| Name | Value |
|---|---|
| FORM FIELD REFERENCE | CMS-1500 |
| SECURITY LEVEL | NATIONAL,NO EDIT |
| DATA ELEMENT | N-DIAGNOSIS CODE 11(HCFA 1500) |
| PAD CHARACTER | NO PAD REQUIRED |
| FORMAT CODE | S IBXDATA=$P($$ICD9^IBACSV(+IBXDATA,$$BDATE^IBACSV(IBXIEN)),U) D PGDX^IBCEF31(11,IBX0,IBXDA,IBXLN,IBXCOL,.IBXSIZE,.IBXSAVE) |