UB-04 (1417)    IB FORM FIELD CONTENT (364.7)

Name Value
FORM FIELD REFERENCE UB-04
SECURITY LEVEL NATIONAL,NO EDIT
DATA ELEMENT N-GET FROM PREVIOUS EXTRACT
PAD CHARACTER NO PAD REQUIRED
FORMAT CODE N Z,Z0,D,T,T4,T5 F Z=1:1 Q:'$G(^TMP($J,"IBC-RC",Z)) S D=^(Z),T=$P(D,U,2),T5=$P(D,U,5),T4=$P(D,U,4),Z0=$S(+D=2:$E(T,31,45),+D=3:$E(T,26,40),T4'=""&(T>219):T4,T5'=""&(T<220)&(T>1):$J(T5,7,2),1:"") S:Z'>22 IBXDATA(Z)=Z0 D:Z>22 CKREV^IBCEF3(Z,Z0)
FORMAT CODE DESCRIPTION
This data element is a group data element where more than one occurrence
formatted with 2 decimal places. Since only 22 lines of service can appear
on one form, if there are more than 22 lines, subsequent pages are forced
for the remaining data lines after 22.
might be expected.  It relies on the presence of data in global
^TMP($J,"IBC-RC",n) extracted previously.  The first '^' piece of the array
indicates whether this is a 'normal' service data line (=1) or a text line
(=2 or =3).  For a normal service line, the data is found in the fourth
(procedure code and modifiers) or fifth (unit charge) '^' pieces of the
array. If there is a procedure and a unit charge, only the procedure code
and its modifiers will print. If there is a unit charge and this is an
inpatient bill and the revenue code is 100-219, it is printed and