the second surgical opinion indicator. A 'Y' value indicates a second surgical opinion is required; an 'N' value indicates a second surgical opinion is not required for this request.`
105	TRN SEGMENTS	105;0	Multiple #356.22105	356.22105 DESCRIPTION: `This multiple contains TRN segments data.`
107	HI SEGMENTS	107;0	Multiple #356.22107	356.22107 DESCRIPTION: `This multiple contains data for HI segments.`

Customize PDF page

Package: Integrated Billing

Global: ^IBT(356.22

Information

Description

Accessed By FileMan Db Calls, Total: 26

Pointed To By FileMan Files, Total: 1

Pointer To FileMan Files, Total: 51

Fields, Total: 178