Files > PROCEDURES

parent
399
name
PROCEDURES
number
399.0304
Fields
#NameLocationTypeDetailsIndexDescription
.01procedures0;1VARIABLE-POINTER81, 80.1BThese are ICD, CPT, or HCFA procedure codes associated with the episode of care on this bill.
1procedure date0;2DATE-TIMEThis is the date the procedure was performed.
2*additional procedure name0;3FREE TEXTThis is the name of the procedure. This field has been marked for deletion 11/4/91.
3print order0;4NUMERICDThis is the relative order that this procedure will appear on the bill. For the UB-04, the procedure with the lowest print order is the principal procedure and the rest print in FL74 in lowest to highest print order.
4basc billable0;5BOOLEAN1:YES
ASCThis field will be completed by the system if this procedure is an Ambulatory Surgery that can be billed under the HCFA rate system.
5division0;6POINTER40.8Enter the Division at which this procedure was performed. This is only required if the bill's charges are based on CPT and region and the division is different than the bill's Default Division.
6associated clinic0;7POINTER44Enter the clinic where this procedure was performed. This field must be completed in order for this procedure to be successfully transferred to the Add/Edit Stop code logic for inclusion in OPC workload.
7*associated diagnosis0;8POINTER80This is the diagnosis most closely related to this procedure. Used on the HFCA 1500, block 24e.
8place of service0;9POINTER353.1This is the Place of Service appropriate for this Procedure. Used only for the CMS-1500 claim form.
9type of service0;10POINTER353.2This is the Type of Service to be associated with this procedure.
10associated diagnosis (1)0;11POINTER362.3The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
11associated diagnosis (2)0;12POINTER362.3The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
12associated diagnosis (3)0;13POINTER362.3The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
13associated diagnosis (4)0;14POINTER362.3The diagnosis most closely related to this procedure. Used only for the CMS-1500, box 24e.
14*cpt modifier0;15POINTER81.3Enter the modifier which should be printed on the claim form with the CPT code.
15minutes0;16NUMERICEnter the number of minutes of care, usually related to Anesthesia.
16cpt modifier sequenceMOD;0MULTIPLE399.30416
17emergency procedure?0;17BOOLEAN0:NO
1:YES
This field stores whether the procedure performed was emergency or scheduled/routine.
18provider0;18POINTER200This is the provider who performed the procedure.
19purchased cost0;19NUMERICThis is the actual amount the VA paid for a service provided to a VA patient at a NON-VA facility or provider.
20outpatient encounter0;20POINTER409.68The Outpatient Encounter where this procedure was performed.
21miles0;21NUMERICEnter the number of miles the patient was transported.
22hours0;22NUMERICEnter the number of hours of care, usually related to Observation.
50.01*hcfa box 24k (local use only)AUX;1FREE TEXTThis field is obsolete. Field contains the text to print in HCFA box 24K for this line item when the bill is printed locally only. If anything is entered in this field, it will override any system defaults that may apply to this field. However, this data will NEVER be transmitted electronically for the claim. If you need to submit data in this field, set the PRINT LOCAL flag on the claim so you can print and mail it from the site.
50.02*last xray dateAUX;2DATE-TIMEThis field has been deactivated and is not in use anymore.
50.03attending not hospice employeeAUX;3SET OF CODES1: ATTENDING PHYSICIAN IS NOT A HOSPICE EMPLOYEE
This is the flag that indicates that an attending physician for hospice care charges was not employed by the hospice.
50.04*level of subluxationAUX;4FREE TEXTThis field has been deactivated and is not in use anymore.
50.05*chiro treatment series numAUX;5NUMERICThis field has been deactivated and is not in use anymore.
50.06*chiropractic quantityAUX;6NUMERICThis field has been deactivated and is not in use anymore.
50.07epsdt flagAUX;7BOOLEAN1:YES
This is the field to indicate a service is EPSDT related (Early and Periodic Screen for Diagnosis and Treatment of children). For printed claims, this data will print in CMS-1500 box 24H.
50.08service line commentAUX;8FREE TEXTEnter a free text comment as supplemental information associated with this procedure. This text will print up to 59 characters across the shaded line of Box 24 of the CMS-1500 form. The following qualifiers can be entered after the text when reporting NDC units when the NDC Units are required in addition to the HCPCS units: F2 International Unit GR Gram ML Milliliter UN Unit
50.09service line comment qualifierAUX;9FREE TEXTEnter an optional free text Qualifier. The following qualifiers should be used when reporting the following services. 7 Anesthesia information ZZ Narrative description of unspecified code N4 National Drug Codes (NDC) VP Vendor Product Number Health Industry Business Communications Council (HIBCC) Labeling Standard OZ Product Number Health Care Uniform Code Council - Global Trade Item Number (GTIN) CTR Contract rate If required to report other supplemental information not listed above, follow payer instructions for the use of a qualifier for the information being reported. When reporting a service that does not have a qualifier, then leave this field blank. In this case, two blank spaces will be inserted on the printed 1500 form before the service line supplemental information is displayed.
51procedure description1;4FREE TEXTEnter a 1-80 character NOC - Not Otherwise Classified - procedure description.
53ndc1;7FREE TEXTEnter a National Drug Code in a 5-4-2 format (nnnnn-nnnn-nn) if required on a non-prescription claim.
54units1;8NUMERICEnter the number of units of the non-prescription medication administered.
60line providerLNPRV;0MULTIPLE399.0404These are the providers who performed specific functions for the services on this claim line.
70attachment control number1;1FREE TEXTThe Attachment Control Number (alphanumeric) identifies the documentation that will provide additional information for this claim line.
71attachment report type1;2POINTER353.3The Report Type describes the type of documentation that will provide additional information for this claim line.
72attachment report trans code1;3SET OF CODESAA:Available on Request at Provider Site
BM:By Mail
EL:Electronically Only
EM:E-Mail
FT:File Transfer
FX:By Fax
This is the method for transmitting the claim line.
74additional ob minutes1;5NUMERICThis is the number of additional minutes needed for anesthesia for obstetric services than those reported in the normal procedure base units.

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