source: WorldVistAEHR/trunk/r/INTEGRATED_BILLING-IB-PRQ--IBD--IBQ--PRQS/IBCBB2.m@ 619

IBCBB2  ;ALB/ARH - CONTINUATION OF EDIT CHECKS ROUTINE (CMS-1500) ;04/14/92
        ;;2.0;INTEGRATED BILLING;**51,137,210,245,232,296,320,349,371**;21-MAR-94;Build 57
        ;;Per VHA Directive 2004-038, this routine should not be modified.
        ;
        ;MAP TO DGCRBB2
        ;
EN      ;
        N IBI,IBJ,IBN,IBY,IBDX,IBDXO,IBDXL,IBCPT,IBCPTL,IBOLAB,Z,IBXSAVE,IBLOC,IBTX,IBPS,IBSP,IBLCT,IBNVFLG,IBU3
        I '$D(IBER) S IBER=""
        S IBTX=$$TXMT^IBCEF4(IBIFN)
        ;
        ; Max 4 modifiers per CPT code allowed before warning
        K IBXDATA
        D F^IBCEF("N-HCFA 1500 MODIFIERS",,,IBIFN) ;Get modifiers
        ;
        S Z=0 F  S Z=$O(IBZPRC92(Z)) Q:'Z  I $P(IBZPRC92(Z),U)["ICPT(",$L($P(IBZPRC92(Z),U,15),",")>4 S IBI="Proc "_$$PRCD^IBCEF1($P(IBZPRC92(Z),U))_" has > 4 modifiers - only first 4 will be used" D WARN^IBCBB11(IBI)
        ; ICD-9 diagnosis, at least 1 required
        D SET^IBCSC4D(IBIFN,.IBDX,.IBDXO) I '$P(IBDX,U,2) S IBER=IBER_"IB071;"
        S IBI=$O(IBDXO(0))
        I IBI,$$INPAT^IBCEF(IBIFN,1),$E($$ICD9^IBACSV(+$P(IBDXO(IBI),U)))="V" S Z="Principal Dx V-code may not be valid" D WARN^IBCBB11(Z)
        ;
        ; CPT procs must be associated with a dx, must have a defined provider
        S (IBLOC,IBN,IBI,IBY)=0 F  S IBI=$O(^DGCR(399,IBIFN,"CP",IBI)) Q:IBI'?1N.N  S IBCPT=^(IBI,0) D  I +IBY S IBN=1
        . I 'IBLOC,$P(IBCPT,U,15)'="",IBTX S Z="At least 1 charge has local box 24K data that will not be transmitted - " S IBLOC=1 D WARN^IBCBB11(Z) S Z="  This data will only print locally" D WARN^IBCBB11(Z)
        . I $P(IBCPT,U)'["ICPT(" S:IBER'["IB092" IBER=IBER_"IB092;" Q
        . S IBY=1 F IBJ=11:1:14 I +$P(IBCPT,"^",IBJ) S IBCPTL(+$P(IBCPT,"^",IBJ))="",IBY=0
        I +IBN S IBER=IBER_"IB072;"
        ;
        I '$$OCC10(IBIFN,.IBDX,2) S IBER=IBER_"IB093;"
        ; CMS-1500: dxs associated with procs must be defined dxs for the bill
        S IBI=0 F  S IBI=$O(IBDX(IBI))  Q:'IBI  S IBDXL(IBDX(IBI))=""
        S (IBN,IBI)=0 F  S IBI=$O(IBCPTL(IBI)) Q:'IBI  I '$D(IBDXL(IBI)) S IBN=1 Q
        I +IBN S IBER=IBER_"IB073;"
        ; ejk *296* Change # of diagnoses codes from 4 to 8 on CMS-1500 Claims. 
        I IBTX S IBI=8 F  S IBI=$O(IBDXO(IBI)) Q:'IBI  S Z=+$G(IBDX(+$G(IBDXO(IBI)))) I Z,$D(IBCPTL(Z)) D WARN^IBCBB11("Too many diagnoses for claim & will be rejected - consider printing locally")
        ;
        I $$WNRBILL^IBEFUNC(IBIFN),$$MRATYPE^IBEFUNC(IBIFN)'="B" S IBER=IBER_"IB087;"
        ;
        ; IB*320 - CLIA# error/warning - error msg for MRA claims, else warning
        I $P(IBNDU2,U,13)="",$$CLIAREQ^IBCEP8A(IBIFN) D
        . I $$REQMRA^IBEFUNC(IBIFN) S IBER=IBER_"IB235;" Q
        . D WARN^IBCBB11("Claim contains laboratory services. The payer may require a CLIA #.")
        . Q
        ;
        ; Only one occurrence code can be present for event date for box 14
        S Z=$$EVENT^IBCF22(IBIFN,.IBXSAVE,.IBI)
        I IBI S IBER=IBER_"IB099;"
        ;
        ; esg - 6/6/07 - warning if missing non-VA care type for outside facility
        S IBNVFLG=0
        I $P(IBNDU2,U,10),'$P(IBNDU2,U,11) D WARN^IBCBB11("Non-VA facility indicated, but the Non-VA Care Type field is not defined") S IBNVFLG=1
        ;
        ; unit/charge limits
        K IBXDATA
        D F^IBCEF("N-HCFA 1500 SERVICES (PRINT)",,,IBIFN) ;Get charge lines
        S (IBLCT,IBOLAB)=0,IBPS="",IBSP=$$BILLSPEC^IBCEU3(IBIFN)
        S IBI=0 F  S IBI=$O(IBXDATA(IBI)) Q:'IBI  D  Q:IBER["IB310"!(IBER["IB311")
        . S IBLCT=IBLCT+1
        . I $P(IBNDU2,U,11) D
        .. I '$P(IBXDATA(IBI),U,11) S IBPS=IBPS_$S(IBPS'="":",",1:"")_IBI Q
        .. I $P(IBXDATA(IBI),U,14),"24"'[$P(IBNDU2,U,11) D WARN^IBCBB11("Outside lab charges exist on a non-lab NON-VA bill")
        . I '$P(IBNDU2,U,11),$P(IBXDATA(IBI),U,11) D WARN^IBCBB11("Purchased service amounts are invalid unless this is a NON-VA bill")
        . I IBNVFLG,'$P(IBXDATA(IBI),U,11) D WARN^IBCBB11("Non-VA facility indicated, but no purchased service charge on line# "_IBI)
        . I $D(IBXDATA(IBI,"A")) S IBER=IBER_"IB310;" Q
        . I $D(IBXDATA(IBI,"ARX")),IBER'["311;" S IBER=IBER_"IB311;" Q
        . I $P(IBXDATA(IBI),U,14) S IBOLAB=IBOLAB+1
        . ; Place of service required
        . I $G(IBER)'["IB314;",$P(IBXDATA(IBI),U,3)="" S IBER=IBER_"IB314;"
        . ; Type of service required
        . I $G(IBER)'["IB313;",$P(IBXDATA(IBI),U,4)="" S IBER=IBER_"IB313;"
        . ; 43 and 53 are invalid types of service
        . I $G(IBER)'["IB110;",($P(IBXDATA(IBI),U,4)=43!($P(IBXDATA(IBI),U,4)=53)) S IBER=IBER_"IB110;"
        . ; Units for the line item must be less than 100/1000
        . I IBER'["IB088",$P(IBXDATA(IBI),U,9)'<100 D
        .. I $P(IBXDATA(IBI),U,4)'=7 S IBER=IBER_"IB088;" Q
        .. I $P(IBXDATA(IBI),U,9)'<1000 S IBER=IBER_"IB088;"
        . ; Line item total charge must be less than $10,000.00, greater than 0
        . I IBER'["IB090",$P(IBXDATA(IBI),U,9)'<10000 S IBER=IBER_"IB090;"
        . I '($P(IBXDATA(IBI),U,9)*$P(IBXDATA(IBI),U,8)),$$COBN^IBCEF(IBIFN)'>1 S Z="Procedure "_$P(IBXDATA(IBI),U,5)_" has a 0-charge and will not be transmitted" D WARN^IBCBB11(Z)
        I IBTX,IBLCT>50 D
        . I '$$REQMRA^IBEFUNC(IBIFN) S IBER=IBER_"IB308;" Q
        . I '$P(IBNDTX,U,9) S IBER=IBER_"IB325;"
        S IBU3=$P($G(^DGCR(399,IBIFN,"U3")),U,4,7) I $TR(IBU3,U)'="" D
        .I +IBSP'=35 D WARN^IBCBB11("Chiropractic service details only valid if provider specialty is '35'")
        .I $P(IBU3,U,2)="" S IBER=IBER_"IB137;"
        .I $P(IBU3,U,4)="" S IBER=IBER_"IB138;" Q
        .I $P(IBU3,U,3)="","AM"[$P(IBU3,U,4) S IBER=IBER_"IB139;"
        .Q
        I IBPS'="" D WARN^IBCBB11("NON-VA facility indicated, but no purchased service charge on line item"_$S(IBPS[",":"s",1:"")_" #"_IBPS)
        I $P(IBNDU2,U,11),$P(IBNDU2,U,11)=4,IBOLAB>1 D WARN^IBCBB11("For proper payment, you must bill each outside lab on a separate claim form")
        K IBXDATA
        ;
        ;       ; Check for Physician Name
        D F^IBCEF("N-REFERRING PROVIDER NAME",,,IBIFN)
        I $P($G(IBXDATA),U)]"" D
        .N IBZ,FUNCTION,IBINS
        .S FUNCTION=1
        .F IBINS=1:1:3 D
        .. S Z=$$GETTYP^IBCEP2A(IBIFN,IBINS,FUNCTION)
        .. I Z,$P(Z,U,2) D  ; Rendering/attending prov secondary id required
        ... N IBID,IBOK,Q0
        ... D PROVINF^IBCEF74(IBIFN,IBINS,.IBID,1,"C")  ; check all as though they were current
        ... S IBOK=0
        ... S Q0=0 F  S Q0=$O(IBID(1,FUNCTION,Q0)) Q:'Q0  I $P(IBID(1,FUNCTION,Q0),U,9)=+Z S IBOK=1 Q
        ... I 'IBOK S IBER=IBER_$S(IBINS=1:"IB239;",IBINS=2:"IB240;",IBINS=3:"IB241;",1:"")
        ;
        Q
        ;
OCC10(IBIFN,IBARR,IBFT) ; Determine if occurrence code 10 exists for pregnancy dx
        ; IBARR=array subscripted by ien of DX code if IBFT=2 (CMS-1500 form)
        ;                         by seq # and = ien of DX code if IBFT'=2
        ;
        N IBN,IBI,IBXDATA,IBXSAVE,IBDX,Z
        S IBN=1
        ;
        I '$D(^TMP($J,"LMD")) D
        . D F^IBCEF("N-OCCURRENCE CODES",,,IBIFN)
        . S ^TMP($J,"LMD")=""
        . S Z=0 F  S Z=$O(IBXSAVE("OCC",Z)) Q:'Z  I +IBXSAVE("OCC",Z)=10 S ^TMP($J,"LMD")=1 Q
        ;
        I '^TMP($J,"LMD") S IBI=0 F  S IBI=$O(IBARR(IBI))  Q:'IBI  D  Q:'IBN
        . N Z,Z1
        . ; If a pregnancy DX exists, must be an occurrence code 10 for LMP date
        . ; dx ranges are: V22*-V24*, V27*-V28*, 630*-677*
        . S IBDX=$S($G(IBFT)'=2:+IBARR(IBI),1:IBI)
        . S Z=$E($P($$ICD9^IBACSV(IBDX),U),1,3),Z1=$E(Z,2,3)
        . I $S(Z'<630&(Z<678):1,$E(Z)="V":$S(Z1'<22&(Z1<25):1,1:Z1'<27&(Z1<28)),1:0) S IBN=0 ;Pregnancy Dx exists
        ;
OCC10Q  K ^TMP($J,"LMD")
        Q IBN
        ;