# | 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 | This is the facility/division where the extract was performed. | ||
4 | patient no. dfn(+) | 0;5 | POINTER | 2 | This is the patient to whom this extract record pertains. | |
5 | ssn(+) | 0;6 | FREE TEXT | The patient's Social Security Number. | ||
6 | name | 0;7 | FREE TEXT | The first four characters of the patient's last name. | ||
7 | in outpatient indicator | 0;8 | SET OF CODES | I:INPATIENT O:OUTPATIENT | Indicates whether the patient was an inpatient or an outpatient for this extract. | |
8 | date of service(+) | 0;9 | FREE TEXT | Date on which the new or repaired prosthetic appliance was delivered and accepted by the patient. | ||
9 | feeder location(+) | 0;10 | FREE TEXT | Location within a facility where the product is produced. | ||
10 | feeder key(+) | 0;11 | FREE TEXT | Code that uniquely identifies a DSS product. | ||
11 | quantity | 0;12 | NUMERIC | The number of units issued or units repaired as indicated in the patient's prosthetic record. | ||
12 | primary care team | 0;13 | FREE TEXT | The IEN of the primary care team assigned to this patient in the PCMM module. | ||
13 | primary care provider | 0;14 | FREE TEXT | The primary care provider assigned to this patient through the Primary Care Management Module (PCMM) application. | ||
14 | pce cpt/hcpcs code & modifiers(+) | 0;15 | FREE TEXT | HCPCS code for the item selected. | ||
15 | icd-9 code | 0;16 | FREE TEXT | ICD-9 CODE is the diagnostic code for the patient's prosthetic record. | ||
16 | secondary icd-9 code 1 | 0;17 | FREE TEXT | This field contains the ICD9 diagnostic code for this extract record. | ||
17 | secondary icd-9 code 2 | 0;18 | FREE TEXT | This field contains the ICD9 diagnostic code for this extract record. | ||
18 | secondary icd-9 code 3 | 0;19 | FREE TEXT | This field contains the ICD9 diagnostic code for this extract record. | ||
19 | secondary icd-9 code 4 | 0;20 | FREE TEXT | This field contains the ICD9 diagnostic code for this extract record. | ||
20 | agent orange status | 0;21 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates whether patient was exposed to Agent Orange. | |
21 | radiation exposure status | 0;22 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates if patient claims exposure to ionizing radiation. | |
22 | sw asia conditions | 0;23 | SET OF CODES | Y:YES N:NO U:UNKNOWN | This field is used to indicate if patient claims exposure to Southwest Asia Conditions. | |
23 | patient eligibility | 0;24 | FREE TEXT | PATIENT ELIGIBILITY is the patient's primary eligibility code. | ||
24 | cost of transaction | 0;25 | FREE TEXT | Cost to produce the prosthetic. | ||
25 | lab labor cost | 0;26 | FREE TEXT | The total cost of labor to perform the job. | ||
26 | lab material cost | 0;27 | FREE TEXT | The cost of all materials required to perform the job. | ||
27 | billing status | 0;28 | SET OF CODES | 1:SC/OP (Service Connected Outpatient) 2:SC/IP (Service Connected Inpatient) 3:NSC/IP (Non Service Connected Inpatient) 4:NSC/OP (Non Service Connected Outpatient) 5:Other (Patient Category unknown) | Patient's billing status. | |
28 | vet/non vet | 0;29 | SET OF CODES | Y:Patient is a veteran N:Patient is not a veteran | Patient's veteran status. | |
29 | type of transaction | 0;30 | SET OF CODES | I:Initial issue R:Replacement S:Spare X:Repair 5:Rental | The code that best describes the prosthetic transaction. | |
30 | requesting station | 0;31 | FREE TEXT | The facility that initiates the request for a Lab prosthetic. | ||
31 | receiving station | 0;32 | FREE TEXT | The Lab facility that fills the Lab request and provides the prosthetic to the requesting station. | ||
32 | psas hcpcs code | 0;33 | FREE TEXT | This field is used to hold the PSAS HCPCS Code from the Prosthetics record being extracted. | ||
33 | zip code | 1;1 | FREE TEXT | The ZIP code for where the patient resides. The 5-character ZIP code is provided if ZIP+4 is not available. | ||
34 | date of birth | 1;2 | FREE TEXT | Patient's date of birth. | ||
35 | sex | 1;3 | SET OF CODES | M:MALE F:FEMALE | Patient's gender. | |
36 | amis grouper | 1;4 | NUMERIC | AMIS GROUPER holds the AMIS Grouper number that indicates what items combine to create a prosthetic device. | ||
37 | placeholder | 1;5 | FREE TEXT | Currently NULL. | ||
38 | master patient index | 1;6 | FREE TEXT | Unique national VA patient identifier. | ||
39 | dss product department | 1;7 | FREE TEXT | The nationally defined DSS Intermediate Department Number designated to the patient care product being provided. | ||
40 | pc provider person class | 1;8 | FREE TEXT | The VA Code of the Person Class of the Primary Care Provider as of the date of this extract record. | ||
41 | race | 1;9 | FREE TEXT | Race ABBREVIATION for this patient. | ||
42 | pow status | 1;10 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates if patient was confined as a Prisoner of War. | |
43 | pow location | 1;11 | FREE TEXT | If POW Status is indicated, then this is the POW confinement location/period. 1 WORLD WAR I 2 WORLD WAR II - EUROPE 3 WORLD WAR II - PACIFIC 4 KOREAN 5 VIETNAM 6 OTHER | ||
44 | sharing agreement payor | 1;12 | FREE TEXT | An indicator used for patients participating in sharing agreements. | ||
45 | sharing agreement insurance | 1;13 | POINTER | 36 | Indicates the first insurer for patients who participate in sharing agreements. | |
46 | mst status | 1;14 | SET OF CODES | Y:Yes, screened reports MST N:Screened, does not report MST D:Screened, declines to answer U:Unknown, not screened | Indicates the Military Sexual Trauma (MST) status of a patient on the date of the encounter. | |
47 | enrollment location | 1;15 | FREE TEXT | The facility that the patient chooses to designate as his preferred location for care. | ||
48 | state | 1;16 | FREE TEXT | The state in which the patient resides. | ||
49 | county | 1;17 | FREE TEXT | The county in which the patient resides. | ||
50 | associate pc provider | 1;18 | FREE TEXT | The Associate Primary Care Provider assigned to this patient through the Primary Care Management Module (PCMM) application. | ||
51 | assoc. pc prov. person class | 1;19 | FREE TEXT | VA Code of the Person Class of the patient's Associate Primary Care Provider. | ||
52 | placeholder | 1;20 | FREE TEXT | Currently NULL. | ||
53 | dom,prrtp and saartp indicator | 1;21 | SET OF CODES | P:GEN. PRRTP T:PTSD PRRTP S:DOM. PRRTP H:HOMELESS CWT/TR A:SA CWT/TR D:DOMICILIARY B:PTSD CWT/TR C:GEN. CET/TR | Indicates if the patient is admitted to either a RRTP, PRRTP or SARRTP at the time care is provided. | |
54 | enrollment category | 1;22 | FREE TEXT | Patient's enrollment category. | ||
55 | enrollment status | 1;23 | POINTER | 27.15 | Patient's enrollment status. | |
56 | placeholder | 1;24 | FREE TEXT | |||
57 | purple heart indicator | 1;25 | BOOLEAN | Y:YES N:NO | Indicates whether or not a patient is a Purple Heart recipient. | |
58 | period of service | 1;26 | FREE TEXT | The period of service that best classifies the patient based on eligibility code. | ||
59 | observation patient indicator | 1;27 | SET OF CODES | NO:NO YES:YES | Indicates if patient is considered to be an observation patient. | |
60 | encounter number | 1;28 | FREE TEXT | The unique number assigned for DSS. | ||
61 | agent orange location | 1;29 | FREE TEXT | Indicates the location where the patient was exposed to Agent Orange. | ||
62 | cnh status | 1;30 | SET OF CODES | YES:YES NO:NO | This field is used to indicate whether a patient is currently in a contract nursing home. | |
63 | production division code | 1;31 | FREE TEXT | Identifies the division/facility where the work was performed. | ||
64 | head & neck cancer indicator | 1;32 | BOOLEAN | Y:YES N:NO | Indicates whether patient has head and/or neck cancer. | |
65 | ethnicity | 1;33 | FREE TEXT | The patient's PTF Ethnicity code. | ||
66 | race 1 | 1;34 | FREE TEXT | Self-reported by patient as recorded in VistA patient file. | ||
67 | dss ip # | 1;35 | NUMERIC | The nationally defined DSS Intermediate Product Number designated to the patient care product. | ||
68 | enrollment priority | 1;36 | FREE TEXT | This field contains the enrollment priority group and the enrollment priority subgroup. | ||
69 | user enrollee | 1;37 | SET OF CODES | U:USER ENROLLED | Indicates whether a Veteran has User Enrollee status for the current or future fiscal year. | |
70 | patient type | 1;38 | SET OF CODES | AC:ACTIVE DUTY AL:ALLIED VETERAN CO:COLLATERAL EM:EMPLOYEE IN:INELIGIBLE MI:MILITARY RETIREE NO:NON-VETERAN (OTHER) NS:NSC VETERAN SC:SC VETERAN TR:TRICARE | Refers to the various types of patient which may be seen at a VA facility. Every patient in the system must have a TYPE specified. | |
71 | cv status eligibility | 1;39 | SET OF CODES | Y:YES E:ELIGIBILITY EXPIRED | Records if veteran served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | |
72 | cv eligibility end date | 1;40 | FREE TEXT | Records the Combat Veteran eligibility expiration date of veteran who served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | ||
73 | encounter cv | 1;41 | BOOLEAN | Y:YES | Records is veteran served on active duty in a theater of combat operations during a period of war after the Persian Gulf War or in combat against a hostile force during a period of hostilities after November 11, 1998. | |
74 | national patient record flag | 1;42 | BOOLEAN | Y:YES | This field records whether the patient's record contains 1 or more active category 1 (National) Patient Record Flags. | |
75 | eri | 1;43 | FREE TEXT | This field identifies patients from impacted zip code areas designated by the Federal Emergency Management Agency (FEMA). | ||
76 | agent orange enc indicator | 1;44 | BOOLEAN | Y:YES N:NO | Indicates whether service provided during this patient encounter is related to exposure to Agent Orange. | |
77 | encounter swac | 1;45 | BOOLEAN | Y:YES N:NO | This field indicates whether treatment provided during this patient encounter is related to exposure to Southwest Asia conditions while serving in the Southwest Asia Theater of operations. | |
78 | enc head/neck ca | 1;46 | BOOLEAN | Y:YES N:NO | Indicates whether service provided during this patient encounter is related to head and/or neck cancer. | |
79 | encounter mst | 1;47 | BOOLEAN | Y:YES N:NO | Indicates whether service provided during this patient encounter is related to military sexual trauma. | |
80 | radiation encounter indicator | 1;48 | BOOLEAN | Y:YES N:NO | Indicates whether service provided during this patient encounter is related to ionizing radiation. | |
81 | oef/oif | 2;1 | FREE TEXT | The Military Operation in which the patient was in combat during the specified time period. This field reflects the OEF or OIF where this patient was in combat. | ||
82 | oef/oif return date | 2;2 | FREE TEXT | The date the patient left the OEF/OIF area, if known. Otherwise, it is the end date of military pay for this OEF/OIF deployment. | ||
83 | nppd code | 2;3 | FREE TEXT | The National Prosthetics Product Database (NPPD) report line number to which the HCPCS are assigned. | ||
84 | nppd entry date | 2;4 | FREE TEXT | The date the entry was first made in the VistA Prosthetics Package. | ||
85 | associate pc provider npi | 2;5 | FREE TEXT | A standard unique life-long identifier of the associate primary care provider. This field has a length of fifteen characters. | ||
86 | primary care provider npi | 2;6 | FREE TEXT | A standard unique life-long identifier of the primary care provider. This field has a length of fifteen characters. | ||
87 | country code | 2;7 | FREE TEXT | The code for the country associated with the address. | ||
88 | shad status | 2;8 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates whether patient meets requirements for Shipboard Hazard and Defense (SHAD). | |
89 | encounter shad | 2;9 | BOOLEAN | Y:YES N:NO | Indicates if treatment provided during this patient encounter is related to exposure PROJ 112/SHAD condition. Values: Y=YES, N=NO | |
90 | labor hours | 2;10 | NUMERIC | This is the number of hours spent on the job. | ||
91 | patcat | 2;11 | SET OF CODES | AD:Active Duty ADD:Active Duty Dependent FNRS:Former Non-Remarried Spouse RET:Retired RETD:Retiree Dependent RES:Reservist REC:Recruit TDRL:Temporary Disability TFL:TRICARE for Life | This is the Patient's category which will be used for FHCC (Federal Health Care Center) Reconciliation. DSS must capture and report DoD patients so that the FHCC reconciliation process can function as designed. "Reconciliation" is the process used within the new FHCC to determine which patients DoD pays for and which VA pays for. | |
92 | primary icd-10 code | 2;12 | FREE TEXT | The primary ICD-10 code for the procedure performed. Not available in PRO extract. | ||
93 | secondary icd-10 code #1 | 2;13 | FREE TEXT | The first secondary ICD-10 code for the procedure performed. Not available in PRO extract. | ||
94 | secondary icd-10 code #2 | 2;14 | FREE TEXT | The second secondary ICD-10 code for the procedure performed. Not available in PRO extract. | ||
95 | secondary icd-10 code #3 | 2;15 | FREE TEXT | The third secondary ICD-10 code for the procedure performed. Not available in PRO extract. | ||
96 | secondary icd-10 code #4 | 2;16 | FREE TEXT | The fourth secondary ICD-10 code for the procedure performed. Not available in PRO extract. | ||
97 | encounter sc | 2;17 | BOOLEAN | Y:YES N:NO | Indicates if treatment provided during this patient encounter is Service Connected. | |
98 | vietnam | 2;18 | SET OF CODES | Y:YES N:NO U:UNKNOWN | Indicates if patient is a Vietnam era veteran. | |
99 | camp lejeune status | 2;19 | BOOLEAN | Y:YES N:NO | Indicates if patient was exposed to contaminated water while stationed at Camp Lejeune, NC between January 1, 1957 and December 31, 1987. | |
100 | encounter camp lejeune | 2;20 | BOOLEAN | Y:YES N:NO | Indicates if episode of care is related to exposure to contaminated water while stationed at Camp Lejeune, NC between January 1, 1957 and December 31, 1987. | |
101 | combat veteran indicator | 2;21 | BOOLEAN | Y:YES N:NO | Identifies if the patient served in a combat zone. | |
102 | combat veteran location | 2;22 | FREE TEXT | Identifies the war in which the combat service was incurred. | ||
103 | form requested on | 2;23 | FREE TEXT | Identifies which form was used to enter a prosthetics request. |
Not Referenced