CR4 Enteral or Parenteral Therapy Certification

To supply information regarding certification of medical necessity for enteral or parenteral nutrition therapy

Position
Element
Name
Type
Requirement
Min
Max
Repeat
CR4-01
Yes/No Condition or Response Code
Identifier (ID)
Mandatory
1
1
-
Code indicating a Yes or No condition or response
CR401 is enteral or parenteral indicator. A "Y" value indicates enteral; an "N" value indicates parenteral.
CR4-02
Certification Type Code
Identifier (ID)
Optional
1
1
-
Code indicating the type of certification
CR4-03
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0304: If either CR4-03 or CR4-04 is present, then the other is required
CR4-04
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity
CR404 is the estimated duration of therapy.
CR4-05
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0506: If either CR4-05 or CR4-06 is present, then the other is required
CR4-06
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity
CR406 is the time period covered by this certification.
CR4-07
Non-Visit Code
Identifier (ID)
Optional
1
1
-
Code indicating on what a medical evaluation is based, when not based on a physician's visit
CR4-08
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P0809: If either CR4-08 or CR4-09 is present, then the other is required
CR4-09
Quantity
Decimal number (R)
Conditional
1
15
-
Numeric value of quantity
CR409 is the age of the patient.
CR4-10
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1011: If either CR4-10 or CR4-11 is present, then the other is required
CR4-11
Height
Decimal number (R)
Conditional
1
8
-
Vertical dimension of an object measured when the object is in the upright position
CR411 is the height of the patient.
CR4-12
Unit or Basis for Measurement Code
Identifier (ID)
Conditional
2
2
-
Code specifying the units in which a value is being expressed, or manner in which a measurement has been taken
P1213: If either CR4-12 or CR4-13 is present, then the other is required
CR4-13
Weight
Decimal number (R)
Optional
1
10
-
Numeric value of weight
CR413 is the weight of the patient.
CR4-14
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR414 is the number of times the patient is fed per week for parenteral claims or the number of times the patient is fed per day for enteral claims.
CR4-15
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
CR415 is the product name.
CR4-16
Nutrient Administration Method Code
Identifier (ID)
Optional
1
1
-
Code indicating the method used to administer nutrient to a patient
CR4-17
Nutrient Administration Technique Code
Identifier (ID)
Optional
1
1
-
Code indicating the technique used to administer nutrient to a patient
CR4-18
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR418 is the total number of calories per day of all nutrients prescribed.
CR4-19
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR419 is the total number of calories per day prescribed for this product.
CR4-20
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
CR420 is the amino acid name.
CR4-21
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR421 is the number of milliliters of amino acid solution used in the prescription per day.
CR4-22
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR422 is the percentage of concentration of amino acid used in the prescription.
CR4-23
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR423 is the number of grams of amino acid used per day.
CR4-24
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR424 is the number of milliliters of dextrose solution used in the prescription per day.
CR4-25
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR425 is the percentage of concentration of dextrose used in the prescription.
CR4-26
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR426 is the number of milliliters of lipids used in the prescription.
CR4-27
Percent
Decimal number (R)
Optional
1
10
-
Percentage expressed as a decimal
CR427 is the percentage of concentration of lipids used in the prescription.
CR4-28
Quantity
Decimal number (R)
Optional
1
15
-
Numeric value of quantity
CR428 is the number of times per week lipids are used in the prescription.
CR4-29
Description
String (AN)
Optional
1
80
-
A free-form description to clarify the related data elements and their content
CR429 is the special circumstances or medical justification.

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