============================================================================= Run Date: SEP 24, 2003 Designation: IB*2*210 Package : IB - INTEGRATED BILLING Priority: Mandatory Version : 2 SEQ #211 Status: Released Compliance Date: OCT 15, 2003 ============================================================================= Associated patches: (v)IB*2*159 <<= must be installed BEFORE `IB*2*210' (v)IB*2*161 <<= must be installed BEFORE `IB*2*210' (v)IB*2*182 <<= must be installed BEFORE `IB*2*210' (v)ICPT*6*14 <<= must be installed BEFORE `IB*2*210' (v)IB*2*207 <<= must be installed BEFORE `IB*2*210' (v)ICD*18*7 <<= must be installed BEFORE `IB*2*210' Subject: Code Set Versioning, the IB part. Category: - Routine - Data Dictionary - Informational - Enhancement (Mandatory) Description: ============ ********************************************************************* * THIS PATCH MUST BE INSTALLED AT ALL SITES BY * * SEPTEMBER 30, 2003 * ********************************************************************* Description: =========== This patch is the Integrated Billing part of Code Set Versioning project. There are no NOIS messages or E3Rs associated with this patch. Overview -------- This patch supports Code Set Versioning, mandated under the Health Information Portability and Accountability Act (HIPAA). It contains routines and data dictionary changes to recognize code sets for the Current Procedural Terminology (CPT) and Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS). When implemented, applications will be able to retrieve appropriate CPT and HCPCS codes based upon a date that a clinical event occurred. Functional Description ---------------------- The patch IB*2.0*210 provides the following modifications, related to the HIPAA Code Set Versioning requirements: 1) The IB package was modified to ensure, that only CPT code and CPT modifiers, ICD diagnosis and procedure codes that are valid for the date of service shall be selectable by the user, regardless of when an entry or edit is made. That will guarantee that the selected code belongs to the Code Set, active for the date of service. 2) The method of accessing data for ICD0, ICD9 and DRG codes has been changed. Previously IB was using the direct global access for retrieving the above data. With this patch, the IB package will be only using external API calls. That ensures, that the retrieved data will belong to the required Code Set Version, depending on the date of service. These modifications have been made in accordance with HIPAA CSV requirements. 3) The IB calls to the DRG Grouper interface have been modified by this patch. In accordance with the HIPAA Code Set Versioning project requirements, the DRG Grouper interface has been extended to accept one more parameter - the Date of Service, to return the DRG data regarding the date of service, using the corresponding DRG Code Set Version. All occurrences of the DRG Grouper usage in the IB package, have been modified to pass the additional parameter. Thus the IB will retrieve data of correct version, in accordance with the HIPAA CSV requirements. Technical Description --------------------- The patch contains 46 modified routines, 2 new routines and 11 modified FileMan Data Dictionaries. The following routines are added/modified by this patch: 1 IBACSV WOIFO/AAT-CODE SET VERSIONING IB UTILITIES This is a new routine. It contains a set of functions (API) for supporting the Code Set Versioning IB functionality. 2 IBATEI ALB/BGA - TRANSFER PRICING INPATIENT TRACKER This routine has been modified to replace direct global access to the DRG file with appropriate API call. 3 IBATLM2A LL/ELZ - TRANSFER PRICING PT TRANSACTION DETAIL This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 4 IBCBB2 ALB/ARH - CONTINUATION OF EDIT CHECKS ROUTINE (HCFA 1500) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 5 IBCBB21 ALB/AAS - CONTINUATION OF EDIT CHECK ROUTINE FOR UB-92 This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 6 IBCBB8 ALB/BGA - CON'T MEDICARE EDIT CHECKS This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 7 IBCD3 ALB/ARH - AUTOMATED BILLER (ADD NEW BILL - CREATE BILL ENTRY) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 8 IBCEF1 ALB/TMP - FORMATTER SPECIFIC BILL FUNCTIONS - CONT This routine has been modified to replace direct global access to the ICD0 file with appropriate API call. 9 IBCEF3 ALB/TMP - FORMATTER SPECIFIC BILL FLD FUNCTIONS This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 10 IBCEU4 ALB/TMP - EDI UTILITIES This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 11 IBCF10 ALB/MJB - PRINT UB-82 BILL (CONT.) This routine has been modified to replace direct global access to ICD9 and ICD0 files with appropriate API calls. 12 IBCF11 ALB/MJB - PRINT UB-82 BILL (CONT.) This routine has been modified to replace direct global access to the ICD0 file with appropriate API call. 13 IBCF12 ALB/AAS - PRINT BILL CONT. This routine has been modified to add one more parameter to the existing call of CPT^ICPTCOD API. The second parameter - Date of Service is passed to ensure that the API output will belong to correct Code Set. 14 IBCF22 ALB/ARH - HCFA 1500 19-90 DATA (gather other data) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 15 IBCF32 ALB/BGA-UB92 HCFA-1450 (GATHER CODES) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 16 IBCF331 ALB/ARH - UB92 HCFA-1450 (GATHER CODES CONT) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 17 IBCIUT1 DSI/SLM - MISC UTILITIES FOR CLAIMSMANAGER INTERFACE This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 18 IBCIUT5 DSI/ESG - UTILITIES FOR CLAIMSMANAGER INTERFACE This routine has been modified to replace direct global access to the CPT Modifier file ^DIC(81.3) with appropriate API call. 19 IBCRBG ALB/ARH-RATES: BILL SOURCE EVENTS (INPT) This routine has been modified to replace direct global access to ICD9 and ICD0 files with appropriate API calls. Also, one more input parameter - the Date of Service - has been added to existing call of the DRG Grouper API. 20 IBCRU1 ALB/ARH - RATES: UTILITIES The existing subroutine GETDRG was modified to apply screening to the users lookup of the DRG codes. The screen allows selection of active DRG codes only. By default the screening is disabled, and can be activated by setting the second input parameter "ALL" of the GETDRG subroutine to 0 (false). 21 IBCRU2 ALB/ARH - RATES: UTILITIES (CI DEFINITIONS) This routine has been modified to replace direct global access to CPT and DRG files with appropriate API calls. 22 IBCSC4 ALB/MJB - MCCR SCREEN 4 (INPT. EOC) This routine has been modified to replace direct global access to the ICD9 file with appropriate API call. 23 IBCSC4B ALB/MJB - MCCR PTF SCREEN (CONT.) This routine has been modified to replace direct global access to ICD9 and ICD0 files with appropriate API calls. 24 IBCSC4C ALB/MJB - MCCR PTF SCREEN (CONT.) The modified routine shall use the function ICD9^IBACSV and ICD0^IBACSV to retrieve information about Diagnosis/Operational ICD codes for the date of service (if the date is available). Besides this, the routine shall provides screening of users input to make it possible to input only active ICD Operational/Procedure and ICD Diagnosis Codes. The Active/Inactive status of ICD Procedural codes shall be determined for the date of procedure (if it exists). The Active/Inactive status for ICD Diagnosis codes shall be determined for the date of service, associated with the bill. The date of service, associated with the bill, shall be determined by the API call $$BDATE^IBACSV. 25 IBCSC4D ALB/ARH - ADD/ENTER DIAGNOSIS The routine has been modified to replace direct global access to ICD9 file with the API call ICD9^IBACSV to retrieve information about ICD Diagnosis codes. The function $$BDATE^IBACSV(IBIFN) is used to determine date of service. 26 IBCSC4E ALB/ARH - ADD/ENTER PTF/OE DIAGNOSIS The routine has been modified to utilize API call ICD9^IBACSV to retrieve information about ICD Diagnosis codes, using the function $$BDATE^IBACSV(IBIFN) to determine the date of service. 27 IBCSC5 ALB/MJB - MCCR SCREEN 5 (OPT. EOC) The modified routine replaced direct global access to ICD9 file with the API call ICD9^IBACSV to retrieve ICD DX data. The output of the function $$BDATE^IBACSV the date of service - shall be used as second argument of the API. The required pointer to BILL/CLAIM file is the field #.02 "BILL NUMBER" of the file 362.3 28 IBCSC61 ALB/MJB - MCCR SCREEN UTILITY The modified routine replaced direct global access to DRG file with the API call $$DRG^IBACSV to retrieve DRG code for the given IEN. Passing the date of service is not required for this call. 29 IBCSC82 ALB/MJB - MCCR SCREEN 8 (UB-92 BILL SPECIFIC INFO) The modified routine replaced direct global access to ICD9 file with the API call ICD9^IBACSV. The function $$BDATE^IBACSV will be used as second argument to the API call. 30 IBCSC8H ALB/ARH - MCCR SCREEN 8 (BILL SPECIFIC INFO) HCFA 1500 The modified routine replaced direct global access to ICD9 file with the API call ICD9^IBACSV. The function $$BDATE^IBACSV will be used as second argument to the API call. 31 IBCU1 ALB/MRL - BILLING UTILITY ROUTINE (CONTINUED) The modified routine changes the existing call to the API MODP^ICPTMOD to pass the date of service. That is required to ensure, that the received CPT Modifier status is correct for the Date of Service. 32 IBCU7 ALB/AAS - INTERCEPT SCREEN INPUT OF PROCEDURE CODES The modified routine uses API call ICD0^IBACSV to retrieve ICD Operation/Procedure data. The PROCEDURE DATE of corresponding PROCEDURES (Sub-file #399.0304) will be used as second argument of the API. The required date can be determined from the variable DGPROCDT. If the code is not active for the date of service, the routine will print the following message: "Warning: Procedure code is inactive on this date" 33 IBCU71 ALB/AAS - INTERCEPT SCREEN INPUT OF PROCEDURE CODES The modified routine utilizes the API call ICD9^IBACSV to retrieve the CODE NUMBER. The second argument to the API shall be the date of service, returned by the function $$BDATE^IBACSV. 34 IBCU72 ALB/CPM - ADD/EDIT/DELETE PROCEDURE DIAGNOSES The modified routine utilizes the API call ICD9^IBACSV to retrieve information about the ICD Diagnosis Code. The second argument to the API shall be the output of the function $$BDATE^IBACSV. 35 IBCVA1 ALB/MJB - SET MCCR VARIABLES CONT. The modified routine shall use the API call ICD9^IBACSV to determine the name of diagnosis. The function $$BDATE^IBACSV shall be used a second parameter to the API. 36 IBEPAR ALB/AAS - MCCR SITE PARAMETER ENTER/EDIT The modified routine shall use API call ICD9^IBACSV to determine ICD Diagnosis code. The second optional parameter (date) will not be passed. 37 IBJTBB ALB/ARH - TPI BILL DIAGNOSIS SCREEN The modified routine shall use API call ICD9^IBACSV to retrieve data of ICD Diagnosis Code. The function $$BDATE^IBACSV will be passed as second parameter to the API. 38 IBJTBC ALB/ARH - TPI BILL PROCEDURES SCREEN The modified routine shall use API call ICD9^IBACSV to retrieve data of ICD Diagnosis Code. The EVENT DATE of the bill shall be passed as second parameter to the API. Besides this, the routine shall use API call $$PRCD^IBCEF1 to retrieve procedures data. The PROCEDURE DATE (sub-file #399.0304, field #1) shall be passed as second parameter to the API. If the PROCEDURE DATA is empty, the date of service for the whole bill ( function $$BDATE^IBACSV). 39 IBRFN3 ALB/ARH - PASS BILL/CLAIM TO AR The modified routine shall use API call ICD9^IBACSV to retrieve data of ICD Diagnosis Code. The date of service returned by shall be passed as second parameter to the API. Besides this, the routine shall use API call ICD0^IBACSV to retrieve data of ICD Operation/ Procedure Code. The PROCEDURE DATE (sub-file #399.0304, field #1) shall be passed as second parameter to the API. The existing call to CPT^ICPTCOD shall be replaced with PRCD^IBCEF1 with passing the third parameter (date), and shall be set to the PROCEDURE DATE (sub-file #399.0304, field #1). If the PROCEDURE DATE is empty, the date of service will be determined by the function $$BDATE^IBACSV. 40 IBTOBI2 ALB/AAS - CLAIMS TRACKING BILLING INFORMATION PRINT The call to DIAG^IBTRE6 shall be modified to pass the Date of Service, to ensure that the diagnosis information is correct. The function TRNDATE^IBACSV returns the date of service associated with the claims tracking record. 41 IBTOBI4 ALB/AAS - CLAIMS TRACKING BILLING INFORMATION PRINT The call LIST shall be modified to ensure that the CPT information is correct. It will call PRCD^IBCEF1 procedure with passing one more parameter - the Date of Service, to ensure that the procedure information is of right Code Set Version. 42 IBTRCD ALB/AAS - CLAIMS TRACKING - EXPAND CONTACTS SCREEN The modified routine shall use pass the third parameter (the date of service) to the API DIAG^IBTRE6 to ensure, that the diagnosis information will have correct version. 43 IBTRE3 ALB/AAS - CLAIMS TRACKING EDIT DIAGNOSIS The modified routine shall use API call ICD9^IBACSV to retrieve data of ICD Diagnosis Code. The date of service associated with the Claims Tracking Record will be determined by function TRNDATE^IBACSV. 44 IBTRE4 ALB/AAS - CLAIMS TRACKING EDIT PROCEDURE The modified routine shall use API call ICD0^IBACSV to retrieve data of ICD Operation/Procedure Code. The date of service shall be determined using function $$BDATE^IBACSV. The API call ICD0ACT^IBACSV shall be used for screening purposes. 45 IBTRE6 ALB/AAS - CLAIMS TRACKING OUTPUT CLIN DATA The modified routine shall use API calls ICD0^IBACSV and ICD9^IBACSV to retrieve data of ICD Operation/Procedure Codes and ICD Diagnosis Codes. For ICD Operation/Procedure the date of procedure can be determined as $P(X, ^ ,3) For ICD Diagnosis code the field "ONSET DATE THIS VISIT (file #356.9, field #.03) may be used as second parameter to the API. 46 IBTRED0 ALB/AAS - EXPAND/EDIT CLAIMS TRACKING ENTRY - CONT. The modified routine shall pass the third parameter (the date of service) to the API DIAG^IBTRE6 to ensure, that the diagnosis information will have correct version. 47 IBTRV2 ALB/AAS - CLAIMS TRACKING - REVIEW ACTIONS The modified routine shall set local variable ICDDAT to the date of service. The date of service shall be determined by the field "DATE/TIME #.01 of the file #405 (PATIENT MOVEMENT). The pointer to the file #405 shall be determined by the field #.05 of the file #356 "CLAIMS TRACKING . 48 IB20P210 WOIFO/AAT - Code Set Versioning Post Install Procedure This new routine contains post-install procedure for the patch. It recompiles all Input Templates, affected by the Data Dictionaries modification. ROUTINE SUMMARY =============== The following is a list of the routines included in this patch. The second line of each of these routines now looks like: ;;2.0;INTEGRATED BILLING;**[patch list]**;21-MAR-94 Routine Before Patch After Patch Patch List ------- ------------ ----------- ---------- IB20P210 N/A 1141592 210 IBACSV N/A 3140739 210 IBATEI 15460540 15664245 115,210 IBATLM2A 6578662 6629474 115,210 IBCBB2 16334963 16367859 51,137,210 IBCBB21 6878885 6826047 51,137,210 IBCBB8 2541219 2551198 51,137,210 IBCD3 13920382 13947868 14,55,52,91,106,125, 51,148,160,137,210 IBCEF1 12389038 12663965 52,124,51,137,210 IBCEF3 10453903 10460818 52,84,121,51,152,210 IBCEU4 11919696 11925965 51,137,210 IBCF10 12774230 12665944 133,210 IBCF11 3617927 3430364 133,210 IBCF12 8226764 7181048 133,210 IBCF22 5262160 4802534 52,80,122,51,210 IBCF32 4769225 4571565 210 IBCF331 4520623 4569181 52,210 IBCIUT1 7312503 7334468 161,210 IBCIUT5 7692940 7710768 161,210 IBCRBG 15108268 14305888 52,80,106,51,142,159,210 IBCRU1 6452670 6624976 52,106,210 IBCRU2 3223557 3017018 52,106,138,210 IBCSC4 9797764 9640301 52,51,210 IBCSC4B 16543108 16037138 210 IBCSC4C 11565822 10304268 210 IBCSC4D 15648310 15483936 55,62,91,106,124,51,210 IBCSC4E 15564967 15872127 8,106,121,124,210 IBCSC5 9362180 9495592 52,125,51,210 IBCSC61 5620112 5588721 52,80,106,51,210 IBCSC82 9773793 9846140 51,137,210 IBCSC8H 12543053 12652084 51,137,207,210 IBCU1 9868631 10024821 27,52,106,138,51,182,210 IBCU7 21627290 20493121 62,52,106,125,51,137,210 IBCU71 7270730 7389068 41,60,91,106,125,138,210 IBCU72 4946590 5043003 62,210 IBCVA1 10236478 9930294 52,80,109,51,137,210 IBEPAR 12807150 12716274 133,51,153,210 IBJTBB 1565884 1651908 39,210 IBJTBC 5615165 5752047 39,80,51,137,210 IBRFN3 8235558 8192110 61,133,210 IBTOBI2 7990714 8137432 210 IBTOBI4 7545109 7459087 91,125,51,210 IBTRCD 9107959 9296129 210 IBTRE3 7853130 8155240 10,60,210 IBTRE4 7064085 8749328 10,210 IBTRE6 4226128 4283263 210 IBTRED0 8915791 9111836 160,210 IBTRV2 7742303 7880820 60,210 Total number of routines - 48 DATA DICTIONARY SUMMARY ======================= The following files and sub-files were modified with this patch: File # Field # Name ---------- ------- ------------------------------ 350.71 AMBULATORY SURG. CHECK-OFF SHEET PRINT FIELDS .06 PROCEDURE 350.9 IB SITE PARAMETERS 1.29 DEFAULT RX REFILL DX 1.3 DEFAULT RX REFILL CPT 351.61 TRANSFER PRICING TRANSACTIONS 1.01 DRG 351.612 ICD DIAGNOSIS (sub-file) .01 ICD DIAGNOSIS 351.613 PROCEDURES (sub-file) .01 PROCEDURES 356.2 INSURANCE REVIEW .14 DIAGNOSIS AUTHORIZED 356.5 CLAIMS TRACKING ALOS .01 DRG 356.9 INPATIENT DIAGNOSIS .01 DIAGNOSIS 356.91 INPATIENT PROCEDURE .01 PROCEDURE 356.93 INPATIENT INTERIM DRG .01 NAME 361.1 EXPLANATION OF BENEFITS 361.115 835 LINE LEVEL ADJUSTMENTS (sub-file) .04 PROCEDURE 362.3 IB BILL/CLAIMS DIAGNOSIS .01 DIAGNOSIS 399 BILL/CLAIMS 215 ADMITTING DIAGNOSIS 399.0304 PROCEDURES (sub-file) .01 PROCEDURES 399.042 REVENUE CODE (sub-file) .06 PROCEDURE 399.30416 CPT MODIFIER SEQUENCE (sub-file) .02 CPT MODIFIER In these files, all fields, that point to files CPT, ICD0, ICD9, DRG and CPT Modifier, have been modified as follows: Sreening has been added (or extended) to ensure, that only codes, active for the date of service, can be selected by user. SOFTWARE AND DOCUMENTATION RETRIEVAL ==================================== The software for this patch is being distributed in host file CSV_MS_1_0.KID. The host file will contain nine KIDS builds. The builds contained in the CSV MS 1.0 multi-package distribution are: Package Patch(es) ------- --------- AICS IBD*3.0*51 Ambulatory Care DG*5.3*511 SD*5.3*295 DRG Grouper ICD*18.0*7 Event Capture EC*2.0*47 PCE PX*1.0*121 Registration (PTF) DG*5.3*510 Integrated Billing IB*2.0*210 Fee Basis FB*3.5*55 Please refer to the 'Software and Documentation Retrieval' section of the EC*2*47 patch description for instructions on how to acquire the patch software and documentation. INSTALLATION ============ Please refer to the Health Insurance Portability and Accountability Act (HIPAA) Code Set Versioning (CSV) Installation Guide for details of the installation procedure for this patch. The HIPAA CSV Installation Guide can be found in the following [ANONYMOUS.SOFTWARE] directories: Preferred Address ------------------------- First available FTP server download.vista.med.va.gov Specific Field Office FTP Address --------------------- ------------------------ Albany ftp.fo-albany.med.va.gov Hines ftp.fo-hines.med.va.gov Salt Lake City ftp.fo-slc.med.va.gov File Name Description Format FTP Protocol -------------- ------------- ------- ------------ CSV_1_0_IG.DOC Install Guide MS Word Binary Routine Information: ==================== Routine Name: - IBACSV Routine Checksum: Routine Name: - IBCRBG Routine Checksum: Routine Name: - IBATLM2A Routine Checksum: Routine Name: - IBCBB2 Routine Checksum: Routine Name: - IBCBB21 Routine Checksum: Routine Name: - IBCBB8 Routine Checksum: Routine Name: - IBCD3 Routine Checksum: Routine Name: - IBCEF1 Routine Checksum: Routine Name: - IBCEF3 Routine Checksum: Routine Name: - IBCEU4 Routine Checksum: Routine Name: - IBCF10 Routine Checksum: Routine Name: - IBCF22 Routine Checksum: Routine Name: - IBCF32 Routine Checksum: Routine Name: - IBCF331 Routine Checksum: Routine Name: - IBCIUT1 Routine Checksum: Routine Name: - IBCSC4 Routine Checksum: Routine Name: - IBCSC4B Routine Checksum: Routine Name: - IBCSC4C Routine Checksum: Routine Name: - IBCSC4D Routine Checksum: Routine Name: - IBCSC4E Routine Checksum: Routine Name: - IBCSC5 Routine Checksum: Routine Name: - IBCSC82 Routine Checksum: Routine Name: - IBCU7 Routine Checksum: Routine Name: - IBCU71 Routine Checksum: Routine Name: - IBCU72 Routine Checksum: Routine Name: - IBCVA1 Routine Checksum: Routine Name: - IBEPAR Routine Checksum: Routine Name: - IBJTBB Routine Checksum: Routine Name: - IBJTBC Routine Checksum: Routine Name: - IBRFN3 Routine Checksum: Routine Name: - IBTRE3 Routine Checksum: Routine Name: - IBTRE4 Routine Checksum: Routine Name: - IBTRE6 Routine Checksum: Routine Name: - IBTRV2 Routine Checksum: Routine Name: - IBCSC8H Routine Checksum: Routine Name: - IBCF11 Routine Checksum: Routine Name: - IBCF12 Routine Checksum: Routine Name: - IBATEI Routine Checksum: Routine Name: - IBCRU1 Routine Checksum: Routine Name: - IBCRU2 Routine Checksum: Routine Name: - IBCSC61 Routine Checksum: Routine Name: - IBTOBI2 Routine Checksum: Routine Name: - IBTRED0 Routine Checksum: Routine Name: - IBTRCD Routine Checksum: Routine Name: - IBTOBI4 Routine Checksum: Routine Name: - IBCU1 Routine Checksum: Routine Name: - IBCIUT5 Routine Checksum: Routine Name: - IB20P210 Routine Checksum: ============================================================================= User Information: Entered By : TUSEYEV,ANDREY Date Entered : FEB 19, 2003 Completed By: TORRANCE,LORI Date Completed: SEP 04, 2003 Released By : DU GARD,ROBERT Date Released : SEP 24, 2003 ============================================================================= Packman Mail Message: ===================== No routines included