- ABMDVCK1 ; IHS/ASDST/DMJ - PCC VISIT CHECK - PART 2 ;
- ;;2.6;IHS Third Party Billing System;**2**;NOV 12, 2009
- ;Original;TMD;
- ;
- ; IHS/SD/SDR - v2.6 CSV
- ; IHS/SD/SDR - abm*2.6*2 - 3PMS10003A - modified to call ABMFEAPI
- ;
- ; *********************************************************************
- ;
- VTYP(ABMVDFN,SERVCAT,ABMINS,ABMCLN) ;EP - to get visit type
- ;This is an extrinsic function
- N VTYP
- I 'ABMVDFN Q ""
- ;If visit in dental file type=998, other wise 131
- ;
- VAR ;
- S VTYP=$S($D(^AUPNVDEN("AD",ABMVDFN)):998,1:131)
- S ABM("LOCK")=0
- ;If the visit is in the V hospitalization file set type to 111
- I +$O(^AUPNVINP("AD",ABMVDFN,"")),$D(^AUPNVINP($O(^AUPNVINP("AD",ABMVDFN,"")),0)) S VTYP=111
- ;Begin mods for inpat lt 30 days
- I VTYP=131,SERVCAT="H" S VTYP=111
- ;End mods
- ;If not in hosp file go thru insurance file
- N QUIT
- E I SERVCAT'="S" D
- .;Note that the visit type must be in the insurer file for this to set
- .;the visit type.
- .S QUIT=0
- .S ABM=0
- .F S ABM=$O(^ABMNINS(DUZ(2),ABMINS,1,ABM)) Q:'ABM D Q:QUIT
- ..I ABM=131 Q
- ..Q:'ABMCLN
- ..S D1=0
- ..F S D1=$O(^ABMDVTYP(ABM,1,D1)) Q:'D1 D Q:QUIT
- ...I +^ABMDVTYP(ABM,1,D1,0)=ABMCLN D
- ....S VTYP=ABM
- ....S QUIT=1
- I SERVCAT="S" S VTYP=831
- ;If type is still 131 check to see if it is surgery
- I "A"[SERVCAT,VTYP=131 D OPCK
- I $P($G(^AUTNINS(+ABMINS,2)),U)="R" D
- .S ABMLOC=$P($G(^AUPNVSIT(ABMVDFN,0)),"^",6)
- .Q:$P($G(^ABMDPARM(+ABMLOC,1,5)),U)'=1
- .S VTYP=999
- .K ABMLOC
- Q VTYP
- ;
- ; *********************************************************************
- ;This code is only reached if VTYP=131
- OPCK ;EP for checking if ambulatory surgery
- N C,ASC
- D SURGTAB
- S ABM=0
- F S ABM=$O(^AUPNVPRC("AD",ABMVDFN,ABM)) Q:'ABM D Q:VTYP'=131
- .;What we need to find is if from the ICD code we can determine visit
- .;type.
- .;From the CPT code we should be able to tell if it is surgery
- .;If one of the ASC codes from 1 - 8 exists it should be amb surg
- .;CPT from 10000-70000 is surgery.
- .Q:'$D(^AUPNVPRC(ABM,0))
- .S ABM("CPT")=$O(^ICPT("I",+^AUPNVPRC(ABM,0),""))
- .Q:'ABM("CPT")
- .S ASC=$P($$IHSCPT^ABMCVAPI(ABM("CPT"),ABMP("VDT")),U,6) ;CSV-c
- .I ASC>0,ASC<9 D OPSURG
- .Q
- Q
- ;
- ; *********************************************************************
- OPSURG ;
- ;I $D(^ABMNINS(DUZ(2),ABMINS,1,831,0)),+$P(^(0),U,5),'+$P($G(^ABMDFEE($P(^(0),U,5),11,ABM("CPT"),0)),U,2) Q ;abm*2.6*2 3PMS10003A
- I $D(^ABMNINS(DUZ(2),ABMINS,1,831,0)),+$P(^(0),U,5),'+$P($$ONE^ABMFEAPI($P(^(0),U,5),11,ABM("CPT"),ABMP("VDT")),U) Q ;abm*2.6*2 3PMS10003A
- S VTYP=831
- Q
- ;
- ; *********************************************************************
- SURGTAB ;EP - Create CPT table if needed
- I '$D(ABMCPTTB("SURGERY")) D
- .S ABM=$O(^ABMDCPT("D","SURGERY",""))
- .S Y=^ABMDCPT(ABM,0)
- .S ABMCPTTB("SURGERY","L")=$P(Y,U,4)
- .S ABMCPTTB("SURGERY","H")=$P(Y,U,5)
- K Y
- Q
- ABMDVCK1 ; IHS/ASDST/DMJ - PCC VISIT CHECK - PART 2 ;
- +1 ;;2.6;IHS Third Party Billing System;**2**;NOV 12, 2009
- +2 ;Original;TMD;
- +3 ;
- +4 ; IHS/SD/SDR - v2.6 CSV
- +5 ; IHS/SD/SDR - abm*2.6*2 - 3PMS10003A - modified to call ABMFEAPI
- +6 ;
- +7 ; *********************************************************************
- +8 ;
- VTYP(ABMVDFN,SERVCAT,ABMINS,ABMCLN) ;EP - to get visit type
- +1 ;This is an extrinsic function
- +2 NEW VTYP
- +3 IF 'ABMVDFN
- QUIT ""
- +4 ;If visit in dental file type=998, other wise 131
- +5 ;
- VAR ;
- +1 SET VTYP=$SELECT($DATA(^AUPNVDEN("AD",ABMVDFN)):998,1:131)
- +2 SET ABM("LOCK")=0
- +3 ;If the visit is in the V hospitalization file set type to 111
- +4 IF +$ORDER(^AUPNVINP("AD",ABMVDFN,""))
- IF $DATA(^AUPNVINP($ORDER(^AUPNVINP("AD",ABMVDFN,"")),0))
- SET VTYP=111
- +5 ;Begin mods for inpat lt 30 days
- +6 IF VTYP=131
- IF SERVCAT="H"
- SET VTYP=111
- +7 ;End mods
- +8 ;If not in hosp file go thru insurance file
- +9 NEW QUIT
- +10 IF '$TEST
- IF SERVCAT'="S"
- Begin DoDot:1
- +11 ;Note that the visit type must be in the insurer file for this to set
- +12 ;the visit type.
- +13 SET QUIT=0
- +14 SET ABM=0
- +15 FOR
- SET ABM=$ORDER(^ABMNINS(DUZ(2),ABMINS,1,ABM))
- IF 'ABM
- QUIT
- Begin DoDot:2
- +16 IF ABM=131
- QUIT
- +17 IF 'ABMCLN
- QUIT
- +18 SET D1=0
- +19 FOR
- SET D1=$ORDER(^ABMDVTYP(ABM,1,D1))
- IF 'D1
- QUIT
- Begin DoDot:3
- +20 IF +^ABMDVTYP(ABM,1,D1,0)=ABMCLN
- Begin DoDot:4
- +21 SET VTYP=ABM
- +22 SET QUIT=1
- End DoDot:4
- End DoDot:3
- IF QUIT
- QUIT
- End DoDot:2
- IF QUIT
- QUIT
- End DoDot:1
- +23 IF SERVCAT="S"
- SET VTYP=831
- +24 ;If type is still 131 check to see if it is surgery
- +25 IF "A"[SERVCAT
- IF VTYP=131
- DO OPCK
- +26 IF $PIECE($GET(^AUTNINS(+ABMINS,2)),U)="R"
- Begin DoDot:1
- +27 SET ABMLOC=$PIECE($GET(^AUPNVSIT(ABMVDFN,0)),"^",6)
- +28 IF $PIECE($GET(^ABMDPARM(+ABMLOC,1,5)),U)'=1
- QUIT
- +29 SET VTYP=999
- +30 KILL ABMLOC
- End DoDot:1
- +31 QUIT VTYP
- +32 ;
- +33 ; *********************************************************************
- +34 ;This code is only reached if VTYP=131
- OPCK ;EP for checking if ambulatory surgery
- +1 NEW C,ASC
- +2 DO SURGTAB
- +3 SET ABM=0
- +4 FOR
- SET ABM=$ORDER(^AUPNVPRC("AD",ABMVDFN,ABM))
- IF 'ABM
- QUIT
- Begin DoDot:1
- +5 ;What we need to find is if from the ICD code we can determine visit
- +6 ;type.
- +7 ;From the CPT code we should be able to tell if it is surgery
- +8 ;If one of the ASC codes from 1 - 8 exists it should be amb surg
- +9 ;CPT from 10000-70000 is surgery.
- +10 IF '$DATA(^AUPNVPRC(ABM,0))
- QUIT
- +11 SET ABM("CPT")=$ORDER(^ICPT("I",+^AUPNVPRC(ABM,0),""))
- +12 IF 'ABM("CPT")
- QUIT
- +13 ;CSV-c
- SET ASC=$PIECE($$IHSCPT^ABMCVAPI(ABM("CPT"),ABMP("VDT")),U,6)
- +14 IF ASC>0
- IF ASC<9
- DO OPSURG
- +15 QUIT
- End DoDot:1
- IF VTYP'=131
- QUIT
- +16 QUIT
- +17 ;
- +18 ; *********************************************************************
- OPSURG ;
- +1 ;I $D(^ABMNINS(DUZ(2),ABMINS,1,831,0)),+$P(^(0),U,5),'+$P($G(^ABMDFEE($P(^(0),U,5),11,ABM("CPT"),0)),U,2) Q ;abm*2.6*2 3PMS10003A
- +2 ;abm*2.6*2 3PMS10003A
- IF $DATA(^ABMNINS(DUZ(2),ABMINS,1,831,0))
- IF +$PIECE(^(0),U,5)
- IF '+$PIECE($$ONE^ABMFEAPI($PIECE(^(0),U,5),11,ABM("CPT"),ABMP("VDT")),U)
- QUIT
- +3 SET VTYP=831
- +4 QUIT
- +5 ;
- +6 ; *********************************************************************
- SURGTAB ;EP - Create CPT table if needed
- +1 IF '$DATA(ABMCPTTB("SURGERY"))
- Begin DoDot:1
- +2 SET ABM=$ORDER(^ABMDCPT("D","SURGERY",""))
- +3 SET Y=^ABMDCPT(ABM,0)
- +4 SET ABMCPTTB("SURGERY","L")=$PIECE(Y,U,4)
- +5 SET ABMCPTTB("SURGERY","H")=$PIECE(Y,U,5)
- End DoDot:1
- +6 KILL Y
- +7 QUIT
