| # | Name | Location | Type | Details | Index | Description |
|---|---|---|---|---|---|---|
| .01 | sequence number(+) | 0;1 | NUMERIC | The record number for this extract entry. | ||
| 1 | year month | 0;2 | FREE TEXT | A six character string representing the year and the month for which this extract was performed. | ||
| 2 | extract number | 0;3 | POINTER | 727 | AC | The corresponding entry in the DSS EXTRACT LOG file (#727) for this extract. |
| 3 | facility | 0;4 | FREE TEXT | Identifies the facility for this extract record. | ||
| 4 | patient no. - dfn | 0;5 | POINTER | 2 | An identifying number for the patient at the local site. | |
| 5 | ssn | 0;6 | FREE TEXT | The patient's social security number. Any patient with an SSN beginning with "00000" is considered a "test patient" and will not be included in the extract. | ||
| 6 | name | 0;7 | FREE TEXT | The first four characters of the patient's last name. | ||
| 7 | in out patient indicator | 0;8 | FREE TEXT | Indicates whether the patient was an inpatient or an outpatient for this extract entry. | ||
| 8 | day | 0;9 | FREE TEXT | This 8-character string represents the date on which the Dental procedure was performed. | ||
| 9 | provider | 0;10 | FREE TEXT | Provider of medical care for this patient for this extract. | ||
| 10 | screening/complete exam | 0;11 | SET OF CODES | S:SCREENING C:COMPLETE | Exam will be S for screening or C for complete. | |
| 11 | admin procedure | 0;12 | SET OF CODES | 1:ADMIN PROCEDURE | An entry should be made in this field when a case, a service or a procedure has been administratively completed or terminated without an actual patient visit (i.e., chart review, telephone call, death, etc.). | |
| 12 | x-rays extraoral # | 0;13 | NUMERIC | Enter the number of EXTRAORAL radiographs taken on this patient for panoramic, cephalometric or other extraoral procedures. | ||
| 13 | x-rays intraoral # | 0;14 | NUMERIC | Enter the number of INTRAORAL radiographs taken for this patient for PA, bitewing, occlusal and other intraoral procedures. | ||
| 14 | prophy natural dentition | 0;15 | BOOLEAN | 1:YES | In special circumstances, when a patient is of such a difficult nature that two or more appointments are needed to complete the prophylaxis, credit for each treatment episode may be recorded. | |
| 15 | prophy denture | 0;16 | BOOLEAN | 1:YES | If a patient had a prophylaxis of natural dentition and a removable prosthesis cleaned on the same visit, an entry can be made for both procedures. | |
| 16 | operating room | 0;17 | BOOLEAN | 1:YES | Patient was treated in the operating room. These cases must be credited to a dental staff provider or a dental consultant or attending. | |
| 17 | neoplasm confirmed malignant # | 0;18 | NUMERIC | The number of confirmed malignant neoplasms initially recognized by a member of the Dental Service. | ||
| 18 | neoplasm removed # | 0;19 | NUMERIC | The number of neoplasms removed including excisional biopsies. | ||
| 19 | biopsy/smear # | 0;20 | NUMERIC | The number of incisional biopsies plus the number of cytological smears taken. | ||
| 20 | fracture # | 0;21 | NUMERIC | The number of maxillofacial fractures (surgical sites or procedures) reduced. | ||
| 21 | patient category | 0;22 | POINTER | 220.2 | The appropriate patient category for this dental sitting. | |
| 22 | other signif. surg. (ctv) | 0;23 | NUMERIC | The weighted value (CTV's) for the surgical procedure performed. | ||
| 23 | surfaces restored # | 0;24 | NUMERIC | The number of surfaces restored with permanent restorative material. | ||
| 24 | root canal therapy # | 0;25 | NUMERIC | The number of root canals permanently filled. | ||
| 25 | peridontal quads (surgical) # | 0;26 | NUMERIC | The number of quadrant equivalents of periodontal surgery. | ||
| 26 | perio quads (root plane) # | 0;27 | NUMERIC | The number of quadrant equivalents of subgingival curettage and/or root planing. | ||
| 27 | patient ed (ctv) | 0;28 | SET OF CODES | 0:NONE 3:INDIVIDUAL 4:GROUP | The weighted value of preventive dentistry instructions. | |
| 28 | spot check exam | 0;29 | SET OF CODES | 1:STAFF 3:FEE | Spot check examination was performed on this patient by staff or a fee dentist. | |
| 29 | individual crowns # | 0;30 | NUMERIC | The number of permanent crowns cemented. | ||
| 30 | post & cores # | 0;31 | NUMERIC | The number of teeth on which a post/core or overdenture coping was cemented. | ||
| 31 | fixed partials (abut) # | 0;32 | NUMERIC | The number of abut units contained in the fixed prosthesis inserted. | ||
| 32 | fixed partials (pont only) # | 0;33 | NUMERIC | The number of PONTIC UNITS contained in the fixed prosthesis inserted. | ||
| 33 | removable partials # | 0;34 | NUMERIC | The number of R.P.D.s that were delivered to the patient. | ||
| 34 | complete dentures # | 0;35 | NUMERIC | The number of COMPLETE DENTURE units (each separate prosthesis is one unit) delivered to the patient. | ||
| 35 | prosthetic repair # | 0;36 | NUMERIC | The number of removable dentures and special appliances that were repaired for this patient. | ||
| 36 | splint and spec. process (ctv) | 0;37 | NUMERIC | Contains the weighted values (CTV) assigned to special appliance delivered to or disposed of for the patient. | ||
| 37 | extractions # | 0;38 | NUMERIC | The number of non-impacted (erupted) teeth extracted. These are simple extractions where no surgical techniques are involved. | ||
| 38 | surgical extractions # | 0;39 | NUMERIC | This includes any type of impaction or an erupted tooth where an intentional flap is required. Also includes all post-operative care and instructions. | ||
| 39 | other sig treatment (ctv) | 0;40 | NUMERIC | Contains weighted values for procedures (CTV). | ||
| 40 | division (station division) | 0;41 | FREE TEXT | Contains the appropriate station number for this entry. | ||
| 41 | completions/terminations | 0;42 | SET OF CODES | 2:COMPLETION 3:TERMINATION | Contains a code indicating completion or termination of a case. | |
| 42 | interdisciplinary consult | 0;43 | SET OF CODES | 1:INTERDISCIPLINARY CONSULT | Contains all consults instituted via forms 513 and 10-10m. | |
| 43 | evaluations | 0;44 | SET OF CODES | 1:Evaluation | Describes the professional evaluations not to exceed one per visit. | |
| 44 | pre authorization/2nd opinion | 0;45 | SET OF CODES | 2:PRE-AUTH/2ND OPINION | A pre-authorization exam is performed on a fee basis patient in order to determine treatment needs prior to authorization of the patient to a fee-for-service provider. A second opinion exam is performed when the original estimate on a fee basis dental case exceeds $500.00. | |
| 45 | spot check discrepancy | 0;46 | NUMERIC | Indicates the category of discrepancy. 1 is a minor discrepancy only. 2 is a major discrepancy, quality only. 3 is a major discrepancy, misrepresentation only. | ||
| 46 | movement file # | 0;47 | POINTER | 405 | Current patient movement record associated with this extract record. | |
| 47 | treating specialty | 0;48 | POINTER | 42.4 | The name of the treating specialty associated with this extract record. | |
| 48 | primary care team | 0;49 | FREE TEXT | The primary care team assigned to this patient. | ||
| 49 | primary care provider | 0;50 | FREE TEXT | The primary care provider assigned to this patient. | ||
| 50 | time | 0;51 | FREE TEXT | A 6-character numeric string which represents the Dental procedure time. | ||
| 51 | master patient index | 1;1 | FREE TEXT | A national VA system identifier which uniquely identifies a patient. | ||
| 52 | dss department | 1;2 | FREE TEXT | The DSS Department Code for the Dental product. This field is currently not populated. | ||
| 53 | provider npi | 1;3 | FREE TEXT | The Provider's National Provider Identifier code. | ||
| 54 | pc provider npi | 1;4 | FREE TEXT | The Primary Care Provider's National Provider Identifier code. | ||
| 55 | pc provider person class | 1;5 | FREE TEXT | The VA Code of the Person Class of the Primary Care Provider associated with this record. | ||
| 56 | associate pc provider | 1;6 | FREE TEXT | This is a reference to the NEW PERSON file (#200) for the provider who is the patients Associate Provider for Primary Care as assigned with the PCMM application. The IEN to file #200 is prefixed with the character 2. | ||
| 57 | assoc. pc prov. person class | 1;7 | FREE TEXT | The field will hold the VA Code associated with the active Person Class of the Associate Primary Care Provider as assigned by through the PCMM appilcation. The VA Code is always of the form "V"_six numeric digits; exactly 7 characters in length. | ||
| 58 | associate pc provider npi | 1;8 | FREE TEXT | The Associate Primary Care PRovider's National Provider Identifier. | ||
| 59 | dom,prrtp and saartp indicator | 1;9 | FREE TEXT | DOM, PRRTP and SAARTP Indicator indicates if the patient is admitted to either a DOM, PRRTP or SAARTP at the time hospital service is provided. Domiciliary (DOM) Psychiatric Residential Rehabilitation Treatment Program (PRRTP) Substance Abuse Residential Rehabiltation Treatment Program (SARRTP) | ||
| 60 | observation patient indicator | 1;10 | FREE TEXT | This field is derived from the inpatient/outpatient status, treating specialty, and DSS Identifier or feeder key values in the record. | ||
| 61 | encounter number | 1;11 | FREE TEXT | This field is derived from the inpatient/outpatient status, SSN, admit/visit date, treating specialty, observation patient indicator, and DSS Identifier or feeder key values in the record. | ||
| 62 | production division code | 1;12 | FREE TEXT | Data represents the medical center division the work was performed in. This field corresponds to an entry in the INSTITUTION file (#4). |
Not Referenced