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Segment
in
X12 Release 003040

CR4 Enteral or Parenteral Therapy Certification

To supply information regarding certification of medical necessity for enteral or parenteral nutrition therapy
Sequence
Element
Name
Type
Requirement
Min
Max
Repeat
01
1073
Yes/No Condition or Response Code
Identifier (ID)
Mandatory
1
1
-
Code indicating a Yes or No condition or response.
CR401 is enteral or parenteral indicator. A ``Y'' value indicates enteral. An ``N'' value indicates parenteral.
Codes (3)
02
Certification Type Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of certification
Codes (6)
03
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0304
Codes (719)
04
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
CR404 is estimated duration of therapy.
05
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0506
Codes (719)
06
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
CR406 is the time period covered by this certification.
07
Non-Visit Code
Identifier (ID)
Optional
1
1
-
Code indicating on what a medical evaluation is based, when not based on a physician's visit
Codes (3)
08
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0809
Codes (719)
09
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity.
CR409 is age of patient.
10
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1011
Codes (719)
11
Height
Decimal number (R)
Conditional
1
8
-
Vertical dimension of an object measured when the object is in the upright position.
CR411 is height of patient.
12
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1213
Codes (719)
13
Weight
Decimal number (R)
Optional
1
10
-
Numeric value of weight.
CR413 is weight of patient.
14
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR414 is number of times per day that the patient was fed.
15
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
CR415 is the product name.
16
Nutrient Administration Method Code
Identifier (ID)
Optional
1
1
-
Code indicating the method used to administer nutrient to a patient
Codes (3)
17
Nutrient Administration Technique Code
Identifier (ID)
Optional
1
1
-
Code indicating the technique used to administer nutrient to a patient
Codes (4)
18
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR418 is total number of calories per day of all nutrients prescribed.
19
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR419 is total number of calories per day prescribed for this product.
20
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
CR420 is the amino acid name.
21
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR421 is the number of milliliters of amino acid solution used in the prescription per day.
22
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR422 is percentage of concentration of amino acid used in the prescription.
23
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR423 is number of grams of amino acid used per day.
24
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR424 is number of milliliters of dextrose solution used in the prescription per day.
25
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR425 is percentage of concentration of dextrose used in the prescription.
26
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR426 is number of milliliters of lipids used in the prescription.
27
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR427 is percentage of concentration of lipids used in the prescription.
28
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity.
CR428 is the number of times per week lipids are used in the prescription.
29
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content.
CR429 is special circumstances or medical justification.
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Stedi is a registered trademark of Stedi, Inc. Stedi's EDI Reference and Mapping Guides are provided for marketing purposes and are free of charge. All names, logos, and brands of third parties listed on our site are trademarks of their respective owners (including “X12”, which is a trademark of X12 Incorporated). Stedi, Inc. and its products and services are not endorsed by, sponsored by, or affiliated with these third parties. Our use of these names, logos, and brands is for identification purposes only, and does not imply any such endorsement, sponsorship, or affiliation.