IBRSUTL ;ALB/ARH - ASCD INTERFACE UTILITIES ; 23-MAR-07
;;2.0;INTEGRATED BILLING;**369**;21-MAR-94;Build 2
;;Per VHA Directive 2004-038, this routine should not be modified.
;
CT(IB0E) ; Return Claims Tracking record for Outpatient Encounter
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: IEN of Outpatient Encounters Claims Tracking record #356
; or null if no CT entry found
;
N IBTRN S IBTRN="" I +$G(IB0E) S IBTRN=$O(^IBT(356,"ASCE",+IB0E,0))
Q IBTRN
;
RNBU(IB0E,CHNG) ; Update Claims Tracking record Reason Not Billable for an Outpatient Encounter
; Input: IB0E - IEN of Outpatient Encounter #409.68
; CHNG - 1 if Outpatient Encounter changed from NSC to SC
; 2 if Outpatient Encounter changed from SC to NSC
; Output: 1 - Reason Not Billable SC TREATMENT was added to Outpatient Encounters Claims Tracking Record
; also adds CT Billable Finding of NSC TO SC and Last Reviewed By
; 2 - Reason Not Billable SC TREATMENT was deleted from Outpatient Encounters Claims Tracking Record
; also adds CT Billable Finding of SC TO NSC and Last Reviewed By
; 0 - no change made
;
N DA,DR,DIC,DIE,DD,DO,DLAYGO,IBTRN,IBUPD,IBRNBSC,IBCTRNB,X,Y S DLAYGO=356.03,IBUPD=0
I +$G(IB0E) S IBTRN=+$$CT(IB0E) I +IBTRN S IBCTRNB=$P($G(^IBT(356,IBTRN,0)),U,19)
S IBRNBSC=$O(^IBE(356.8,"B","SC TREATMENT",""))
;
I +$G(CHNG)=1,+IBTRN,IBCTRNB="" D S IBUPD=1 ; if CT has no RNB then add RNB of SC - NSC to SC
. S DA=IBTRN,DIE="^IBT(356,",DR=".19////"_IBRNBSC_";2.02////"_DUZ D ^DIE K DIE,DIC,DA,DR,X,Y
. S X=$O(^IBT(356.85,"B","NSC TO SC",0)) I +X S DIC(0)="L",DA(1)=IBTRN,DIC="^IBT(356,"_DA(1)_",3," D FILE^DICN
;
I +$G(CHNG)=2,+IBTRN,IBCTRNB=IBRNBSC D S IBUPD=2 ; if CT has SC RNB then delete RNB - SC to NSC
. S DA=IBTRN,DIE="^IBT(356,",DR=".19////@;2.02////"_DUZ D ^DIE K DIE,DIC,DA,DR,X,Y
. S X=$O(^IBT(356.85,"B","SC TO NSC",0)) I +X S DIC(0)="L",DA(1)=IBTRN,DIC="^IBT(356,"_DA(1)_",3," D FILE^DICN
;
Q IBUPD
;
FPBILL(IB0E) ; Return First Party Bill data for Outpatient Encounter, last encounter transaction if not cancelled
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: First Party AR Bill Number (#350,.11) ^ AR Transaction Number (#350,.12) ^ Total Charge (#350,.07)
; null if no active First Party Bill found for encounter
;
N IB0E0,DFN,IBFROM,IBIFN,IBFP0,IBFND,IBDT,IBPAR,IBNDT,IBLAST S IBFROM="409.68:"_$G(IB0E) S IBFND=""
S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1
;
I +DFN S IBIFN=0 F S IBIFN=$O(^IB("AFDT",DFN,-IBDT,IBIFN)) Q:'IBIFN D
. S IBFP0=$G(^IB(IBIFN,0)) I IBFROM'=$P(IBFP0,U,4) Q
. S IBPAR=$P(IBFP0,U,9),IBNDT=$O(^IB("APDT",IBPAR,"")),IBLAST=$O(^IB("APDT",IBPAR,IBNDT,""),-1) Q:'IBLAST
. S IBFP0=$G(^IB(IBLAST,0)) I $P($G(^IBE(350.1,+$P(IBFP0,U,3),0)),U,5)=2 S IBFND="" Q ; action type cancelled
. I +$P($G(^IBE(350.21,+$P(IBFP0,U,5),0)),U,5) S IBFND="" Q ; status cancelled
. S IBFND=$P(IBFP0,U,11)_U_$P(IBFP0,U,12)_U_$P(IBFP0,U,7)
;
Q IBFND
;
TPBILL(IB0E) ; Return Third Party Bill numbers for Outpatient Encounter, only not cancelled
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: Third Party Bill Number (#399,.01) ^ Third Party Bill Number (#399,.01) ^ ...
; or null if no Third Party Bill found for encounter
;
N IB0E0,DFN,IBDT,IBOPV,IBIFN,IBTP0,IBCPT,IBFND S IBFND=""
S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1
;
I +DFN S IBOPV=IBDT-.1 F S IBOPV=$O(^DGCR(399,"AOPV",DFN,IBOPV)) Q:'IBOPV!(IBOPV>(IBDT+.6)) D
. S IBIFN=0 F S IBIFN=$O(^DGCR(399,"AOPV",DFN,IBOPV,IBIFN)) Q:'IBIFN D
.. S IBTP0=$G(^DGCR(399,IBIFN,0)) I $P(IBTP0,U,13)=7 Q
.. ;
.. S IBCPT=0 F S IBCPT=$O(^DGCR(399,IBIFN,"CP",IBCPT)) Q:'IBCPT I +$P($G(^DGCR(399,IBIFN,"CP",IBCPT,0)),U,20)=IB0E S IBFND=IBFND_$P(IBTP0,U,1)_U Q
;
Q IBFND
;
FIRST(IB0E) ; Return true if Outpatient Encounter is Billable for First Party
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: 0 ^ non-billable reason
; 1 if encounter is First Party billable
;
N IB0E0,DFN,IBDT,IBFND S IB0E=+$G(IB0E),IBFND=1
S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1 I 'DFN Q 0
;
I '$$BIL^DGMTUB(DFN,+IBDT) S IBFND=0_U_"Patient not MT billable"
I '$$APPTCT^IBEFUNC(IB0E0) S IBFND=0_U_"Appt Status, not billable"
I $$NCTCL^IBEFUNC(IB0E0) S IBFND=0_U_"Non-count Clinic, not billable"
I $$IGN^IBEFUNC(+$P(IB0E0,U,10),IBDT) S IBFND=0_U_"Appt Type not MT billable"
I $$NBCL^IBEFUNC(+$P(IB0E0,U,4),IBDT) S IBFND=0_U_"Clinic not MT billable"
I $$NBCSC^IBEFUNC(+$P(IB0E0,U,3),IBDT) S IBFND=0_U_"Stop code not MT billable"
;
Q IBFND
;
THIRD(IB0E) ; Return true if Outpatient Encounter is Billable for Third Party
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: 0 ^ non-billable reason
; 1 if encounter is Third Party billable
;
N IB0E0,DFN,IBDT,IBFND S IB0E=+$G(IB0E),IBFND=1
S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1 I 'DFN Q 0
;
I '$$APPTCT^IBEFUNC(IB0E0) S IBFND=0_U_"Appt Status, not billable"
I $$NCTCL^IBEFUNC(IB0E0) S IBFND=0_U_"Non-count Clinic, not billable"
I '$$RPT^IBEFUNC(+$P(IB0E0,U,10),IBDT) S IBFND=0_U_"Appt Type not TP billable"
I $$NBCT^IBEFUNC(+$P(IB0E0,U,4),IBDT) S IBFND=0_U_"Clinic not TP billable"
I $$NBST^IBEFUNC(+$P(IB0E0,U,3),IBDT) S IBFND=0_U_"Stop code not TP billable"
;
Q IBFND
;
TPCHG(IB0E) ; Return Outpatient Encounters potential Third Party charges, based on encounters procedures
; Input: IB0E - IEN of Outpatient Encounter #409.68
; Output: Total Institutional Amount ^ Total Professional Amount
; 0 if no encounter billable procedures with charges
;
N IB0E0,DFN,IBDT,IBDV,IBRT,IBCPTS,IBZERR,IBFN,IBCPT,IBINST,IBPROF,IBFND S (IBINST,IBPROF)=0,IBFND=0
S IB0E0=$$SCE^IBSDU(+$G(IB0E)),DFN=$P(IB0E0,U,2),IBDT=+IB0E0\1,IBDV=$P(IB0E0,U,11) I 'DFN Q 0
S IBRT=$O(^DGCR(399.3,"B","REIMBURSABLE INS.")) I 'IBRT S IBRT=8
I '$$THIRD(IB0E) Q 0
;
D GETCPT^SDOE(IB0E,"IBCPTS","IBZERR")
S IBFN=0 F S IBFN=$O(IBCPTS(IBFN)) Q:'IBFN D S IBFND=IBINST_U_IBPROF
. S IBCPT=$P(IBCPTS(IBFN),U,1)
. ;
. S IBINST=IBINST+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,1)
. S IBPROF=IBPROF+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,2)
;
Q IBFND
--- Routine Detail --- with STRUCTURED ROUTINE LISTING ---[H[J[2J[HIBRSUTL 6406 printed Dec 13, 2024@02:26:58 Page 2
IBRSUTL ;ALB/ARH - ASCD INTERFACE UTILITIES ; 23-MAR-07
+1 ;;2.0;INTEGRATED BILLING;**369**;21-MAR-94;Build 2
+2 ;;Per VHA Directive 2004-038, this routine should not be modified.
+3 ;
CT(IB0E) ; Return Claims Tracking record for Outpatient Encounter
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: IEN of Outpatient Encounters Claims Tracking record #356
+3 ; or null if no CT entry found
+4 ;
+5 NEW IBTRN
SET IBTRN=""
IF +$GET(IB0E)
SET IBTRN=$ORDER(^IBT(356,"ASCE",+IB0E,0))
+6 QUIT IBTRN
+7 ;
RNBU(IB0E,CHNG) ; Update Claims Tracking record Reason Not Billable for an Outpatient Encounter
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; CHNG - 1 if Outpatient Encounter changed from NSC to SC
+3 ; 2 if Outpatient Encounter changed from SC to NSC
+4 ; Output: 1 - Reason Not Billable SC TREATMENT was added to Outpatient Encounters Claims Tracking Record
+5 ; also adds CT Billable Finding of NSC TO SC and Last Reviewed By
+6 ; 2 - Reason Not Billable SC TREATMENT was deleted from Outpatient Encounters Claims Tracking Record
+7 ; also adds CT Billable Finding of SC TO NSC and Last Reviewed By
+8 ; 0 - no change made
+9 ;
+10 NEW DA,DR,DIC,DIE,DD,DO,DLAYGO,IBTRN,IBUPD,IBRNBSC,IBCTRNB,X,Y
SET DLAYGO=356.03
SET IBUPD=0
+11 IF +$GET(IB0E)
SET IBTRN=+$$CT(IB0E)
IF +IBTRN
SET IBCTRNB=$PIECE($GET(^IBT(356,IBTRN,0)),U,19)
+12 SET IBRNBSC=$ORDER(^IBE(356.8,"B","SC TREATMENT",""))
+13 ;
+14 ; if CT has no RNB then add RNB of SC - NSC to SC
IF +$GET(CHNG)=1
IF +IBTRN
IF IBCTRNB=""
Begin DoDot:1
+15 SET DA=IBTRN
SET DIE="^IBT(356,"
SET DR=".19////"_IBRNBSC_";2.02////"_DUZ
DO ^DIE
KILL DIE,DIC,DA,DR,X,Y
+16 SET X=$ORDER(^IBT(356.85,"B","NSC TO SC",0))
IF +X
SET DIC(0)="L"
SET DA(1)=IBTRN
SET DIC="^IBT(356,"_DA(1)_",3,"
DO FILE^DICN
End DoDot:1
SET IBUPD=1
+17 ;
+18 ; if CT has SC RNB then delete RNB - SC to NSC
IF +$GET(CHNG)=2
IF +IBTRN
IF IBCTRNB=IBRNBSC
Begin DoDot:1
+19 SET DA=IBTRN
SET DIE="^IBT(356,"
SET DR=".19////@;2.02////"_DUZ
DO ^DIE
KILL DIE,DIC,DA,DR,X,Y
+20 SET X=$ORDER(^IBT(356.85,"B","SC TO NSC",0))
IF +X
SET DIC(0)="L"
SET DA(1)=IBTRN
SET DIC="^IBT(356,"_DA(1)_",3,"
DO FILE^DICN
End DoDot:1
SET IBUPD=2
+21 ;
+22 QUIT IBUPD
+23 ;
FPBILL(IB0E) ; Return First Party Bill data for Outpatient Encounter, last encounter transaction if not cancelled
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: First Party AR Bill Number (#350,.11) ^ AR Transaction Number (#350,.12) ^ Total Charge (#350,.07)
+3 ; null if no active First Party Bill found for encounter
+4 ;
+5 NEW IB0E0,DFN,IBFROM,IBIFN,IBFP0,IBFND,IBDT,IBPAR,IBNDT,IBLAST
SET IBFROM="409.68:"_$GET(IB0E)
SET IBFND=""
+6 SET IB0E0=$$SCE^IBSDU(+$GET(IB0E))
SET DFN=$PIECE(IB0E0,U,2)
SET IBDT=+IB0E0\1
+7 ;
+8 IF +DFN
SET IBIFN=0
FOR
SET IBIFN=$ORDER(^IB("AFDT",DFN,-IBDT,IBIFN))
if 'IBIFN
QUIT
Begin DoDot:1
+9 SET IBFP0=$GET(^IB(IBIFN,0))
IF IBFROM'=$PIECE(IBFP0,U,4)
QUIT
+10 SET IBPAR=$PIECE(IBFP0,U,9)
SET IBNDT=$ORDER(^IB("APDT",IBPAR,""))
SET IBLAST=$ORDER(^IB("APDT",IBPAR,IBNDT,""),-1)
if 'IBLAST
QUIT
+11 ; action type cancelled
SET IBFP0=$GET(^IB(IBLAST,0))
IF $PIECE($GET(^IBE(350.1,+$PIECE(IBFP0,U,3),0)),U,5)=2
SET IBFND=""
QUIT
+12 ; status cancelled
IF +$PIECE($GET(^IBE(350.21,+$PIECE(IBFP0,U,5),0)),U,5)
SET IBFND=""
QUIT
+13 SET IBFND=$PIECE(IBFP0,U,11)_U_$PIECE(IBFP0,U,12)_U_$PIECE(IBFP0,U,7)
End DoDot:1
+14 ;
+15 QUIT IBFND
+16 ;
TPBILL(IB0E) ; Return Third Party Bill numbers for Outpatient Encounter, only not cancelled
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: Third Party Bill Number (#399,.01) ^ Third Party Bill Number (#399,.01) ^ ...
+3 ; or null if no Third Party Bill found for encounter
+4 ;
+5 NEW IB0E0,DFN,IBDT,IBOPV,IBIFN,IBTP0,IBCPT,IBFND
SET IBFND=""
+6 SET IB0E0=$$SCE^IBSDU(+$GET(IB0E))
SET DFN=$PIECE(IB0E0,U,2)
SET IBDT=+IB0E0\1
+7 ;
+8 IF +DFN
SET IBOPV=IBDT-.1
FOR
SET IBOPV=$ORDER(^DGCR(399,"AOPV",DFN,IBOPV))
if 'IBOPV!(IBOPV>(IBDT+.6))
QUIT
Begin DoDot:1
+9 SET IBIFN=0
FOR
SET IBIFN=$ORDER(^DGCR(399,"AOPV",DFN,IBOPV,IBIFN))
if 'IBIFN
QUIT
Begin DoDot:2
+10 SET IBTP0=$GET(^DGCR(399,IBIFN,0))
IF $PIECE(IBTP0,U,13)=7
QUIT
+11 ;
+12 SET IBCPT=0
FOR
SET IBCPT=$ORDER(^DGCR(399,IBIFN,"CP",IBCPT))
if 'IBCPT
QUIT
IF +$PIECE($GET(^DGCR(399,IBIFN,"CP",IBCPT,0)),U,20)=IB0E
SET IBFND=IBFND_$PIECE(IBTP0,U,1)_U
QUIT
End DoDot:2
End DoDot:1
+13 ;
+14 QUIT IBFND
+15 ;
FIRST(IB0E) ; Return true if Outpatient Encounter is Billable for First Party
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: 0 ^ non-billable reason
+3 ; 1 if encounter is First Party billable
+4 ;
+5 NEW IB0E0,DFN,IBDT,IBFND
SET IB0E=+$GET(IB0E)
SET IBFND=1
+6 SET IB0E0=$$SCE^IBSDU(+$GET(IB0E))
SET DFN=$PIECE(IB0E0,U,2)
SET IBDT=+IB0E0\1
IF 'DFN
QUIT 0
+7 ;
+8 IF '$$BIL^DGMTUB(DFN,+IBDT)
SET IBFND=0_U_"Patient not MT billable"
+9 IF '$$APPTCT^IBEFUNC(IB0E0)
SET IBFND=0_U_"Appt Status, not billable"
+10 IF $$NCTCL^IBEFUNC(IB0E0)
SET IBFND=0_U_"Non-count Clinic, not billable"
+11 IF $$IGN^IBEFUNC(+$PIECE(IB0E0,U,10),IBDT)
SET IBFND=0_U_"Appt Type not MT billable"
+12 IF $$NBCL^IBEFUNC(+$PIECE(IB0E0,U,4),IBDT)
SET IBFND=0_U_"Clinic not MT billable"
+13 IF $$NBCSC^IBEFUNC(+$PIECE(IB0E0,U,3),IBDT)
SET IBFND=0_U_"Stop code not MT billable"
+14 ;
+15 QUIT IBFND
+16 ;
THIRD(IB0E) ; Return true if Outpatient Encounter is Billable for Third Party
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: 0 ^ non-billable reason
+3 ; 1 if encounter is Third Party billable
+4 ;
+5 NEW IB0E0,DFN,IBDT,IBFND
SET IB0E=+$GET(IB0E)
SET IBFND=1
+6 SET IB0E0=$$SCE^IBSDU(+$GET(IB0E))
SET DFN=$PIECE(IB0E0,U,2)
SET IBDT=+IB0E0\1
IF 'DFN
QUIT 0
+7 ;
+8 IF '$$APPTCT^IBEFUNC(IB0E0)
SET IBFND=0_U_"Appt Status, not billable"
+9 IF $$NCTCL^IBEFUNC(IB0E0)
SET IBFND=0_U_"Non-count Clinic, not billable"
+10 IF '$$RPT^IBEFUNC(+$PIECE(IB0E0,U,10),IBDT)
SET IBFND=0_U_"Appt Type not TP billable"
+11 IF $$NBCT^IBEFUNC(+$PIECE(IB0E0,U,4),IBDT)
SET IBFND=0_U_"Clinic not TP billable"
+12 IF $$NBST^IBEFUNC(+$PIECE(IB0E0,U,3),IBDT)
SET IBFND=0_U_"Stop code not TP billable"
+13 ;
+14 QUIT IBFND
+15 ;
TPCHG(IB0E) ; Return Outpatient Encounters potential Third Party charges, based on encounters procedures
+1 ; Input: IB0E - IEN of Outpatient Encounter #409.68
+2 ; Output: Total Institutional Amount ^ Total Professional Amount
+3 ; 0 if no encounter billable procedures with charges
+4 ;
+5 NEW IB0E0,DFN,IBDT,IBDV,IBRT,IBCPTS,IBZERR,IBFN,IBCPT,IBINST,IBPROF,IBFND
SET (IBINST,IBPROF)=0
SET IBFND=0
+6 SET IB0E0=$$SCE^IBSDU(+$GET(IB0E))
SET DFN=$PIECE(IB0E0,U,2)
SET IBDT=+IB0E0\1
SET IBDV=$PIECE(IB0E0,U,11)
IF 'DFN
QUIT 0
+7 SET IBRT=$ORDER(^DGCR(399.3,"B","REIMBURSABLE INS."))
IF 'IBRT
SET IBRT=8
+8 IF '$$THIRD(IB0E)
QUIT 0
+9 ;
+10 DO GETCPT^SDOE(IB0E,"IBCPTS","IBZERR")
+11 SET IBFN=0
FOR
SET IBFN=$ORDER(IBCPTS(IBFN))
if 'IBFN
QUIT
Begin DoDot:1
+12 SET IBCPT=$PIECE(IBCPTS(IBFN),U,1)
+13 ;
+14 SET IBINST=IBINST+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,1)
+15 SET IBPROF=IBPROF+$$BICOST^IBCRCI(IBRT,3,IBDT,"PROCEDURE",IBCPT,,IBDV,1,2)
End DoDot:1
SET IBFND=IBINST_U_IBPROF
+16 ;
+17 QUIT IBFND
