# | Name | Location | Type | Details | Index | Description |
---|---|---|---|---|---|---|
.01 | cpt code(+) | 0;1 | POINTER | 81 | B | This is the procedure, services, or supplies used for the patient. It is using the Healthcare Common Procedure Coding System (HCPCS) or Common Procedure Terminology (CPT) code. This value appears on the CMS 1500 in box 24d. The values in this field will be provided to the billing package when the record is closed. |
.02 | cpt modifier 1 | 0;2 | POINTER | 81.3 | Used to indicate that a service or procedure has been altered by some specific circumstance but without changing the definition or code. | |
.03 | cpt modifier 2 | 0;3 | POINTER | 81.3 | Used to indicate that a service or procedure has been altered by some specific circumstance but not changed definition or code. | |
.04 | primary diagnosis | 0;4 | POINTER | 80 | The diagnosis code most directly related to the procedure code performed for this professional service. This field must be entered for each CPT code entered. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.05 | secondary diagnosis 1 | 0;5 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.06 | secondary diagnosis 2 | 0;6 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.07 | secondary diagnosis 3 | 0;7 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.08 | treated for sc condition(+) | 0;8 | BOOLEAN | 1:YES 0:NO | Enter 'Y' if this applicant is service connected and the professional service is related to that service connection. Otherwise enter 'N'. This field can only be entered if the service connection information was entered in registration. See field .301 in file 2. | |
.09 | treated for ao condition(+) | 0;9 | BOOLEAN | 1:YES 0:NO | The Agent Orange questions must be answered yes in registration before this field can be entered. Enter 'Y' if this procedure is related to Agent Orange exposure based on the related diagnosis. See field .32102 in file 2. | |
.1 | treated for ir condition(+) | 0;10 | BOOLEAN | 1:YES 0:NO | Enter 'Y' if the procedure performed is related to exposure to ionizing . Enter 'N' if the procedure performed is unrelated to ionizing radiation. The ionizing radiation information must be entered in registration before it can be entered here. See field .32111 in file 2. | |
.11 | exposed to envir contaminants(+) | 0;11 | BOOLEAN | 1:YES 0:NO | Enter 'Y' if the procedure performed is related to exposure to environmental contamination. Enter 'N' if the procedure performed is unrelated to environmental contamination. This information must be entered in Registration before it can be entered here. See field .322013 in file 2. | |
.12 | treatment for mst(+) | 0;12 | BOOLEAN | 1:YES 0:NO | Enter 'Y' if the procedure performed is related to military sexual trauma. Enter 'N' if the procedure performed is unrelated to military sexual trauma. This information must be entered in registration first. | |
.13 | treatment for head/neck ca(+) | 0;13 | BOOLEAN | 1:YES 0:NO | Enter 'Y' if this procedure is related to treatment for head/neck cancer. Enter 'N' is the procedure is unrelated to the patient's head/neck cancer. | |
.131 | combat vet | 0;19 | BOOLEAN | Y:YES N:NO | Indiacte if the inpatient stay at this location is related to military service in combat and not from cause other than military service in combat operations (congenital, developmental, pre-service existing conditions, or conditions having specific and well-established etiology that began after military combat service, i.e., bone fractures occuring after separation date, comon colds, ect). This information can only be entered if the patient has CV status in Registration. | |
.14 | cpt record date/time(+) | 1;1 | DATE-TIME | The date and time the professional service was performed. May not be exact. Must be unique. | ||
.16 | ptf(+) | 1;3 | POINTER | 45 | C | Pointer to the inpatient record in the PTF file (45). |
.17 | source | 1;4 | FREE TEXT | SOURCE is a string of text (3-30 character) identifying the source of the data or Examples of SOURCE are: "LAB DATA". "RADIOLOGY DATA". | ||
.18 | user | 1;2 | POINTER | 200 | User who is responsible for add/edit/delete action on the encounter. Pointer to the New Person file (200). | |
.2 | quantity | 0;14 | NUMERIC | This is the number of times this procedure was done to the patient for one professional service. | ||
.21 | secondary diagnosis 4 | 0;15 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.22 | secondary diagnosis 5 | 0;16 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.23 | secondary diagnosis 6 | 0;17 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
.24 | secondary diagnosis 7 | 0;18 | POINTER | 80 | A secondary diagnosis related to the procedure performed for this professional service. This field is optional. It appears in box 21 on the CMS-1500 and is associated with a procedure in box 24e. | |
1 | delete date | 9;1 | DATE-TIME |
Not Referenced