CMS-1500 (1178)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE CMS-1500
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-DIAGNOSIS CODE 4 (HCFA 1500)
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE S IBXDATA=$P($$ICD9^IBACSV(+IBXDATA,$$BDATE^IBACSV(IBXIEN)),U) D PGDX^IBCEF31(4,IBX0,IBXDA,IBXLN,IBXCOL,.IBXSIZE,.IBXSAVE)
FORMAT CODE DESCRIPTION
Output the forth diagnosis code. Check for any diagnosis codes that should
display in the forth position on pages subsequent to page 1 and output
them.