PTOS 5.6 - User`s Guide

14) Box 66 – Leave Box 66 empty. We recommend that you leave this box empty. Used to indicate the diagnosis version qualifier. The default value printed by PTOS is 9 to indicate

ICD9 codes. Several payers do not want the 9 to print in this box, so checking this option will clear box 66.

15) Box 69 (Print Primary ICD9) – Used to denote the diagnosis that describes the patient’s condition or reason for admission/outpatient registration. By default, this will be left blank. If checked, the patient’s primary diagnosis code will print.

16) Box 74 (Principal) – Used to enter the principal diagnosis code and date. It is required on inpatient claims when a procedure was performed.

17) Box 74A-E (Other Procedures) – Used to enter any additional diagnosis codes and dates.

18) Box 76 (Qualifier) – Used for the referring Dr.’s name, NPI number and a second identifier. If second identifier is provided, it may need to be accompanied by a 2 character qualifier code in the “qual” field of box 76. Default for this field is empty. Generally accepted qualifiers are: a. 0B (state license #) b. 1G (UPIN #) c. G2 (Commercial #)

19) Box 80 – Use this area for Remarks for Unusual Services.

20) Box 81 A-D – Free form area that allows the user to enter additional taxonomy numbers and qualifiers for boxes 81A-D on the UB04 form. By default, this will be left blank.

eClaims Attachment Information

eClaims Attachment Information

Drop-down lists of attachments that relate to eClaims can be located in the Patient Editor | HCFA tab. Locate the button in the top section - Additional CMS-1500/HCFA Boxes - 'eClaims Attach

Info'.

User’s Guide – Patterson PTOS 5.6 Using PTOS

 26

Attachment Report Type Code

Remove these settings after sending the requested attachment to avoid resending the attachment information on subsequent claims.

In the Attachment Report Type Code drop-down list, the following possibilities are available to describe the type of attachment:

 Admission Summary – AS

 Allergies/Sensitivities Document – A3

 Ambulance Certification – AM

 Autopsy Report – A4

 Baseline

BS

 Benchmark Testing Results – BR

 Blanket Test Results – BT

 Certification

CT

 Certified Test Report – 13

 Chemical Analysis – 11

 Chiropractic Justification – CB

 Consent Form(s) – CK

 Continued Treatment – 10

 Death Notification – V5

 Dental Models – DA

 Diagnostic Report – DG

 Discharge Monitoring Report – DJ

 Discharge Summary – DS

 Drug Profile Document – D2

 Drugs Administered – 04

 Durable Medical Equipment Prescription – DB

 Explanation of Benefits (Coordination of Benefits or

Medicare Secondary Payer) – EB

 Functional Goals – 07

 Health Certificate – HC

User’s Guide – Patterson PTOS 5.6 Using PTOS

 27

User’s Guide – Patterson PTOS 5.6

 Health Clinic Records – HR

 Immunization Record – I5

 Initial Assessment – 06

 Justification for Admission – 15

 Laboratory Results – LA

 Medical Record Attachment – M1

 Models – MT

 Nursing Notes – NM

 Objective Physical Examination (including vital signs)

Document – OE

 Operative Notes – OB

 Orders and Treatments Document – OD

 Oxygen Content Averaging Report – OC

 Oxygen Therapy Certification – OX

 Paramedical Results – PQ

 Parenteral or Enteral Certification – PE

 Pathology Report – P4

 Patient Medical History Document – P5

 Photographs – XP

 Physical Therapy Notes – PN

 Physical Therapy Certification – PZ

 Physician Order – B3

 Physician’s Report – PY

 Plan of Treatment – 08

 Prescription

B2

 Progress Report – 09

 Prosthetics or Orthotic Certification – PO

 Radiology Films – RB

 Radiology Reports – RR

 Recovery Plan – 21

 Referral Form – B4



Renewable Oxygen Content Averaging Report – RX

 Report Justifying Treatment Beyond Utilization Guidelines

– 03

Using PTOS

 28

 Report of Tests and Analysis Report – RT

 State School Immunization Records - IR

 Support Data for Claim – OZ

 Symptoms Document – SG

 Treatment Diagnosis – 05

Attachment Transmission Code

In the Attachments Transmission Code section, use the dropdown list to select the desired delivery method for sending the requested documentation to the payer. These options include:

 Available on Request at Provider Site – AA

 By Fax – FX

 By Mail – BM

 By eMail – EM

 Electronically – EL

 File Transfer – FT

Attachment Control Number

In the Attachment Control Number section, enter the Document

Control Number (DCN) provided by the Payer. This number identifies the claim and the attachment for the payer. An

Attachment Control Number is not required when using the

Available on Request at Provider Site option in the Attachment

Transmission Code section.

User’s Guide – Patterson PTOS 5.6 Using PTOS

 29