source: FOIAVistA/tag/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCEU3.m@ 628

Last change on this file since 628 was 628, checked in by George Lilly, 14 years ago

initial load of FOIAVistA 6/30/08 version
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1IBCEU3 ;ALB/TMP - EDI UTILITIES FOR 1500 CLAIM FORM ;12/29/05 9:58am
2 ;;2.0;INTEGRATED BILLING;**51,137,155,323,348,371**;21-MAR-94;Build 57
3 ;;Per VHA Directive 2004-038, this routine should not be modified.
4 ;
5BOX19(IBIFN) ; Returns the text that should print in box 19 of the CMS-1500
6 ; for bill ien IBIFN
7 ; Data is derived from a combo of data throughout
8 ; the system and is limited to 80 characters. The hierarchy for
9 ; including data is as follows (until 80 characters have been used):
10 ; DATE LAST SEEN and REFERRING PHYSICIAN ID# (physical therapy)
11 ; specialty codes = 025,065,073,067,048
12 ; LAST X-RAY DATE (chiropractic) specialty code = 35
13 ; HOMEBOUND INDICATOR (independent lab renders an EKG or obtains
14 ; a specimen from a homebound patient)
15 ; NO ASSIGNMENT OF BENEFITS (if no assignment of benefits indicated)
16 ; Hearing aid testing (if applicable)
17 ; ATTENDING PHYSICIAN NOT HOSPICE EMPLOYEE (if applicable)
18 ; SPECIAL PROGRAM indicator if Medicare demonstration project for
19 ; lung volume reduction surgery study is set
20 ; COMMENTS FOUND IN BOX 19 DATA FIELD FOR THE CLAIM
21 ; REMARKS FOUND IN BILL COMMENT FOR THE CLAIM, INCLUDING PROSTHETICS
22 ; DETAIL
23 ;
24 N IBGO,IBHOSP,IBID,IBLSDT,IBXDATA,IB19,IBHAID,IBXRAY,IBSPEC,Z,Z0,IBSUB,IBPRT,IBREM
25 S IB19="",IBGO=1
26 S IBSUB=$S('$G(^TMP("IBTX",$J,IBIFN)):"BOX24",1:"OUTPT")
27 I $D(IBXSAVE(IBSUB)) N IBXSAVE
28 S IBPRT=(IBSUB["24")
29 ;
30 S IBSPEC=$$BILLSPEC(IBIFN)
31 G:'IBPRT NPRT
32 ; Check for chiropractic services
33 I $P($G(^DGCR(399,IBIFN,"U3")),U,5)'="" S:$P($G(^DGCR(399,IBIFN,"U3")),U,4)'="" IBGO=$$LENOK("Last X-ray: "_$TR($$DATE^IBCF2($P(^DGCR(399,IBIFN,"U3"),U,4))," ","/"),.IB19)
34 G:'IBGO BOX19Q
35 ;
36 I "^25^65^73^67^48^"[(U_IBSPEC_U) D
37 . K IBXDATA D F^IBCEF("N-DATE LAST SEEN",,,IBIFN)
38 . I IBXDATA'="" S IBID="",IBLSDT=$$DATE^IBCF2(IBXDATA,0,1) D I IBLSDT'="" S IBGO=$$LENOK("Date Last Seen:"_IBLSDT_IBID,.IB19)
39 .. ; Only print if specialty is OT or PT or proc for routine foot care
40 .. D F^IBCEF("N-REFERRING PROVIDER ID",,,IBIFN) I IBXDATA'="" S IBID=" By:"_IBXDATA
41 ;
42 G:'IBGO BOX19Q
43 K IBXDATA D F^IBCEF("N-HOMEBOUND",,,IBIFN)
44 I IBXDATA G:'$$LENOK("Homebound",.IB19) BOX19Q
45 ;
46 K IBXDATA D F^IBCEF("N-ASSIGN OF BENEFITS INDICATOR",,,IBIFN)
47 I "Nn0"[IBXDATA&(IBXDATA'="") G:'$$LENOK("Patient refuses to assign benefits",.IB19) BOX19Q
48 ;
49 I '$D(IBXSAVE(IBSUB)) D B24^IBCEF3(.IBXSAVE,IBIFN,$S($G(IBNOSHOW)=0:0,1:1))
50 ;
51 S (IBHAID,IBHOSP,IBXRAY)=0
52 ;
53 S Z=0 F S Z=$O(IBXSAVE(IBSUB,Z)) Q:'Z D G:'IBGO BOX19Q
54 . I $D(IBXSAVE(IBSUB,Z,"RX")),$P(IBXSAVE(IBSUB,Z,"RX"),U,3)="" S IBGO=$$LENOK("NOC Drug:"_$P(IBXSAVE(IBSUB,Z,"RX"),U,2)_" Units:"_+$P(IBXSAVE(IBSUB,Z,"RX"),U,6),.IB19)
55 . ;
56 . Q:'IBGO
57 . I 'IBHAID,$P(IBXSAVE(IBSUB,Z),U,5)="V5010",$$COBCT^IBCEF(IBIFN)>1 D Q
58 .. S IBHAID=1,IBGO=$$LENOK("Testing for hearing aid",.IB19) Q
59 . ;
60 . Q:'IBGO
61 . I 'IBHOSP,$P($G(IBXSAVE(IBSUB,Z,"AUX")),U,3) S IBHOSP=1,IBGO=$$LENOK("Attending physician,not hospice employee",.IB19) Q
62 G:'IBGO BOX19Q
63 K IBXDATA D F^IBCEF("N-SPECIAL PROGRAM",,,IBIFN)
64 I IBXDATA=30 G:'$$LENOK("Medicare demonstration project for lung volume reduction surgery study",.IB19) BOX19Q
65 ;
66 G:'IBGO BOX19Q
67NPRT K IBXDATA D F^IBCEF("N-HCFA 1500 BOX 19 RAW DATA",,,IBIFN)
68 S IBREM=0
69 I IBXDATA'="" G:'$$LENOK("Remarks:"_IBXDATA,.IB19) BOX19Q S IBREM=1
70 K IBXDATA D F^IBCEF("N-BILL REMARKS",,,IBIFN)
71 I IBXDATA'="" G:'$$LENOK($S('IBREM:"Remarks:",1:"")_IBXDATA,.IB19) BOX19Q
72 ;
73BOX19Q Q IB19
74 ;
75LENOK(IBDATA,IB19) ; Add text IBDATA to box 19 string (IB19 passed by ref)
76 ; Check length of box 19 data - truncate at 96 (max length)
77 ; Returns 0 if max length reached or exceeded, otherwise, 1
78 N OK
79 S OK=1
80 S IB19=IB19_$S(IB19'="":" ",1:"")_$G(IBDATA)
81 I $L(IB19)'<96 S OK=0,IB19=$E(IB19,1,96) G LENOKQ
82LENOKQ Q OK
83 ;
84ASK19(IBIFN) ; Ask to display CMS-1500 box 19 data for current IBIFN
85 N DIR,DIC,X,Y,DIE,DR,Z
86 S DIR(0)="YA",DIR("B")="NO",DIR("A")="DISPLAY THE FULL CMS-1500 BOX 19?: "
87 D ^DIR
88 I Y=1 S Z=$$BOX19(IBIFN) W !!,?4,"19",?20,$E(Z,1,32) W:$L(Z)>32 !,?4,$E(Z,33,80),!
89 Q
90 ;
91ONLAB(IBIFN) ; Functions returns 1 if the bill IBIFN is outside non-lab
92 N IBP,IBPUR
93 S IBP=0
94 S IBPUR=$P($G(^DGCR(399,IBIFN,"U2")),U,11)
95 I IBPUR,"13"[IBPUR S IBP=1
96 Q IBP
97 ;
98TEXT24(FLD,IBXSAVE,IBXDATA,IBSUB) ; Format the text line of box 24 by fld
99 ; INPUT:
100 ; FLD = the letter of the field in box 24 (A-J)
101 ; IBXSAVE = passed by reference = extracted data for the box 24 lines
102 ; IBSUB = the subscript of the IBXSAVE array to use.
103 ; If null, use "BOX24"
104 ; OUTPUT:
105 ; IBXDATA = passed by reference, set to the correct part of the
106 ; text that will print in the field's positions
107 ;
108 ; esg - 8/14/06 - modified for the new cms-1500 form - IB*2*348
109 ;
110 N Z,IBLINE,IBVAL,IBS,IBE,IBTEXT,IBAUX,IBDAT,IBZ,IBREN,IBRENQ,IBRENNPI,IBRENSID
111 K IBXDATA
112 S (IBLINE,Z)=0 S:$G(IBSUB)="" IBSUB="BOX24"
113 ;
114 I FLD="I"!(FLD="J") D ; extract the Rendering provider data
115 . I '$G(IBXIEN) Q ; assume that the claim# exists
116 . S IBREN=$$CFIDS^IBCEF77(IBXIEN)
117 . S IBRENQ=$P(IBREN,U,1) ; qual
118 . S IBRENSID=$P(IBREN,U,2) ; id
119 . S IBRENNPI=$P(IBREN,U,3) ; npi
120 . Q
121 ;
122 F S Z=$O(IBXSAVE(IBSUB,Z)) Q:'Z D
123 . S IBDAT=$G(IBXSAVE(IBSUB,Z))
124 . S IBAUX=$G(IBXSAVE(IBSUB,Z,"AUX"))
125 . S IBTEXT=$G(IBXSAVE(IBSUB,Z,"TEXT"))
126 . S IBZ=$P(IBAUX,U,9)
127 . I IBZ="" S IBZ=" "
128 . S IBTEXT=IBZ_IBTEXT
129 . ;
130 . I $S($G(IBAC)=4:$S($D(IBXSAVE(IBSUB,Z,"ARX")):1,1:$D(IBXSAVE(IBSUB,Z,"A"))),$D(IBXSAVE(IBSUB,Z,"RX")):0,1:$G(IBNOSHOW)) S IBTEXT=""
131 . ;
132 . I FLD="AF" S IBVAL=$P(IBDAT,U),IBS=1,IBE=9 D ; From date of service
133 .. S IBVAL=$E(IBVAL,1,2)_" "_$E(IBVAL,3,4)_" "_$E(IBVAL,7,8)
134 .. Q
135 . ;
136 . I FLD="AT" S IBVAL=$S($P(IBDAT,U,2):$P(IBDAT,U,2),1:$P(IBDAT,U)),IBS=10,IBE=18 D ; To date of service
137 .. S IBVAL=$E(IBVAL,1,2)_" "_$E(IBVAL,3,4)_" "_$E(IBVAL,7,8)
138 .. Q
139 . ;
140 . I FLD="B" S IBVAL=$P(IBDAT,U,3),IBS=19,IBE=21 ; place of service
141 . I FLD="C" S IBVAL=$S($P(IBDAT,U,13)=1:"Y",1:""),IBS=22,IBE=24 ; emergency indicator
142 . I FLD="D" S IBVAL=$P(IBDAT,U,5),IBS=25,IBE=44 D ; procedures and modifiers
143 .. N M S M=$$MODLST^IBEFUNC($P(IBDAT,U,10)) ; modifier list
144 .. S IBVAL=$$FO^IBCNEUT1(IBVAL,6)_" " ; procedure code
145 .. S IBVAL=IBVAL_$$FO^IBCNEUT1($P(M,",",1),3) ; mod#1
146 .. S IBVAL=IBVAL_$$FO^IBCNEUT1($P(M,",",2),3) ; mod#2
147 .. S IBVAL=IBVAL_$$FO^IBCNEUT1($P(M,",",3),3) ; mod#3
148 .. S IBVAL=IBVAL_$$FO^IBCNEUT1($P(M,",",4),3) ; mod#4
149 .. Q
150 . ;
151 . I FLD="E" S IBVAL=$TR($P(IBDAT,U,7),","),IBS=45,IBE=48 ; diagnosis pointer
152 . I FLD="F" S IBVAL=$P(IBDAT,U,8)*$P(IBDAT,U,9),IBS=49,IBE=57 D
153 .. ; total charges
154 .. S IBVAL=$$DOL^IBCEF77(IBVAL,9)
155 .. Q
156 . ;
157 . I FLD="G" S IBVAL=$S($P(IBDAT,U,12):$P(IBDAT,U,12),1:$P(IBDAT,U,9)),IBS=58,IBE=61 D
158 .. ; days or units or anesthesia minutes
159 .. S IBVAL=$J(+IBVAL,4)
160 .. Q
161 . ;
162 . ; columns H,I,J don't have any free text supplemental information
163 . ;
164 . I FLD="H" D ; epsdt family plan
165 .. S IBVAL=$P(IBAUX,U,7),IBS=0,IBE=0,IBTEXT="" ; line 1 blank
166 .. I IBVAL S IBVAL="Y"
167 .. Q
168 . I FLD="I" D ; ID qualifier for rendering provider
169 .. S IBVAL="",IBS=1,IBE=2 ; line 2 blank
170 .. S IBTEXT=$G(IBRENQ) ; qualifier on line 1
171 .. Q
172 . I FLD="J" D ; rendering provider ID and NPI
173 .. S IBTEXT=$G(IBRENSID),IBS=1,IBE=11 ; secondary ID line 1
174 .. S IBVAL=$G(IBRENNPI) ; NPI# line 2
175 .. Q
176 . ;
177 . S IBLINE=IBLINE+1 ; top line
178 . S IBXDATA(IBLINE)=$E(IBTEXT,IBS,IBE) ; text in shaded area (top)
179 . S IBLINE=IBLINE+1 ; bottom line
180 . S IBXDATA(IBLINE)=IBVAL ; field value in unshaded area (bottom)
181 . Q
182 ;
183 Q
184 ;
185BILLSPEC(IBIFN,IBPRV) ; Returns the specialty of the provider on bill IBIFN
186 ; If IBPRV is supplied, returns the data for that provider, otherwise,
187 ; returns the specialty of the 'main/required' provider on the bill.
188 ; Default = 99 if no valid code found
189 ; IBPRV = vp of provider (file 200 or 355.93)
190 N Z,IBSPEC,IBINS,IBDT
191 S IBSPEC="",IBPRV=$G(IBPRV)
192 S IBDT=$P($G(^DGCR(399,+IBIFN,"U")),U,1) ; use statement from date
193 ;
194 I $G(IBPRV) D G SPECQ
195 . S IBSPEC=$$SPEC^IBCEU(IBPRV,IBDT)
196 ;
197 ;Get rendering for professional, attending for institutional,
198 S IBINS=($$FT^IBCEF(IBIFN)=3)
199 D GETPRV^IBCEU(IBIFN,"ALL",.IBPRV)
200 S Z=$S('IBINS:3,1:4)
201 I $G(IBPRV(Z,1))'="" D
202 . I $P(IBPRV(Z,1),U,3) S IBSPEC=$$SPEC^IBCEU($P($G(IBPRV(Z,1)),U,3),IBDT) Q:IBSPEC'=""
203 . S Z0=+$O(^DGCR(399,IBIFN,"PRV","B",Z,0))
204 . I Z0,$P($G(^DGCR(399,IBIFN,"PRV",Z0,0)),U,8)'="" S IBSPEC=$P(^(0),U,8)
205 ;
206SPECQ I IBSPEC="" S IBSPEC="99"
207 Q IBSPEC
208 ;
209CHAMPVA(IBIFN) ; Returns 1 if the bill IBIFN has a CHAMPVA rate type
210 Q $E($P($G(^DGCR(399.3,+$P($G(^DGCR(399,IBIFN,0)),U,7),0)),U),1,7)="CHAMPVA"
211 ;
212FAC(IBIFN) ; Is facility always to print in box 32 for bill ien IBIFN?
213 ; Returns 1 if yes, 0 if no
214 Q $S($P($G(^DGCR(399,IBIFN,"UF2")),U,2):1,1:$P($G(^IBE(350.9,1,2)),U,12))
215 ;
216MCR24K(IBIFN) ;Function returns MEDICARE id# for professional (CMS-1500) box 24k for bill IBIFN if appropriate
217 Q $S($$FT^IBCEF(IBIFN)=2&$$MCRONBIL^IBEFUNC(IBIFN):"V"_$$MCRSPEC^IBCEU4(IBIFN,1)_$P($$SITE^VASITE,U,3),1:"")
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