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@@ -6,6 +6,140 @@ $leanView = request()->input('popupmode') && request()->input('fromNoteUid');
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?>
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+<?php
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+$posOptions = [
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+ "01" => "01 - PHARMACY",
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+ "02" => "02 - TELEHEALTH PROVIDED OTHER THAN IN PATIENT'S HOME",
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+ "03" => "03 - SCHOOL",
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+ "04" => "04 - HOMELESS SHELTER",
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+ "05" => "05 - INDIAN HEALTH SERVICE FREE-STANDING FACILITY",
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+ "06" => "06 - INDIAN HEALTH SERVICE PROVIDER-BASED FACILITY",
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+ "07" => "07 - TRIBAL 638 FREE-STANDING FACILITY",
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+ "08" => "08 - TRIBAL 638 PROVIDER-BASED FACILITY",
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+ "09" => "09 - PRISON/CORRECTIONAL FACILITY",
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+ "10" => "10 - TELEHEALTH PROVIDED IN PATIENT'S HOME",
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+ "11" => "11 - OFFICE",
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+ "12" => "12 - HOME",
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+ "13" => "13 - ASSISTED LIVING FACILITY",
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+ "14" => "14 - GROUP HOME",
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+ "15" => "15 - MOBILE UNIT",
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+ "16" => "16 - TEMPORARY LODGING",
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+ "17" => "17 - WALK-IN RETAIL HEALTH CLINIC",
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+ "18" => "18 - PLACE OF EMPLOYMENT/WORKSITE",
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+ "19" => "19 - OUTPATIENT HOSPITAL - OFF CAMPUS",
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+ "20" => "20 - URGENT CARE FACILITY",
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+ "21" => "21 - INPATIENT HOSPITAL",
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+ "22" => "22 - OUTPATIENT HOSPITAL - ON CAMPUS",
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+ "23" => "23 - EMERGENCY ROOM - HOSPITAL",
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+ "24" => "24 - AMBULATORY SURGICAL CENTER",
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+ "25" => "25 - BIRTHING CENTER",
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+ "26" => "26 - MILITARY TREATMENT FACILITY",
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+ "27" => "27 - OUTREACH SITE/STREET",
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+ "31" => "31 - SKILLED NURSING FACILITY",
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+ "32" => "32 - NURSING FACILITY",
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+ "33" => "33 - CUSTODIAL CARE FACILITY",
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+ "34" => "34 - HOSPICE",
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+ "41" => "41 - AMBULANCE - LAND",
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+ "42" => "42 - AMBULANCE AIR OR WATER",
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+ "49" => "49 - INDEPENDENT CLINIC",
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+ "50" => "50 - FEDERALLY QUALIFIED HEALTH CENTER",
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+ "51" => "51 - INPATIENT PSYCHIATRIC FACILITY",
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+ "52" => "52 - PSYCHIATRIC FACILITY PARTIAL HOSPITALIZATION",
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+ "53" => "53 - COMMUNITY MENTAL HEALTH CENTER",
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+ "54" => "54 - INTERMEDIATE CARE FACILITY/MENTALLY RETARDED",
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+ "55" => "55 - RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY",
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+ "56" => "56 - PSYCHIATRIC RESIDENTIAL TREATMENT CENTER",
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+ "57" => "57 - NON-RESIDENTIAL SUBSTANCE ABUSE TREATMENT FACILITY",
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+ "58" => "58 - NON-RESIDENTIAL OPIOID TREATMENT FACILITY",
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+ "60" => "60 - MASS IMMUNIZATION CENTER",
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+ "61" => "61 - COMPREHENSIVE INPATIENT REHABILITATION FACILITY",
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+ "62" => "62 - COMPREHENSIVE OUTPATIENT REHABILITATION FACILITY",
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+ "65" => "65 - END STAGE RENAL DISEASE TREATMENT FACILITY",
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+ "71" => "71 - PUBLIC HEALTH CLINIC",
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+ "72" => "72 - RURAL HEALTH CLINIC",
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+ "81" => "81 - INDEPENDENT LABORATORY",
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+ "99" => "99 - OTHER PLACE OF SERVICE",
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+];
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+$modifierOptions = [
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+ "20" => "20 - MICROSURGERY",
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+ "21" => "21 - PROLONGED EVALUATION & MANAGEMENT SERVICE",
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+ "22" => "22 - UNUSUAL PROCEDURAL SERVICES",
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+ "23" => "23 - UNUSUAL ANESTHESIA",
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+ "24" => "24 - UNRELATED EVALUATION & MANAGEMENT SERVICE",
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+ "25" => "25 - SIGNIFICANT, SEPARATELY IDENTIFIABLE EVA",
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+ "26" => "26 - PROFESSIONAL COMPONENT",
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+ "32" => "32 - MANDATED SERVICES",
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+ "47" => "47 - ANESTHESIA BY SURGEON",
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+ "50" => "50 - BILATERAL PROCEDURE",
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+ "51" => "51 - MULTIPLE PROCEDURES",
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+ "52" => "52 - REDUCED SERVICES",
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+ "53" => "53 - DISCONTINUED PROCEDURE",
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+ "54" => "54 - SURGICAL CARE ONLY",
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+ "55" => "55 - POSTOPERATIVE MANAGEMENT ONLY",
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+ "56" => "56 - PREOPERATIVE MANAGEMENT ONLY",
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+ "57" => "57 - DECISION FOR SURGERY",
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+ "58" => "58 - STAGED OR RELATED PROCEDURE OR SERVICE B",
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+ "59" => "59 - DISTINCT PROCEDURAL SERVICE",
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+ "62" => "62 - TWO SURGEONS",
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+ "66" => "66 - SURGICAL TEAM",
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+ "73" => "73 - DISCONTINUED OUT-PATIENT HOSPITAL/AMBULA",
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+ "74" => "74 - DISCONTINUED OUT-PATIENT HOSPITAL/AMBULA",
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+ "76" => "76 - REPEAT PROCEDURE BY SAME PHYSICIAN",
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+ "77" => "77 - REPEAT PROCEDURE BY ANOTHER PHYSICIAN",
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+ "78" => "78 - RETURN TO THE OPERATING ROOM FOR A RELAT",
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+ "79" => "79 - UNRELATED PROCEDURE OR SERVICE BY THE SA",
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+ "80" => "80 - ASSISTANT SURGEON",
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+ "81" => "81 - MINIMUM ASSISTANT SURGEON",
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+ "82" => "82 - ASSISTANT SURGEON (WHEN QUALIFIED RESIDE",
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+ "90" => "90 - REFERENCE (OUTSIDE) LABORATORY",
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+ "91" => "91 - REPEAT CLINICAL DIAGNOSTIC LAB TEST",
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+ "93" => "93 - AUDIO-ONLY TELEMEDICINE SERVICES",
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+ "95" => "95 - MCR TELEHEALTH VISIT",
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+ "99" => "99 - MULTIPLE MODIFIERS",
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+ "E1" => "E1 - UPPER LEFT, EYELID",
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+ "E2" => "E2 - LOWER LEFT, EYELID",
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+ "E3" => "E3 - UPPER RIGHT, EYELID",
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+ "E4" => "E4 - LOWER RIGHT, EYELID",
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+ "F1" => "F1 - LEFT HAND, SECOND DIGIT",
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+ "F2" => "F2 - LEFT HAND, THIRD DIGIT",
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+ "F3" => "F3 - LEFT HAND, FOURTH DIGIT",
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+ "F4" => "F4 - LEFT HAND, FIFTH DIGIT",
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+ "F5" => "F5 - RIGHT HAND, THUMB",
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+ "F6" => "F6 - RIGHT HAND, SECOND DIGIT",
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+ "F7" => "F7 - RIGHT HAND, THIRD DIGIT",
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+ "F8" => "F8 - RIGHT HAND, FOURTH DIGIT",
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+ "F9" => "F9 - RIGHT HAND, FIFTH DIGIT",
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+ "FA" => "FA - LEFT HAND, THUMB",
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+ "FQ" => "FQ - FURNISHED USING AUDIO-ONLY COMM TECH",
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+ "GT" => "GT - VIA INTERACTIVE AUDIO AND VIDEO TELECOM",
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+ "GW" => "GW - HOSPICE",
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+ "LC" => "LC - LEFT CIRCUMFLEX CORONARY ARTERY (HOSPITA",
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+ "LD" => "LD - LEFT ANTERIOR DESCENDING CORONARY ARTERY",
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+ "LT" => "LT - LEFT SIDE (USED TO IDENTIFY PROCEDURES P",
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+ "QM" => "QM - AMBULANCE SERVICE PROVIDED UNDER ARRANGE",
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+ "QN" => "QN - AMBULANCE SERVICE FURNISHED DIRECTLY BY",
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+ "QR" => "QR - REPEAT LABORATORY TEST PERFORMED ON THE",
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+ "RC" => "RC - RIGHT CORONARY ARTERY (HOSPITALS USE WIT",
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+ "RT" => "RT - RIGHT SIDE (USED TO IDENTIFY PROCEDURES",
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+ "T1" => "T1 - LEFT FOOT, SECOND DIGIT",
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+ "T2" => "T2 - LEFT FOOT, THIRD DIGIT",
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+ "T3" => "T3 - LEFT FOOT, FOURTH DIGIT",
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+ "T4" => "T4 - LEFT FOOT, FIFTH DIGIT",
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+ "T5" => "T5 - RIGHT FOOT, GREAT TOE",
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+ "T6" => "T6 - RIGHT FOOT, SECOND DIGIT",
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+ "T7" => "T7 - RIGHT FOOT, THIRD DIGIT",
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+ "T8" => "T8 - RIGHT FOOT, FOURTH DIGIT",
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+ "T9" => "T9 - RIGHT FOOT, FIFTH DIGIT",
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+ "TA" => "TA - LEFT FOOT, GREAT TOE",
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+ "TC" => "TC - TECHNICAL COMPONENT",
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+ "XE" => "XE - Separate Encounter",
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+ "XP" => "XP - Separate Practitioner",
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+ "XS" => "XS - Separate Structure",
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+ "XU" => "XU - Unusual Non-Overlapping Service",
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+];
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+?>
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+
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+
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@extends($leanView ? 'layouts.empty' : 'layouts.patient')
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@section($leanView ? 'content' : 'inner-content')
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@@ -1270,6 +1404,7 @@ $leanView = request()->input('popupmode') && request()->input('fromNoteUid');
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<tr>
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<th class="border-bottom-0 pl-2">IID</th>
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<th class="border-bottom-0">Details</th>
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+ <th class="border-bottom-0">POS & Modifier</th>
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<th class="border-bottom-0">Current Version</th>
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<th class="border-bottom-0">Status</th>
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<th class="border-bottom-0">Submissions</th>
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@@ -1348,6 +1483,58 @@ $leanView = request()->input('popupmode') && request()->input('fromNoteUid');
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<p>No lines for this claim</p>
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@endif
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</td>
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+ <td class="border-right">
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+ <?php
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+ $pos = $claim->claimProperty('pos');
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+ $modifier = $claim->claimProperty('modifier');
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+ ?>
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+ <div class="mb-2 d-flex">
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+ POS: <b>{{$pos ?: '-'}}</b>
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+ <div moe class="ml-1">
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+ <a class="text-primary" href="" show start><i class="fa fa-edit"></i></a>
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+ <form url="/put-claim-property">
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+ <input type="hidden" name="uid" value="{{$claim->uid}}">
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+ <input type="hidden" name="name" value="pos">
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+ <div class="mb-2">
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+ <label>POS:</label>
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+ <select name="value" class="form-control form-control-sm">
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+ <option value="">-- select --</option>
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+ @foreach($posOptions as $kOpt => $vOpt)
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+ <option value="{{$kOpt}}" {{$pos == $kOpt ? 'selected' : ''}}>{{$vOpt}}</option>
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+ @endforeach
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+ </select>
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+ </div>
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+ <div class="mb-0">
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+ <button class="btn btn-primary btn-sm" submit>Submit</button>
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+ <button class="btn btn-default border btn-sm" cancel>Cancel</button>
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+ </div>
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+ </form>
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+ </div>
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+ </div>
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+ <div class="d-flex">
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+ Modifier: <b>{{$modifier ?: '-'}}</b>
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+ <div moe class="ml-1">
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+ <a class="text-primary" href="" show start><i class="fa fa-edit"></i></a>
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+ <form url="/put-claim-property">
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+ <input type="hidden" name="uid" value="{{$claim->uid}}">
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+ <input type="hidden" name="name" value="modifier">
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+ <div class="mb-2">
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+ <label>Modifier:</label>
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+ <select name="value" class="form-control form-control-sm">
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+ <option value="">-- select --</option>
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+ @foreach($modifierOptions as $kOpt => $vOpt)
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+ <option value="{{$kOpt}}" {{$modifier == $kOpt ? 'selected' : ''}}>{{$vOpt}}</option>
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+ @endforeach
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+ </select>
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+ </div>
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+ <div class="mb-0">
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+ <button class="btn btn-primary btn-sm" submit>Submit</button>
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+ <button class="btn btn-default border btn-sm" cancel>Cancel</button>
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+ </div>
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+ </form>
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+ </div>
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+ </div>
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+ </td>
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<td class="border-right">
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{{$claim->currentVersion ? friendlier_date_time($claim->currentVersion->created_at) : '-'}}
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</td>
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