Hello Johnny:
I hope all is well with you. It has been awhile since we have spoke. The way the guide is right now, you would use HS for any services in an inpatient or outpatient episode of care. AR is used only to request admission to a facility. The guide provides an example on page 391 indicating that provider of service associated with an inpatient stay would have a value of "HS" for UM01. "HS" would "not" be the only value used for services performed by a physician regardless of where/how the services are performed. Please reference the example on page 387 of the IG where the PCP submits a request for a patient to see a cardiologist.
I have submitted your question to the 278 WG for additional feedback since the WG is working on version 4050 of the IG. Below is a copy of feedback from another WG participant regarding processing a request for outpatient services.
Services from a physician can also come in as an SC-Specialty referral. In that instance the PCP would probably name the doctor and the procedure to be
performed but not the facility at which it will be performed. Whenever an AR comes in, according to the business example in the guide a HS is expected to accompany it on a separate 2000 F loop. However, we don't agree that AR should be and would be used for an inpatient admission, only. On page 141 of the IG the direction for AR says "Use this code to request admission to a facility." Outpatient requests for a procedure require admission to a facility, too, even though it is not an overnight stay. We expect the provider would use the service type code # 50-Outpatient stay. But even if they don't, we know by the facility name and/or our internal provider ID # that the facility is not an acute care facility. We wouldn't expect the requester to name the outpatient facility in a 2000 F loop with a request category code of HS but instead expect AR and another 2000 F loop containing the HS to name the doctor performing the procedure. If you're going for clarification in 4050 then I would say it has to be made more clear that whenever AR is used an additional 2000F loop for the procedure itself (HS) is required. I wouldn't want to see verbiage stating that AR is specifically for inpatient, only.
The 278 WG is in the process of reviewing updates for version 4050 of the IG. Questions such as yours are helpful in clarifying points within version 4050 of the IG.
In a message dated 05/30/2002 11:48:32 AM Eastern Daylight Time, [EMAIL PROTECTED] writes:
I'm trying to understand the business issues
around the 278 transaction and have a question regarding the
2000F:UM01 Request Category Code. Does a value of "AR"
(Admission Review) in this request category code imply an
inpatient stay at a facility? In other words is an
"admission" defined as checking in to a facility for inpatient
stay, or can "AR" be used for outpatient services at a
faciltiy .. an outpatient admission per se? Also, would you
ever see a request category code of "AR" in a service
loop(2000F) under a physician, or do you always use a value
of "HS" (Health Services Review) for services performed by
a physician regardless of where/how the services are
performed? Thanks in advance for your help.
Claudia Faulkner
Tactical Business Solutions
Phone: 305-558-3778
E-mail: [EMAIL PROTECTED]
Fax: 305-558-6159
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