Segment
X12 EDI Release 00401
To specify the claim service detail for anesthesia
Elements
  • SV601C003Composite Medical Procedure IdentifierM必须(Mandatory)
    2352341339133913391339352
    • SV60101235Product/Service ID Qualifier
      ID
      M必须(Mandatory)

      Code identifying the type/source of the descriptive number used in Product/Service ID (234)

      Codes (477)
    • SV60102234Product/Service ID
      AN
      M必须(Mandatory)
      Min 0 / Max 48

      Identifying number for a product or service

    • SV601031339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV601041339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV601051339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV601061339Procedure Modifier
      AN
      O可选(Optional)
      Min 2 / Max 2

      This identifies special circumstances related to the performance of the service, as defined by trading partners

    • SV60107352Description
      AN
      O可选(Optional)
      Min 1 / Max 80

      A free-form description to clarify the related data elements and their content

  • SV6021332Facility Code Qualifier
    ID
    O可选(Optional)

    Code identifying the type of facility referenced

    Codes (2)
  • SV6031331Facility Code Value
    AN
    O可选(Optional)
    Min 1 / Max 2

    Code identifying the type of facility where services were performed; the first and second positions of the Uniform Bill Type code or the Place of Service code from the Electronic Media Claims National Standard Format

  • SV604782Monetary Amount
    R
    O可选(Optional)
    Min 1 / Max 18

    Monetary amount

  • SV605C004Composite Diagnosis Code PointerO可选(Optional)
    1328132813281328
    • SV605011328Diagnosis Code Pointer
      N
      M必须(Mandatory)
      Min 0 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV605021328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV605031328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

    • SV605041328Diagnosis Code Pointer
      N
      O可选(Optional)
      Min 1 / Max 2

      A pointer to the claim diagnosis code in the order of importance to this service

  • SV606380Quantity
    R
    O可选(Optional)
    Min 1 / Max 15

    Numeric value of quantity

  • SV6071073Yes/No Condition or Response Code
    ID
    O可选(Optional)

    Code indicating a Yes or No condition or response

    Codes (4)