ABME3FA0 ; IHS/ASDST/DMJ - HCFA-1500 NSF 3.01 RECORD FA0 (Claim Root Segment) ;
Source file <ABME3FA0.m>
| Name | Comments | DBIA/ICR reference |
|---|---|---|
| 150 | ;79-79 Diag Code Pointer 2
|
|
| 210 | ;91-91 COB Ind
|
|
| 450 | ;210-212 EPO Dosage
|
|
| 310 | ;142-151 Mammography Cert No
|
|
| 380 | ;191-191 Podiatry Therapy Ind
|
|
| 190 | ;86-89 Anesthesia/Oxygen Min
|
|
| 60 | ;48-55 Service Date To
|
|
| 430 | ;205-206 HCT Result
|
|
| 130 | ;71-77 Line Charges
|
|
| 110 | ;67-68 Modifier 2
|
|
| 80 | ;58-59 Type of Service Code
|
|
| 230 | ;93-107 Rendering Prov ID
|
|
| 250 | ;123-124 Referring Prov State
|
|
| 170 | ;81-81 Diag Code Pointer 4
|
|
| 20 | ;4-5 Sequence
|
|
| 490 | ;231-237 Drug Discount Amt
|
|
| 320 | ;152-160 Class Findings
|
|
| 40 | ;23-39 Line Item Control #
|
|
| 180 | ;82-85 Units of Service
|
|
| 500 | ;238-320 Filler (National)
|
|
| 340 | ;164-178 CLIA ID #
|
|
| 400 | ;193-193 Hospice Employed Prov Ind
|
|
| 280 | ;133-139 Disallowed Other
|
|
| 480 | ;224-230 Obligated Accept Amt
|
|
| 360 | ;186-187 HCPCS Modifier 4
|
|
| 200 | ;90-90 Emergency Ind
|
|
| 140 | ;78-78 Diag Code Pointer 1
|
|
| 300 | ;141-141 Multi Procedure Ind
|
|
| 440 | ;207-209 Patient Weight
|
|
| 460 | ;213-220 Serum Creatine Date
|
|
| 330 | ;161-163 Podiatry Svc Cond
|
|
| 120 | ;69-70 Modifier 3
|
|
| START | ;START HERE
|
|
| ADD | ;ADD TO RECORD
|
|
| 260 | ;125-125 Pur Svc Ind
|
|
| 240 | ;108-122 Referring Prov ID
|
|
| 70 | ;56-57 Place of Service Code
|
|
| 90 | ;60-64 HCPCS Procedure Code
|
|
| 100 | ;65-66 Modifier 1
|
|
| 160 | ;80-80 Diag Code Pointer 3
|
|
| 220 | ;92-92 HPSA Ind
|
|
| 10 | ;1-3 Record type
|
|
| 420 | ;202-204 HGB Result
|
|
| 270 | ;126-132 Disallowed Cost Cont
|
|
| 30 | ;6-22 Patient Control Number
|
|
| 50 | ;40-47 Service Date From
|
|
| 470 | ;221-223 Creatine Result
|
|
| 390 | ;192-192 Podiatry Therapy Type
|
|
| 410 | ;194-201 HGB/HCT Date
|
|
| 290 | ;140-140 Review By Code Ind
|
|
| 350 | ;179-185 Primary Paid Amount (Other Insurance)
|
|
| 370 | ;188-190 Provider Specialty
|
|
| EX(ABMX,ABMY,ABMZ) | ;EXTRINSIC FUNCTION HERE
|
|
| LOOP | ;LOOP HERE
|
| Name | Field # of Occurrence |
|---|---|
| FRATE^ABMDF11 | START+4 |
| $$Y2KD2^ABMDUTL | 50+3, 60+3 |
| $$NPI^ABMEEPRV | 230+2, 230+3, 230+4, 230+5 |
| WRITE^ABMEF20 | LOOP+16 |
| ^ABMEH62 | LOOP+19 |
| ^ABMEHGRV | START+5 |
| ADTT^ABMER60 | LOOP+14 |
| $$FMT^ABMERUTL | 20+2, 30+2, 40+2, 50+4, 60+4, 70+2, 80+2, 90+2, 100+2, 110+2 , 120+2, 130+3, 140+4, 150+2, 160+2, 170+2, 180+2, 190+3, 200+3, 210+2 , 220+2, 230+6, 240+2, 250+2, 260+2, 270+2, 280+2, 290+2, 300+2, 310+2 , 320+2, 330+2, 340+2, 350+2, 360+2, 370+2, 380+2, 390+2, 400+2, 410+2 , 420+2, 430+2, 440+2, 450+2, 460+2, 470+2, 480+2, 490+2, 500+2 |
| $$POS^ABMERUTL | 70+1 |
| $$TOS^ABMERUTL | 80+1 |
| S90^ABMERUTL | LOOP+17 |
| SET^ABMERUTL | START+3, EX+2 |
| Name | Line Occurrences (* Changed, ! Killed) |
|---|---|
| ^ABMDBILL( | 50+2, 60+2, 200+1, 400+1 |
| ^ABMEXLM("AA" | LOOP+9 |
| Name | Line Occurrences |
|---|---|
| @( | LOOP+8, LOOP+9, EX+4 |
| ADD | LOOP+10 |
| LOOP | START+6 |
| Name | Field # of Occurrence |
|---|---|
| ^( | LOOP+9 |
| >> | Not killed explicitly |
| * | Changed |
| ! | Killed |
| ~ | Newed |
| Name | Field # of Occurrence |
|---|---|
| ABM | START+7!, EX+7! |
| ABM("ACTOT" | LOOP+12* |
| ABM("NCTOT" | LOOP+13* |
| >> ABMAPRV | 230+4, 230+5 |
| ABMCDX | 140+1*, 140+2*, 140+3, 150+1, 160+1, 170+1, 170+3! |
| ABME | START+7!, EX+7! |
| ABME("RTYPE" | LOOP+17* |
| ABME("S#" | START+2*, LOOP+6*, 20+1 |
| >> ABMEF("LINE" | LOOP+15* |
| >> ABMP("BDFN" | 50+2, 60+2, 200+1, 400+1, EX+2* |
| >> ABMP("EXP" | LOOP+9 |
| >> ABMP("FLAT" | START+4!, LOOP+19 |
| >> ABMP("FMT" | EX+3*, EX+6* |
| >> ABMP("INS" | LOOP+9, 230+2, 230+3, 230+4, 230+5 |
| >> ABMP("LDFN" | 230+2, 230+4 |
| >> ABMP("NOFMT" | ADD+1, EX+3 |
| >> ABMP("PCN" | 30+1 |
| ABMPROV | 230+1*, 230+2, 230+3, 230+7! |
| >> ABMR(61 | START+1!, ADD+1, 10+1*, 20+1*, 20+2*, 30+1*, 30+2*, 40+1*, 40+2*, 50+1* , 50+2*, 50+3*, 50+4*, 60+1*, 60+2*, 60+3*, 60+4*, 70+1*, 70+2*, 80+1* , 80+2*, 90+1*, 90+2*, 100+1*, 100+2*, 110+1*, 110+2*, 120+1*, 120+2*, 130+1* , 130+2, 130+3*, 140+3*, 140+4*, 150+1*, 150+2*, 160+1*, 160+2*, 170+1*, 170+2* , 180+1*, 180+2*, 190+1*, 190+2*, 190+3*, 200+1*, 200+2*, 200+3*, 210+1*, 210+2* , 220+1*, 220+2*, 230+2*, 230+3*, 230+4*, 230+5*, 230+6*, 240+1*, 240+2*, 250+1* , 250+2*, 260+1*, 260+2*, 270+1*, 270+2*, 280+1*, 280+2*, 290+1*, 290+2*, 300+1* , 300+2*, 310+1*, 310+2*, 320+1*, 320+2*, 330+1*, 330+2*, 340+1*, 340+2*, 350+1* , 350+2*, 360+1*, 360+2*, 370+1*, 370+2*, 380+1*, 380+2*, 390+1*, 390+2*, 400+1* , 400+2*, 410+1*, 410+2*, 420+1*, 420+2*, 430+1*, 430+2*, 440+1*, 440+2*, 450+1* , 450+2*, 460+1*, 460+2*, 470+1*, 470+2*, 480+1*, 480+2*, 490+1*, 490+2*, 500+1* , 500+2*, EX+5, EX+7! |
| >> ABMREC(61 | LOOP+5!, LOOP+15, ADD+1* |
| >> ABMRT(90 | 130+2* |
| >> ABMRT(95 | LOOP+18* |
| ABMRV | START+7! |
| ABMRV( | LOOP+1, LOOP+2, LOOP+4, LOOP+12, LOOP+13, 50+1, 60+1, 90+1, 100+1, 110+1 , 120+1, 130+1, 140+1, 180+1, 190+2, 230+1 |
| ABMX | EX~, EX+4, EX+5, EX+7! |
| ABMY | EX~, EX+2, EX+7! |
| ABMZ | EX~, EX+7! |
| DUZ(2 | 50+2, 60+2, 200+1, 230+3, 230+5, 400+1 |
| >> I | LOOP+7*, LOOP+8, LOOP+9, ADD+1 |
| >> J | LOOP+1*, LOOP+2, LOOP+4, LOOP+11, LOOP+12, LOOP+13, LOOP+19, 50+1, 60+1, 80+1 , 90+1, 100+1, 110+1, 120+1, 130+1, 140+1, 180+1, 190+2, 230+1 |
| >> K | LOOP+2*, LOOP+4, LOOP+12, LOOP+13, 50+1, 60+1, 90+1, 100+1, 110+1, 120+1 , 130+1, 140+1, 180+1, 190+2, 230+1 |
| >> M | LOOP+3*, LOOP+4*, LOOP+12, LOOP+13, 50+1, 60+1, 90+1, 100+1, 110+1, 120+1 , 130+1, 140+1, 180+1, 190+2, 230+1 |
| U | LOOP+12, LOOP+13, 50+1, 50+2, 60+1, 90+1, 100+1, 110+1, 120+1, 130+1 , 140+1, 180+1, 190+2, 230+1 |
| >> Y | EX+5*, EX+8 |