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_Ref_ |
Id |
_________Element Name__________ |
Req |
Type |
Min/Max |
|
|
| |
CR601 |
923 |
Prognosis Code |
M |
ID |
1/1 |
|
|
| |
|
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Description: Code indicating physician's prognosis for the patient |
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Code |
Name_______________________________ |
| |
|
|
|
1 |
Poor |
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|
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2 |
Guarded |
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|
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3 |
Fair |
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4 |
Good |
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|
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5 |
Very Good |
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6 |
Excellent |
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7 |
Less than 6 Months to Live |
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8 |
Terminal |
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CR602 |
373 |
Date |
M |
DT |
8/8 |
|
|
| |
|
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Description: Date expressed as CCYYMMDD |
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CR603 |
1250 |
Date Time Period Format Qualifier |
C |
ID |
2/3 |
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| |
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Description: Code indicating the date format, time format, or date and time format |
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|
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Code |
Name_______________________________ |
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RD8 |
Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD |
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Description: A range of dates expressed in the format CCYYMMDD-CCYYMMDD where CCYY is the numerical expression of the century CC and year YY, MM is the numerical expression of the month within the year, and DD is the numerical expression of the day within the year; the first occurrence of CCYYMMDD is the beginning date and the second occurrence is the ending date |
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CR604 |
1251 |
Date Time Period |
C |
AN |
1/35 |
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| |
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Description: Expression of a date, a time, or range of dates, times or dates and times |
| |
CR606 |
1073 |
Yes/No Condition or Response Code |
O |
ID |
1/1 |
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| |
|
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Description: Code indicating a Yes or No condition or response |
| |
|
|
|
Code |
Name_______________________________ |
| |
|
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N |
No |
| |
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U |
Unknown |
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Y |
Yes |
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CR607 |
1073 |
Yes/No Condition or Response Code |
M |
ID |
1/1 |
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Description: Code indicating a Yes or No condition or response |
| |
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|
Code |
Name_______________________________ |
| |
|
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N |
No |
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U |
Unknown |
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Y |
Yes |
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CR608 |
1322 |
Certification Type Code |
M |
ID |
1/1 |
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Description: Code indicating the type of certification |
| |
|
|
|
Code |
Name_______________________________ |
| |
|
|
|
1 |
Appeal - Immediate |
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2 |
Appeal - Standard |
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3 |
Cancel |
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4 |
Extension |
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I |
Initial |
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R |
Renewal |
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S |
Revised |
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CR609 |
373 |
Date |
C |
DT |
8/8 |
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Description: Date expressed as CCYYMMDD |
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CR610 |
235 |
Product/Service ID Qualifier |
C |
ID |
2/2 |
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Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234) |
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Code |
Name_______________________________ |
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HC |
Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
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Description: HCFA coding scheme to group procedure(s) performed on an outpatient basis for payment to hospital under Medicare; primarily used for ambulatory surgical and other diagnostic departments |
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ID |
International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
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Description: The International Classification of Diseases, Clinical Modification, is designated for the classification of morbidity and mortality information for statistical purposes and for the indexing of hospital records by disease and operations, for data storage and retrieval; this is a procedure code |
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CR611 |
1137 |
Medical Code Value |
C |
AN |
1/15 |
|
|
| |
|
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Description: Code value for describing a medical condition or procedure |
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CR612 |
373 |
Date |
O |
DT |
8/8 |
|
|
| |
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Description: Date expressed as CCYYMMDD |
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CR613 |
373 |
Date |
O |
DT |
8/8 |
|
|
| |
|
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Description: Date expressed as CCYYMMDD |
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CR614 |
373 |
Date |
O |
DT |
8/8 |
|
|
| |
|
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Description: Date expressed as CCYYMMDD |
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CR615 |
1250 |
Date Time Period Format Qualifier |
C |
ID |
2/3 |
|
|
| |
|
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Description: Code indicating the date format, time format, or date and time format |
| |
|
|
|
Code |
Name_______________________________ |
| |
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|
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RD8 |
Range of Dates Expressed in Format CCYYMMDD-CCYYMMDD |
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|
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|
|
Description: A range of dates expressed in the format CCYYMMDD-CCYYMMDD where CCYY is the numerical expression of the century CC and year YY, MM is the numerical expression of the month within the year, and DD is the numerical expression of the day within the year; the first occurrence of CCYYMMDD is the beginning date and the second occurrence is the ending date |
| |
CR616 |
1251 |
Date Time Period |
C |
AN |
1/35 |
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Description: Expression of a date, a time, or range of dates, times or dates and times |
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CR617 |
1384 |
Patient Location Code |
C |
ID |
1/1 |
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Description: Code identifying the location where patient is receiving medical treatment |
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Code |
Name_______________________________ |
| |
|
|
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A |
Acute Care Facility |
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B |
Boarding Home |
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C |
Hospice |
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D |
Intermediate Care Facility |
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E |
Long-term or Extended Care Facility |
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F |
Not Specified |
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G |
Nursing Home |
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H |
Sub-acute Care Facility |
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L |
Other Location |
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M |
Rehabilitation Facility |
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O |
Outpatient Facility |
| |
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P |
Private Home |
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R |
Residential Treatment Facility |
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S |
Skilled Nursing Home |
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T |
Rest Home |
