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Medical necessity, when it comes to medical billing, is one of the most critical parts of establishing the validity of a claim. To do this, CMNs, or G records, are electronically transmitted to the carrier while a paper CMN is kept on file. In this installment, we continue our review of the GD0 record picking up with field number 11.GD0 field 11, position 54, is the room confined indicator. This indicator is used to tell the carrier if the patient is confined to his or her room. If they are this field is filled with a Y. If not, it is filled with the letter N.GD0 field 12, position 55, is the ambulation/mobility indicator. This indicator tells the carrier if the patient is able to walk but needs some sort of aid, like a cane or walker, to assist in mobility. If they do need some sort of device then this field is filled with a Y. If not, it is filled with an N.GD0 field 13, position 56, is the body positioning indicator. This is a rather strange description for what amounts to telling the carrier if the patient needs special positioning while in bed that would not be possible with an ordinary bed, such as head elevated. If so, this field is filled with a Y. If not, it is filled with an N.GD0 field 14, position 57, is the respiratory/other indicator. This indicator tells the carrier if the patient needs a trapeze bar to sit up because of a respiratory condition. If so, this field is filled with a Y. If not, it is filled with an N.GD0 field 15, position 58, is the breathing impaired indicator. This indicator tells the carrier if the patient's ability to breathe is severely impaired. Most patients who fit this condition are also on oxygen. If this is true, the field is filled with a Y. If not, it is filled with an N.GD0 field 16, position 59, is the freq/immed changes indicator. You will start to notice that quite a few of these indicators are abbreviated to the point where you can just about understand what they mean. This indicator tells the carrier if the patient requires frequent changes in positioning while lying in bed. If so, this field is filled with a Y. If not, it is filled with an N.GD0 field 17, position 60, is the operate controls indicator. This indicator tells the carrier if the patient is able to operate controls on a bed, wheelchair or other device. This is important to know because some devices require the patient to be able to do this. If they can't, in most cases, the device will not be paid on. If the patient is able to operate controls this field is filled with a Y. If not, it is filled with an N.In our next installment of medical billing, we'll cover the GD0 record picking up with field number 18, which covers siderails for beds. As we said in installment one, this is a very generic CMN.
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Michael Russell Your Independent guide to Medical Billing
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