Code indicating a condition
Type
ID
Length
Max 2 / Min 2
Codes
<> 01
Patient was admitted to a hospital
<> 02
Patient was bed confined before the ambulance service
<> 03
Patient was bed confined after the ambulance service
<> 04
Patient was moved by stretcher
<> 05
Patient was unconscious or in shock
<> 06
Patient was transported in an emergency situation
<> 07
Patient had to be physically restrained
<> 08
Patient had visible hemorrhaging
<> 09
Ambulance service was medically necessary
<> 10
Patient is ambulatory
<> 11
Ambulation is Impaired and Walking Aid is Used for Therapy or Mobility
<> 12
Patient is confined to a bed or chair
<> 13
Patient is Confined to a Room or an Area Without Bathroom Facilities
<> 14
Ambulation is Impaired and Walking Aid is Used for Mobility
<> 15
Patient Condition Requires Positioning of the Body or Attachments Which Would Not be Feasible With the Use of an Ordinary Bed
<> 16
Patient needs a trapeze bar to sit up due to respiratory condition or change body positions for other medical reasons
<> 17
Patient's Ability to Breathe is Severely Impaired
<> 18
Patient condition requires frequent and/or immediate changes in body positions
<> 19
Patient can operate controls
<> 20
Siderails Are to be Attached to a Hospital Bed Owned by the Beneficiary
<> 21
Patient owns equipment
<> 22
Mattress or Siderails are Being Used with Prescribed Medically Necessary Hospital Bed Owned by the Beneficiary
<> 23
Patient Needs Lift to Get In or Out of Bed or to Assist in Transfer from Bed to Wheelchair
<> 24
Patient has an orthopedic impairment requiring traction equipment which prevents ambulation during period of use
<> 25
Item has been prescribed as part of a planned regimen of treatment in patient home
<> 26
Patient is highly susceptible to decubitus ulcers
<> 27
Patient or a care-giver has been instructed in use of equipment
<> 28
Patient has poor diabetic control
<> 29
A 6-7 hour nocturnal study documents 30 episodes of apnea each lasting more than 10 seconds
<> 30
Without the equipment, the patient would require surgery
<> 31
Patient has had a total knee replacement
<> 32
Patient has intractable lymphedema of the extremities
<> 33
Patient is in a nursing home
<> 34
Patient is conscious
<> 35
This Feeding is the Only Form of Nutritional Intake for This Patient
<> 36
Patient was administered premix
<> 37
Oxygen delivery equipment is stationary
<> 38
Certification signed by the physician is on file at the supplier's office
<> 39
Patient Has Mobilizing Respiratory Tract Secretions
<> 40
Patient or Caregiver is Capable of Using the Equipment Without Technical or Professional Supervision
<> 41
Patient or Caregiver is Unable to Propel or Lift a Standard Weight Wheelchair
<> 42
Patient Requires Leg Elevation for Edema or Body Alignment
<> 43
Patient Weight or Usage Needs Necessitate a Heavy Duty Wheelchair
<> 44
Patient Requires Reclining Function of a Wheelchair
<> 45
Patient is Unable to Operate a Wheelchair Manually
<> 46
Patient or Caregiver Requires Side Transfer into Wheelchair, Commode or Other
<> 47
Advertisement Run Condition
<> 48
Individual Paid for Last Day Worked
<> 49
Full Wages Paid for Date of Injury
<> 50
Citation or Ticket Issued
<> 51
Individual is Member of Policyholder's Household
<> 52
Individual Permitted to Use Vehicle
<> 53
Individual Wore Seatbelt
<> 54
Child Restraint Device in Vehicle
<> 55
Child Restraint Device Used
<> 56
Individual Injured
<> 57
Individual Transported to Another Location
<> 58
Durable Medical Equipment (DME) Purchased New
<> 59
Durable Medical Equipment (DME) Is Under Warranty
<> 60
Transportation Was To the Nearest Facility
<> PS
Publication is Included in Sharing
