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Segment
in
X12 Release 005040

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
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 (4)
02
Certification Type Code
Identifier (ID)
Optional
1
1
1
Code indicating the type of certification
Codes (15)
03
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0304
Codes (884)
04
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
CR404 is the estimated duration of therapy.
05
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0506
Codes (884)
06
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
CR406 is the time period covered by this certification.
07
Non-Visit Code
Identifier (ID)
Optional
1
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
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0809
Codes (884)
09
Quantity
Decimal number (R)
Conditional
1
15
1
Numeric value of quantity
CR409 is the age of the patient.
10
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1011
Codes (884)
11
Height
Decimal number (R)
Conditional
1
8
1
Vertical dimension of an object measured when the object is in the upright position
CR411 is the height of the patient.
12
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
1
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1213
Codes (884)
13
Weight
Decimal number (R)
Conditional
1
10
1
Numeric value of weight
CR413 is the weight of the patient.
14
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR414 is the number of times the patient is fed per week for parenteral claims or the number of times the patient is fed per day for enteral claims.
15
Description
String (AN)
Optional
1
80
1
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
1
Code indicating the method used to administer nutrient to a patient
Codes (3)
17
Nutrient Administration Technique Code
Identifier (ID)
Optional
1
1
1
Code indicating the technique used to administer nutrient to a patient
Codes (4)
18
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR418 is the total number of calories per day of all nutrients prescribed.
19
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR419 is the total number of calories per day prescribed for this product.
20
Description
String (AN)
Optional
1
80
1
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
1
Numeric value of quantity
CR421 is the number of milliliters of amino acid solution used in the prescription per day.
22
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
CR422 is the percentage of concentration of amino acid used in the prescription.
23
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR423 is the number of grams of amino acid used per day.
24
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR424 is the number of milliliters of dextrose solution used in the prescription per day.
25
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
CR425 is the percentage of concentration of dextrose used in the prescription.
26
Quantity
Decimal number (R)
Optional
1
15
1
Numeric value of quantity
CR426 is the number of milliliters of lipids used in the prescription.
27
Percentage as Decimal
Decimal number (R)
Optional
1
10
1
Percentage expressed as a decimal (e.g., 0.0 through 1.0 represents 0% through 100%)
CR427 is the percentage of concentration of lipids used in the prescription.
28
Quantity
Decimal number (R)
Optional
1
15
1
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
1
A free-form description to clarify the related data elements and their content
CR429 is the 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.