Home   Package List   Routine Alphabetical List   Global Alphabetical List   FileMan Files List   FileMan Sub-Files List   Package Component Lists   Package-Namespace Mapping  
Routine: FBAAFSR

FBAAFSR.m

Go to the documentation of this file.
  1. FBAAFSR ;WCIOFO/TCK,SS,DMK,SAB - RBRVS FEE SCHEDULE ;1/14/11 11:07am
  1. ;;3.5;FEE BASIS;**4,53,71,84,92,93,99,102,105,109,110,112,118,145,179,184**;JAN 30, 1995;Build 4
  1. ;Per VA Directive 6402, this routine should not be modified.
  1. ;
  1. Q
  1. ;
  1. RBRVS(CPT,MODL,DOS,ZIP,FAC,TIME) ; calculate RBRVS Fee Schedule amount
  1. ; Input
  1. ; CPT = CPT/HCPCS code (external value)
  1. ; MODL = list of CPT/HCPCS modifiers (external values)
  1. ; delimited by commas (e.g. "26,51")
  1. ; DOS = date of service (fileman format e.g. 2980101)
  1. ; ZIP = ZIP code of service (external 5 digit value)
  1. ; FAC = facility flag =1 if site of service is facility setting
  1. ; TIME = time in minutes, only passed on anesthesia CPT codes
  1. ; Returns string
  1. ; dollar amount^sched year OR null value if not on RBRVS schedule
  1. ; Output
  1. ; FBERR( array of error messages OR undefined if none
  1. ;
  1. N FBAMT,FBCF,FBCPT0,FBCPTY0,FBCY,FBERR,FBGPCIY0
  1. ;
  1. ; initialization
  1. S FBAMT=""
  1. K FBERR
  1. ;
  1. ; check for required input parameters
  1. I $G(CPT)="" D ERR^FBAAFS("CPT missing")
  1. I $G(DOS)'?7N D ERR^FBAAFS("Date of Service missing")
  1. I $D(FBERR) Q FBAMT
  1. ;
  1. ;if date of service prior to VA implementation, don't use RBRVS
  1. I DOS<2990901 Q FBAMT
  1. ;
  1. ;if modifier SG present, don't use RBRVS, patch FB*3.5*84
  1. I MODL["SG" Q FBAMT
  1. ;
  1. ; determine schedule calendar year based on date of service
  1. S FBCY=$E(DOS,1,3)+1700
  1. ;
  1. ;If date of service in 2003 but prior to Mar 1, 2003 treat as 2002
  1. I $E(DOS,1,3)=303,DOS<3030301 S FBCY=FBCY-1
  1. ;
  1. ; if year after most recent RBRVS schedule then use prior year schedule
  1. I FBCY>$$LASTCY() S FBCY=FBCY-1
  1. ;
  1. ; get procedure data from schedule for year
  1. D PROC(CPT,MODL,FBCY)
  1. ;
  1. ; if procedure:
  1. ; - covered
  1. ; - payable
  1. ; - not for anesthesia
  1. ; then calculate amount
  1. I FBCPTY0]"",'$$ANES^FBAAFS(CPT) D
  1. . ;
  1. . ;validate parameters
  1. . I $G(ZIP)="" D ERR^FBAAFS("Missing ZIP Code")
  1. . I $G(FAC)="" D ERR^FBAAFS("Missing Facility Flag")
  1. . I $D(FBERR) Q
  1. . ;
  1. . ; get GPCIs for calendar year
  1. . D ZIP(FBCY,ZIP)
  1. . I FBGPCIY0="" D ERR^FBAAFS("Could not determine GPCIs") Q
  1. . ;
  1. . ; get conversion factor
  1. . S FBCF=$$CF(FBCY,$P(FBCPT0,U,2))
  1. . I FBCF="" D ERR^FBAAFS("Could not determine the conversion factor") Q
  1. . ;
  1. . ; calculate full schedule amount
  1. . D CALC(FBCY,FAC,FBCPTY0,FBGPCIY0,FBCF)
  1. . ;
  1. . ; apply adjustments to calculation
  1. . S FBAMT=$J(FBAMT,0,3) ;FB*3.5*184 - Adjust rounding to match CMS, go to 3 digits first (Anything $0.0045 or above is rounded up to next cent)
  1. . S FBAMT=$J(FBAMT,0,2)*$$ADJ(CPT,DOS)
  1. . ; apply multiplier based on modifier
  1. . I MODL]"" S FBAMT=FBAMT*$$MULT(FBCY,MODL,FBCPT0,FBCPTY0)
  1. ;
  1. ; return result
  1. Q $S(FBAMT>0:$J(FBAMT,0,2)_U_FBCY,1:"")
  1. ;
  1. PROC(CPT,MODL,FBCY,FBNONPBL) ; get procedure data for RBRVS schedule
  1. ; Input
  1. ; CPT = CPT/HCPCS code (external value)
  1. ; MODL = list of CPT/HCPCS modifiers (external value)
  1. ; delimited by commas
  1. ; FBCY = calendar year (4 digit)
  1. ; FBNONPBL ( optional):
  1. ; if $G(FBNONPBL)=0 then will make search among payable records only in #162.97
  1. ; ignoring those non-payable ones with field #.08 NONPAYABLE = 1
  1. ; if $G(FBNONPBL)=1 then will make search among all items in #162.97
  1. ;
  1. ; Output
  1. ; FBCPT0 = zero node from file 162.97 OR "" if not covered
  1. ; FBCPTY0 = zero node from subfile 162.971 or "" if not covered
  1. N CPTM,MOD,FBI
  1. S (FBCPT0,FBCPTY0)=""
  1. Q:$G(FBCY)']""!($G(CPT)']"")
  1. ;
  1. ; if modifier exists try to find entry with modifier
  1. I MODL]"" D
  1. . F FBI=1:1 S MOD=$P(MODL,",",FBI) Q:MOD="" D Q:FBCPTY0]""
  1. . . S CPTM=CPT_"-"_MOD
  1. . . D PROC1(CPTM,FBCY,$G(FBNONPBL))
  1. ;
  1. ; if not found with modifier, try just CPT code
  1. I FBCPTY0="" D PROC1(CPT,FBCY,$G(FBNONPBL))
  1. ;
  1. Q
  1. ;
  1. PROC1(CPTM,FBCY,FBNONPBL) ; get procedure data for CPT-Modifier
  1. ; input
  1. ; CPTM - CPT Code - Modifier (e.g. 57335-TC or 57335)
  1. ; FBCY - 4 digit calendar year
  1. ; FBNONPBL ( optional):
  1. ; if $G(FBNONPBL)=0 then will make search among payable records only in #162.97
  1. ; ignoring those non-payable ones with field #.08 NONPAYABLE = 1
  1. ; if $G(FBNONPBL)=1 then will make search among all items in #162.97
  1. ; output
  1. ; FBCPT0 = zero node from file 162.97 OR "" if not covered
  1. ; FBCPTY0 = zero node from subfile 162.971 or "" if not covered
  1. N FBDA,FBDA1
  1. S (FBCPT0,FBCPTY0)=""
  1. S FBDA=$O(^FB(162.97,"B",CPTM,0))
  1. S FBDA1=$S(FBDA:$O(^FB(162.97,FBDA,"CY","B",FBCY,0)),1:"")
  1. I $G(FBDA),$G(FBDA1) D
  1. . N FBI,FBSUM,FBY
  1. . S FBY=$G(^FB(162.97,FBDA,"CY",FBDA1,0))
  1. . ;if non-payable records should not be considered
  1. . ;then quit if this is NONPAYBLE
  1. . I +$G(FBNONPBL)=0 Q:$P(FBY,U,8)=1
  1. . ; check if procedure covered by schedule
  1. . I +$G(FBNONPBL)=0,$$ANES^FBAAFS($P(CPTM,"-")),$P(FBY,U,6)']"" Q ; missing anes base
  1. . I +$G(FBNONPBL)=0,'$$ANES^FBAAFS($P(CPTM,"-")) D I FBSUM'>0 Q ; sum of RVUs = 0
  1. . . S FBSUM=0 F FBI=3,4,5,6 S FBSUM=FBSUM+$P(FBY,U,FBI)
  1. . ; passed checks
  1. . S FBCPTY0=FBY
  1. . S FBCPT0=$G(^FB(162.97,FBDA,0))
  1. Q
  1. ;
  1. ZIP(FBCY,ZIP) ; get GPCIs
  1. ; Input
  1. ; FBCY = calendar year (4 digit)
  1. ; ZIP = zip code (5 digit external value)
  1. ; Output
  1. ; FBGPCIY0 = zero node from file 162.96 or "" if not found
  1. S FBGPCIY0=""
  1. Q:$G(FBCY)']""!($G(ZIP)']"")
  1. N FBDA,FBDA1
  1. S FBDA=$O(^FB(162.96,"B",ZIP,0))
  1. S FBDA1=$S(FBDA:$O(^FB(162.96,FBDA,"CY","B",FBCY,0)),1:"")
  1. I FBDA,FBDA1 S FBGPCIY0=$G(^FB(162.96,FBDA,"CY",FBDA1,0))
  1. Q
  1. ;
  1. CF(FBCY,FBDA) ; get conversion factor
  1. ; Input
  1. ; FBCY = calendar year
  1. ; FBDA = optional conversion category (internal)
  1. ; Returns
  1. ; conversion factor from file 162.99
  1. N FBCF,FBDA1
  1. I '$G(FBDA) S FBDA=4 ; use Medicine category if not specified
  1. S FBDA1=$O(^FB(162.99,FBDA,"CY","B",FBCY,0))
  1. S FBCF=$S(FBDA1:$P($G(^FB(162.99,FBDA,"CY",FBDA1,0)),U,2),1:"")
  1. Q +FBCF
  1. ;
  1. CALC(FBCY,FAC,FBCPTY0,FBGPCIY0,FBCF) ;
  1. ; Input
  1. ; FBCY = calendar year (4 digit)
  1. ; FAC = facility flag (0 or 1)
  1. ; FBCPTY0 = zero node from file 162.71
  1. ; FBGPCI0 = zero node from file 162.61
  1. ; FBCF = conversion factor (number)
  1. ; Returns $ amount
  1. ;
  1. N GPCI,RVU,FBI,TMP,TMPRVU
  1. S FBAMT=0
  1. ;Old formula for RBRVS pre-2007 payment amounts
  1. I DOS<3070101 D
  1. .S RVU(1)=$P(FBCPTY0,U,3)
  1. I (DOS=3070101!(DOS>3070101)&(DOS<3080101)) D
  1. .;New formula for RBRVS 2007 payment amounts
  1. .;Multiply Work RVU by the Budget Neutrality Adjustor (0.8994)
  1. .S TMP=$P(FBCPTY0,U,3),TMPRVU=$J((TMP*(.8994)),".",2)
  1. .S RVU(1)=TMPRVU
  1. I (DOS=3080101!(DOS>3080101)&(DOS<3090101)) D
  1. .;New formula for the RBRVS 2008 payment amounts
  1. .;Multiply Work RVU by the Budget Neutrality Adjustor (0.8994)
  1. .S TMP=$P(FBCPTY0,U,3),TMPRVU=$J((TMP*(.8806)),".",2)
  1. .S RVU(1)=TMPRVU
  1. ;RBRVS 2009 does not have a budget neutrality adjustor.
  1. I (DOS=3090101!(DOS>3090101)) D
  1. .S RVU(1)=$P(FBCPTY0,U,3)
  1. S RVU(2)=$P(FBCPTY0,U,4+FAC)
  1. S RVU(3)=$P(FBCPTY0,U,6)
  1. F FBI=2,3,4 S GPCI(FBI-1)=$P(FBGPCIY0,U,FBI)
  1. S FBAMT=((RVU(1)*GPCI(1))+(RVU(2)*GPCI(2))+(RVU(3)*GPCI(3)))*FBCF
  1. ; some procedures can't be performed in a facility setting by
  1. ; definition. the facility PE RVU for such a procedure is a null
  1. ; value.
  1. ; when facility setting - check for a null PE value and don't return amt
  1. I RVU(2)="",FAC S FBAMT=0 Q
  1. Q
  1. ;
  1. MULT(FBCY,MODL,FBCPT0,FBCPTY0) ;returns multiplier based on table type
  1. ; Input
  1. ; FBCY = calendar year (4 digit)
  1. ; MODL = list of CPT/HCPCS modifiers (external values)
  1. ; delimited by commas
  1. ; FBCPT0 = zero node of file 162.7 for procedure
  1. ; FBCPTY0 = zero node of subfile 162.71 for year
  1. ; Returns
  1. ; multiplier value OR 1 if none
  1. N FBDA,FBDA1,FBI,FBML,FBPD,FBRET,FBTBL,MOD
  1. S FBRET=1
  1. S FBML=$P(FBCPTY0,U,2) ; mod level table for procedure
  1. I MODL]"",FBML]"",FBCY]"" D
  1. . S FBTBL=FBCY_"-"_FBML ; mod level table for year
  1. . S FBDA=$O(^FB(162.98,"B",FBTBL,0))
  1. . Q:'FBDA ; table not found
  1. . ; loop thru the modifiers
  1. . F FBI=1:1 S MOD=$P(MODL,",",FBI) Q:MOD="" D
  1. . . I $P($P(FBCPT0,U),"-",2)=MOD Q ; modifier already built in schedule
  1. . . ; look up modifier in mod level table
  1. . . S FBDA1=$O(^FB(162.98,FBDA,"M","B",MOD,0))
  1. . . Q:'FBDA1 ; modifier not found in table
  1. . . S FBPD=$P($G(^FB(162.98,FBDA,"M",FBDA1,0)),U,2) ; percentage
  1. . . I FBPD>0 S FBRET=FBRET*(FBPD/100) ; multiplier
  1. Q FBRET
  1. ;
  1. LASTCY() ; Determine last calendar year of RBRVS FEE schedule data
  1. ; based on last year for Medicine conversion factor
  1. N YEAR
  1. S YEAR=$O(^FB(162.99,4,"CY","B"," "),-1)
  1. Q YEAR
  1. ADJ(CPT,DOS) ;Apply Adjustments to Fee Amount
  1. ;Apply 5% increase based on CR 6208 Adjustment for Medicare Mental Health Services
  1. ;Calculate 98% for CPT 98940,98941,98942 (RVU10AR), ends 12/31/2014
  1. N ADJ
  1. S ADJ=1.0
  1. I (DOS>3080630)&(DOS<3120301)&((CPT>90803)&(CPT<90830))&((CPT'=90820)&(CPT'=90825)) S ADJ=1.05
  1. I ((DOS>3091231)&(DOS<3150101)&(CPT>98939)&(CPT<98943)) S ADJ=0.98 ;98% adjustment for codes 98940, 98941, and 98942 no longer in effect as on 01/01/2015, FB*3.5*179
  1. Q ADJ
  1. ;FBAAFSR