Sub-Field: 9002080.197

Parent File	Name	Number	Package
9002080.01	CPT,ADA, OR REV INFORMATION	9002080.197	Contract Health Management Information System

Field #	Name	Loc	Type	Details
.01	CPT/ADA/REV CODE	0;1	VARIABLE POINTER	CPT(#81) REVENUE CODES(#9999999.72) ADA CODE(#9999999.31) LAST EDITED: `AUG 04, 2003` HELP-PROMPT: `ENTER THE CPT/ADA/REV CODE` DESCRIPTION: `This field is a variable pointer. If you have CPT information, enter "CPT." followed immediately by the CPT code. If you have Revenue information, enter "REV." followed immediately by the Revenue code. If` this is a Dental Document use "ADA." followed by the ADA code. Here is an example: "ADA.0150" CROSS-REFERENCE: `9002080.197^B` 1)= S ^ACHSF(DA(2),"D",DA(1),11,"B",$E(X,1,30),DA)="" 2)= K ^ACHSF(DA(2),"D",DA(1),11,"B",$E(X,1,30),DA) 3)= Required Index for Variable Pointer
1	DOS FROM	0;2	DATE	INPUT TRANSFORM: `S %DT="ESTX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the date the CPT/REVENUE CODE action began.` DESCRIPTION: ENTER THE BEGINNING DATE OF SERVICE
2	DOS TO	0;3	DATE	INPUT TRANSFORM: `S %DT="ESTX" D ^%DT S X=Y K:Y<1 X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the date the CPT/REVENUE CODE action ended.` DESCRIPTION: ENTER THE ENDING DATE OF SERVICE
3	UNITS	0;4	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the corresponding number of UNITS for this CPT/REVENUE CODE.` DESCRIPTION: ENTER THE NUMBER OF CORRESPONDING UNITS FOR THIS CPT/REV CODE
4	CHARGES BILLED	0;5	NUMBER	INPUT TRANSFORM: `S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the CHARGES BILLED by the provider for this CPT/REVENUE CODE.` DESCRIPTION: ENTER THE CHARGED BILLED
5	CHARGES ALLOWABLE	0;6	NUMBER	INPUT TRANSFORM: `S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the CHARGES ALLOWABLE for this CPT/REVENUE CODE.` DESCRIPTION: ENTER THE CHARGES ALLOWED
6	MSG CODE	0;7	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>4!($L(X)<4)!'(X?1U3N) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the processing Message code accompanying this CPT/REVENUE CODE (if any) from the FI.` DESCRIPTION: This code should be an upper case letter followed by 3 digits. NOTES: `XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER`
7	TOOTH NUMBER	0;8	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the TOOTH NUMBER for this CPT/REVENUE CODE (Dental only).` DESCRIPTION: ENTER THE NUMBER OF THE TOOTH
8	TOOTH SURFACE	0;9	FREE TEXT	INPUT TRANSFORM: `K:$L(X)>5!($L(X)<1) X` LAST EDITED: `JUL 13, 1990` HELP-PROMPT: `Enter the TOOTH SURFACE for this CPT/REVENUE CODE (Dental only).` DESCRIPTION: ENTER THE TOOTH SURFACE FOR THIS CPT/REV CODE
9	MESSAGE TEXT	1;0	WORD-PROCESSING #9002080.1979	DESCRIPTION: ENTER THE TEXT FOR THE MESSAGE
10	EOBR TRANSACTION	0;10	NUMBER	INPUT TRANSFORM: `K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X` LAST EDITED: `APR 21, 1992` HELP-PROMPT: `Type a Number between 0 and 9999999, 0 Decimal Digits` DESCRIPTION: TYPE A NUMBER BETWEEN 0 AND 9999999

Field #

Name

Loc

Type

Details

.01

CPT/ADA/REV CODE

0;1

VARIABLE POINTER

CPT(#81) REVENUE CODES(#9999999.72) ADA CODE(#9999999.31)

LAST EDITED: AUG 04, 2003
HELP-PROMPT: ENTER THE CPT/ADA/REV CODE
DESCRIPTION: This field is a variable pointer. If you have CPT information, enter "CPT." followed immediately by the CPT code. If you have Revenue information, enter "REV." followed immediately by the Revenue code. If
```
this is a Dental Document use "ADA." followed by the ADA code.  Here is an example: "ADA.0150"
```

CROSS-REFERENCE: 9002080.197^B

1)= S ^ACHSF(DA(2),"D",DA(1),11,"B",$E(X,1,30),DA)=""

2)= K ^ACHSF(DA(2),"D",DA(1),11,"B",$E(X,1,30),DA)

3)= Required Index for Variable Pointer

1

DOS FROM

0;2

DATE

INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the date the CPT/REVENUE CODE action began.
DESCRIPTION:
```
ENTER THE BEGINNING DATE OF SERVICE
```

2

DOS TO

0;3

DATE

INPUT TRANSFORM: S %DT="ESTX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the date the CPT/REVENUE CODE action ended.
DESCRIPTION:
```
ENTER THE ENDING DATE OF SERVICE
```

3

UNITS

0;4

NUMBER

INPUT TRANSFORM: K:+X'=X!(X>999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the corresponding number of UNITS for this CPT/REVENUE CODE.

DESCRIPTION:

ENTER THE NUMBER OF CORRESPONDING UNITS FOR THIS CPT/REV CODE

4

CHARGES BILLED

0;5

NUMBER

INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the CHARGES BILLED by the provider for this CPT/REVENUE CODE.
DESCRIPTION:
```
ENTER THE CHARGED BILLED
```

5

CHARGES ALLOWABLE

0;6

NUMBER

INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>99999)!(X<0) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the CHARGES ALLOWABLE for this CPT/REVENUE CODE.
DESCRIPTION:
```
ENTER THE CHARGES ALLOWED
```

6

MSG CODE

0;7

FREE TEXT

INPUT TRANSFORM: K:$L(X)>4!($L(X)<4)!'(X?1U3N) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the processing Message code accompanying this CPT/REVENUE CODE (if any) from the FI.

DESCRIPTION:

This code should be an upper case letter followed by 3 digits.

NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER

7

TOOTH NUMBER

0;8

NUMBER

INPUT TRANSFORM: K:+X'=X!(X>99)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the TOOTH NUMBER for this CPT/REVENUE CODE (Dental only).
DESCRIPTION:
```
ENTER THE NUMBER OF THE TOOTH
```

8

TOOTH SURFACE

0;9

FREE TEXT

INPUT TRANSFORM: K:$L(X)>5!($L(X)<1) X
LAST EDITED: JUL 13, 1990
HELP-PROMPT: Enter the TOOTH SURFACE for this CPT/REVENUE CODE (Dental only).

DESCRIPTION:

ENTER THE TOOTH SURFACE FOR THIS CPT/REV CODE

9

MESSAGE TEXT

1;0

WORD-PROCESSING #9002080.1979

DESCRIPTION:
```
ENTER THE TEXT FOR THE MESSAGE
```

10

EOBR TRANSACTION

0;10

NUMBER

INPUT TRANSFORM: K:+X'=X!(X>9999999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: APR 21, 1992
HELP-PROMPT: Type a Number between 0 and 9999999, 0 Decimal Digits
DESCRIPTION:
```
TYPE A NUMBER BETWEEN 0 AND 9999999
```

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Package: Contract Health Management Information System

CHS FACILITY(#9002080)-->9002080.01-->9002080.197

Sub-Field: 9002080.197

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