STANDARD DATA DICTIONARY #162.5 -- FEE BASIS INVOICE FILE 3/24/25 PAGE 1
STORED IN ^FBAAI( *** NO DATA STORED YET *** SITE: WWW.BMIRWIN.COM UCI: VISTA,VISTA (VERSION 3.5)
DATA NAME GLOBAL DATA
ELEMENT TITLE LOCATION TYPE
-----------------------------------------------------------------------------------------------------------------------------------
This file contains the payment data associated with the inpatient hospital programs of FEE Basis.
Per VHA Directive 10-93-142, this file definition should not be modified.
DD ACCESS: @
RD ACCESS: #
WR ACCESS: #
DEL ACCESS: #
LAYGO ACCESS: #
POINTED TO BY: INVOICE NUMBER field (#1.03) of the IB-FB INTERFACE TRACKING File (#360)
CROSS
REFERENCED BY: BATCH NUMBER(AC), CHECK NUMBER(ACK), CONTRACT(ACN), DATE FINALIZED(AD), VENDOR(AF), VETERAN(AG),
OLD BATCH NUMBER(AH), ASSOCIATED 7078/583(AJ), VETERAN(AK), VENDOR(AK1), ADJUSTMENT REASON(AL),
DATE FINALIZED(AP), NUMBER(B), VENDOR(C), VETERAN(D), DoD INVOICE NUMBER(DODI), IPAC VENDOR AGREEMENT(IPAC)
INDEXED BY: VENDOR & VETERAN & TREATMENT FROM DATE (AA), BATCH NUMBER & VETERAN (AE), FPPS CLAIM ID (AFC), VENDOR & INVOICE DATE
RECEIVED & VETERAN & SUSPEND CODE (AI)
LAST MODIFIED: JAN 30,2018@14:48:55
162.5,.01 NUMBER 0;1 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>99999999)!(X<1)!(X?.E1"."1N.N)!('$$CHKBI^FBAAUTL4(X)) X S:$D(X) DINUM=X
LAST EDITED: JUL 22, 1994
HELP-PROMPT: Type a Number between 1 and 99999999, 0 Decimal Digits
DESCRIPTION:
This field contains the internal entry number for the Fee Basis Invoice.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 162.5^B
1)= S ^FBAAI("B",$E(X,1,30),DA)=""
2)= K ^FBAAI("B",$E(X,1,30),DA)
162.5,1 INVOICE DATE RECEIVED 0;2 DATE (Required)
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 31, 2000
DESCRIPTION: This field contains the date the correct invoice was received. It is used by Austin for the
calculation of any applicable interest payments.
RECORD INDEXES: AI (#75)
162.5,2 VENDOR 0;3 POINTER TO FEE BASIS VENDOR FILE (#161.2) (Required)
LAST EDITED: JAN 31, 2000
DESCRIPTION: Reference to the vendor file, this field contains the name of the vendor associated with this
invoice.
CROSS-REFERENCE: 162.5^C
1)= S ^FBAAI("C",$E(X,1,30),DA)=""
2)= K ^FBAAI("C",$E(X,1,30),DA)
CROSS-REFERENCE: 162.5^AF^MUMPS
1)= S ^FBAAI("AF",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)=""
2)= K ^FBAAI("AF",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)
CROSS-REFERENCE: 162.5^AK1^MUMPS
1)= S:$P(^FBAAI(DA,0),U,4) ^FBAAI("AK",$P(^(0),U,4),$E(X,1,30),DA)=""
2)= K:$P(^FBAAI(DA,0),U,4) ^FBAAI("AK",$P(^(0),U,4),$E(X,1,30),DA)
Update cross-reference on veteran field, which includes vendor. Used for displaying payment data
by veteran.
RECORD INDEXES: AA (#73), AI (#75)
162.5,3 VETERAN 0;4 POINTER TO FEE BASIS PATIENT FILE (#161) (Required)
LAST EDITED: JAN 31, 2000
DESCRIPTION: Reference the Fee Basis Patient file, this field contains the name of the veteran for which this
invoice is established.
CROSS-REFERENCE: 162.5^D
1)= S ^FBAAI("D",$E(X,1,30),DA)=""
2)= K ^FBAAI("D",$E(X,1,30),DA)
CROSS-REFERENCE: 162.5^AG^MUMPS
1)= S ^FBAAI("AG",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)=""
2)= K ^FBAAI("AG",$E(X,1,30),9999999.9999-$P(^FBAAI(DA,0),U,2),DA)
CROSS-REFERENCE: 162.5^AK^MUMPS
1)= S:$P(^FBAAI(DA,0),U,3) ^FBAAI("AK",$E(X,1,30),$P(^FBAAI(DA,0),U,3),DA)=""
2)= K:$P(^FBAAI(DA,0),U,3) ^FBAAI("AK",$E(X,1,30),$P(^(0),U,3),DA)
Cross-reference on veteran field to include vendor.
RECORD INDEXES: AA (#73), AE (#74), AI (#75)
162.5,4 ASSOCIATED 7078/583 0;5 VARIABLE POINTER
FILE ORDER PREFIX LAYGO MESSAGE
162.4 1 AUTH n Select associated 7078
162.7 2 UNAUTH n Select associated 583
LAST EDITED: OCT 11, 1990
DESCRIPTION:
This field contains the pointer to the appropriate 7078 or 583 file.
CROSS-REFERENCE: 162.5^AJ^MUMPS
1)= S ^FBAAI("E",$E(X,1,30),DA)=""
2)= K ^FBAAI("E",$E(X,1,30),DA)
162.5,5 TREATMENT FROM DATE 0;6 DATE (Required)
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JAN 31, 2000
DESCRIPTION: Information in this field indicates the starting date for this invoice. (i.e. the starting
treatment date for which this billing covers).
RECORD INDEXES: AA (#73)
162.5,6 TREATMENT TO DATE 0;7 DATE (Required)
INPUT TRANSFORM: S %DT="ETX" D ^%DT S X=Y K:Y<1 X I $D(X),$P(^FBAAI(DA,0),U,6)>X K X W !,*7,"To Date cannot be befor
e From date!",!
LAST EDITED: JAN 29, 1991
DESCRIPTION: Information in this field indicates the ending date for this invoice. (i.e. the ending treatment
date this billing covers).
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162.5,6.5 DISCHARGE TYPE CODE 0;21 POINTER TO FEE BASIS DISPOSITION CODE FILE (#162.6)
LAST EDITED: APR 16, 1990
DESCRIPTION:
This field contains the code pertaining to the type of discharge associated with this invoice.
162.5,6.6 BILLED CHARGES 0;22 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X
LAST EDITED: NOV 17, 2008
HELP-PROMPT: Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
DESCRIPTION: This field contains cost information on the amount the VA was initially billed by the vendor for an
inpatient stay.
162.5,6.7 PAYMENT BY MEDICARE/FED AGENCY 0;23 FREE TEXT (Required)
INPUT TRANSFORM: I $D(X) D YN^FBAAUTL3
OUTPUT TRANSFORM: D OUTYN^FBAAUTL3
LAST EDITED: MAR 18, 1994
HELP-PROMPT: Answer 'Yes' or '1' for YES and 'No' or '0' for NO.
DESCRIPTION: Answer 'Yes' if Medicare or some other federal agency has paid some of the bill for contract
hospital.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162.5,7 AMOUNT CLAIMED 0;8 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X I $D(X),$P(^FBAAI(DA,0),U,12)=6,$P(^
(0),U,22)9999999.99)!(X<0) X I $D(X),$P(^FBAAI(DA,0),U,12)'=6,$P(^F
BAAI(DA,0),U,8)9999999.99)!(X<0) X
LAST EDITED: NOV 17, 2008
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
DESCRIPTION:
The difference between the amount claimed and the amount paid.
162.5,10 SUSPEND CODE 0;11 POINTER TO FEE BASIS SUSPENSION FILE (#161.27)
LAST EDITED: JAN 31, 2000
DESCRIPTION: If an amount was suspended, the user is requested to indicate the reason for suspense from the
selection of suspense codes.
RECORD INDEXES: AI (#75)
162.5,11 FEE PROGRAM 0;12 POINTER TO FEE BASIS PROGRAM FILE (#161.8) (Required)
DESCRIPTION: This field contains the valid Fee Program associated with this Invoice as contained in the Fee
Basis Program file (i.e. Contract Hospital or Community Nursing Home for an inpatient stay).
162.5,12 PAYMENT TYPE CODE 0;13 SET
'R' FOR REIMBURSEMENT;
'V' FOR VENDOR;
'S' FOR STATISTICAL;
'SR' FOR STAT-REIMBURSEMENT;
DESCRIPTION: An entry of 'R' will indicate the invoice is for a reimbursement to the veteran for services that
he/she has already paid. An entry of 'V' will indicate the invoice is for a payment directly to a
vendor. An entry of 'S' will indicate the invoice was paid "out of system" to a vendor and allows
the update of the payment history files. An entry of 'SR' will indicate a statistical
reimbursement to a party other than the vendor.
162.5,13 REJECT STATUS FBREJ;1 SET
'P' FOR REJECTED, PENDING ACTION;
'C' FOR REJECTED, COMPLETED;
DESCRIPTION: An entry in this field will indicate that the invoice has been rejected. An entry of 'P' will
indicate the invoice has been rejected and it is awaiting action. An entry of 'C' will indicate
the invoice has been rejected and action on it has been completed.
162.5,14 REJECT REASON FBREJ;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<2) X
HELP-PROMPT: Answer must be 2-40 characters in length.
DESCRIPTION: If the invoice has a status of rejected, the user will be prompted to enter a reason that the
reject has occurred.
162.5,15 OLD BATCH NUMBER FBREJ;3 POINTER TO FEE BASIS BATCH FILE (#161.7)
LAST EDITED: JAN 31, 1989
DESCRIPTION: This field is populated only if there is a reject pending. It will contain the batch number of the
old batch associated with the invoice. This is to provide a link back to that batch if the user
deletes the reject.
CROSS-REFERENCE: 162.5^AH^MUMPS
1)= S ^FBAAI("AH",$E(X,1,30),DA)=""
2)= K ^FBAAI("AH",$E(X,1,30),DA)
162.5,15.3 INTERFACE REJECT FBREJ;4 SET
'1' FOR YES;
LAST EDITED: DEC 12, 2011
HELP-PROMPT: Enter YES if the line item was rejected by Central Fee.
DESCRIPTION: This field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options when a
payment line item is rejected via the interface with Central Fee. This field is used to
distinguish line items that were locally rejected from those that were rejected by a downstream
system. This field is not populated for a local reject.
162.5,15.6 REJECT CODE FBREJC;0 Multiple #162.515
DESCRIPTION: The REJECT CODE multiple is populated with one to four reject codes by the FBAA BATCH SERVER and
FBAA REJECT SERVER server options when a line item is rejected via the interface with Central Fee.
The REJECT CODE multiple is not used for local rejects. The reason for a local reject is entered
into the REJECT REASON (#14) field.
162.515,.01 REJECT CODE 0;1 FREE TEXT (Multiply asked)
INPUT TRANSFORM: K:$L(X)>4!($L(X)<1) X
LAST EDITED: FEB 01, 2012
HELP-PROMPT: Answer must be 1-4 characters in length.
DESCRIPTION: The REJECT CODE field is populated by the FBAA BATCH SERVER and FBAA REJECT SERVER server options
when a line item is rejected via the interface with Central Fee. The REJECT CODE field is not
used for local rejects. The reason for a local reject is entered into the REJECT REASON (#14)
field.
TECHNICAL DESCR: Values stored in the REJECT CODE field are normally expected to have a matching entry in the FEE
BASIS PAYMENT REJECT CODE (#161.99) file. The FEE BASIS PAYMENT REJECT CODE file contains a list
of reject codes and their descriptions.
However it is possible that a new reject code will be transmitted to VistA by Central Fee and
stored in the REJECT CODE field before the FEE BASIS PAYMENT REJECT CODE file is updated with
that new code. In this case outputs that display the description of a code will display text
similar to "Reject reason code not currently defined in list."
CROSS-REFERENCE: 162.515^B
1)= S ^FBAAI(DA(1),"FBREJC","B",$E(X,1,30),DA)=""
2)= K ^FBAAI(DA(1),"FBREJC","B",$E(X,1,30),DA)
162.5,16 VOID PAYMENT 0;14 SET
'VP' FOR VOIDED PAYMENT;
DESCRIPTION:
Entry into this field is made when the user indicates the payment must be voided.
162.5,16.5 REASON FOR VOIDED PAYMENT R;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>75!($L(X)<3) X
LAST EDITED: MAR 04, 1993
HELP-PROMPT: Answer must be 3-75 characters in length.
DESCRIPTION: This field is only populated if the Void Payment field is flagged for a void. The user is prompted
to enter a reason the payment was voided.
162.5,17 SUPERVISOR WHO VOIDED 0;15 POINTER TO NEW PERSON FILE (#200)
LAST EDITED: APR 05, 1990
DESCRIPTION: This field is only populated when the Void Payment field is flagged for a void. The field is
stuffed with the user who voided the payment (and in all instances, the user must be a supervisor).
162.5,18 DESCRIPTION OF SUSPENSION 1;0 WORD-PROCESSING #162.518 (NOWRAP)
DESCRIPTION: This field is only populated when there is a dollar amount that has been suspended. The user is
prompted to enter a description of the suspension in word-processing format.
LAST EDITED: JAN 17, 1991
162.5,19 DATE FINALIZED 0;16 DATE
INPUT TRANSFORM: S %DT="EX" D ^%DT S X=Y K:Y<1 X
LAST EDITED: JUN 11, 1990
DESCRIPTION:
This field contains the date the invoice was vouchered by Fiscal.
CROSS-REFERENCE: 162.5^AP^MUMPS
1)= S:$P(^FBAAI(DA,0),U,20)]"" ^FBAAI("AP",$P(^FBAAI(DA,0),U,20),9999999-$E(X,1,30),DA)=""
2)= K:$P(^FBAAI(DA,0),U,20)]"" ^FBAAI("AP",$P(^FBAAI(DA,0),U,20),9999999-$E(X,1,30),DA)
CROSS-REFERENCE: 162.5^AD
1)= S ^FBAAI("AD",$E(X,1,30),DA)=""
2)= K ^FBAAI("AD",$E(X,1,30),DA)
162.5,20 BATCH NUMBER 0;17 POINTER TO FEE BASIS BATCH FILE (#161.7)
INPUT TRANSFORM: S DIC("S")="I $P(^(0),U,3)=""B9""&($P(^(0),U,5)=DUZ)&($P(^(""ST""),U,1)=""O"")" D ^DIC K DIC S DIC=
DIE,X=+Y K:Y<0 X
LAST EDITED: JAN 31, 2000
DESCRIPTION: This field contains the batch number associated with this invoice. (The batch number that the
invoice resides in).
SCREEN: S DIC("S")="I $P(^(0),U,3)=""B9""&($P(^(0),U,5)=DUZ)&($P(^(""ST""),U,1)=""O"")"
EXPLANATION: ONLY BATCHES WITH A STATUS OF 'OPEN'
CROSS-REFERENCE: 162.5^AC^MUMPS
1)= S ^FBAAI("AC",$E(X,1,30),DA)=""
2)= K ^FBAAI("AC",$E(X,1,30),DA)
RECORD INDEXES: AE (#74)
162.5,21 PURPOSE OF VISIT 0;18 POINTER TO FEE BASIS PURPOSE OF VISIT FILE (#161.82)
INPUT TRANSFORM: S DIC("S")="I $S('$G(^(""I"")):1,DT'>^(""I""):1,1:0)" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: FEB 05, 1993
DESCRIPTION:
Contains the valid Purpose of Visit code as defined in the Fee Basis Purpose of Visit file.
SCREEN: S DIC("S")="I $S('$G(^(""I"")):1,DT'>^(""I""):1,1:0)"
EXPLANATION: An inactive Purpose of Visit Code may not be selected.
162.5,22 PATIENT TYPE CODE 0;19 SET
'00' FOR SURGICAL;
'10' FOR MEDICAL;
'60' FOR HOME NURSING SERVICE;
'85' FOR PSYCHIATRIC-CONTRACT;
'86' FOR PSYCHIATRIC;
'95' FOR NEUROLOGICAL-CONTRACT;
'96' FOR NEUROLOGICAL;
LAST EDITED: APR 25, 1989
DESCRIPTION: This field requires the entry of the type of treatment being provided to the patient (i.e.
Surgical, Medical, Home Nursing Service, etc.)
162.5,23 PRIMARY SERVICE FACILITY 0;20 POINTER TO INSTITUTION FILE (#4)
LAST EDITED: JUN 04, 1990
DESCRIPTION:
The VA Hospital responsible for that Veterans care.
162.5,24 DISCHARGE DRG 0;24 POINTER TO DRG FILE (#80.2)
LAST EDITED: JAN 11, 1993
DESCRIPTION:
This field should contain the discharge DRG that is returned from the Austin Pricer System.
TECHNICAL DESCR: This field is a pointer to the DRG file, however it is the grouped DRG as calculated by the Austin
Pricer system.
162.5,24.5 DRG WEIGHT 2;12 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999.9999)!(X<0)!(X?.E1"."5N.N) X
LAST EDITED: SEP 22, 2003
HELP-PROMPT: Type a Number between 0 and 999.9999, 4 Decimal Digits
DESCRIPTION:
Enter the DRG weight as reported by the Austin Pricer.
162.5,25 RESUBMISSION 0;25 SET
'1' FOR YES;
LAST EDITED: MAR 04, 1993
DESCRIPTION: Entry into this field indicates that this invoice is a resubmission. Failure to annotate an
invoice in such a manner would cause Austin to reject the payment as duplicate.
162.5,26 NVH PRICER AMOUNT 0;26 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<.01) X
LAST EDITED: NOV 17, 2008
HELP-PROMPT: Type a Dollar Amount between .01 and 9999999.99, 2 Decimal Digits
DESCRIPTION:
The amount for this payment as determined by the Austin Pricer.
162.5,30 ICD1 DX;1 POINTER TO ICD DIAGNOSIS FILE (#80) (Required)
LAST EDITED: MAY 29, 1990
DESCRIPTION:
The first valid ICD code associated with this payment.
162.5,30.02 POA1 POA;1 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD1 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD1 field.
162.5,31 ICD2 DX;2 POINTER TO ICD DIAGNOSIS FILE (#80)
DESCRIPTION:
The second valid ICD code (if one exists) associated with this payment.
162.5,31.02 POA2 POA;2 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD2 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD2 field.
162.5,32 ICD3 DX;3 POINTER TO ICD DIAGNOSIS FILE (#80)
DESCRIPTION:
The third valid ICD code (if one exists) associated with this payment.
162.5,32.02 POA3 POA;3 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD3 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD3 field.
162.5,33 ICD4 DX;4 POINTER TO ICD DIAGNOSIS FILE (#80)
DESCRIPTION:
The fourth valid ICD code (if one exists) associated with this payment.
162.5,33.02 POA4 POA;4 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD4 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD4 field.
162.5,34 ICD5 DX;5 POINTER TO ICD DIAGNOSIS FILE (#80)
DESCRIPTION:
The fifth valid ICD code (if one exists) associated with this payment.
162.5,34.02 POA5 POA;5 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD5 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD5 field.
162.5,35 ICD6 DX;6 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The sixth valid ICD code (if one exists) associated with this payment.
162.5,35.02 POA6 POA;6 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD6 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD6 field.
162.5,35.1 ICD7 DX;7 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The seventh valid ICD code (if one exists) associated with this payment.
162.5,35.12 POA7 POA;7 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD7 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD7 field.
162.5,35.2 ICD8 DX;8 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The eighth valid ICD code (if one exists) associated with this payment.
162.5,35.22 POA8 POA;8 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD8 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD8 field.
162.5,35.3 ICD9 DX;9 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The ninth valid ICD code (if one exists) associated with this payment.
162.5,35.32 POA9 POA;9 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD9 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD9 field.
162.5,35.4 ICD10 DX;10 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The tenth valid ICD code (if one exists) associated with this payment.
162.5,35.42 POA10 POA;10 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD10 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD10 field.
162.5,35.5 ICD11 DX;11 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The eleventh valid ICD code (if one exists) associated with this payment.
162.5,35.52 POA11 POA;11 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD11 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD11 field.
162.5,35.6 ICD12 DX;12 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twelfth valid ICD code (if one exists) associated with this payment.
162.5,35.62 POA12 POA;12 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD12 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD12 field.
162.5,35.7 ICD13 DX;13 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The thirteenth valid ICD code (if one exists) associated with this payment.
162.5,35.72 POA13 POA;13 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD13 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD13 field.
162.5,35.8 ICD14 DX;14 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The fourteenth valid ICD code (if one exists) associated with this payment.
162.5,35.82 POA14 POA;14 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD14 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD14 field.
162.5,35.9 ICD15 DX;15 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The fifteenth valid ICD code (if one exists) associated with this payment.
162.5,35.92 POA15 POA;15 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD15 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD15 field.
162.5,36 ICD16 DX;16 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The sixteenth valid ICD code (if one exists) associated with this payment.
162.5,36.02 POA16 POA;16 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD16 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD16 field.
162.5,36.1 ICD17 DX;17 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The seventeenth valid ICD code (if one exists) associated with this payment.
162.5,36.12 POA17 POA;17 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD17 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD17 field.
162.5,36.2 ICD18 DX;18 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The eighteenth valid ICD code (if one exists) associated with this payment.
162.5,36.22 POA18 POA;18 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD18 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD18 field.
162.5,36.3 ICD19 DX;19 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The nineteenth valid ICD code (if one exists) associated with this payment.
162.5,36.32 POA19 POA;19 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD19 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD19 field.
162.5,36.4 ICD20 DX;20 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twentieth valid ICD code (if one exists) associated with this payment.
162.5,36.42 POA20 POA;20 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD20 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD20 field.
162.5,36.5 ICD21 DX;21 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twenty-first valid ICD code (if one exists) associated with this payment.
162.5,36.52 POA21 POA;21 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD21 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD21 field.
162.5,36.6 ICD22 DX;22 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twenty-second valid ICD code (if one exists) associated with this payment.
162.5,36.62 POA22 POA;22 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD22 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD22 field.
162.5,36.7 ICD23 DX;23 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twenty-third valid ICD code (if one exists) associated with this payment.
162.5,36.72 POA23 POA;23 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD23 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD23 field.
162.5,36.8 ICD24 DX;24 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twenty-fourth valid ICD code (if one exists) associated with this payment.
162.5,36.82 POA24 POA;24 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD24 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD24 field.
162.5,36.9 ICD25 DX;25 POINTER TO ICD DIAGNOSIS FILE (#80)
LAST EDITED: NOV 19, 2008
DESCRIPTION:
The twenty-fifth valid ICD code (if one exists) associated with this payment.
162.5,36.92 POA25 POA;25 POINTER TO PRESENT ON ADMISSION FILE (#161.94)
LAST EDITED: NOV 20, 2008
HELP-PROMPT: Enter the present on admission indicator for the ICD25 diagnosis.
DESCRIPTION:
This field contains the present on admission (POA) indicator for the diagnosis in the ICD25 field.
162.5,39 ADMITTING DIAGNOSIS 5;9 POINTER TO ICD DIAGNOSIS FILE (#80) (Required)
LAST EDITED: NOV 19, 2008
HELP-PROMPT: Enter the admitting diagnosis for this claim.
DESCRIPTION:
This is the admitting diagnosis code from the claim.
162.5,40 PROC1 PROC;1 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
DESCRIPTION:
The first valid procedure code (if one exists) associated with this payment.
162.5,41 PROC2 PROC;2 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
DESCRIPTION:
The second valid procedure code (if one exists) associated with this payment.
162.5,42 PROC3 PROC;3 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
DESCRIPTION:
The third valid procedure code (if one exists) associated with this payment.
162.5,43 PROC4 PROC;4 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
DESCRIPTION:
The fourth valid procedure code (if one exists) associated with this payment.
162.5,44 PROC5 PROC;5 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
DESCRIPTION:
The fifth valid procedure code (if one exists) associated with this payment.
162.5,44.06 PROC6 PROC;6 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The sixth valid procedure code (if one exists) associated with this payment.
162.5,44.07 PROC7 PROC;7 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The seventh valid procedure code (if one exists) associated with this payment.
162.5,44.08 PROC8 PROC;8 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The eighth valid procedure code (if one exists) associated with this payment.
162.5,44.09 PROC9 PROC;9 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The ninth valid procedure code (if one exists) associated with this payment.
162.5,44.1 PROC10 PROC;10 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The tenth valid procedure code (if one exists) associated with this payment.
162.5,44.11 PROC11 PROC;11 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The eleventh valid procedure code (if one exists) associated with this payment.
162.5,44.12 PROC12 PROC;12 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twelfth valid procedure code (if one exists) associated with this payment.
162.5,44.13 PROC13 PROC;13 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The thirteenth valid procedure code (if one exists) associated with this payment.
162.5,44.14 PROC14 PROC;14 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The fourteenth valid procedure code (if one exists) associated with this payment.
162.5,44.15 PROC15 PROC;15 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The fifteenth valid procedure code (if one exists) associated with this payment.
162.5,44.16 PROC16 PROC;16 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The sixteenth valid procedure code (if one exists) associated with this payment.
162.5,44.17 PROC17 PROC;17 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The seventeenth valid procedure code (if one exists) associated with this payment.
162.5,44.18 PROC18 PROC;18 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The eighteenth valid procedure code (if one exists) associated with this payment.
162.5,44.19 PROC19 PROC;19 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The nineteenth valid procedure code (if one exists) associated with this payment.
162.5,44.2 PROC20 PROC;20 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twentieth valid procedure code (if one exists) associated with this payment.
162.5,44.21 PROC21 PROC;21 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twenty-first valid procedure code (if one exists) associated with this payment.
162.5,44.22 PROC22 PROC;22 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twenty-second valid procedure code (if one exists) associated with this payment.
162.5,44.23 PROC23 PROC;23 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twenty-third valid procedure code (if one exists) associated with this payment.
162.5,44.24 PROC24 PROC;24 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twenty-fourth valid procedure code (if one exists) associated with this payment.
162.5,44.25 PROC25 PROC;25 POINTER TO ICD OPERATION/PROCEDURE FILE (#80.1)
LAST EDITED: NOV 20, 2008
DESCRIPTION:
The twenty-fifth valid procedure code (if one exists) associated with this payment.
162.5,45 DATE PAID 2;1 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 15, 1994
HELP-PROMPT: This is the date of the check, as issued by the treasury.
DESCRIPTION: This is the date of the check, as issued by the treasury. This information will be passed back to
DHCP from the Financial Management System (FMS) when the check is issued to the vendor. This field
will use the check date beginning with version 3.5 of Fee Basis.
162.5,46 VENDOR INVOICE DATE 2;2 DATE (Required)
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X I X>$P(^FBAAI(DA,0),U,2) W !,*7,"Vendor Invoice Date cannot be later
than the Date Correct Invoice Received" K X
LAST EDITED: APR 15, 1994
HELP-PROMPT: Enter the date the vendor issued the invoice.
DESCRIPTION:
This is the date that the vendor issued the invoice.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162.5,47 PROMPT PAY TYPE 2;3 SET
'1' FOR MONEY MANAGED;
LAST EDITED: MAR 18, 1994
HELP-PROMPT: Set equal to 1 if payment is subject to interest payments.
DESCRIPTION:
Field is set to 1 if the payment is subject to interest payments (prompt pay).
162.5,48 CHECK NUMBER 2;4 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>8!($L(X)<1)!'(X?.AN) X
LAST EDITED: APR 25, 1994
HELP-PROMPT: Answer must be 1-8 characters in length.
DESCRIPTION: Contains the check number as issued by the treasury. This field is updated after the check is
issued, through a server option that records actual payment information for each Fee payment made.
CROSS-REFERENCE: 162.5^ACK^MUMPS
1)= S ^FBAAI("ACK",$E(X,1,30),DA)=""
2)= K ^FBAAI("ACK",X,DA)
This cross-reference is used to find payment line items for specific check numbers.
162.5,49 CANCELLATION DATE 2;5 DATE
INPUT TRANSFORM: S %DT="E" D ^%DT S X=Y K:Y<1 X
LAST EDITED: MAR 15, 1994
HELP-PROMPT: The date the check was cancelled by the treasury.
DESCRIPTION: This is the date the treasury cancelled the check. This field is updated through a server option
that records cancellations of previously recorded payment data.
162.5,50 REASON CODE 2;6 POINTER TO FEE BASIS CHECK CANCELLATION REASON FILE (#162.95)
LAST EDITED: MAR 15, 1994
HELP-PROMPT: Enter the reason the check was cancelled.
DESCRIPTION: This field contains a pointer to the Fee Basis Check Cancellation Reason file. It is populated
through a server option that updates the payment record when the treasury cancels a check that was
previously payed.
162.5,51 CANCELLATION ACTIVITY 2;7 SET
'R' FOR WILL BE REPLACED;
'C' FOR WILL BE REISSUED;
'X' FOR WILL NOT BE REISSUED;
LAST EDITED: APR 26, 1994
HELP-PROMPT: Field will contain cancellation code if there has been cancellation activity on this payment.
DESCRIPTION: This field is populated when a cancellation is recorded for the payment referenced. This field
will always remain populated, to indicate that there was cancellation activity on this payment at
one time. New payments will replace the cancellation date and reason code fields, but the
cancellation activity flag will not be overwritten. This flag will allow the user to know that
previous cancellation activity existed, and to review the cancellation history output for further
information.
162.5,52 DISBURSED AMOUNT 2;8 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
LAST EDITED: NOV 19, 2008
HELP-PROMPT: Type a Dollar Amount between 0 and 9999999.99, 2 Decimal Digits
DESCRIPTION:
This is the dollar amount paid by the treasury, less any interest paid.
162.5,53 INTEREST AMOUNT 2;9 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>999999)!(X<0) X
LAST EDITED: APR 21, 1994
HELP-PROMPT: Type a Dollar Amount between 0 and 999999, 2 Decimal Digits
DESCRIPTION:
The interest amount paid on this line item by the treasury.
162.5,54 COVERED DAYS 2;10 NUMBER (Required)
INPUT TRANSFORM: K:+X'=X!(X>99999)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: JUL 07, 2003
HELP-PROMPT: Type a Number between 0 and 99999, 0 Decimal Digits
DESCRIPTION: This is the number of total number of Inpatient days that the Fee Staff has determined will be
paid. Enter number of inpatient days to be paid.
162.5,55 PATIENT CONTROL NUMBER 2;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 17, 2003
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION: Please enter the Patient control number. This could be either the Patient Identification Number or
Patient Account Number from the vendor's invoice.
162.5,56 FPPS CLAIM ID 3;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>32!($L(X)<1)!'(X?1.32N) X
LAST EDITED: JUN 18, 2003
HELP-PROMPT: Enter a non-zero number from 1 to 32 digits long, 0 decimal digits.
DESCRIPTION: Enter the entire FPPS Claim ID as shown on the invoice document. (1-32 character text ID created
by FPPS system).
FIELD INDEX: AFC (#301) REGULAR IR SORTING ONLY
Short Descr: Cross-reference on FPPS CLAIM ID.
Description: Regular cross-reference on the FPPS CLAIM ID.
Set Logic: S ^FBAAI("AFC",$E(X,1,32),DA)=""
Kill Logic: K ^FBAAI("AFC",$E(X,1,32),DA)
Whole Kill: K ^FBAAI("AFC")
X(1): FPPS CLAIM ID (162.5,56) (Subscr 1) (Len 32) (forwards)
162.5,57 FPPS LINE ITEM 3;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>40!($L(X)<1) X
LAST EDITED: JUN 17, 2003
HELP-PROMPT: This response must be a number or a list or range or ALL, e.g., 1,3,5 or 2-4,8.
DESCRIPTION: Enter the line item sequence number associated with this charge. Each charge on the FPPS invoice
document will have a line item sequence number associated with it. A line item can be entered
individually or a group of charges from multiple lines can be entered. If all line items in a
group are in numerical sequence, you may enter the first line item sequence number followed by a
hyphen and the last line item sequence number. If the grouped charges are not in sequential order,
each line item must be entered individually, followed by a comma.
162.5,58 ADJUSTMENT 8;0 POINTER Multiple #162.558
162.558,.01 ADJUSTMENT REASON 0;1 POINTER TO ADJUSTMENT REASON FILE (#161.91)
INPUT TRANSFORM: S DIC("S")="I $P($$AR^FBUTL1(Y),U,4)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: MAR 26, 2015
HELP-PROMPT: Select a HIPAA Adjustment (suspense) Reason Code.
DESCRIPTION:
Adjustment reason codes explain why the amount paid differs from the amount claimed.
SCREEN: S DIC("S")="I $P($$AR^FBUTL1(Y),U,4)=1"
EXPLANATION: Only adjustment reasons that are applicable for Fee use can be selected.
CROSS-REFERENCE: 162.558^B
1)= S ^FBAAI(DA(1),8,"B",$E(X,1,30),DA)=""
2)= K ^FBAAI(DA(1),8,"B",$E(X,1,30),DA)
CROSS-REFERENCE: 162.5^AL^MUMPS
1)= Q
2)= D KILLRR^FBCHFR(X,.DA)
Deletes remittance remarks associated with the adjustment reason when the reason is deleted.
162.558,1 ADJUSTMENT GROUP 0;2 POINTER TO ADJUSTMENT GROUP FILE (#161.92) (Required)
INPUT TRANSFORM: S DIC("S")="I $P($$AG^FBUTL1(Y),U,4)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUN 25, 2003
HELP-PROMPT: Select a HIPAA Adjustment Group Code.
DESCRIPTION:
The Adjustment Group Code pertains to the previously entered adjustment reason code.
SCREEN: S DIC("S")="I $P($$AG^FBUTL1(Y),U,4)=1"
EXPLANATION: Only adjustment groups that are applicable for Fee use can be selected.
162.558,2 ADJUSTMENT AMOUNT 0;3 NUMBER (Required)
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?."-".N.1".".2N!(X>9999999.99)!(X<-9999999.99) X I $D(X) K:+X=0 X
LAST EDITED: NOV 19, 2008
HELP-PROMPT: Type a non-zero Dollar Amount between -9999999.99 and 9999999.99, 2 Decimal Digits
DESCRIPTION:
Enter the dollar amount that is not being paid for this charge per the adjustment reason.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162.5,59 REMITTANCE REMARK 9;0 POINTER Multiple #162.559
162.559,.01 REMITTANCE REMARK 0;1 POINTER TO REMITTANCE REMARK FILE (#161.93) (Multiply asked)
INPUT TRANSFORM: S DIC("S")="I $P($$RR^FBUTL1(Y),U,4)=1" D ^DIC K DIC S DIC=DIE,X=+Y K:Y<0 X
LAST EDITED: JUL 17, 2003
HELP-PROMPT: Select a HIPAA Remittance Remark Code.
DESCRIPTION: Select a remittance remark code to provide non-financial information critical to understanding
the adjudication of the claim.
SCREEN: S DIC("S")="I $P($$RR^FBUTL1(Y),U,4)=1"
EXPLANATION: Only remittance remarks applicable for Fee use can be selected.
CROSS-REFERENCE: 162.559^B
1)= S ^FBAAI(DA(1),9,"B",$E(X,1,30),DA)=""
2)= K ^FBAAI(DA(1),9,"B",$E(X,1,30),DA)
162.559,1 ADJUSTMENT 0;2 NUMBER
INPUT TRANSFORM: K:+X'=X!(X>999)!(X<1)!(X?.E1"."1N.N) X
LAST EDITED: MAR 25, 2015
HELP-PROMPT: Type a number between 1 and 999, 0 decimal digits.
DESCRIPTION: For Internal use only. Used to associate a remittance remark entry with an adjustment reason
within the ADJUSTMENT Multiple (#162.558), ADJUSTMENT REASON (#.01) field. The value entered into
the ADJUSTMENT field is the DA of the adjustment reason entry.
162.5,60 CONTRACT 5;8 POINTER TO FEE BASIS CONTRACT FILE (#161.43)
LAST EDITED: JUL 09, 2009
HELP-PROMPT: If applicable, select the contract.
DESCRIPTION: If the payment is for contracted services, the contract number can be specified in this field. The
selected contract must be active and applicable to the vendor being paid.
TECHNICAL DESCR: In some cases this field will be automatically populated by the software based on the associated
authorization. In other cases, the user will be prompted for a value.
CROSS-REFERENCE: 162.5^ACN
1)= S ^FBAAI("ACN",$E(X,1,30),DA)=""
2)= K ^FBAAI("ACN",$E(X,1,30),DA)
This is an index of contracts entered for invoices. The index will be used to prevent deletion of
entries from the FEE BASIS CONTRACT file that are referenced (pointed to) by an invoice.
162.5,61 ROUTING NUMBER 2;13 FREE TEXT
INPUT TRANSFORM: K:$L(X)>9!($L(X)<9) X
LAST EDITED: MAY 13, 2011
HELP-PROMPT: Answer must be 9 characters in length.
DESCRIPTION: Enter the financial routing number information that was returned with the payment from Central Fee
for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the
vendor can be notified of the payment. This field must be 9 characters, including any leading
zeros. Note: The Central Fee nightly update will automatically set this field if the data is
included in their message.
162.5,62 ACCOUNT NUMBER 2;14 FREE TEXT
INPUT TRANSFORM: K:$L(X)>17!($L(X)<1) X
LAST EDITED: MAY 13, 2011
HELP-PROMPT: Answer must be 1-17 characters in length.
DESCRIPTION: Enter the financial account number information that was returned with the payment from Central Fee
for Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the
vendor can be notified of the payment. This field must be 1-17 characters, including any leading
zeros. Note: The Central Fee nightly update will automatically set this field if the data is
included in their message.
162.5,63 FINANCIAL INSTITUTION 2;15 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: MAY 13, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: Enter the financial institution name that was returned with the payment from Central Fee for
Electronic Fund Transfer (EFT) entries. This information will be forwarded to FPPS so that the
vendor can be notified of the payment. Note: The Central Fee nightly update will automatically set
this field if the data is included in their message.
162.5,64 ATTENDING PROV NAME 4;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Enter the Attending Provider's name found in the claim information.
162.5,65 ATTENDING PROV NPI 4;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Attending Provider's National Provider Identifier (NPI) found in the claim information.
This value must be 10 characters, including any leading zeros.
162.5,66 ATTENDING PROV TAXONOMY CODE 4;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Attending Provider's Taxonomy code found in the claim information. This value must be 10
characters, including any leading zeros.
162.5,67 OPERATING PROV NAME 4;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Enter the Operating Provider's name found in the claim information.
162.5,68 OPERATING PROV NPI 4;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Operating Provider's National Provider Identifier (NPI) found in the claim information.
This value must be 10 characters, including any leading zeros.
162.5,69 RENDERING PROV NAME 4;6 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 29, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Enter the Rendering Provider's name found in the claim information.
162.5,70 RENDERING PROV NPI 4;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Rendering Provider's National Provider Identifier (NPI) found in the claim information.
This value must be 10 characters, including any leading zeros.
162.5,71 RENDERING PROV TAXONOMY CODE 4;8 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Rendering Provider's Taxonomy code found in the claim information. This value must be 10
characters, including any leading zeros.
162.5,72 SERVICING PROV NAME 4;9 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Enter the Servicing Provider's name found in the claim information.
162.5,73 SERVICING PROV NPI 4;10 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Servicing Provider's National Provider Identifier (NPI) found in the claim information.
This value must be 10 characters, including any leading zeros.
162.5,74 REFERRING PROV NAME 4;11 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION:
Enter the Referring Provider's name found in the claim information.
162.5,75 REFERRING PROV NPI 4;12 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the Referring Provider's National Provider Identifier (NPI) found in the claim information.
This value must be 10 characters, including any leading zeros.
162.5,79 LINE ITEM RENDERING PROV RPROV;0 Multiple #162.579
DESCRIPTION: This multiple stores Rendering Provider information that is specific to a line item on the claim. A
record should only be added to this multiple if the Rendering Provider for a line item is different
from the Rendering Provider at the claim level. Example, if the PROC1 code is entered and has a
different Rendering Provider than the claim Rendering Provider (field #70) the multiple will store
the different data. Line item #1 would be referencing PROC1; Line Item #5 would reference PROC5.
162.579,.01 LINE ITEM NUMBER 0;1 NUMBER (Multiply asked)
INPUT TRANSFORM: K:+X'=X!(X>25)!(X<0)!(X?.E1"."1N.N) X
LAST EDITED: FEB 15, 2012
HELP-PROMPT: Type a number between 0 and 25, 0 decimal digits.
DESCRIPTION: Enter the line item number for the associated Rendering Provider information. Example, Line item
3 has a Rendering Provider different than the claim level Rendering Provider. You would enter 3
to associate this different Rendering Provider to the line item 3 of the claim.
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
CROSS-REFERENCE: 162.579^B
1)= S ^FBAAI(DA(1),"RPROV","B",$E(X,1,30),DA)=""
2)= K ^FBAAI(DA(1),"RPROV","B",$E(X,1,30),DA)
162.579,.02 RENDERING PROV NAME 0;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 1-30 characters in length.
DESCRIPTION: Enter the associated line item Rendering Provider's name found in the line item level claim
information.
162.579,.03 RENDERING PROV NPI 0;3 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the associated line item Rendering Provider's National Provider Identifier (NPI) for the
line level claim information.
162.579,.04 RENDERING PROV TAXONOMY CODE 0;4 FREE TEXT
INPUT TRANSFORM: K:$L(X)>10!($L(X)<10) X
LAST EDITED: APR 22, 2011
HELP-PROMPT: Answer must be 10 characters in length.
DESCRIPTION: Enter the associated line item Rendering Provider's Taxonomy code found in the line item level of
the claim information. This value must be 10 characters, including any leading zeros.
162.5,80 SERVICING FACILITY ADDRESS 5;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>60!($L(X)<1) X
LAST EDITED: JUN 16, 2011
HELP-PROMPT: Answer must be 1-60 characters in length.
DESCRIPTION:
Enter the Servicing Facility street address found in the claim information.
162.5,81 SERVICING FACILITY CITY 5;2 FREE TEXT
INPUT TRANSFORM: K:$L(X)>20!($L(X)<1) X
LAST EDITED: JUN 16, 2011
HELP-PROMPT: Answer must be 1-20 characters in length.
DESCRIPTION:
Enter the Servicing Facility city found in the claim information.
162.5,82 SERVICING FACILITY STATE 5;3 POINTER TO STATE FILE (#5)
LAST EDITED: JUN 16, 2011
DESCRIPTION:
Enter the Servicing Facility state found in the claim information.
162.5,83 SERVICING FACILITY ZIP 5;4 FREE TEXT
INPUT TRANSFORM: K:X[""""!($A(X)=45) X I $D(X) K:$L(X)>20!($L(X)<5) X I $D(X) D ZIPIN^VAFADDR
OUTPUT TRANSFORM: D ZIPOUT^VAFADDR
LAST EDITED: JUN 16, 2011
HELP-PROMPT: Answer with either 5 digit or 9 digit zip code.
DESCRIPTION: Enter the Servicing Facility zip code, in either the 5 digit format (e.g. 12345) or 9 digit format
(e.g. 12345-6789 or 123456789).
NOTES: XXXX--CAN'T BE ALTERED EXCEPT BY PROGRAMMER
162.5,85 UNIQUE CLAIM IDENTIFIER 5;5 FREE TEXT
INPUT TRANSFORM: K:$L(X)>28!($L(X)<1) X
LAST EDITED: MAY 29, 2012
HELP-PROMPT: Answer must be 1-28 characters in length.
DESCRIPTION:
This field contains a unique identifier for tracking claims. Fee5010 Project.
162.5,86 DoD INVOICE NUMBER 5;7 FREE TEXT
INPUT TRANSFORM: K:$L(X)>22!($L(X)<3) X
LAST EDITED: JAN 30, 2014
HELP-PROMPT: Answer must be 3-22 characters in length.
DESCRIPTION: The DoD invoice number that is associated with the invoice. Note that if the invoice vendor is not
a federal vendor then this field is null.
CROSS-REFERENCE: 162.5^DODI
1)= S ^FBAAI("DODI",$E(X,1,30),DA)=""
2)= K ^FBAAI("DODI",$E(X,1,30),DA)
This is the cross reference for the DoD invoice number
162.5,87 IPAC VENDOR AGREEMENT 5;10 POINTER TO IPAC VENDOR AGREEMENT FILE FILE (#161.95)
LAST EDITED: MAR 05, 2014
HELP-PROMPT: Enter the IPAC agreement associated with this invoice.
DESCRIPTION: The IPAC Agreement record that is associated with this invoice. Note that if the invoice vendor is
not a federal vendor this is field is null.
CROSS-REFERENCE: 162.5^IPAC
1)= S ^FBAAI("IPAC",$E(X,1,30),DA)=""
2)= K ^FBAAI("IPAC",$E(X,1,30),DA)
This cross reference is used to identify invoices associated with IPAC.
162.5,88 AUTHORIZATION NUMBER 7;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<3) X
LAST EDITED: MAY 27, 2015
HELP-PROMPT: Answer must be 3-30 characters in length.
DESCRIPTION:
This field holds the authorization numbers transmitted from FBCS.
162.5,89 CLAIM LEVEL ALLOWED AMOUNT 7;2 NUMBER
INPUT TRANSFORM: S:X["$" X=$P(X,"$",2) K:X'?.N.1".".2N!(X>9999999.99)!(X<0) X
LAST EDITED: SEP 10, 2015
HELP-PROMPT: Type a dollar amount between 0 and 9999999.99, 2 decimal digits.
DESCRIPTION: This field is for internal use only. FBCS will populate the value, if available, for claims sent to
VistA from FBCS.
162.5,90 PAYMENT METHODOLOGY 2;16 POINTER TO FEE BASIS PAYMENT METHODOLOGY FILE (#163.98)
LAST EDITED: FEB 04, 2016
HELP-PROMPT: Enter a valid Fee Basis Payment methodology
DESCRIPTION: The values in this field come from FBCS and represents the actual payment methodology used in FBCS
to adjudicate the claim.
162.5,91 ATTACHMENT ID 10;0 Multiple #162.591 (Add New Entry without Asking)
162.591,.01 ATTACHMENT ID 0;1 FREE TEXT
INPUT TRANSFORM: K:$L(X)>30!($L(X)<1) X
LAST EDITED: APR 19, 2016
HELP-PROMPT: Enter a new Attachment ID, 1-30 characters in length.
DESCRIPTION: This field contains the ID of an attachment supporting this invoice in the Attachment Retrieval
System (ARS). This data is populated automatically and should not be edited by users.
CROSS-REFERENCE: 162.591^B
1)= S ^FBAAI(DA(1),10,"B",$E(X,1,30),DA)=""
2)= K ^FBAAI(DA(1),10,"B",$E(X,1,30),DA)
162.591,.02 ATTACHMENT REPORT TYPE 0;2 POINTER TO IB ATTACHMENT REPORT TYPE FILE (#353.3)
LAST EDITED: APR 19, 2016
DESCRIPTION: The Report Type Code describes the type of documentation that will provide additional information
for this claim. The Attachment Report Type Code is at both the claim level and line level.
FILES POINTED TO FIELDS
ADJUSTMENT GROUP (#161.92) ADJUSTMENT:ADJUSTMENT GROUP (#1)
ADJUSTMENT REASON (#161.91) ADJUSTMENT:ADJUSTMENT REASON (#.01)
DRG (#80.2) DISCHARGE DRG (#24)
FEE BASIS BATCH (#161.7) OLD BATCH NUMBER (#15)
BATCH NUMBER (#20)
FEE BASIS CHECK CANCELLATION R
(#162.95) REASON CODE (#50)
FEE BASIS CONTRACT (#161.43) CONTRACT (#60)
FEE BASIS DISPOSITION CODE
(#162.6) DISCHARGE TYPE CODE (#6.5)
FEE BASIS PATIENT (#161) VETERAN (#3)
FEE BASIS PAYMENT METHODOLOGY
(#163.98) PAYMENT METHODOLOGY (#90)
FEE BASIS PROGRAM (#161.8) FEE PROGRAM (#11)
FEE BASIS PURPOSE OF VISIT
(#161.82) PURPOSE OF VISIT (#21)
FEE BASIS SUSPENSION (#161.27) SUSPEND CODE (#10)
FEE BASIS UNAUTHORIZED CLAIMS
(#162.7) ASSOCIATED 7078/583 (#4)
FEE BASIS VENDOR (#161.2) VENDOR (#2)
IB ATTACHMENT REPORT TYPE
(#353.3) ATTACHMENT ID:ATTACHMENT REPORT TYPE (#.02)
ICD DIAGNOSIS (#80) ICD1 (#30)
ICD2 (#31)
ICD3 (#32)
ICD4 (#33)
ICD5 (#34)
ICD6 (#35)
ICD7 (#35.1)
ICD8 (#35.2)
ICD9 (#35.3)
ICD10 (#35.4)
ICD11 (#35.5)
ICD12 (#35.6)
ICD13 (#35.7)
ICD14 (#35.8)
ICD15 (#35.9)
ICD16 (#36)
ICD17 (#36.1)
ICD18 (#36.2)
ICD19 (#36.3)
ICD20 (#36.4)
ICD21 (#36.5)
ICD22 (#36.6)
ICD23 (#36.7)
ICD24 (#36.8)
ICD25 (#36.9)
ADMITTING DIAGNOSIS (#39)
ICD OPERATION/PROCEDURE (#80.1) PROC1 (#40)
PROC2 (#41)
PROC3 (#42)
PROC4 (#43)
PROC5 (#44)
PROC6 (#44.06)
PROC7 (#44.07)
PROC8 (#44.08)
PROC9 (#44.09)
PROC10 (#44.1)
PROC11 (#44.11)
PROC12 (#44.12)
PROC13 (#44.13)
PROC14 (#44.14)
PROC15 (#44.15)
PROC16 (#44.16)
PROC17 (#44.17)
PROC18 (#44.18)
PROC19 (#44.19)
PROC20 (#44.2)
PROC21 (#44.21)
PROC22 (#44.22)
PROC23 (#44.23)
PROC24 (#44.24)
PROC25 (#44.25)
INSTITUTION (#4) PRIMARY SERVICE FACILITY (#23)
IPAC VENDOR AGREEMENT FILE
(#161.95) IPAC VENDOR AGREEMENT (#87)
NEW PERSON (#200) SUPERVISOR WHO VOIDED (#17)
PRESENT ON ADMISSION (#161.94) POA1 (#30.02)
POA2 (#31.02)
POA3 (#32.02)
POA4 (#33.02)
POA5 (#34.02)
POA6 (#35.02)
POA7 (#35.12)
POA8 (#35.22)
POA9 (#35.32)
POA10 (#35.42)
POA11 (#35.52)
POA12 (#35.62)
POA13 (#35.72)
POA14 (#35.82)
POA15 (#35.92)
POA16 (#36.02)
POA17 (#36.12)
POA18 (#36.22)
POA19 (#36.32)
POA20 (#36.42)
POA21 (#36.52)
POA22 (#36.62)
POA23 (#36.72)
POA24 (#36.82)
POA25 (#36.92)
REMITTANCE REMARK (#161.93) FIELD^NL^1^2:REMITTANCE REMARK (#.01)
STATE (#5) SERVICING FACILITY STATE (#82)
VA FORM 10-7078 (#162.4) ASSOCIATED 7078/583 (#4)
File #162.5
Record Indexes:
AA (#73) RECORD REGULAR IR SORTING ONLY
Short Descr: Index of vendor, veteran, treatment from date.
Description: The "AA" cross reference is a compound cross reference on fields in the FEE BASIS INVOICE file. It is defined
as
^FBAAI("AA",vendor,veteran,$E($P(date,"."),1,5),da)
where vendor is the VENDOR (#2)
veteran is the VETERAN (#3)
date is the TREATMENT FROM DATE (#5)
da is the IEN of the FEE BASIS INVOICE entry
Set Logic: S ^FBAAI("AA",X(1),X(2),X(3),DA)=""
Kill Logic: K ^FBAAI("AA",X(1),X(2),X(3),DA)
Whole Kill: K ^FBAAI("AA")
X(1): VENDOR (162.5,2) (Subscr 1) (forwards)
X(2): VETERAN (162.5,3) (Subscr 2) (forwards)
X(3): TREATMENT FROM DATE (162.5,5) (Subscr 3) (forwards)
Transform (Storage): S X=$E($P(X,"."),1,5)
Transform (Display): S X=X
AE (#74) RECORD REGULAR IR SORTING ONLY
Short Descr: Index of batch number, veteran
Description: The "AE" cross reference is a compound cross reference on fields in the FEE BASIS INVOICE file. It is defined
as
^FBAAI("AE",batch,veteran,da)
where batch is the BATCH NUMBER (#20)
veteran is the VETERAN (#3)
da is the IEN of the FEE BASIS INVOICE entry
Set Logic: S ^FBAAI("AE",X(1),X(2),DA)=""
Kill Logic: K ^FBAAI("AE",X(1),X(2),DA)
Whole Kill: K ^FBAAI("AE")
X(1): BATCH NUMBER (162.5,20) (Subscr 1) (forwards)
X(2): VETERAN (162.5,3) (Subscr 2) (forwards)
AI (#75) RECORD REGULAR IR SORTING ONLY
Short Descr: Index of vendor, invoice date, veteran, suspend code.
Description: The "AI" cross-reference is used for printing suspense letters for a date range. It is a compound cross
reference on fields in the FEE BASIS INVOICE file. It is defined as
^FBAAI("AI",vendor,invoice_date,veteran,suspend_code,da)
where vendor is the VENDOR (#2)
invoice_date is the INVOICE DATE RECEIVED (#1)
veteran is the VETERAN (#3)
suspend_code is the SUSPEND CODE (#10)
da is the IEN of the FEE BASIS INVOICE
Set Logic: S ^FBAAI("AI",X(1),X(2),X(3),X(4),DA)=""
Kill Logic: K ^FBAAI("AI",X(1),X(2),X(3),X(4),DA)
Whole Kill: K ^FBAAI("AI")
X(1): VENDOR (162.5,2) (Subscr 1) (forwards)
X(2): INVOICE DATE RECEIVED (162.5,1) (Subscr 2) (forwards)
X(3): VETERAN (162.5,3) (Subscr 3) (forwards)
X(4): SUSPEND CODE (162.5,10) (Subscr 4) (forwards)
INPUT TEMPLATE(S):
FBCH EDIT PAYMENT SEP 01, 2016@14:57 USER #0
FBCH ENTER PAYMENT SEP 01, 2016@14:42 USER #0
FBNH EDIT PAYMENT SEP 01, 2016@15:04 USER #0
PRINT TEMPLATE(S):
SORT TEMPLATE(S):
FORM(S)/BLOCK(S):