Medical Billing - GP0 Record Fields 15 Through 21

By: Michael Russell
Submitted: 2007-01-17 15:35:55
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Medical billing of parental nutrition claims is not an easy task. There are a lot of calculations that need to be done and a lot of things that need to be accounted for such as the actual product being dispensed, calories per day and so on. Computer programs make the job a little easier when billing through electronic media and NSF 3.01 specifications. In this installment we'll be covering the GP0 record, picking up with field number 15.

GP0 field 15, position 63, is the ambulatory indicator. This field tells the carrier whether or not the patient is ambulatory. There are only two valid responses for this field. If the patient is ambulatory, an A is entered. If the patient is not ambulatory, an N is entered. The field cannot be left blank or the claim will be denied.

GP0 field 16, position 64, is the other forms of nutrient indicator. This field tells the carrier if the patient is receiving other forms of nutrition other than what this CMN is prescribed for. This is important because in some cases, if the patient is receiving other treatments, this claim may not be 100% payable. As it is, with Medicare, most claims are only 80% anyway. But if other feedings are involved, this claim may be even less than 80% covered.

GP0 field 17, position 65, is the type of mix indicator. This field tells the carrier the type of mix being administered to the patient. There are basically only two possible mixes. There is a home mix, where the ingredients are put together at the home or facility from various sources. This mix is transmitted with the letter H. A premix is when the mix is something that already comes put together by the manufacturer and just needs to be administered out of the package. This mix is transmitted with the letter P.

GP0 field 18, positions 66 - 68, is the parental frequency field. This field tells the carrier how many times per week the patient is to be fed. If the frequency is less than 100 times per week, which it will almost always be, the field must be left zero filled. So if the patient is fed three times a day, or 21 times in a seven day period, the field is transmitted as 021.

GP0 field 19, positions 69 - 73, is the HCPCS procedure code. This field tells the carrier the procedure code associated with the item being fed to the patient. This is not like the procedure code in the F record, which tells the carrier the condition of the patient or treatment of the patient.

GP0 fields 20 and 21, positions 74 - 77, are the two modifiers for the HCPCS procedure code. These fields transmit these modifiers to the carrier. The modifiers are usually determined by the month number of the CMN itself.

In our next installment of medical billing of claims via electronic media, we'll pick up our discussion of the GP0 record with field number 22.

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