V2.7 HL7-defined tables for NUBC Codes (UVC Data Type issue)

FM agreed to the data type structure recommended by InM co-chair, Grahame Grieved. The FM minutes have not as yet been posted so I am saying this from memory. The solution was to add 2 components to the UVC data type to accommodate the non-monetary amount/quantity and units The v3 equivalent, according to Grahame, is PQ + CD.

Resolution on the FM TC 2/19/08 call:

2. v2.7 HL7-defined tables for NUBC Codes (NUBC.doc) Following the discussion about the different usage of UB2-6 Motion: Keep comp. 1 and 2 of DT UVC and add two other component 3 and 4 3 = non monetary amount 4 = non monetary values

Made: Joann Larson Second: Jeff Strand Motion carried 7-0-0

Remaining issues

InM did not constrain the non-monetary units to UCUM. Does FM wish to do that, either in the data type or in the UVC-6?

What remains to be discussed is: What kinds of things are included in the NUBC FL 39a and related fields that we need to accommodate? In HL7 v2.4 when HL7 itemized the UB codes for form locater 39a - 41d, (HL7 no longer does this), it included things like this: Most Common Semi-private Room Rate Birth weight [from telcon discussion, not v2.4] Any Liability Insurance Pints of Blood Replaced Oxygen Saturation Arterial Blood Gas

Are 39a - 41d still covering this broad range?

Email discussion:

Jeff Strand 2/18/08

I have been following the discussion about value code amount type identification and the UBXX related information. I felt that, to the degree possible, perhaps we should follow the X12 837I standard. It is true that the UB82, UB92 and UB04 actually represent paper data exchanges while the X12 837I represents the electronic equivalent. I thought that since HL7 is primarily focused on electronic data exchange, perhaps we should use the X12 as the proxy for the UBXX forms.

In the X12 837I Implementation guide, Value codes begin on page 280. Legal protections prevent copying portions of the implementation guide so I cannot attach the appropriate pages here.

However, on a more detailed review of that section, the X12 group really seem to drop the ball. The do have an attribute (HI01 – 5) which is Required (when the optional loop is included) but it defines that field as a Monetary Amount. The next field HI01-6 is Not Used and is defined as a Quantity.

So it appears they intended to define 2 optional fields – one for monetary amounts and one for any other quantity amount each to be used situationally, but the final document doesn’t seem to support that. In fact, taken literally, it does not seem to support integer values at all (such as grams for baby weight).

When I look at our internal data model, we do move the value amount into a field which is defined as a numeric with a length of 9 and a precision of 2. (In other words, 2 decimal places which will support dollars. It can also support integers if a period is not in the input data).

So we hold the Value Code, the sequence, the qualifier code list and the Value Amount in a zero to many relationship with the claim. However, by just looking at the data model, it is impossible to tell which specific values should come with monetary amounts and which should come with integer type amounts in order to perform data validations.

That discussion didn’t really answer your question – which is should HL7 require two different fields to appropriately identify the allowable amount type being sent. All I can say is that X12 does not require this additional clarity and the processing systems seem to be handling it OK right now.

Jeff

From Joann Larson 2/17/08

I have asked that the UVC topic be put on the InM agenda for tomorrow. This is backwards from the logical sequence of events, but they happen to be meeting tomorrow and "own" data types. They will definitely want input from FM since the UVC data type is used only in the UB2-6 and the deprecated UB1-10.

I suspect that they will table the discussion for 1 week or make a preliminary decision pending evaluation from FM and Vocab. The options seem to be: 1. Add a new component UVC.3 Non-Monetary Value (CWE) 2. Add a new component UVC.3 Non-Monetary Value (CNE) 3. Add a new component UVC.3 Non-Monetary Value (ID) 4. Deprecate component 2 in favor of a new component UVC.3 Value Amount (ST) 5. Deprecate the field or perhaps the whole segment (FM decision, not InM) [Then no change is needed] 6. Some other v2 solution

Vocab's evaluation of the first 4 options would be very beneficial. However, they have been occupied with concerns about what I call the precision of a clinical assessment. Vocab is meeting this week but I do not know the day or time. I believe it will be after FM telcon, however.

Does FM have any input for InM at this point? I know that Kathleen Connor and George Arges were going to have some further conversation about the NUBC codes.