EDI Dictionary

Transaction Sets Segments

EDI-Dictionary

4010

837 Health Care Claim

SV6-405

SV6 Anesthesia Service

Opt

AtMax 1

To specify the claim service detail for anesthesia

Elements

Position	Element	Name		Type	Min/Max	Repeat

C003Composite Medical Procedure IdentifierMandatory Exact 1
2	1332	Facility Code Qualifier	Rel	ID	1/2	Exact 1
3	1331	Facility Code Value	Rel	Alphanumeric	1/2	Exact 1
4	782	Monetary Amount	Opt	Decimal	1/18	Exact 1
C004Composite Diagnosis Code PointerOpt Exact 1
6	380	Quantity	Opt	Decimal	1/15	Exact 1
7	1073	Yes/No Condition or Response Code	Opt	ID	1/1	Exact 1

Element Details

ID1332

NameFacility Code Qualifier

LengthMin 1 / Max 2

Position2

RequirementRel

Codes

<>A
Uniform Billing Claim Form Bill Type
<>B
Place of service code from the FAO record of the Electronic Media Claims National Standard Format