CR5

Home Oxygen Therapy Information

Pos: 140

Max: 1

Detail - Optional

Loop: 2000F

Elements: 16


User Option (Usage): Situational
To supply information regarding certification of medical necessity for home oxygen therapy

Element Summary:

 

Ref

Id

Element Name

Req

Type

Min/Max

Usage

 

CR503

1348

Oxygen Equipment Type Code
Description: Code indicating the specific type of equipment being prescribed for the delivery of oxygen
Either CR503 or CR518 is required.
All valid standard codes are used.

O

ID

1/1

Situational

 

CR504

1348

Oxygen Equipment Type Code
Description: Code indicating the specific type of equipment being prescribed for the delivery of oxygen
Required if CR503 is present and more than one type of equipment is required to administer the oxygen therapy.
All valid standard codes are used.

O

ID

1/1

Situational

 

CR505

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Equipment Reason Description
Use if needed to provide additional information that could impact the medical decision.

O

AN

1/80

Situational

 

CR506

380

Quantity
Description: Numeric value of quantity
Industry: Oxygen Flow Rate

O

R

1/15

Required

 

CR507

380

Quantity
Description: Numeric value of quantity
Industry: Daily Oxygen Use Count
Required if relevant to the type of home oxygen therapy requested.

O

R

1/15

Situational

 

CR508

380

Quantity
Description: Numeric value of quantity
Industry: Oxygen Use Period Hour Count
Required if relevant to the type of home oxygen therapy requested.

O

R

1/15

Situational

 

CR509

352

Description
Description: A free-form description to clarify the related data elements and their content
Industry: Respiratory Therapist Order Text
Use at discretion of requester.

O

AN

1/80

Situational

 

CR510

380

Quantity
Description: Numeric value of quantity
Industry: Arterial Blood Gas Quantity
Either CR510 or CR511 is required.

O

R

1/15

Situational

 

CR511

380

Quantity
Description: Numeric value of quantity
Industry: Oxygen Saturation Quantity
Either CR510 or CR511 is required.

O

R

1/15

Situational

 

CR512

1349

Oxygen Test Condition Code
Description: Code indicating the conditions under which a patient was tested
All valid standard codes are used.

O

ID

1/1

Required

 

CR513

1350

Oxygen Test Findings Code
Description: Code indicating the findings of oxygen tests performed on a patient
Required if patient’s arterial PO2 is greater than 55 mmHg and less than 60 mmHg, or oxygen saturation is greater than 88%. Use CR513, CR514, or CR515 as appropriate.
All valid standard codes are used.

O

ID

1/1

Situational

 

CR514

1350

Oxygen Test Findings Code
Description: Code indicating the findings of oxygen tests performed on a patient
Required if patient’s arterial PO2 is greater than 55 mmHg and less than 60 mmHg, or oxygen saturation is greater than 88%. Use CR513, CR514, or CR515 as appropriate.
All valid standard codes are used.

O

ID

1/1

Situational

 

CR515

1350

Oxygen Test Findings Code
Description: Code indicating the findings of oxygen tests performed on a patient
Required if patient’s arterial PO2 is greater than 55 mmHg and less than 60 mmHg, or oxygen saturation is greater than 88%. Use CR513, CR514, or CR515 as appropriate.
All valid standard codes are used.

O

ID

1/1

Situational

 

CR516

380

Quantity
Description: Numeric value of quantity
Industry: Portable Oxygen System Flow Rate
Required if either CR503, CR505 or CR518 = “D” (Liquid Portable) or “E” (Gaseous Portable).

O

R

1/15

Situational

 

CR517

1382

Oxygen Delivery System Code
Description: Code to indicate if a particular form of delivery was prescribed
All valid standard codes are used.

O

ID

1/1

Required

 

CR518

1348

Oxygen Equipment Type Code
Description: Code indicating the specific type of equipment being prescribed for the delivery of oxygen
Either CR503 or CR518 is required.
All valid standard codes are used.

O

ID

1/1

Situational


Semantics:

1.

CR502 is the number of months covered by this certification.

2.

CR505 is the reason for equipment.

3.

CR506 is the oxygen flow rate in liters per minute.

4.

CR507 is the number of times per day the patient must use oxygen.

5.

CR508 is the number of hours per period of oxygen use.

6.

CR509 is the special orders for the respiratory therapist.

7.

CR510 is the arterial blood gas.

8.

CR511 is the oxygen saturation.

9.

CR516 is the oxygen flow rate for a portable oxygen system in liters per minute.


Notes:

1. Required if requesting initial, extended, or revised certification of home oxygen therapy.
2. Use the UM segment data element UM02 instead of CR501 to specify the Certification Type Code.
3. Use the HSD segment instead of CR502 to specify the treatment period.

Example:

CR5***D***1*****87*N*****A~



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