IBCRBC1 ;ALB/ARH - RATES: BILL CALCULATION BILLABLE EVENTS ; 22 MAY 96
Source file <IBCRBC1.m>
| action | A | extended action | Ea | event driver | Ed | subscriber | Su | protocol | O | limited protocol | LP | run routine | RR | broker | B | edit | E | server | Se | P | screenman | SM | inquire | I |
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| INPTBS(IBIFN,RS,CS) | ; Determine charges for INPATIENT BEDSECTION STAY billable events
; - the billable events are billable bedsections based on the patient movement treating specialties, ; these are pulled from the PTF record each time the charges are calculated (INPTPTF^IBCRCG) ; - each day of billable care is calculated separately in case a rate becomes inactive |
|
| OPTVST(IBIFN,RS,CS) | ; Determine charges for OUTPATIENT VISIT DATE billable events
; - the billable event is the outpatient visit date(s) on the bill (399,43) |
|
| RX(IBIFN,RS,CS) | ; Determine charges for PRESCRIPTION billable events
; - the billable event is an rx that has been added to the bill (362.4) ; - the insurance company Prescription Refill Rev Code (36,.15) is passed to the calculator to be used as ; the rev code for all Rx charges, all types, this overrides the rev codes for the set or item ; - on HCFA 1500, the site parameter Default Rx Refill CPT (350.9,1.3) is added as the CPT to all Rx RC entries |
|
| CPT(IBIFN,RS,CS) | ; Determine charges for PROCEDURE billable events
; - the billable event is a CPT procedure from the bill (399,304) ; - the item to be billed is a CPT, this may include Modifier ; - for each CPT found on the bill that has a modifier, will first check to see if that CPT-modifier ; combination is billable (ie. is defined as a charge item for the Billing Rate, does not have to be active) ; if it does not then assumes the charge should be the CPT charge ; - if the charge set is limited by region then either the CPT's division or if no CPT division then the bill's ; Default Division must be contained in the sets region ; - the billable CPT is added as the CPT of the charge entry, Division is also added if defined for the CPT ; - the procedures provider may affect the charges due to a provider discount ; - if an inpatient bill then the bedsection on date of procedure will be used as the default bedsection ; - different sets of charges apply to SNF and Inpatient care although the bill is defined as inpatient ; - the Default Rx CPT should not be billed the CPT charge, instead the Rx is charged |
|
| PI(IBIFN,RS,CS) | ; Determine charges for PROSTHETICS billable events
; - the billable event is a prosthetic item that has been added to the bill (362.5) |
| Name | Field # of Occurrence |
|---|---|
| $$CURR^IBCEF2 | INPTBS+11, OPTVST+9, RX+13, CPT+21, PI+9 |
| $$CHGOTH^IBCRBC2 | CPT+35 |
| $$CPTUNITS^IBCRBC2 | CPT+38 |
| ALLBEDS^IBCRBC2 | OPTVST+16, RX+23, PI+16 |
| BITMCHG^IBCRBC2 | INPTBS+23, RX+31, RX+38, CPT+49, PI+23 |
| INPTPTF^IBCRBG | INPTBS+7, CPT+26 |
| CPT^IBCRBG1 | CPT+17 |
| OPTVD^IBCRBG1 | OPTVST+5 |
| $$CPTMOD^IBCRCU1 | CPT+45 |
| $$CSBR^IBCRU3 | INPTBS+9, OPTVST+7, RX+11, CPT+19, PI+7 |
| $$CSDV^IBCRU3 | INPTBS+20, CPT+44 |
| SET^IBCSC5A | RX+9 |
| SET^IBCSC5B | PI+5 |
| $$FT^IBCU3 | RX+16 |
| $$MCRWNR^IBEFUNC | INPTBS+11, OPTVST+9, RX+13, CPT+21, PI+9 |
| $$CPT^ICPTCOD | CPT+43 |
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^DGCR(399 - [#399] | INPTBS+10, INPTBS+14, OPTVST+8, RX+12, CPT+20, CPT+25, PI+8 |
| ^DIC(36 - [#36] | INPTBS+12, OPTVST+10, RX+14, CPT+22, PI+10 |
| ^IBA(362.4 - [#362.4] | CPT+23 |
| ^IBA(363.21 - [#363.21] | RX+29 |
| ^IBE(350.9 - [#350.9] | RX+16, CPT+23 |
| ^IBE(363.1 - [#363.1] | INPTBS+9, OPTVST+7, RX+11, CPT+19, PI+7 |
| ^TMP($J | INPTBS+17, INPTBS+18, INPTBS+24!, CPT+40, CPT+41, CPT+50! |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| CS | INPTBS~, INPTBS+5, INPTBS+7, INPTBS+9, INPTBS+20, INPTBS+23, OPTVST~, OPTVST+3, OPTVST+7, OPTVST+16 , RX~, RX+7, RX+11, RX+23, RX+31, RX+38, CPT~, CPT+15, CPT+19, CPT+26 , CPT+38, CPT+44, CPT+45, CPT+49, PI~, PI+3, PI+7, PI+16, PI+23 |
| IBBDIV | INPTBS+5~, INPTBS+14*, INPTBS+20, CPT+14~, CPT+25*, CPT+44 |
| IBBLITEM | INPTBS+5~, INPTBS+9*, INPTBS+16, OPTVST+3~, OPTVST+7*, OPTVST+12, RX+6~, RX+11*, RX+18, RX+25 , CPT+14~, CPT+19*, CPT+28, PI+3~, PI+7*, PI+12 |
| IBBR | CPT+14~, CPT+23* |
| IBBS | CPT+15~, CPT+40*, CPT+41*, CPT+48 |
| IBCHGMTH | INPTBS+5~, INPTBS+9*, INPTBS+16, OPTVST+3~, OPTVST+7*, OPTVST+12, RX+6~, RX+11*, RX+18, RX+25 , RX+33, CPT+14~, CPT+19*, CPT+38, PI+3~, PI+7*, PI+12, PI+18 |
| IBCLIN | CPT+15~, CPT+32*, CPT+48 |
| IBCMPNT | INPTBS+5~, INPTBS+9*, INPTBS+22, OPTVST+3~, OPTVST+7*, OPTVST+15, RX+6~, RX+11*, RX+22, RX+30 , RX+37, CPT+14~, CPT+19*, CPT+48, PI+3~, PI+7*, PI+15, PI+22 |
| IBCPT | CPT+14~, CPT+29*, CPT+30, CPT+31, CPT+36, CPT+43, CPT+45, CPT+48, CPT+49 |
| IBCPTARR | CPT+14~, CPT+17 |
| IBCPTARR( | CPT+29, CPT+30, CPT+31 |
| IBCPTFN | CPT+14~, CPT+30*, CPT+31, CPT+48 |
| IBCPTRX | CPT+15~, CPT+23*, CPT+36 |
| IBCPTUT | CPT+15~, CPT+33*, CPT+48 |
| IBDIV | INPTBS+5~, INPTBS+18*, INPTBS+20, INPTBS+22, CPT+14~, CPT+32*, CPT+44, CPT+48 |
| IBEVDT | INPTBS+5~, INPTBS+17*, INPTBS+18, INPTBS+23, OPTVST+3~, OPTVST+14*, OPTVST+16, RX+6~, RX+20*, RX+22 , RX+23, RX+27*, RX+28, RX+31, RX+35*, RX+36, RX+38, CPT+14~, CPT+31*, CPT+35 , CPT+40, CPT+41, CPT+43, CPT+45, CPT+49, PI+3~, PI+13*, PI+14, PI+16, PI+19* , PI+20, PI+21, PI+23 |
| IBI | OPTVST+3~, OPTVST+13*, OPTVST+14 |
| IBIDRC | INPTBS+5~, INPTBS+10*, INPTBS+11*, INPTBS+12*, INPTBS+23, OPTVST+3~, OPTVST+8*, OPTVST+9*, OPTVST+10*, OPTVST+16 , RX+6~, RX+12*, RX+13*, RX+14*, RX+23, RX+31, RX+38, CPT+14~, CPT+20*, CPT+21* , CPT+22*, CPT+49, PI+3~, PI+8*, PI+9*, PI+10*, PI+16, PI+23 |
| IBIFN | INPTBS~, INPTBS+5, INPTBS+7, INPTBS+10, INPTBS+11, INPTBS+14, OPTVST~, OPTVST+3, OPTVST+5, OPTVST+8 , OPTVST+9, RX~, RX+7, RX+9, RX+12, RX+13, RX+16, CPT~, CPT+15, CPT+17 , CPT+20, CPT+21, CPT+23, CPT+25, CPT+26, CPT+35, PI~, PI+3, PI+5, PI+8 , PI+9 |
| IBIRC | RX+6~, RX+14*, RX+23, RX+31, RX+38 |
| IBITM | INPTBS+5~, INPTBS+18*, INPTBS+23, RX+6~, RX+28*, RX+30, RX+36*, RX+37, RX+38, PI+3~ , PI+21*, PI+22, PI+23 |
| IBMOD | CPT+14~, CPT+31*, CPT+45*, CPT+49 |
| IBMODS | CPT+15~, CPT+31*, CPT+48 |
| IBNDC | RX+6~, RX+28*, RX+29*, RX+31 |
| IBOE | CPT+15~, CPT+32*, CPT+36, CPT+48 |
| IBOPVARR | OPTVST+3~, OPTVST+5 |
| IBOPVARR( | OPTVST+13, OPTVST+14 |
| IBPI | PI+3~, PI+14*, PI+20*, PI+21 |
| IBPIARR | PI+3~, PI+5 |
| IBPIARR( | PI+13, PI+14, PI+19, PI+20, PI+21 |
| IBPPRV | CPT+15~, CPT+32*, CPT+48 |
| IBRX | RX+6~, RX+19*, RX+20, RX+22, RX+26*, RX+27, RX+28, RX+34*, RX+35, RX+36 |
| IBRXARR | RX+6~, RX+9 |
| IBRXARR( | RX+19, RX+20, RX+22, RX+26, RX+27, RX+28, RX+34, RX+35, RX+36 |
| IBRXCPT | RX+6~, RX+16*, RX+22, RX+30, RX+37 |
| IBSAVE | INPTBS+5~, INPTBS+22*, INPTBS+23, OPTVST+3~, OPTVST+15*, OPTVST+16, RX+6~, RX+22*, RX+23, RX+30* , RX+31, RX+37*, RX+38, CPT+15~, CPT+48*, CPT+49, PI+3~, PI+15*, PI+16, PI+22* , PI+23 |
| IBTYPE | INPTBS+5~, INPTBS+9*, INPTBS+22, OPTVST+3~, OPTVST+7*, OPTVST+15, RX+6~, RX+11*, RX+22, RX+30 , RX+37, CPT+14~, CPT+19*, CPT+48, PI+3~, PI+7*, PI+15, PI+22 |
| IBUNIT | RX+6~, RX+28*, RX+31, RX+36*, RX+38, CPT+15~, CPT+38*, CPT+49 |
| IBX | INPTBS+5~, INPTBS+9*, INPTBS+18*, OPTVST+3~, OPTVST+7*, RX+6~, RX+11*, RX+28*, RX+36*, CPT+14~ , CPT+19*, CPT+23, CPT+31*, CPT+32, CPT+33, CPT+38, CPT+41*, PI+3~, PI+7* |
| RS | INPTBS~, INPTBS+23, OPTVST~, OPTVST+16, RX~, RX+23, RX+31, RX+38, CPT~, CPT+35 , CPT+49, PI~, PI+16, PI+23 |
| U | INPTBS+9, INPTBS+12, INPTBS+14, INPTBS+18, OPTVST+7, OPTVST+10, RX+9, RX+11, RX+14, RX+16 , RX+28, RX+36, CPT+19, CPT+22, CPT+23, CPT+25, CPT+31, CPT+32, CPT+33, CPT+40 , CPT+41, CPT+43, CPT+48, PI+5, PI+7, PI+10 |