| | | | | | | | | | | |
| | _Ref_ | Id | _________Element Name__________ | Req | Type | Min/Max | | |
| | SVC01 | C003 | Composite Medical Procedure Identifier | M | Comp | | | |
| | | | Description: To identify a medical procedure by its standardized codes and applicable modifiers |
| | | 235 | Product/Service ID Qualifier | M | ID | 2/2 | | |
| | | | Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234) |
| | | | | Code | Name_______________________________ |
| | | | | AD | American Dental Association Codes |
| | | | | | Description: This association's membership consists of U.S. dentists. It sets standards for the dental profession |
| | | | | ER | Jurisdiction Specific Procedure and Supply Codes |
| | | | | HC | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
| | | | | | 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 |
| | | | | ID | International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
| | | | | | 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 |
| | | | | IV | Home Infusion EDI Coalition (HIEC) Product/Service Code |
| | | | | N1 | National Drug Code in 4-4-2 Format |
| | | | | | Description: 4-digit manufacturer ID, 4-digit product ID, 2-digit trade package size |
| | | | | N2 | National Drug Code in 5-3-2 Format |
| | | | | | Description: 5-digit manufacturer ID, 3-digit product ID, 2-digit trade package size |
| | | | | N3 | National Drug Code in 5-4-1 Format |
| | | | | | Description: 5-digit manufacturer ID, 4-digit product ID, 1-digit trade package size |
| | | | | N4 | National Drug Code in 5-4-2 Format |
| | | | | | Description: 5-digit manufacturer ID, 4-digit product ID, 2-digit trade package size |
| | | | | ND | National Drug Code (NDC) |
| | | | | NU | National Uniform Billing Committee (NUBC) UB92 Codes |
| | | | | RB | National Uniform Billing Committee (NUBC) UB82 Codes |
| | | | | ZZ | Mutually Defined |
| | | 234 | Product/Service ID | M | AN | 1/48 | | |
| | | | Description: Identifying number for a product or service |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 352 | Description | O | AN | 1/80 | | |
| | | | Description: A free-form description to clarify the related data elements and their content |
| | SVC02 | 782 | Monetary Amount | M | R | 1/18 | | |
| | | | Description: Monetary amount |
| | SVC03 | 782 | Monetary Amount | O | R | 1/18 | | |
| | | | Description: Monetary amount |
| | SVC04 | 234 | Product/Service ID | O | AN | 1/48 | | |
| | | | Description: Identifying number for a product or service |
| | SVC05 | 380 | Quantity | O | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
| | SVC06 | C003 | Composite Medical Procedure Identifier | O | Comp | | | |
| | | | Description: To identify a medical procedure by its standardized codes and applicable modifiers |
| | | 235 | Product/Service ID Qualifier | M | ID | 2/2 | | |
| | | | Description: Code identifying the type/source of the descriptive number used in Product/Service ID (234) |
| | | | | Code | Name_______________________________ |
| | | | | AD | American Dental Association Codes |
| | | | | | Description: This association's membership consists of U.S. dentists. It sets standards for the dental profession |
| | | | | ER | Jurisdiction Specific Procedure and Supply Codes |
| | | | | HC | Health Care Financing Administration Common Procedural Coding System (HCPCS) Codes |
| | | | | | 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 |
| | | | | ID | International Classification of Diseases Clinical Modification (ICD-9-CM) - Procedure |
| | | | | | 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 |
| | | | | IV | Home Infusion EDI Coalition (HIEC) Product/Service Code |
| | | | | N1 | National Drug Code in 4-4-2 Format |
| | | | | | Description: 4-digit manufacturer ID, 4-digit product ID, 2-digit trade package size |
| | | | | N2 | National Drug Code in 5-3-2 Format |
| | | | | | Description: 5-digit manufacturer ID, 3-digit product ID, 2-digit trade package size |
| | | | | N3 | National Drug Code in 5-4-1 Format |
| | | | | | Description: 5-digit manufacturer ID, 4-digit product ID, 1-digit trade package size |
| | | | | N4 | National Drug Code in 5-4-2 Format |
| | | | | | Description: 5-digit manufacturer ID, 4-digit product ID, 2-digit trade package size |
| | | | | ND | National Drug Code (NDC) |
| | | | | NU | National Uniform Billing Committee (NUBC) UB92 Codes |
| | | | | RB | National Uniform Billing Committee (NUBC) UB82 Codes |
| | | | | ZZ | Mutually Defined |
| | | 234 | Product/Service ID | M | AN | 1/48 | | |
| | | | Description: Identifying number for a product or service |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 1339 | Procedure Modifier | O | AN | 2/2 | | |
| | | | Description: This identifies special circumstances related to the performance of the service, as defined by trading partners |
| | | 352 | Description | O | AN | 1/80 | | |
| | | | Description: A free-form description to clarify the related data elements and their content |
| | SVC07 | 380 | Quantity | O | R | 1/15 | | |
| | | | Description: Numeric value of quantity |
