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PR1 - Procedures Segment

The PR1 segment contains information relative to various types of procedures that can be performed on a patient. The PR1 segment can be used to send procedure information, for example: Surgical, Nuclear Medicine, X-ray with contrast, etc. The PR1 segment is used to send multiple procedures, for example, for medical records encoding or for billing systems.

HL7 Attribute Table - PR1 - Procedures Segment
Seq# DataElement Description Must Implement Flags Cardinality Length C.LEN Vocabulary DataType
PR1
1 00391 Set ID - PR1 SHALL [1..1] [1..4] SI
2 00392 Procedure Coding Method SHALL NOT W [0..0]
3 00393 Procedure Code SHALL [1..1] CNE
4 00394 Procedure Description SHALL NOT W [0..0]
5 00395 Procedure Date/Time SHALL [1..1] DTM
6 00396 Procedure Functional Type [0..1] CWE
7 00397 Procedure Minutes = [0..1] 4 NM
8 00398 Anesthesiologist SHALL NOT W [0..0]
9 00399 Anesthesia Code [0..1] CWE
10 00400 Anesthesia Minutes = [0..1] 4 NM
11 00401 Surgeon SHALL NOT W [0..0]
12 00402 Procedure Practitioner SHALL NOT W [0..0]
13 00403 Consent Code [0..1] CWE
14 00404 Procedure Priority [0..1] [1..2] NM
15 00772 Associated Diagnosis Code [0..1] CWE
16 01316 Procedure Code Modifier [0..*] CNE
17 01501 Procedure DRG Type [0..1] CWE
18 01502 Tissue Type Code [0..*] CWE
19

01848 Procedure Identifier MAY
True:
False:
C
[1..1]
[0..1]
EI
20

01849 Procedure Action Code MAY
True:
False:
C
[1..1]
[0..1]
[1..1] ID
21 02177 DRG Procedure Determination Status [0..1] CWE
22 02178 DRG Procedure Relevance [0..1] CWE
23 02371 Treating Organizational Unit [0..*] PL
24 02372 Respiratory Within Surgery [0..1] [1..1] ID
25 02373 Parent Procedure ID [0..1] EI

PR1-1: Set ID - PR1 (SI) 00391

Definition: This field contains the number that identifies this transaction. For the first occurrence of the segment the sequence number shall be 1, for the second occurrence it shall be 2, etc.

PR1-2: Procedure Coding Method

Attention: PR1-2 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

PR1-3: Procedure Code (CNE) 00393

(Definition from OBR.44 in Ch. 4)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined table 0088 – Procedure code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from FT1.25 in Ch. 6)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of v 2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Coding Systems (from HL7 Table 0396)

Code

Description

Comment / Source

C4

CPT-4

American Medical Association, P.O. Box 10946, Chicago IL 60610.

C5

CPT-5

(under development – same contact as above)

HCPCS

CMS (formerly HCFA) Common Procedure Coding System

HCPCS: contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

HPC

CMS (formerly HCFA )Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

I10P

ICD-10 Procedure Codes

Procedure Coding System (ICD-10-PCS.) See http://www/hcfa.gov/stats/icd10.icd10.htm for more information.


(Definition from PR1.3 in Ch. 6)

Definition: This field contains a unique identifier assigned to the procedure. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems.

(Definition from OBR.44 in Ch. 7)

Definition: This field contains a unique identifier assigned to the procedure, if any, associated with the charge. Refer to Externally-defined table 0088 – Procedure code in Chapter 2C, Code Tables, for suggested values. This field is a coded data type for compatibility with clinical and ancillary systems.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from CDM.7 in Ch. 8)

Definition: This field contains the procedure code for procedure, if any, associated with this charge description. Repeating field allows for different procedure coding systems such as CPT4, ICD9. Coded entry made up of code plus coding schema. Refer to Externally-defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values.

(Definition from IIM.14 in Ch. 17)

Definition: This field contains a unique identifier assigned to the service item, if any, associated with the charge. In the United States this is often the HCPCS code. Refer to Externally Defined Table 0088 - Procedure Code in Chapter 2C, Code Tables, for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Coding Systems

Coding System

Description

Comment

C4

CPT-4

American Medical Association, P.O. Box 10946, Chicago IL 60610.

C5

CPT-5

(under development – same contact as above)

HCPCS

CMS (formerly HCFA) Common Procedure Coding System

HCPCS: contains codes for medical equipment, injectable drugs, transportation services, and other services not found in CPT4.

HPC

CMS (formerly HCFA) Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.


(Definition from ITM.27 in Ch. 17)

Definition: This field contains a unique identifier assigned to the service item, if any, associated with the charge. In the United States this is often the HCPCS code. Refer to Externally defined Table 0088 - Procedure code for suggested values. This field is a CNE data type for compatibility with clinical and ancillary systems. Refer to HL7 Table 0088 – Procedure Coding Systems in Chapter 2C, Code Tables, for valid values.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

(Definition from SCD.32 in Ch. 17)

Definition: The unique identifier indicating the type of procedure performed on the patient with the supplies being sterilized.

Refer to HL7 Table 0088 – Procedure Code in Chapter 2C, Code Tables, for suggested values.

As of v2.6, the known applicable external coding systems include those in the referenced table. If the code set you are using is in this table, then you must use that designation.

PR1-4: Procedure Description

Attention: PR1-4 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

PR1-5: Procedure Date/Time (DTM) 00395

Definition: This field contains the date/time that the procedure was performed.

PR1-6: Procedure Functional Type (CWE) 00396

Definition: This field contains the optional code that further defines the type of procedure. Refer to User-defined Table 0230 - Procedure Functional Type in Chapter 2C, Code Tables, for suggested values.

PR1-7: Procedure Minutes (NM) 00397

Definition: This field indicates the length of time in whole minutes that the procedure took to complete. The duration starts with the point in time in PR1-5.

PR1-8: Anesthesiologist

Attention: PR1-8 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

PR1-9: Anesthesia Code (CWE) 00399

Definition: This field contains a unique identifier of the anesthesia used during the procedure. Refer to User-defined Table 0019 - Anesthesia Code in Chapter 2C, Code Tables, for suggested values.

PR1-10: Anesthesia Minutes (NM) 00400

Definition: This field contains the length of time in minutes that the anesthesia was administered.

PR1-11: Surgeon

Attention: PR1-11 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

PR1-12: Procedure Practitioner

Attention: PR1-12 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

PR1-13: Consent Code (CWE) 00403

Definition: This field contains the type of consent that was obtained for permission to treat the patient. Refer to User-defined Table 0059 - Consent Code in Chapter 2C, Code Tables, for suggested values.

PR1-14: Procedure Priority (NM) 00404

Definition: This field contains a number that identifies the significance or priority of the procedure code. Refer to HL7 Table 0418 - Procedure Priority in Chapter 2C, Code Tables, for valid values.

Note: As of v 2.7, the data type has been changed to numeric. The meaning of the values remain the same as those in HL7 Table 0418 – Procedure Priority, The value 0 conveys that this procedure is not included in the ranking. The value 1 means that this is the primary procedure. Values 2-99 convey ranked secondary procedures.

PR1-15: Associated Diagnosis Code (CWE) 00772

Definition: This field contains the diagnosis that is the primary reason this procedure was performed, e.g., in the US, Medicare wants to know for which diagnosis this procedure is submitted for inclusion on CMS 1500 form. Refer to User-defined Table 0051 - Diagnosis Code in Chapter 2C, Code Tables, for suggested values.

PR1-16: Procedure Code Modifier (CNE) 01316

(Definition from OBR.45 in Ch. 4)

Definition: This field contains the procedure code modifier to the procedure code reported in OBR-44-procedure code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. In the USA, this is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally- defined table 0340 – Procedure code modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if OBR-44 – procedure code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from FT1.26 in Ch. 6)

Definition: This field contains the procedure code modifier to the procedure code reported in FT1-25 - Procedure Code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. This is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if FT1-25 - Procedure Code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of v 2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

Procedure Code Modifier Coding Systems (From HL7 Table 0396)

Code

Description

Comment / Source

CPTM

CPT Modifier Code

Available for the AMA at the address listed for CPT above. These codes are found in Appendix A of CPT 2000 Standard Edition. (CPT 2000 Standard Edition, American Medical Association, Chicago, IL).

HPC

CMS (formerly HCFA )Procedure Codes (HCPCS)

Health Care Financing Administration (HCFA) Common Procedure Coding System (HCPCS) including modifiers.

I10P

ICD-10 Procedure Codes

Procedure Coding System (ICD-10-PCS.) See http://www/hcfa.gov/stats/icd10.icd10.htm for more information.

I9C

ICD-9CM

Commission on Professional and Hospital Activities, 1968 Green Road, Ann Arbor, MI 48105 (includes all procedures and diagnostic tests).

ICD10AM

ICD-10 Australian modification

ICD10CA

ICD-10 Canada


(Definition from PR1.16 in Ch. 6)

Definition: This field contains the procedure code modifier to the procedure code reported in field 3, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

(Definition from OBR.45 in Ch. 7)

Definition: This field contains the procedure code modifier to the procedure code reported in OBR-44-procedure code, when applicable. Procedure code modifiers are defined by regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. The modifiers are sequenced in priority according to user entry. In the USA, this is a requirement of the UB and the 1500 claim forms. Multiple modifiers are allowed and the order placed on the form affects reimbursement. Refer to Externally- defined table 0340 – Procedure code modifier in Chapter 2C, Code Tables, for suggested values.

Usage Rule: This field can only be used if OBR-44 – procedure code contains certain procedure codes that require a modifier in order to be billed or performed. For example, HCPCS codes that require a modifier to be precise.

As of version 2.6, applicable external coding systems include those in the referenced table. If the code set used is in the referenced table, then the coding scheme designation in the table shall be used.

(Definition from IIM.15 in Ch. 17)

Definition: This field contains the procedure code modifier to the procedure code reported in IIM-14 Procedure Code, when applicable. Procedure code modifiers are defined by USA regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

As of v2.6, the known applicable external coding systems include those in the table below. If the code set you are using is in this table, then you must use that designation.

(Definition from ITM.28 in Ch. 17)

Definition: This field contains the procedure code modifier to the procedure code reported in ITM-27, Procedure Code, when applicable. Procedure code modifiers are defined by USA regulatory agencies such as CMS and the AMA. Multiple modifiers may be reported. Refer to Externally-defined Table 0340 - Procedure Code Modifier in Chapter 2C, Code Tables, for suggested values.

PR1-17: Procedure DRG Type (CWE) 01501

Definition: This field indicates a procedure's priority ranking relative to its DRG. Refer to User-defined Table 0416 - Procedure DRG Type in Chapter 2C, Code Tables, for suggested values.

PR1-18: Tissue Type Code (CWE) 01502

Definition: Code representing type of tissue removed from a patient during this procedure. Refer to User-defined Table 0417 - Tissue Type Code in Chapter 2C, Code Tables, for suggested values.

PR1-19: Procedure Identifier (EI) 01848

This field contains a value that uniquely identifies a single procedure for an encounter. It is unique across all segments and messages for an encounter. This field is required in all implementations employing Update Diagnosis/Procedures (P12) messages.

PR1-20: Procedure Action Code (ID) 01849

This field defines the action to be taken for this procedure. Refer to HL7 Table 0206 - Segment Action Code in Chapter 2C, Code Tables, for valid values. This field is required for the Update Diagnosis/Procedures (P12) message. In all other events it is optional.

PR1-21: DRG Procedure Determination Status (CWE) 02177

Definition: This field contains the status of the use of this particular procedure for the DRG determination. Refer to User-defined Table 0761 – DRG Procedure Determination Status in Chapter 2C, Code Tables, for suggested values.

PR1-22: DRG Procedure Relevance (CWE) 02178

Definition: This field contains the relevance of this particular procedure for the DRG determination. Refer to User-defined Table 0763 – DRG Procedure Relevance in Chapter 2C, code Tables, for suggested values.

PR1-23: Treating Organizational Unit (PL) 02371

Definition: This field contains information about the organizational unit that has performed the procedure.

PR1-24: Respiratory Within Surgery (ID) 02372

Definition: This field indicates whether or not a respiratory procedure has occurred during a surgery. This field is optional and only needs to be valued for respiratory procedures. Refer to HL7 Table 0136 - Yes/no Indicator in Chapter 2C, Code TableS, for valid values.

PR1-25: Parent Procedure ID (EI) 02373

Definitions: This field contains a procedure ID which points to the procedure group (e.g., complete surgery) in which this instance belongs.