Draft Website - For Review Purposes Only

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]			0230 Procedure Functional Type	CWE
7	00397	Procedure Minutes		=	[0..1]		4		NM
8	00398	Anesthesiologist	SHALL NOT	W	[0..0]
9	00399	Anesthesia Code			[0..1]			0019	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]			0059	CWE
14	00404	Procedure Priority			[0..1]	[1..2]		0418 Procedure Priority	NM
15	00772	Associated Diagnosis Code			[0..1]			0051	CWE
16	01316	Procedure Code Modifier			[0..*]				CNE
17	01501	Procedure DRG Type			[0..1]			0416 Procedure DRG Type	CWE
18	01502	Tissue Type Code			[0..*]			0417 Tissue Type Code	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]		0206 Segment Action Code	ID
21	02177	DRG Procedure Determination Status			[0..1]			0761 DRG Procedure Determination Status	CWE
22	02178	DRG Procedure Relevance			[0..1]			0763 DRG Procedure Relevance	CWE
23	02371	Treating Organizational Unit			[0..*]				PL
24	02372	Respiratory Within Surgery			[0..1]	[1..1]		0136 Yes/no Indicator	ID
25	02373	Parent Procedure ID			[0..1]				EI

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.

Attention: PR1-2 was deprecated as of v 2.3 and the detail was withdrawn and removed from the standard as of v 2.6.

(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.

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.

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

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.

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.

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.

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.

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

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.

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.

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.

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.

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.

(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.

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.

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.

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.

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.

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.

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.

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

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.

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