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Sub-Field: 399.042

Package: Integrated Billing

BILL/CLAIMS(#399)-->399.042

Sub-Field: 399.042


Information

Parent File Name Number Package
BILL/CLAIMS(#399) REVENUE CODE 399.042 Integrated Billing

Details

Field # Name Loc Type Details
.001 NUMBER NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<1)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUL 10, 1990
  • HELP-PROMPT:  Type a Number between 1 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    This is the sequential number of the entry. Use of this number facilitates reference to the line item charges and revenue codes it is associated with.
    WRITE AUTHORITY: ^
.01 REVENUE CODE 0;1 POINTER TO REVENUE CODE FILE (#399.2)
************************REQUIRED FIELD************************
REVENUE CODE(#399.2)

  • INPUT TRANSFORM:  S DIC("S")="I +$P(^(0),U,3)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  JUN 22, 2000
  • HELP-PROMPT:  Enter the code(s) which identify a specific accommodation, ancillary service, or billing calculation. You may enter up to 10 codes per bill.
  • DESCRIPTION:  
    Enter the Revenue Code to assign the charge for the care being billed.
  • SCREEN:  S DIC("S")="I +$P(^(0),U,3)"
  • EXPLANATION:  Select active revenue codes only!
  • CROSS-REFERENCE:  399.042^B
    1)= S ^DGCR(399,DA(1),"RC","B",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"RC","B",$E(X,1,30),DA)
  • CROSS-REFERENCE:  399.042^ABS1^MUMPS
    1)= I $P(^DGCR(399,DA(1),"RC",DA,0),U,5) S ^DGCR(399,DA(1),"RC","ABS",$P(^DGCR(399,DA(1),"RC",DA,0),U,5),$E(X,1,30),DA)=""
    2)= I $P(^DGCR(399,DA(1),"RC",DA,0),U,5) K ^DGCR(399,DA(1),"RC","ABS",$P(^DGCR(399,DA(1),"RC",DA,0),U,5),$E(X,1,30),DA)
    Cross reference of all revenue codes with bedsections.
  • FIELD INDEX:  ADPR (#53) MUMPS IR ACTION
    Short Descr: DELETES PROCEDURE ENTRY FOR RX REVENUE CODES
    Set Logic: Q
    Kill Logic: I X(2)'=""&'$D(^TMP("IBCRRX",$J)) D DELPR^IBCU1(DA(1),X(2))
    X(1): REVENUE CODE (399.042,.01) (Subscr 1) (forwards)
    X(2): RX PROCEDURE (399.042,.15) (forwards)
.02 CHARGES 0;2 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  SEP 24, 2010
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This is the unit charge for this revenue code. It will be multiplied times the number of units to determine the total cost for this revenue code.
  • CROSS-REFERENCE:  399.042^TC1^MUMPS
    1)= D 21^IBCU2
    2)= D 22^IBCU2
    Sets/deletes total charges.
  • CROSS-REFERENCE:  ^^TRIGGER^399.042^.16
    1)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=+$G(IBMAED) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399.042,.02,1,2,1.4)
    1.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=399.042,DIG=.16 D ^DICR
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=+$G(IBMAED) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,16),X=X S DIU=X K Y S X=DIV S X=1 X ^DD(399.042,.02,1,2,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,16)=DIV,DIH=399.042,DIG=.16 D ^DICR
    3)= This is a software controlled field and should not be manually edited by a user.
    CREATE CONDITION)= S X=+$G(IBMAED)
    CREATE VALUE)= S X=1
    DELETE CONDITION)= S X=+$G(IBMAED)
    DELETE VALUE)= S X=1
    FIELD)= MANUALLY EDITED
    This trigger is designed to set the MANUALLY EDITED flag when a user directly edits the CHARGE value for the REVENUE CODE. This is used in the process of preventing the auto charge update from changing user entered
    values.
.03 UNITS OF SERVICE 0;3 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:X'?1.3N X I $D(X) S:X=0 X=1 I X>800 K X
  • LAST EDITED:  MAY 05, 2014
  • HELP-PROMPT:  Enter the number of units of service (accommodation days, miles, treatments, etc.) rendered to or for this patient for this revenue code. Cannot be greater than 800.
  • DESCRIPTION:  
    This is the number of day of inpatient care or the number of outpatient visits for this revenue code. It will be multiplied by the CHARGES field to determine the TOTAL charges for this revenue code.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399.042^TC^MUMPS
    1)= D 31^IBCU2
    2)= D 32^IBCU2
    Adds/deletes total charges.
.04 TOTAL 0;4 NUMBER
************************REQUIRED FIELD************************

  • INPUT TRANSFORM:  K:X?1.10N.1".".2N X
  • LAST EDITED:  SEP 21, 1992
  • HELP-PROMPT:  Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
  • DESCRIPTION:  
    This is the total charges for this revenue code. It is computed by the system.
    UNEDITABLE
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399.042^ATC^MUMPS
    1)= S DGXRF=1 D TC^IBCU2 K DGXRF
    2)= S DGXRF=2 D TC^IBCU2 K DGXRF
    Sets/deletes total charges
.05 BEDSECTION 0;5 POINTER TO MCCR UTILITY FILE (#399.1)
************************REQUIRED FIELD************************
MCCR UTILITY(#399.1)

  • INPUT TRANSFORM:  S DIC("S")="I $P(^(0),U,5)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
  • LAST EDITED:  MAY 14, 1990
  • DESCRIPTION:  
    If this is an inpatient bill then this is the Specialty associated with authorized rates for the type of care provided for this revenue code.
  • TECHNICAL DESCR:  
    Includes only billable bedsections.
  • SCREEN:  S DIC("S")="I $P(^(0),U,5)"
  • EXPLANATION:  ONLY BILLABLE BEDSECTIONS
  • CROSS-REFERENCE:  399.042^ABS^MUMPS
    1)= S ^DGCR(399,DA(1),"RC","ABS",$E(X,1,30),+^DGCR(399,DA(1),"RC",DA,0),DA)=""
    2)= K ^DGCR(399,DA(1),"RC","ABS",$E(X,1,30),+^DGCR(399,DA(1),"RC",DA,0),DA)
    Cross reference of all revenue codes with bedsections.
.06 PROCEDURE 0;6 POINTER TO CPT FILE (#81) CPT(#81)

  • INPUT TRANSFORM:  S ICPTVDT=$$BDATE^IBACSV($G(DA(1))),DIC("S")="I $$CPTACT^IBACSV(+Y,ICPTVDT)",DIC("W")="D EN^DDIOL("" ""_$P($$CPT^IBACSV(+Y,ICPTVDT),U,2),,""?0"")" D ^DIC K DIC S DIC=$G(DIE),X=+Y K:Y<0 X
  • LAST EDITED:  SEP 08, 2006
  • DESCRIPTION:  This field may be used to associate the revenue code with a procedure. This will be needed primarily to accomodate the CMS-1500 which allows charges by procedure not revenue code. The charge associated with the revenue
    code will be printed on the CMS-1500 claim form in the same line item as the procedure.
    This field is also used for revenue codes that are for Billable Ambulatory Surgeries (BASC). It identifies the CPT code of the surgery which is being billed for.
  • SCREEN:  S ICPTVDT=$$BDATE^IBACSV($G(DA(1))),DIC("S")="I $$CPTACT^IBACSV(+Y,ICPTVDT)",DIC("W")="D EN^DDIOL("" ""_$P($$CPT^IBACSV(+Y,ICPTVDT),U,2),,""?0"")"
  • EXPLANATION:  Only codes active for the date of service may be selected.
  • CROSS-REFERENCE:  399^ASC1^MUMPS
    1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC1",$E(X,1,30),DA(1),DA)=""
    2)= K ^DGCR(399,"ASC1",$E(X,1,30),DA(1),DA)
    All Billable Ambulatory Surgery Codes (BASC) that have been billed.
  • CROSS-REFERENCE:  399^ASC2^MUMPS
    1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC2",DA(1),$E(X,1,30),DA)=""
    2)= K ^DGCR(399,"ASC2",DA(1),$E(X,1,30),DA)
    All bills with charges for Billable Ambulatory Surgery Codes (BASC).
.07 DIVISION 0;7 POINTER TO MEDICAL CENTER DIVISION FILE (#40.8) MEDICAL CENTER DIVISION(#40.8)

  • LAST EDITED:  MAR 10, 1994
  • HELP-PROMPT:  Enter the division where the care was provided if the charges are based on CPT region and if it is different than the bills Default Division.
  • DESCRIPTION:  
    This identifes the division where the treatement being billed was performed. It is only required if the charges are based on CPT and region and the division is different than the bills Default Division.
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
  • CROSS-REFERENCE:  399^ASC11^MUMPS
    1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC1",$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA(1),DA)=""
    2)= K ^DGCR(399,"ASC1",+$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA(1),DA)
    All Billable Ambulatory Surgery Codes (BASC) that have been billed.
  • CROSS-REFERENCE:  399^ASC21^MUMPS
    1)= I $$RC^IBEFUNC1(DA(1),DA) S ^DGCR(399,"ASC2",DA(1),$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA)=""
    2)= K ^DGCR(399,"ASC2",DA(1),+$P(^DGCR(399,DA(1),"RC",DA,0),U,6),DA)
    All bills with charges for Billable Ambulatory Surgery Codes (BASC).
.08 AUTO 0;8 SET
  • '1' FOR YES;

  • LAST EDITED:  FEB 07, 1994
  • HELP-PROMPT:  This field sould be automatically added by the software, user entry is not necessary.
  • DESCRIPTION:  
    True if the revenue code and charge were added by the automatic charge calculation routine, blank if added manually by the user.
  • TECHNICAL DESCR:  Should only be true if the automatic charge calculator created the revenue code and charge based on the chargable items on the bill. Should be null for any rev code manually entered by a user. (FILE^IBCU62) This is
    used to determine which of the revenue codes should be deleted before the calculator re-builds them. (ALL^IBCU61)
.09 NON-COVERED CHARGE 0;9 NUMBER

  • INPUT TRANSFORM:  S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
  • LAST EDITED:  SEP 24, 2010
  • HELP-PROMPT:  Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
  • DESCRIPTION:  
    This is the amount of the charges that are not covered for this revenue code line item. Use to record things such as pass days that need to be reported but are not chargeable.
.1 TYPE 0;10 SET
  • '1' FOR INPT BS;
  • '2' FOR OPT VST DT;
  • '3' FOR RX;
  • '4' FOR CPT;
  • '5' FOR PROS;
  • '6' FOR DRG;
  • '9' FOR UNASSOCIATED;

  • LAST EDITED:  MAY 26, 2000
  • HELP-PROMPT:  This is an indicator of the type of item the charge is for.
  • DESCRIPTION:  
    The type of item the charge is for. This places the charges into categories and should correspond to the billable event.
  • TECHNICAL DESCR:  
    This defines the file reference of the item pointer. This is automatically set when the charges are set by the auto calculator.
  • CROSS-REFERENCE:  ^^TRIGGER^399.042^.11
    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,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,11),X=X S DIU=X K Y S X="" X ^DD(399.042,.1,1,1,2.4)
    2.4)= S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,11)=DIV,DIH=399.042,DIG=.11 D ^DICR
    3)= DO NOT DELETE
    CREATE VALUE)= NO EFFECT
    DELETE VALUE)= @
    FIELD)= ITEM
    This erases the item pointer if the item type changes.
  • CROSS-REFERENCE:  ^^TRIGGER^399.042^.15
    1)= Q
    2)= X ^DD(399.042,.1,1,2,2.3) I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" S DIH=$G(^DGCR(399,DIV(0),"RC",DIV(1),0)),DIV=X S $P(^(0),U,15)=DIV,DIH=399.042,DIG=.15 D
    ^DICR
    2.3)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,10),X=X S X=X=3
    3)= DO NOT DELETE
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= INTERNAL(TYPE)=3
    DELETE VALUE)= @
    FIELD)= RX PROCEDURE
    This xref deletes the RX pointer to the procedure whenever the type is changed
.11 ITEM 0;11 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>9999999999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  OCT 12, 2000
  • HELP-PROMPT:  Type a Number between 0 and 9999999999, 0 Decimal Digits
  • DESCRIPTION:  
    This is a soft pointer to the item being charged for. The TYPE field defines the file reference this is pointing to. Automatically set when charges are set by the auto calculator.
  • NOTES:  TRIGGERED by the TYPE field of the REVENUE CODE sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  ^^TRIGGER^399.042^.15
    1)= Q
    2)= K DIV S DIV=X,D0=DA(1),DIV(0)=D0,D1=DA,DIV(1)=D1 S Y(0)=X S X=X'="" I X S X=DIV S Y(1)=$S($D(^DGCR(399,D0,"RC",D1,0)):^(0),1:"") S X=$P(Y(1),U,15),X=X S DIU=X K Y S X="" X ^DD(399.042,.11,1,1,2.4)
    2.4)= S DIH=$S($D(^DGCR(399,DIV(0),"RC",DIV(1),0)):^(0),1:""),DIV=X S $P(^(0),U,15)=DIV,DIH=399.042,DIG=.15 D ^DICR
    CREATE VALUE)= NO EFFECT
    DELETE CONDITION)= OLD ITEM'=""
    DELETE VALUE)= @
    FIELD)= #.15
    This trigger deletes the reference to the prescription procedure when the item being billed is changed.
.12 COMPONENT 0;12 SET
  • '1' FOR INSTITUTIONAL;
  • '2' FOR PROFESSIONAL;

  • LAST EDITED:  DEC 02, 1996
  • HELP-PROMPT:  Enter the component of the total charge this charge represents.
  • DESCRIPTION:  
    The total charges for some events are broken into Institutional and Professional charges. If this charge is for only one of these components enter it here.
  • TECHNICAL DESCR:  
    This set should be a subset of the Charge Set Charge Type set (363.1,.04) Automatically set when charges are set by the auto calculator.
.13 *UB92 FORM LOCATOR 49 0;13 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<1) X
  • LAST EDITED:  FEB 14, 2007
  • HELP-PROMPT:  Answer must be 1-4 characters in length.
  • DESCRIPTION:  This is the data that should print for a revenue code line in the form locator 49.
    This field is marked for deletion and can be deleted 11/23/2008.
.15 RX PROCEDURE 0;15 FREE TEXT

  • INPUT TRANSFORM:  S X=$$RXPRLOOK^IBCEU4(X) K:'X X
  • OUTPUT TRANSFORM:  S Y=Y_" - "_$P($$PRCNM^IBCSCH1($P($G(^DGCR(399,D0,"CP",+Y,0)),U)),U)
  • LAST EDITED:  SEP 08, 2006
  • HELP-PROMPT:  Enter the procedure code from the procedure codes on the bill that this charge is for.
  • DESCRIPTION:  
    This is a soft pointer to the CP multiple entry for prescriptions billed on a CMS-1500 billing form.
  • TECHNICAL DESCR:  
    This field is hard-set when prescriptions are auto-entered on a bill.
  • EXECUTABLE HELP:  I $$RXPRLOOK^IBCEU4(X)
  • NOTES:  XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
    TRIGGERED by the TYPE field of the REVENUE CODE sub-field of the BILL/CLAIMS File
    TRIGGERED by the ITEM field of the REVENUE CODE sub-field of the BILL/CLAIMS File
  • CROSS-REFERENCE:  399.042^ACP
    1)= S ^DGCR(399,DA(1),"RC","ACP",$E(X,1,30),DA)=""
    2)= K ^DGCR(399,DA(1),"RC","ACP",$E(X,1,30),DA)
  • FIELD INDEX:  ADPR (#53) MUMPS IR ACTION
    Short Descr: DELETES PROCEDURE ENTRY FOR RX REVENUE CODES
    Set Logic: Q
    Kill Logic: I X(2)'=""&'$D(^TMP("IBCRRX",$J)) D DELPR^IBCU1(DA(1),X(2))
    X(1): REVENUE CODE (399.042,.01) (Subscr 1) (forwards)
    X(2): RX PROCEDURE (399.042,.15) (forwards)
.16 MANUALLY EDITED 0;16 SET
  • '0' FOR NO;
  • '1' FOR YES;

  • LAST EDITED:  JUL 19, 2011
  • HELP-PROMPT:  Were revenue code CHARGES manually changed by the user?
  • DESCRIPTION:  
    This field indicates whether the user manually changed the CHARGES (#.02) field.
  • TECHNICAL DESCR:  This field indicates whether the user manually changed the CHARGES (#.02) field. It is triggered (set to 1 or yes) when the user makes changes to the CHARGES (#.02) field. It can also be triggered (reset to empty) when
    BILL CHARGE TYPE (#399,.27), DIVISION (#399.0304,5), or PROCEDURES (#399.0304,.01) fields are changed.
    This field is used in routines IBCU61 and IBCU62 fields to determine if the REVENUE CODE should be removed and replaced during the "automated revenue code generation" process. If the MANUALLY EDITED field is equal to "1"
    then the REVENUE CODE should not be changed by the "automated revenue code generation" process.
    WRITE AUTHORITY:^
  • NOTES:  TRIGGERED by the CHARGES field of the REVENUE CODE sub-field of the BILL/CLAIMS File
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