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Sub-Field: 538.113

Package: Utilization Management Rollup

UTILIZATION MANAGEMENT ROLLUP(#538)-->538.113

Sub-Field: 538.113


Information

Parent File Name Number Package
UTILIZATION MANAGEMENT ROLLUP(#538) DAY 538.113 Utilization Management Rollup

Details

Field # Name Loc Type Details
.01 DAY 0;1 NUMBER

  • INPUT TRANSFORM:  K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
  • LAST EDITED:  JUN 30, 1995
  • HELP-PROMPT:  Enter a numeric day of this review, number between 0 and 99999, 0 Decimal Digits
  • DESCRIPTION:  
    This is the number of the day of continued stay review. This field is normally computed from the Review date field of the HOSPITAL REVIEW File (#356.1).
  • CROSS-REFERENCE:  538.113^B
    1)= S ^IBQ(538,DA(1),13,"B",$E(X,1,30),DA)=""
    2)= K ^IBQ(538,DA(1),13,"B",$E(X,1,30),DA)
.02 INTENSITY OF SERVICE 0;2 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>4!($L(X)<2) X
  • LAST EDITED:  JUN 29, 1995
  • HELP-PROMPT:  Answer with SI/IS CATEGORIES CODE, or 24??. 2-4 characters in length.
  • DESCRIPTION:  Enter the Intensity of Service (IS) category that best describes the criteria met for continued stay day of care. Select the PRIMARY category for this reason.
    Also, holds 24 Hour Rule/Interqual Process code, 24??.
    24 Hour Rule/Interqual Process (using data entered in HOSPITAL REVIEW File #356.1):
    A continued stay day meets this criteria if there is no INTENSITY
    OF SERVICE, no DISCHARGE SCREEN, no REASONS CODE, and INTENSITY
    OF SERVICE was met on the previous day.
.03 SEVERITY OF ILLNESS 0;3 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JUN 29, 1995
  • HELP-PROMPT:  Answer with SI/IS CATEGORIES CODE, 2 characters in length.
  • DESCRIPTION:  
    Enter the Severity of Illness (SI) category that best describes the criteria met for continued stay day of care. Select the PRIMARY category for this reason.
.04 D/C SCREENS MET 0;4 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>2!($L(X)<2) X
  • LAST EDITED:  JUN 29, 1995
  • HELP-PROMPT:  Answer must be 2 characters in length.
  • DESCRIPTION:  
    Enter the 2 digit code from the CLAIMS TRACKING SI/IS CATEGORIES File which is appropriate with this entry.
.05 INTERVIEWED (Y/N)? 0;5 SET
************************REQUIRED FIELD************************
  • '1' FOR YES;
  • '0' FOR NO;

  • LAST EDITED:  APR 18, 1995
.06 REASON FOR NON-ACUTE STAY 0;6 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>18!($L(X)<4) X
  • LAST EDITED:  JUN 29, 1995
  • HELP-PROMPT:  Answer with NON-ACUTE CLASSIFICATIONS CODE seperate by space if more the one, 4-18 characters in length.
  • DESCRIPTION:  
    This is the external reference with is uniquely known.
.07 TREATING SPECIALTY 0;7 FREE TEXT

  • INPUT TRANSFORM:  K:$L(X)>30!($L(X)<3) X
  • LAST EDITED:  JUN 29, 1995
  • HELP-PROMPT:  Enter the Treating Specialty assigned to this patient with this movement.
  • DESCRIPTION:  
    Contains the name of the facility treating specialty. Types of treating specialties may vary between Facilities.
.08 SERVICE 0;8 SET
************************REQUIRED FIELD************************
  • 'M' FOR MEDICINE;
  • 'S' FOR SURGERY;
  • 'P' FOR PSYCHIATRY;
  • 'NH' FOR NHCU;
  • 'NE' FOR NEUROLOGY;
  • 'I' FOR INTERMEDIATE MED;
  • 'R' FOR REHAB MEDICINE;
  • 'SCI' FOR SPINAL CORD INJURY;
  • 'D' FOR DOMICILIARY;
  • 'B' FOR BLIND REHAB;
  • 'RE' FOR RESPITE CARE;

  • LAST EDITED:  JUL 06, 1995
  • HELP-PROMPT:  Enter the SERVICE Code describing this continued stay review.
  • DESCRIPTION:  
    This field contains the SERVICE Code from the SPECIALTY File (#42.4) which describes this entries contiued stay review for this day.
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