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Sub-Field: 399.0304

Package: Integrated Billing

BILL/CLAIMS(#399)-->399.0304

Sub-Field: 399.0304


Information

Parent File Name Number Package
BILL/CLAIMS(#399) PROCEDURES 399.0304 Integrated Billing

Details

Field # Name Loc Type Details
.01 PROCEDURES 0;1 VARIABLE POINTER CPT(#81)  ICD OPERATION/PROCEDURE(#80.1)  

  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Procedure coding must match the PROCEDURE CODING METHOD entry for this bill.
  • DESCRIPTION:  
    These are ICD, CPT, or HCFA procedure codes associated with the episode of care on this bill.
  • TECHNICAL DESCR:  
  • EXECUTABLE HELP:  D 3^IBCSCH1
  • PRE-LOOKUP:  D ^IBCU7
  • DELETE TEST:  1,0)= N IBZ S IBZ=$$RXLINK^IBCSC5C(DA(1),DA) I IBZ D EN^DDIOL(" Can't delete this procedure while linked to RX revenue code #"_IBZ)
  • CROSS-REFERENCE:  399.0304^B
    1)= S ^DGCR(399,DA(1),"CP","B",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"CP","B",$E(X,1,30),DA)
    3)= Required Index for Variable Pointer
  • CROSS-REFERENCE:  399^ASD^MUMPS
    1)= I $P(X,";",2)="ICPT(",$D(^DGCR(399,DA(1),"CP",DA,0)),$P(^(0),"^",2) S ^DGCR(399,"ASD",-$P(^(0),"^",2),+X,DA(1),DA)=""
    2)= I $P(X,";",2)="ICPT(",$D(^DGCR(399,DA(1),"CP",DA,0)),$P(^(0),"^",2) K ^DGCR(399,"ASD",-$P(^(0),"^",2),+X,DA(1),DA)
    3)= DO NOT DELETE
    Index procedure date and all CPT procedures.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0304^20
    1)= Q
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y(1),U,20),X=X S DIU=X K Y S X="" X ^DD(399.0304,.01,1,3,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),0)),DIV=X S $P(^(0),U,20)=DIV,DIH=399.0304,DIG=20 D ^DICR
    3)= Do Not Delete
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= OUTPATIENT ENCOUNTER
    Delete the Outpatient Encounter link if the Procedure is modified.
  • FIELD INDEX:  AD (#991) MUMPS IR ACTION
    Short Descr: Remove MANUALLY EDITED flag from Revenue Code.
    Description: This cross reference is designed to remove the MANUALLY EDITED flag from records in the REVENUE CODE multiple if changes were made to the PROCEDURE CODE pointed to by the soft pointer in the ITEM (#399.042,.11) field.
    Set Logic: Q
    Kill Logic: D FROMPROC^IBCU9(DA(1),DA,"D")
    X(1): PROCEDURES (399.0304,.01) (Subscr 1) (forwards)
1 PROCEDURE DATE 0;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X I $D(X),$D(IBIFN),'$$OPV2^IBCU41(X,IBIFN,1) K X
  • LAST EDITED:  JAN 23, 1999
  • HELP-PROMPT:  Procedure date must be within the bill's STATEMENT FROM and STATEMENT TO dates.
  • DESCRIPTION:  
    This is the date the procedure was performed.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399^ASD1^MUMPS
    1)= I $D(^DGCR(399,DA(1),"CP",DA,0)),+^(0),$P($P(^(0),"^",1),";",2)="ICPT(" S ^DGCR(399,"ASD",-X,+^(0),DA(1),DA)=""
    2)= I $D(^DGCR(399,DA(1),"CP",DA,0)),+^(0),$P($P(^(0),"^",1),";",2)="ICPT(" K ^DGCR(399,"ASD",-X,+^(0),DA(1),DA)
    3)= DO NOT DELETE
    Index procedure date and all CPT procedures.
2 *ADDITIONAL PROCEDURE NAME 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>28!($L(X)<3)!'(X?.ANP) X
  • LAST EDITED:  NOV 04, 1991
  • HELP-PROMPT:  Answer must be 3-28 characters in length.
  • DESCRIPTION:  This is the name of the procedure.
    This field has been marked for deletion 11/4/91.
    WRITE AUTHORITY: ^
    UNEDITABLE
3 PRINT ORDER 0;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X I $D(X),$D(^DGCR(399,DA(1),"CP","D",X)) W !!,*7,"This number already used!" K X
  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Type a Number between 1 and 99, 0 Decimal Digits
  • DESCRIPTION:  
    This is the relative order that this procedure will appear on the bill. For the UB-04, the procedure with the lowest print order is the principal procedure and the rest print in FL74 in lowest to highest print order.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399.0304^D
    1)= S ^DGCR(399,DA(1),"CP","D",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"CP","D",$E(X,1,30),DA)
4 BASC BILLABLE 0;5 SET
  • '1' FOR YES;

  • LAST EDITED:  FEB 28, 1992
  • DESCRIPTION:  
    This field will be completed by the system if this procedure is an Ambulatory Surgery that can be billed under the HCFA rate system.
  • CROSS-REFERENCE:  399.0304^AREV7^MUMPS
    1)= S DGRVRCAL=1
    2)= S DGRVRCAL=2
    When this field is edited or changed, the revenue codes and charges for this bill will automatically be recalculated.
  • CROSS-REFERENCE:  399.0304^ASC
    1)= S ^DGCR(399,DA(1),"CP","ASC",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"CP","ASC",$E(X,1,30),DA)
    This cross-reference is used to determine if any procedures entered are billable as Ambulatory Surgery Codes.
5 DIVISION 0;6 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) MEDICAL CENTER DIVISION(#40.8)

  • LAST EDITED:  JUL 06, 2011
  • HELP-PROMPT:  Enter the division where this procedure was performed if the CPT charges are based on region and if it is different than the bills Default Division.
  • DESCRIPTION:  
    Enter the Division at which this procedure was performed. This is only required if the bill's charges are based on CPT and region and the division is different than the bill's Default Division.
  • NOTES:  TRIGGERED by the ASSOCIATED CLINIC field of the PROCEDURES sub-field of the BILL/CLAIMS File
  • FIELD INDEX:  AC (#990) MUMPS IR ACTION
    Short Descr: Remove MANUALLY EDITED flag from Revenue Code
    Description: This cross reference is designed to remove the MANUALLY EDITED flag from records in the REVENUE CODE multiple if changes were made to the PROCEDURE CODE pointed to by the soft pointer in the ITEM (#399.042,.11) field.
    Set Logic: D FROMPROC^IBCU9(DA(1),DA,"E")
    Kill Logic: Q
    X(1): DIVISION (399.0304,5) (Subscr 1) (forwards)
6 ASSOCIATED CLINIC 0;7 POINTER TO HOSPITAL LOCATION FILE (#44) HOSPITAL LOCATION(#44)

  • INPUT TRANSFORM:  S DIC("S")="I +$$CLNSCRN^IBCU(+$P($G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)),U,2),+Y)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 30, 1999
  • HELP-PROMPT:  Enter the clinic associated with this procedures visit.
  • DESCRIPTION:  
    Enter the clinic where this procedure was performed. This field must be completed in order for this procedure to be successfully transferred to the Add/Edit Stop code logic for inclusion in OPC workload.
  • SCREEN:  S DIC("S")="I +$$CLNSCRN^IBCU(+$P($G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)),U,2),+Y)"
  • EXPLANATION:  Only active clinics!
  • CROSS-REFERENCE:  ^^TRIGGER^399.0304^5
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y X ^DD(399.0304,6,1,1,1.1) X ^DD(399.0304,6,1,1,1.4)
    1.1)= S X=DIV X ^DD(399.0304,6,1,1,49.2) S X=X S X=X S D0=I(0,0) S D1=I(1,0)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0304,DIG=5 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y(1),U,6),X=X S DIU=X K Y S X="" X ^DD(399.0304,6,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,6)=DIV,DIH=399.0304,DIG=5 D ^DICR
    49.2)= S I(1,0)=$S($D(D1):D1,1:""),I(0,0)=$S($D(D0):D0,1:""),D0=DIV S:'$D(^SC(+D0,0)) D0=-1 S Y(102)=$S($D(^SC(D0,0)):^(0),1:""),Y(101)=X S X=$P(Y(102),U,15)
    CREATE VALUE)= ASSOCIATED CLINIC:INTERNAL(#3.5)
    DELETE VALUE)= @
    FIELD)= DIVISION
    Auto set the procedures division to the clinics division.
7 *ASSOCIATED DIAGNOSIS 0;8 POINTER TO ICD DIAGNOSIS FILE (#80) ICD DIAGNOSIS(#80)

  • LAST EDITED:  NOV 16, 1993
  • HELP-PROMPT:  Enter the diagnosis related to this procedure.
  • DESCRIPTION:  
    This is the diagnosis most closely related to this procedure. Used on the HFCA 1500, block 24e.
  • TECHNICAL DESCR:  
    Replaced by (399,304,10-13) so that could point to the diagnosis file (362.3). "*"ed for deletion 11/16/93.
8 PLACE OF SERVICE 0;9 POINTER TO PLACE OF SERVICE FILE (#353.1) PLACE OF SERVICE(#353.1)

  • LAST EDITED:  SEP 08, 2006
  • HELP-PROMPT:  Enter the Place of Service appropriate for this procedure.
  • DESCRIPTION:  
    This is the Place of Service appropriate for this Procedure. Used only for the CMS-1500 claim form.
9 TYPE OF SERVICE 0;10 POINTER TO TYPE OF SERVICE FILE (#353.2) TYPE OF SERVICE(#353.2)

  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Enter the Type of Service appropriate for this procedure.
  • DESCRIPTION:  
    This is the Type of Service to be associated with this procedure.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0304^15
    1)= X ^DD(399.0304,9,1,1,1.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X="" X ^DD(399.0304,9,1,1,1.4)
    1.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X,I(1,0)=$S($D(D1):D1,1:""),I(0,0)=$S($D(D0):D0,1:""),D0=Y(0) S:'$D(^IBE(353.2,+D0,0)) D0=-1 S Y(101)=$S($D(^IBE(353.2,D0,0)):^(0),1:""),X=$P(Y(101),U,2)'="ANES
    THESIA",D0=I(0,0),D1=I(1,0)
    1.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,16)=DIV,DIH=399.0304,DIG=15 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X="" X ^DD(399.0304,9,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"CP",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,16)=DIV,DIH=399.0304,DIG=15 D ^DICR:$O(^DD(DIH,DIG,1,0))>0
    CREATE CONDITION)= TYPE OF SERVICE:NAME'="ANESTHESIA"
    CREATE VALUE)= @
    DELETE VALUE)= @
    FIELD)= MINUTES
10 ASSOCIATED DIAGNOSIS (1) 0;11 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3) IB BILL/CLAIMS DIAGNOSIS(#362.3)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Enter the diagnosis related to this procedure.
  • DESCRIPTION:  
    The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
  • TECHNICAL DESCR:  
    Converted from (399,304,7) with IB 2.0.
  • SCREEN:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
  • EXPLANATION:  Only Diagnosis for this bill may be chosen.
11 ASSOCIATED DIAGNOSIS (2) 0;12 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3) IB BILL/CLAIMS DIAGNOSIS(#362.3)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Enter a diagnosis related to this procedure.
  • DESCRIPTION:  
    The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
  • SCREEN:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
  • EXPLANATION:  Only Diagnosis for this bill may be chosen.
12 ASSOCIATED DIAGNOSIS (3) 0;13 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3) IB BILL/CLAIMS DIAGNOSIS(#362.3)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Enter a diagnosis related to this procedure.
  • DESCRIPTION:  
    The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
  • SCREEN:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
  • EXPLANATION:  Only Diagnosis for this bill may be chosen.
13 ASSOCIATED DIAGNOSIS (4) 0;14 POINTER TO IB BILL/CLAIMS DIAGNOSIS FILE (#362.3) IB BILL/CLAIMS DIAGNOSIS(#362.3)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JAN 31, 2007
  • HELP-PROMPT:  Enter a diagnosis related to this procedure.
  • DESCRIPTION:  
    The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
  • SCREEN:  S DIC("S")="I +$P(^IBA(362.3,Y,0),U,2)=+$G(DA(1))"
  • EXPLANATION:  Only Diagnosis for this bill may be chosen.
14 *CPT MODIFIER 0;15 POINTER TO CPT MODIFIER FILE (#81.3) CPT MODIFIER(#81.3)

  • INPUT TRANSFORM:  S DIC("S")="N IBXZ S IBXZ=$G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)) I +IBXZ,+$$MODP^ICPTMOD(+IBXZ,+Y,""I"",+$P(IBXZ,U,2))>0" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  AUG 20, 1999
  • HELP-PROMPT:  Enter a CPT modifier.
  • DESCRIPTION:  
    Enter the modifier which should be printed on the claim form with the CPT code.
  • TECHNICAL DESCR:  
    This field has been marked for deletion on 9/1/99.
  • SCREEN:  S DIC("S")="N IBXZ S IBXZ=$G(^DGCR(399,+$G(DA(1)),""CP"",+$G(DA),0)) I +IBXZ,+$$MODP^ICPTMOD(+IBXZ,+Y,""I"",+$P(IBXZ,U,2))>0"
  • EXPLANATION:  Only acceptable modifiers for this CPT Code may be selected!
15 MINUTES 0;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  FEB 19, 1999
  • HELP-PROMPT:  Enter the # of minutes for this service.
  • DESCRIPTION:  
    Enter the number of minutes of care, usually related to Anesthesia.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TYPE OF SERVICE field of the PROCEDURES sub-field of the BILL/CLAIMS File
16 CPT MODIFIER SEQUENCE MOD;0 Multiple #399.30416 399.30416

  • LAST EDITED:  DEC 15, 1998
  • IDENTIFIED BY:  CPT MODIFIER(#.02)[R]
    "WRITE": W ?10,$P($$MOD^ICPTMOD(+$P(^(0),U,2),"I"),U,3)
17 EMERGENCY PROCEDURE? 0;17 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  DEC 10, 1998
  • HELP-PROMPT:  Enter YES if this was an emergency procedure
  • DESCRIPTION:  
    This field stores whether the procedure performed was emergency or scheduled/routine.
18 PROVIDER 0;18 POINTER TO NEW PERSON FILE (#200) NEW PERSON(#200)

  • INPUT TRANSFORM:  S DIC("S")="I $O(^(""USC1"",0))" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUN 14, 2006
  • HELP-PROMPT:  Enter the provider who performed this procedure.
  • DESCRIPTION:  
    This is the provider who performed the procedure.
  • SCREEN:  S DIC("S")="I $O(^(""USC1"",0))"
  • EXPLANATION:  Only medical personnel are selectable for this field.
19 PURCHASED COST 0;19 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  MAR 19, 2014
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This is the actual amount the VA paid for a service provided to a VA patient at a NON-VA facility or provider.
20 OUTPATIENT ENCOUNTER 0;20 POINTER TO OUTPATIENT ENCOUNTER FILE (#409.68) OUTPATIENT ENCOUNTER(#409.68)

  • LAST EDITED:  MAY 10, 2001
  • HELP-PROMPT:  Link between procedure and encounter.
  • DESCRIPTION:  
    The Outpatient Encounter where this procedure was performed.
  • TECHNICAL DESCR:  
    This field is stuffed by the application for procedures extracted from the Outpatient Encounter file.
  • NOTES:  TRIGGERED by the PROCEDURES field of the PROCEDURES sub-field of the BILL/CLAIMS File
21 MILES 0;21 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."2N.N) X
  • LAST EDITED:  SEP 30, 2003
  • HELP-PROMPT:  Type a Number between 0 and 99999, 1 Decimal Digit
  • DESCRIPTION:  
    Enter the number of miles the patient was transported.
22 HOURS 0;22 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>999)!(X<0)!(X?.E1"."2N.N) X
  • LAST EDITED:  DEC 03, 2003
  • HELP-PROMPT:  Type a Number between 0 and 999, 1 Decimal Digit
  • DESCRIPTION:  
    Enter the number of hours of care, usually related to Observation.
23 CMN REQUIRED? CMN;1 SET
************************REQUIRED FIELD************************
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 15, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if this procedure requires a Certificate of Medical Necessity, or 'No' (0) if it does not.
  • DESCRIPTION:  
    This field indicates whether a Certificate of Medical Necessity must be submitted with this procedure.
24 CMN FORM TYPE CMN;2 POINTER TO CMN FORM TYPES FILE (#399.6) CMN FORM TYPES(#399.6)

  • LAST EDITED:  MAR 08, 2018
  • HELP-PROMPT:  Select the REQUIRED CMN form type that will be sent with this procedure.
  • DESCRIPTION:  
    This field indicates the Certificate of Medical Necessity form type that is to be submitted with this procedure.
  • TECHNICAL DESCR:  
    If the CMN Required? field is set to "Y"es, this field must be an entry in the CMS FORM TYPES file #399.6.
24.01 CMN CERTIFICATION TYPE CMN;3 SET
  • 'I' FOR INITIAL;
  • 'R' FOR RENEWAL;
  • 'S' FOR REVISED;

  • LAST EDITED:  MAR 08, 2018
  • HELP-PROMPT:  Select the REQUIRED Type of Certification requested.
  • DESCRIPTION:  
    This field indicates the type of Certification that is being requested.
24.02 CMN PATIENT HEIGHT (IN) CMN;4 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  APR 03, 2018
  • HELP-PROMPT:  Enter the Patient's height in whole numbers representing inches.
  • DESCRIPTION:  
    This field indicates the Patient's height in whole numbers representing inches.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.03 CMN PATIENT WEIGHT (LBS) CMN;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the Patient's weight in whole numbers representing pounds.
  • DESCRIPTION:  
    This field indicates the Patient's weight in whole numbers representing pounds.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.04 CMN MONTHS DME EQUIP NEEDED CMN;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the number of MONTHS the patient will need the DME Equipment. Enter 1-99 with 99 equal to a lifetime.
  • DESCRIPTION:  
    This field indicates the number of MONTHS that the Patient will need the DME Equipment. '99' represents a lifetime.
24.05 CMN DATE THERAPY STARTED CMN;7 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 08, 2018
  • HELP-PROMPT:  Enter the REQUIRED date the therapy began.
  • DESCRIPTION:  
    This field indicates the date the therapy began.
24.06 CMN LAST CERTIFICATION DATE CMN;8 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 08, 2018
  • HELP-PROMPT:  Enter the REQUIRED date the physician signed the Certificate of Medical Necessity.
  • DESCRIPTION:  
    This field indicates the date the physician signed the Certificate of Medical Necessity.
24.07 CMN RECERTIFICATION/REVISN DT CMN;9 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  If the Certification Type is a Renewal or Revised, enter a REQUIRED Recertification/Revision date.
  • DESCRIPTION:  
    If the Certification Type is a Renewal or Revised, this field is REQUIRED and indicates the date of the Recertification/Renewal.
24.08 CMN REPLACEMENT ITEM? CMN;10 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if this item is being billed as a replacement item, or 'No' (0) if it is not.
  • DESCRIPTION:  
    This field indicates whether or not the item being billed is a Replacement item.
24.1 CMN ABG PO2 (MMHG) CMN-484;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the result of the most recent ABG test. Enter a whole Number which will be reported as mmHg.
  • DESCRIPTION:  
    This field indicates the result of the most recent ABG test. The Number entered will be reported as mmHg.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.102 CMN O2 SATURATION % CMN-484;2 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the result of the most recent Oxygen saturation test. Enter a whole number which will be reported as %.
  • DESCRIPTION:  
    This field indicates the result of the most recent Oxygen saturation test. The number entered will be reported as %.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.103 CMN DT LAST ABG PO2 AND O2 SAT CMN-484;3 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 14, 2018
  • HELP-PROMPT:  Enter the REQUIRED date for the most recent ABG PO2 and/or O2 Saturation Test(s).
  • DESCRIPTION:  
    This field indicates the Date for the most recent ABG PO2 and/or O2 Saturation test(s).
24.104 CMN EDEMA DUE TO CHF PRESENT? CMN-484;4 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if Edema being due to CHF being Present, or 'No' (0) if it is not.
  • DESCRIPTION:  
    This field indicates whether or not the patient has dependent Edema due to Congestive Heart Failure.
24.105 CMN COR PULMONARY HYPERTENSN? CMN-484;5 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if COR Pulmonale or Pulmonary Hypertension is Present, or 'No' (0) if it is not.
  • DESCRIPTION:  
    This field indicates whether or not the patient has cor pulmonate or pulmonary hypertension documented by P pulmonale on an EKG or echocardiogram, gated blood pool scan or direct pulmonary artery pressure measurement.
24.106 CMN HEMATOCRIT > 56%? CMN-484;6 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if the patient has a Hematocrit level greater that 56% or 'No' (0) if not.
  • DESCRIPTION:  
    This field indicates whether or not the patient has a Hematocrit level greater than 56%.
24.107 CMN PT CONDITION AT TEST TIME CMN-484;7 SET
  • '1' FOR CHRONIC AND STABLE AS OUTPT;
  • '2' FOR W/I TWO DAYS PRIOR TO D/C FROM INPT FACILITY;
  • '3' FOR UNDER OTHER CIRCUMSTANCES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the patient's condition at the time of the ABG and/or O2 Saturation test(s).
  • DESCRIPTION:  
    This field indicates the patient's condition at the time of the ABG and/or O2 Saturation test(s).
24.108 CMN TEST CONDITIONS CMN-484;8 SET
  • '1' FOR AT REST;
  • '2' FOR DURING EXERCISE;
  • '3' FOR DURING SLEEP;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the conditions for the ABG and/or O2 Saturation test(s).
  • DESCRIPTION:  
    This field indicates the condition for the ABG and/or O2 Saturation test(s).
24.109 CMN PORTABLE O2 INDICATOR CMN-484;9 SET
  • 'Y' FOR PATIENT MOBILE WITHIN HOME;
  • 'N' FOR PATIENT NOT MOBILE WITHIN HOME;
  • 'D' FOR NOT ORDERING PORTABLE OXYGEN;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the patient's mobility if ordering portable oxygen or indicate if not ordering portable oxygen.
  • DESCRIPTION:  
    This field indicates the patient's mobility concerning the ordering of portable oxygen.
24.11 CMN HIGHEST O2 FLOW RATE CMN-484;10 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the highest oxygen flow rate ordered for this patient in liters per minute (LPM). Enter a number. If oxygen rate is less than 1 LPM, enter 'X'.
  • DESCRIPTION:  
    This field indicates the highest oxygen flow rate ordered for this Patient in liters per minute (LPM). The value is either a number, or if the value is less than 1 LPM, it should be entered as an "X".
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.111 CMN LAST 4 LPM ABG PO2 (MMHG) CMN-484;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the result of the most recent ABG test taken on 4 LPM. Enter a whole number which will be reported as mmHg.
  • DESCRIPTION:  
    This field indicates the result of the most recent ABG test taken on 4 LPM. The number entered will be reported as mmHg.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.113 CMN LAST 4 LPM O2 SATURATION % CMN-484;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the result of the most recent Oxygen saturation test. Enter a whole number which will be reported as %.
  • DESCRIPTION:  
    This field indicates the result of the most recent Oxygen saturation test. The number entered will be reported as %.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.114 CMN DATE OF LAST 4 LPM TESTS CMN-484;14 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAR 14, 2018
  • HELP-PROMPT:  Enter the REQUIRED date for the most recent 4 LPM Test(s).
  • DESCRIPTION:  
    This field indicates the Date for the most recent ABG PO2 and/or O2 Saturation test(s) taken on 4 LPM.
24.115 CMN EQUIPMENT/COST DESCRIPTION CMN-484;15 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>50!($L(X)<1) X
    MAXIMUM LENGTH: 50
  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter a 1-50 character free text description of items, accessories, and options ordered, suppliers charge and Medicare Fee Schedule allowance for each item, accessory and option.
  • DESCRIPTION:  
    This field indicates the description of the items, accessories, and options ordered, suppliers charge and Medicare Fee Schedule Allowance for each item, accessory and option.
24.201 CMN SM BOWEL ABSORPTION DOC? CMN-10126;1 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if there is documentation on file for Small Bowel Absorption, or 'No' (0) if there is not.
  • DESCRIPTION:  This field indicates whether or not there is documentation in the medical record that supports the patient's permanent non-function or disease of the structures that permit food to reach or be absorbed from the small
    bowel.
24.202 CMN ENTERAL NUTRITION BY TUBE? CMN-10126;2 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 21, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if the Enteral Nutrition is being administered by a tube, or 'No' (0) if it is not.
  • DESCRIPTION:  
    This field indicates whether or not the Enteral Nutrition is being administered via a tube (Example: gastrostomy tube).
24.203 CMN PROCEDURE A CALORIES CMN-10126;3 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  APR 20, 2018
  • HELP-PROMPT:  Enter the calories per day associated with Procedure A.
  • DESCRIPTION:  
    This field indicates the calories per day associated with Procedure A.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.204 CMN PROCEDURE A CMN-10126;4 POINTER TO CPT FILE (#81) CPT(#81)

  • LAST EDITED:  APR 20, 2018
  • HELP-PROMPT:  Enter first procedure with associated calories.
  • DESCRIPTION:  
    This is the procedure code to which the "Procedure A Calories" field corresponds.
24.205 CMN METHOD OF ADMINISTRATION CMN-10126;5 SET
  • '1' FOR SYRINGE;
  • '2' FOR GRAVITY;
  • '3' FOR PUMP;
  • '4' FOR ORAL;

  • LAST EDITED:  NOV 15, 2017
  • HELP-PROMPT:  Select the appropriate method by which the service was administered.
  • DESCRIPTION:  
    This field indicates the method by which the service was administered.
24.206 CMN DAYS PER WEEK ADMINISTERED CMN-10126;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>7)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the number of days per week that the nutrition is administered or infused.
  • DESCRIPTION:  
    This field indicates the number of days per week that the nutrition is administered or infused.
24.207 CMN SEVERE MALABSORPTION DOC? CMN-10126;7 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter 'Yes' (1) if there is documentation on file for Severe Malabsorption, or 'No' (0) if there is not.
  • DESCRIPTION:  This field indicates whether or not there is documentation in the medical record that supports the patient having permanent disease of the gastrointestinal tract causing malabsorption severe enough to prevent maintenance
    of weight and strength.
24.208 CMN AMINO ACID (ML/DAY) CMN-10126;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the number of milliliters of the component Amino Acid that are administered per day in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the number of milliliters of the component Amino Acid that are administered per day in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.209 CMN AMINO ACID CONCENTRATION % CMN-10126;9 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the percent concentration of Amino Acids in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the percent concentration of Amino Acids in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.21 CMN AMINO ACID PROTEIN (GM/DY) CMN-10126;10 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the amount of protein administered in grams/day in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the amount of protein administered in grams/day in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.211 CMN DEXTROSE (ML/DAY) CMN-10126;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the number of milliliters of the component Dextrose that are administered per day in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the number of milliliters of the component Dextrose that are administered per day in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.212 CMN DEXTROSE CONCENTRATE % CMN-10126;12 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the percent concentration of Dextrose in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the percent concentration of Dextrose in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.213 CMN LIPIDS (ML/DAY) CMN-10126;13 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the number of milliliters of the component Lipids that are administered per day in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the number of milliliters of the component Lipids that are administered per day in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.214 CMN ROUTE OF ADMINISTRATION CMN-10126;14 SET
  • '1' FOR CENTRAL LINE (INCLUDES PICC);
  • '2' FOR HEMODIALYSIS ACCESS LINE;
  • '3' FOR PERITONEAL CATHETER;

  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the number that represents the appropriate route by which the nutrition was administered.
  • DESCRIPTION:  
    This field indicates the route by which the nutrition was administered.
24.215 CMN LIPIDS (DAYS/WEEK) CMN-10126;15 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>7)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  NOV 14, 2017
  • HELP-PROMPT:  Enter the number of days per week the component lipids are administered in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the number of days per week the component Lipids are administered in this nutritional formula.
24.216 CMN LIPIDS CONCENTRATE % CMN-10126;16 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAR 02, 2018
  • HELP-PROMPT:  Enter the percent concentration of Lipids in this nutritional formula.
  • DESCRIPTION:  
    This field indicates the percent concentration of Lipids in this nutritional formula.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.217 CMN PARENTERAL/ENTERAL/BOTH CMN-10126;17 SET
  • 'P' FOR PARENTERAL;
  • 'E' FOR ENTERAL;
  • 'B' FOR BOTH;

  • LAST EDITED:  APR 23, 2018
  • HELP-PROMPT:  Is this CMN for Parenteral nutrition, enteral nutrition, or both?
  • DESCRIPTION:  
    This field designates whether this CMN form is for Parenteral nutrition, enteral nutrition, or both.
24.218 CMN PROCEDURE B CALORIES CMN-10126;18 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  APR 23, 2018
  • HELP-PROMPT:  Enter the calories per day associated with Procedure B.
  • DESCRIPTION:  
    This field indicates the calories per day associated with Procedure B.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
24.219 CMN PROCEDURE B CMN-10126;19 POINTER TO CPT FILE (#81) CPT(#81)

  • LAST EDITED:  APR 20, 2018
  • HELP-PROMPT:  Enter second procedure with associated calories.
  • DESCRIPTION:  
    This is the procedure code to which the "Procedure B Calories" field corresponds.
50.01 *HCFA BOX 24K (LOCAL USE ONLY) AUX;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>15!($L(X)<1) X
  • LAST EDITED:  OCT 13, 2006
  • HELP-PROMPT:  This field is no longer used. Answer must be 1-15 characters in length.
  • DESCRIPTION:  This field is obsolete. Field contains the text to print in HCFA box 24K for this line item when the bill is printed locally only. If anything is entered in this field, it will override any system defaults that may
    apply to this field. However, this data will NEVER be transmitted electronically for the claim. If you need to submit data in this field, set the PRINT LOCAL flag on the claim so you can print and mail it from the
    site.
50.02 *LAST XRAY DATE AUX;2 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  MAY 24, 2007
  • HELP-PROMPT:  This field is obsolete.
  • DESCRIPTION:  
    This field has been deactivated and is not in use anymore.
50.03 ATTENDING NOT HOSPICE EMPLOYEE AUX;3 SET
  • '1' FOR ATTENDING PHYSICIAN IS NOT A HOSPICE EMPLOYEE;

  • LAST EDITED:  MAR 25, 2014
  • HELP-PROMPT:  Enter a 1 if billing for hospice care and the attending physician is not employed by the hospice.
  • DESCRIPTION:  
    This is the flag that indicates that an attending physician for hospice care charges was not employed by the hospice.
50.04 *LEVEL OF SUBLUXATION AUX;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>7!($L(X)<2)!'(X?2.3E1"-"2.3E!(X?2.3E&(X'["-"))) X
  • LAST EDITED:  MAY 25, 2007
  • HELP-PROMPT:  This field is obsolete.
  • DESCRIPTION:  
    This field has been deactivated and is not in use anymore.
50.05 *CHIRO TREATMENT SERIES NUM AUX;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 25, 2007
  • HELP-PROMPT:  This field is obsolete.
  • DESCRIPTION:  
    This field has been deactivated and is not in use anymore.
50.06 *CHIROPRACTIC QUANTITY AUX;6 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  MAY 25, 2007
  • HELP-PROMPT:  This field is obsolete.
  • DESCRIPTION:  
    This field has been deactivated and is not in use anymore.
50.07 EPSDT FLAG AUX;7 SET
  • '1' FOR YES;

  • LAST EDITED:  MAR 19, 2014
  • HELP-PROMPT:  Enter a 1 if the item being billed is EPSDT related
  • DESCRIPTION:  
    This is the field to indicate a service is EPSDT related (Early and Periodic Screen for Diagnosis and Treatment of children). For printed claims, this data will print in CMS-1500 box 24H.
50.08 SERVICE LINE COMMENT AUX;8 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>59!($L(X)<1) X
  • LAST EDITED:  MAR 19, 2014
  • HELP-PROMPT:  Answer must be 1-59 characters in length
  • DESCRIPTION:  Enter a free text comment as supplemental information associated with this procedure. This text will print up to 59 characters across the shaded line of Box 24 of the CMS-1500 form.
    The following qualifiers can be entered after the text when reporting NDC units when the NDC Units are required in addition to the HCPCS units:
    F2 International Unit GR Gram ML Milliliter UN Unit
50.09 SERVICE LINE COMMENT QUALIFIER AUX;9 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>7!($L(X)<1) X
  • LAST EDITED:  MAR 19, 2014
  • HELP-PROMPT:  Answer must be 1-7 characters in length
  • DESCRIPTION:  Enter an optional free text Qualifier.
    The following qualifiers should be used when reporting the following services.
    7 Anesthesia information
    ZZ Narrative description of unspecified code
    N4 National Drug Codes (NDC)
    VP Vendor Product Number Health Industry Business Communications
    Council (HIBCC) Labeling Standard
    OZ Product Number Health Care Uniform Code Council - Global Trade
    Item Number (GTIN)
    CTR Contract rate
    If required to report other supplemental information not listed above, follow payer instructions for the use of a qualifier for the information being reported. When reporting a service that does not have a qualifier,
    then leave this field blank. In this case, two blank spaces will be inserted on the printed 1500 form before the service line supplemental information is displayed.
51 PROCEDURE DESCRIPTION 1;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>80!($L(X)<1) X
  • LAST EDITED:  MAY 08, 2014
  • HELP-PROMPT:  Enter a 1-80 character NOC - Not Otherwise Classified - procedure description.
  • DESCRIPTION:  
    Enter a 1-80 character NOC - Not Otherwise Classified - procedure description.
52 UNITS/BASIS OF MEASUREMENT 2;1 SET
  • 'F2' FOR International Unit;
  • 'GR' FOR Gram;
  • 'ME' FOR Milligram;
  • 'ML' FOR Milliliter;
  • 'UN' FOR Unit;

  • LAST EDITED:  JUN 13, 2017
  • HELP-PROMPT:  Enter the units or basis for measurement associated with the Medication.
  • DESCRIPTION:  
    This field is used to associate the correct unit of measurement when Medication is being specified.
  • TECHNICAL DESCR:  
    This file is required if there is an NDC Number.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the NDC field of the PROCEDURES sub-field of the BILL/CLAIMS File
53 NDC 1;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>13!($L(X)<13)!'(X?5N1"-"4N1"-"2N) X
  • LAST EDITED:  JUN 13, 2017
  • HELP-PROMPT:  Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription claim.
  • DESCRIPTION:  
    Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription claim.
  • TECHNICAL DESCR:  
    Enter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription claim.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  ^^TRIGGER^399.0304^52
    1)= Q
    2)= X ^DD(399.0304,53,1,1,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:""),Y(1)=$S($D(^DGCR(399,D0,"CP",D1,2)):^(2),1:"") S X=$P(Y(1),U,1),X=X S DIU=X K Y S X="" X ^DD(399.0304,53,1,1,2.4)
    2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:"") S X=$P(Y(1),U,7)=""
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),2)),DIV=X S $P(^(2),U,1)=DIV,DIH=399.0304,DIG=52 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= NDC=""
    DELETE VALUE)= @
    FIELD)= UNITS/BASIS OF MEASUREMENT
    When the NDC Code is removed, the UNITS/BASIS OF MEASUREMENT field should be removed as well.
  • CROSS-REFERENCE:  ^^TRIGGER^399.0304^54
    1)= Q
    2)= X ^DD(399.0304,53,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:"") S X=$P(Y(1),U,8),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"CP",DIV(1),1)),DIV=X S $P(^(1),U,8)=DIV,DIH=399.0304,DIG=54 D ^
    DICR
    2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"CP",D1,1)):^(1),1:"") S X=$P(Y(1),U,7)=""
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= NDC=""
    DELETE VALUE)= @
    FIELD)= UNITS
    When the NDC Code is removed, the UNITS field should be removed as well.
54 UNITS 1;8 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999999999)!(X<0)!((X[".")&(X'?.11N1"."1.3N)) X
  • LAST EDITED:  JUN 13, 2017
  • HELP-PROMPT:  Enter a number between 0 and 99999999999 with up to 3 decimal digits.
  • DESCRIPTION:  
    Enter the number of units of the non-prescription medication administerd.
  • TECHNICAL DESCR:  
    The number entered must be greater than zero and have format of 99999999999 and up to 3 decimal digits.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the NDC field of the PROCEDURES sub-field of the BILL/CLAIMS File
60 LINE PROVIDER LNPRV;0 SET Multiple #399.0404 399.0404

  • DESCRIPTION:  
    These are the providers who performed specific functions for the services on this claim line.
  • IDENTIFIED BY:  LINE PERFORMED BY(#.02)
  • INDEXED BY:  LINE FUNCTION (C)
70 ATTACHMENT CONTROL NUMBER 1;1 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<1) X
  • LAST EDITED:  OCT 25, 2010
  • HELP-PROMPT:  Enter an (1-30 chars) Attachment Control Number (alphanumeric).
  • DESCRIPTION:  
    The Attachment Control Number (alphanumeric) identifies the documentation that will provide additional information for this claim line.
71 ATTACHMENT REPORT TYPE 1;2 POINTER TO IB ATTACHMENT REPORT TYPE FILE (#353.3) IB ATTACHMENT REPORT TYPE(#353.3)

  • LAST EDITED:  OCT 25, 2010
  • HELP-PROMPT:  Enter a Report Type.
  • DESCRIPTION:  
    The Report Type describes the type of documentation that will provide additional information for this claim line.
72 ATTACHMENT REPORT TRANS CODE 1;3 SET
  • 'AA' FOR Available on Request at Provider Site;
  • 'BM' FOR By Mail;
  • 'EL' FOR Electronically Only;
  • 'EM' FOR E-Mail;
  • 'FT' FOR File Transfer;
  • 'FX' FOR By Fax;

  • LAST EDITED:  OCT 25, 2010
  • HELP-PROMPT:  Select the Attachment Transmission Method.
  • DESCRIPTION:  
    This is the method for transmitting the claim line.
74 ADDITIONAL OB MINUTES 1;5 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>1440)!(X<1)!(X?.E1"."1.N) X
  • LAST EDITED:  OCT 26, 2010
  • HELP-PROMPT:  Enter the number of additional minutes (1-1440) needed for anesthesia for obstetric services than those reported in the normal procedure base units.
  • DESCRIPTION:  
    This is the number of additional minutes needed for anesthesia for obstetric services than those reported in the normal procedure base units.
90.01 ORAL CAVITY DESIGNATION (1) DEN;1 SET
  • '00' FOR Entire Oral Cavity;
  • '01' FOR Maxillary Arch;
  • '02' FOR Mandibular Arch;
  • '10' FOR Upper Right Quadrant;
  • '20' FOR Upper Left Quadrant;
  • '30' FOR Lower Left Quadrant;
  • '40' FOR Lower Right Quadrant;

  • LAST EDITED:  MAR 02, 2017
  • HELP-PROMPT:  Enter a valid Cavity Designation code. The entered code must not already be present in Oral Cavity Designations #2, #3, #4 or #5.
  • DESCRIPTION:  
    The first Oral Cavity Designation code. You can enter up to five codes.
  • SCREEN:  S DIC("S")="I $$ORALCAV^IBCU7(90.01)"
  • EXPLANATION:  Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations #2, #3, #4 or #5.
90.02 ORAL CAVITY DESIGNATION (2) DEN;2 SET
  • '00' FOR Entire Oral Cavity;
  • '01' FOR Maxillary Arch;
  • '02' FOR Mandibular Arch;
  • '10' FOR Upper Right Quadrant;
  • '20' FOR Upper Left Quadrant;
  • '30' FOR Lower Left Quadrant;
  • '40' FOR Lower Right Quadrant;

  • LAST EDITED:  MAR 02, 2017
  • HELP-PROMPT:  Enter a valid Oral Cavity Designation Code. The entered code must not already be present in Oral Cavity Designations #1, #3, #4 or #5.
  • DESCRIPTION:  
    The second Oral Cavity Designation code. You can enter up to five codes.
  • SCREEN:  S DIC("S")="I $$ORALCAV^IBCU7(90.02)"
  • EXPLANATION:  Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations #1, #3, #4 or #5.
90.03 ORAL CAVITY DESIGNATION (3) DEN;3 SET
  • '00' FOR Entire Oral Cavity;
  • '01' FOR Maxillary Arch;
  • '02' FOR Mandibular Arch;
  • '10' FOR Upper Right Quadrant;
  • '20' FOR Upper Left Quadrant;
  • '30' FOR Lower Left Quadrant;
  • '40' FOR Lower Right Quadrant;

  • LAST EDITED:  MAR 02, 2017
  • HELP-PROMPT:  Enter a valid Oral Cavity Designation Code. The entered code must not already be present in Oral Cavity Designations #1, #2, #4 or #5.
  • DESCRIPTION:  
    The third Oral Cavity Designation code. You can enter up to five codes.
  • SCREEN:  S DIC("S")="I $$ORALCAV^IBCU7(90.03)"
  • EXPLANATION:  Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations #1, #2, #4 or #5.
90.04 ORAL CAVITY DESIGNATION (4) DEN;4 SET
  • '00' FOR Entire Oral Cavity;
  • '01' FOR Maxillary Arch;
  • '02' FOR Mandibular Arch;
  • '10' FOR Upper Right Quadrant;
  • '20' FOR Upper Left Quadrant;
  • '30' FOR Lower Left Quadrant;
  • '40' FOR Lower Right Quadrant;

  • LAST EDITED:  MAR 02, 2017
  • HELP-PROMPT:  Enter a valid Oral Cavity Designation code. The entered code must not already be present in Oral Cavity Designations #1, #2, #3 or #5.
  • DESCRIPTION:  
    The fourth Oral Cavity Designation code. You can enter up to five codes.
  • SCREEN:  S DIC("S")="I $$ORALCAV^IBCU7(90.04)"
  • EXPLANATION:  Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations #1, #2, #3 or #5.
90.05 ORAL CAVITY DESIGNATION (5) DEN;5 SET
  • '00' FOR Entire Oral Cavity;
  • '01' FOR Maxillary Arch;
  • '02' FOR Mandibular Arch;
  • '10' FOR Upper Right Quadrant;
  • '20' FOR Upper Left Quadrant;
  • '30' FOR Lower Left Quadrant;
  • '40' FOR Lower Right Quadrant;

  • LAST EDITED:  MAR 02, 2017
  • HELP-PROMPT:  Enter a valid Oral Cavity Designation code. The entered code must not already be present in Oral Cavity Designations #1, #2, #3 or #4.
  • DESCRIPTION:  
    The fifth Oral Cavity Designation code. You can enter up to five codes.
  • SCREEN:  S DIC("S")="I $$ORALCAV^IBCU7(90.05)"
  • EXPLANATION:  Only allows Oral Cavity Designation Codes that are not already present in Oral Cavity Designations #1, #2, #3 and #4.
90.06 PROSTHESIS/CROWN/INLAY CODE DEN;6 SET
  • 'I' FOR Initial Placement;
  • 'R' FOR Replacement;

  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Select a code that indicates the placement status of the prosthesis, crown or inlay.
  • DESCRIPTION:  
    This code indicates the placement status of the prosthesis.
90.07 PRIOR PLACEMENT DATE QUALIFIER DEN;7 SET
  • '139' FOR Estimated;
  • '441' FOR Prior Placement;

  • LAST EDITED:  JUN 14, 2017
  • HELP-PROMPT:  Select a qualifier that indicates whether or not the Prior Placement Date is known or just estimated.
  • DESCRIPTION:  
    This qualifier indicates whether or not the Prior Placement Date is known or just estimated.
90.08 PRIOR PLACEMENT DATE DEN;8 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 14, 2017
  • HELP-PROMPT:  Enter the date when the prosthesis, crown or inlay was replaced. Date is REQUIRED when Prosthesis/Crown/Inlay code equals Replacement.
  • DESCRIPTION:  
    This is the date when a prosthesis, crown or inlay was replaced. Date is REQUIRED when Prosthesis/Crown/Inlay code equals Replacement. replaced.
90.09 ORTHODONTIC BANDING DATE DEN;9 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the date the patient's orthodontic appliances were placed if different from the claim level date.
  • DESCRIPTION:  
    This is the date the patient's orthodontic appliances were placed if different from the claim level date.
90.1 ORTHO BANDING REPLACEMENT DATE DEN;10 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the date the patient's orthodontic appliances were replaced.
  • DESCRIPTION:  
    This is the date the patient's orthodontic appliances were replaced.
90.11 TREATMENT START DATE DEN;11 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the date for initial impression or preparation for a crown or dentures or initial endodontic treatment or the implant fixture placement.
  • DESCRIPTION:  
    This is the date for initial impression or preparation for a crown or dentures or initial endodontic treatment or the implant fixture placement.
90.12 TREATMENT COMPLETION DATE DEN;12 DATE

  • INPUT TRANSFORM:  S %DT="EX" D ^%DT S X=Y K:Y<1 X
  • LAST EDITED:  JUN 28, 2017
  • HELP-PROMPT:  Enter the date that a course of treatment was completed.
  • DESCRIPTION:  
    This is the date that a course of treatment was completed.
91 TOOTH INFORMATION DEN1;0 POINTER Multiple #399.30491 399.30491

  • DESCRIPTION:  
    This multiple holds tooth information for the dental service line.
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