Parent File | Name | Number | Package |
---|---|---|---|
365.02 | SUBSCRIBER ADDITIONAL INFO | 365.29 | Integrated Billing |
Field # | Name | Loc | Type | Details |
---|---|---|---|---|
.01 | SEQUENCE | 0;1 | NUMBER |
|
.02 | PLACE OF SERVICE | 0;2 | POINTER TO PLACE OF SERVICE FILE (#353.1) | PLACE OF SERVICE(#353.1)
|
.03 | DIAGNOSIS | 0;3 | POINTER TO ICD DIAGNOSIS FILE (#80) | ICD DIAGNOSIS(#80)
|
.04 | QUALIFIER | 0;4 | POINTER TO X12 271 CODE LIST QUALIFIER FILE (#365.044) | X12 271 CODE LIST QUALIFIER(#365.044)
|
.05 | NATURE OF INJURY CODE | 0;5 | POINTER TO X12 271 NATURE OF INJURY CODES FILE (#365.045) | X12 271 NATURE OF INJURY CODES(#365.045)
|
.06 | NATURE OF INJURY CATEGORY | 0;6 | POINTER TO X12 271 INJURY CATEGORY FILE (#365.038) | X12 271 INJURY CATEGORY(#365.038)
|
.07 | NATURE OF INJURY TEXT | 0;7 | FREE TEXT |
|