Da Vinci Prior Authorization Support (PAS) FHIR IG
2.2.0-ballot - STU 2.2 - Ballot

Da Vinci Prior Authorization Support (PAS) FHIR IG, published by HL7 International / Financial Management. This guide is not an authorized publication; it is the continuous build for version 2.2.0-ballot built by the FHIR (HL7® FHIR® Standard) CI Build. This version is based on the current content of https://github.com/HL7/davinci-pas/ and changes regularly. See the Directory of published versions

## ValueSet: PAS LOINC Attachment Codes Value Set

Official URL: http://hl7.org/fhir/us/davinci-pas/ValueSet/pas-loinc-attachment-codes | Version: 2.2.0-ballot
Standards status: Trial-use Active as of 2022-06-29 | Maturity Level: 3 | Computable Name: PASLOINCAttachmentCodesValueSet
Other Identifiers: http://loinc.org#Logical Observation Identifier Names and Codes (LOINC)#valid-hl7-attachment-requests, OID:1.3.6.1.4.1.12009.10.2.6
Copyright/Legal: This material contains content from LOINC (http://loinc.org). LOINC is copyright © 1995-2020, Regenstrief Institute, Inc. and the Logical Observation Identifiers Names and Codes (LOINC) Committee and is available at no cost under the license at http://loinc.org/license. LOINC® is a registered United States trademark of Regenstrief Institute, Inc.

This value set includes LOINC terms that can be sent by a payer as part of an HL7 attachment request for additional information. It has been curated by the HL7 Payer/Provider Information Exchange (PIE) Work Group. More information about using LOINC in HIPAA attachments and the source of this value set can be found at LOINC Attahments.

References

- PAS Task

### Logical Definition (CLD)

- Include these codes as defined in `http://loinc.org` version Not Stated (use latest from terminology server)

  Code | Display
  11526-1 | Pathology study
  11488-4 | Consult note
  80792-5 | Pulmonary Diagnostic study note
  47420-5 | Functional status assessment note
  34117-2 | History and physical note
  74156-1 | Oncology Plan of care and summary note
  18776-5 | Plan of care note
  80785-9 | Radiation oncology Plan of care note
  11506-3 | Progress note
  11504-8 | Surgical operation note
  18842-5 | Discharge summary
  34133-9 | Summary of episode note
  18761-7 | Transfer summary note
  80565-5 | Medication administration record
  28570-0 | Procedure note
  57133-1 | Referral note
  52027-0 | Abortion consent Document
  52028-8 | Hysterectomy consent Document
  52029-6 | Sterilization consent Document
  53245-7 | Driver license
  57828-6 | Prescription list
  18682-5 | Ambulance records
  52063-5 | Prescription for durable medical equipment (DME)
  52062-7 | Transcutaneous electrical neural stimulation (TENS) attachment
  52073-4 | Vision services attachment
  52070-0 | Workers compensation attachment
  80405-4 | Provider Certification [Type]
  53242-4 | Charge ticket or encounter form
  52042-9 | Continuous positive airway pressure (CPAP) attachment
  52040-3 | Dental X-rays and other images (not DICOM)
  18748-4 | Diagnostic imaging study
  53243-2 | Advanced beneficiary notice
  53247-3 | Eligibility acknowledgement
  52071-8 | Employee assistance program attachment
  67796-3 | EMS patient care report - version 3 Document NEMSIS
  77601-3 | Enhanced note
  52043-7 | Enteral nutrition attachment
  11514-7 | Chiropractic Episode of care medical records
  11521-2 | Occupational therapy Episode of care medical records
  11515-4 | Physical therapy Episode of care medical records
  11516-2 | Physician Episode of care medical records
  11517-0 | Podiatry Episode of care medical records
  11518-8 | Psychology Episode of care medical records
  11519-6 | Social service Episode of care medical records
  11520-4 | Speech therapy Episode of care medical records
  52030-4 | Explanation of benefits
  52031-2 | Explanation of benefits to subscriber
  52044-5 | External infusion pump attachment
  103567-4 | Path report IG
  52064-3 | Worker's compensation first report of injury attachment
  52045-2 | Gait trainers attachment
  52033-8 | General correspondence attachment
  11485-0 | Anesthesia records
  52035-3 | Home health claims
  52036-1 | Home health prior authorization
  52046-0 | Hospital beds attachment
  52032-0 | Appeal denial letter
  52047-8 | Immunosuppressive drug attachment
  77600-5 | Interval note
  94093-2 | Itemized bill
  15508-5 | Labor and delivery records
  11502-2 | Laboratory report
  52048-6 | Lymphedema pump attachment
  52049-4 | Manual wheelchair attachment
  11503-0 | Medical records
  28011-5 | Emergency department Medical records
  94118-7 | Medical records in response to authorization denial
  52037-9 | Member ID card copy
  52065-0 | Automobile liability attachment
  52050-2 | Motorized wheelchair attachment
  76641-0 | Neurology study
  52072-6 | Non-emergency transportation attachment
  53246-5 | Non-medical services attachment
  52066-8 | Notice of Discharge Medicare Appeal Rights (NODMAR) form
  53244-0 | Notice of privacy practices receipt
  52051-0 | Orthotic/Prosthetic attachment
  52052-8 | Osteogenesis stimulator attachment
  52053-6 | Oxygen attachment
  52054-4 | Parenteral nutrition attachment
  52067-6 | Past filing limit justification
  52034-6 | Payer letter
  28629-4 | Perimetry study
  74030-8 | Periodontal service attachment
  28633-6 | Polysomnography (sleep) study
  52055-1 | Power operated vehicle attachment
  57073-9 | Prenatal records
  52041-1 | Blood glucose monitor attachment
  52068-4 | Property and casualty state mandated forms
  52075-9 | Purchase invoice
  18823-5 | Alcohol and/or substance abuse service attachment
  18824-3 | Cardiac service attachment
  18825-0 | Medical social services attachment
  18826-8 | Occupational therapy service attachment
  19002-5 | Physical therapy service attachment
  18594-2 | Psychiatric service attachment
  52184-9 | Pulmonary therapy service attachment
  19003-3 | Respiratory therapy service attachment
  29206-0 | Speech therapy service attachment
  52056-9 | Repair of durable medical equipment attachment
  52057-7 | Seat lift mechanism attachment
  52058-5 | Seating system attachment
  52039-5 | Skilled Nursing Facility (SNF) record
  101657-5 | Special investigation unit (SIU) medical record request Document
  52059-3 | Speech generating device attachment
  52060-1 | Standers/standing frame attachment
  52038-7 | Subscriber Information including retroactive and presumptive eligibility
  52061-9 | Support surface attachment
  52069-2 | Tax ID number - IRS form W9
  103595-5 | Certificate of Medical Necessity
  103596-3 | Durable medical equipment proof of delivery receipt
  103597-1 | Pain management form or template
  46212-7 | Pre operative photo
  52459-5 | CMS certification number (CCN) Provider

### Expansion

Expansion from tx.fhir.org based on Loinc v2.81

This value set contains 113 concepts

System | Code | Display (en) | status | JSON | XML
`http://loinc.org` | 11526-1 | Pathology study |  |  |
`http://loinc.org` | 11488-4 | Consult note |  |  |
`http://loinc.org` | 80792-5 | Pulmonary Diagnostic study note |  |  |
`http://loinc.org` | 47420-5 | Functional status assessment note |  |  |
`http://loinc.org` | 34117-2 | History and physical note |  |  |
`http://loinc.org` | 74156-1 | Oncology Plan of care and summary note |  |  |
`http://loinc.org` | 18776-5 | Plan of care note |  |  |
`http://loinc.org` | 80785-9 | Radiation oncology Plan of care note |  |  |
`http://loinc.org` | 11506-3 | Progress note |  |  |
`http://loinc.org` | 11504-8 | Surgical operation note |  |  |
`http://loinc.org` | 18842-5 | Discharge summary |  |  |
`http://loinc.org` | 34133-9 | Summary of episode note |  |  |
`http://loinc.org` | 18761-7 | Transfer summary note |  |  |
`http://loinc.org` | 80565-5 | Medication administration record |  |  |
`http://loinc.org` | 28570-0 | Procedure note |  |  |
`http://loinc.org` | 57133-1 | Referral note |  |  |
`http://loinc.org` | 52027-0 | Abortion consent Document |  |  |
`http://loinc.org` | 52028-8 | Hysterectomy consent Document |  |  |
`http://loinc.org` | 52029-6 | Sterilization consent Document |  |  |
`http://loinc.org` | 53245-7 | Driver license |  |  |
`http://loinc.org` | 57828-6 | Prescription list |  |  |
`http://loinc.org` | 18682-5 | Ambulance records |  |  |
`http://loinc.org` | 52063-5 | Prescription for durable medical equipment (DME) |  |  |
`http://loinc.org` | 52062-7 | Transcutaneous electrical neural stimulation (TENS) attachment |  |  |
`http://loinc.org` | 52073-4 | Vision services attachment |  |  |
`http://loinc.org` | 52070-0 | Workers compensation attachment |  |  |
`http://loinc.org` | 80405-4 | Provider Certification [Type] | TRIAL |  |
`http://loinc.org` | 53242-4 | Charge ticket or encounter form |  |  |
`http://loinc.org` | 52042-9 | Continuous positive airway pressure (CPAP) attachment |  |  |
`http://loinc.org` | 52040-3 | Dental X-rays and other images (not DICOM) |  |  |
`http://loinc.org` | 18748-4 | Diagnostic imaging study |  |  |
`http://loinc.org` | 53243-2 | Advanced beneficiary notice |  |  |
`http://loinc.org` | 53247-3 | Eligibility acknowledgement |  |  |
`http://loinc.org` | 52071-8 | Employee assistance program attachment |  |  |
`http://loinc.org` | 67796-3 | EMS patient care report - version 3 Document NEMSIS |  |  |
`http://loinc.org` | 77601-3 | Enhanced note | TRIAL |  |
`http://loinc.org` | 52043-7 | Enteral nutrition attachment |  |  |
`http://loinc.org` | 11514-7 | Chiropractic Episode of care medical records |  |  |
`http://loinc.org` | 11521-2 | Occupational therapy Episode of care medical records |  |  |
`http://loinc.org` | 11515-4 | Physical therapy Episode of care medical records |  |  |
`http://loinc.org` | 11516-2 | Physician Episode of care medical records |  |  |
`http://loinc.org` | 11517-0 | Podiatry Episode of care medical records |  |  |
`http://loinc.org` | 11518-8 | Psychology Episode of care medical records |  |  |
`http://loinc.org` | 11519-6 | Social service Episode of care medical records |  |  |
`http://loinc.org` | 11520-4 | Speech therapy Episode of care medical records |  |  |
`http://loinc.org` | 52030-4 | Explanation of benefits |  |  |
`http://loinc.org` | 52031-2 | Explanation of benefits to subscriber |  |  |
`http://loinc.org` | 52044-5 | External infusion pump attachment |  |  |
`http://loinc.org` | 103567-4 | Previous cancer therapy (narrative) |  |  |
`http://loinc.org` | 52064-3 | Worker's compensation first report of injury attachment |  |  |
`http://loinc.org` | 52045-2 | Gait trainers attachment |  |  |
`http://loinc.org` | 52033-8 | General correspondence attachment |  |  |
`http://loinc.org` | 11485-0 | Anesthesia records |  |  |
`http://loinc.org` | 52035-3 | Home health claims |  |  |
`http://loinc.org` | 52036-1 | Home health prior authorization |  |  |
`http://loinc.org` | 52046-0 | Hospital beds attachment |  |  |
`http://loinc.org` | 52032-0 | Appeal denial letter |  |  |
`http://loinc.org` | 52047-8 | Immunosuppressive drug attachment |  |  |
`http://loinc.org` | 77600-5 | Interval note |  |  |
`http://loinc.org` | 94093-2 | Itemized bill |  |  |
`http://loinc.org` | 15508-5 | Labor and delivery records |  |  |
`http://loinc.org` | 11502-2 | Laboratory report |  |  |
`http://loinc.org` | 52048-6 | Lymphedema pump attachment |  |  |
`http://loinc.org` | 52049-4 | Manual wheelchair attachment |  |  |
`http://loinc.org` | 11503-0 | Medical records |  |  |
`http://loinc.org` | 28011-5 | Emergency department Medical records |  |  |
`http://loinc.org` | 94118-7 | Medical records in response to authorization denial |  |  |
`http://loinc.org` | 52037-9 | Member ID card copy |  |  |
`http://loinc.org` | 52065-0 | Automobile liability attachment |  |  |
`http://loinc.org` | 52050-2 | Motorized wheelchair attachment |  |  |
`http://loinc.org` | 76641-0 | Neurology study |  |  |
`http://loinc.org` | 52072-6 | Non-emergency transportation attachment |  |  |
`http://loinc.org` | 53246-5 | Non-medical services attachment |  |  |
`http://loinc.org` | 52066-8 | Notice of Discharge Medicare Appeal Rights (NODMAR) form |  |  |
`http://loinc.org` | 53244-0 | Notice of privacy practices receipt |  |  |
`http://loinc.org` | 52051-0 | Orthotic/Prosthetic attachment |  |  |
`http://loinc.org` | 52052-8 | Osteogenesis stimulator attachment |  |  |
`http://loinc.org` | 52053-6 | Oxygen attachment |  |  |
`http://loinc.org` | 52054-4 | Parenteral nutrition attachment |  |  |
`http://loinc.org` | 52067-6 | Past filing limit justification |  |  |
`http://loinc.org` | 52034-6 | Payer letter |  |  |
`http://loinc.org` | 28629-4 | Perimetry study |  |  |
`http://loinc.org` | 74030-8 | Periodontal service attachment |  |  |
`http://loinc.org` | 28633-6 | Polysomnography (sleep) study |  |  |
`http://loinc.org` | 52055-1 | Power operated vehicle attachment |  |  |
`http://loinc.org` | 57073-9 | Prenatal records |  |  |
`http://loinc.org` | 52041-1 | Blood glucose monitor attachment |  |  |
`http://loinc.org` | 52068-4 | Property and casualty state mandated forms |  |  |
`http://loinc.org` | 52075-9 | Purchase invoice |  |  |
`http://loinc.org` | 18823-5 | Alcohol and/or substance abuse service attachment |  |  |
`http://loinc.org` | 18824-3 | Cardiac service attachment |  |  |
`http://loinc.org` | 18825-0 | Medical social services attachment |  |  |
`http://loinc.org` | 18826-8 | Occupational therapy service attachment |  |  |
`http://loinc.org` | 19002-5 | Physical therapy service attachment |  |  |
`http://loinc.org` | 18594-2 | Psychiatric service attachment |  |  |
`http://loinc.org` | 52184-9 | Pulmonary therapy service attachment |  |  |
`http://loinc.org` | 19003-3 | Respiratory therapy service attachment |  |  |
`http://loinc.org` | 29206-0 | Speech therapy service attachment |  |  |
`http://loinc.org` | 52056-9 | Repair of durable medical equipment attachment |  |  |
`http://loinc.org` | 52057-7 | Seat lift mechanism attachment |  |  |
`http://loinc.org` | 52058-5 | Seating system attachment |  |  |
`http://loinc.org` | 52039-5 | Skilled Nursing Facility (SNF) record |  |  |
`http://loinc.org` | 101657-5 | Special investigation unit (SIU) medical record request Document |  |  |
`http://loinc.org` | 52059-3 | Speech generating device attachment |  |  |
`http://loinc.org` | 52060-1 | Standers/standing frame attachment |  |  |
`http://loinc.org` | 52038-7 | Subscriber Information including retroactive and presumptive eligibility |  |  |
`http://loinc.org` | 52061-9 | Support surface attachment |  |  |
`http://loinc.org` | 52069-2 | Tax ID number - IRS form W9 |  |  |
`http://loinc.org` | 103595-5 | Certificate of Medical Necessity |  |  |
`http://loinc.org` | 103596-3 | Durable medical equipment proof of delivery receipt |  |  |
`http://loinc.org` | 103597-1 | Pain management form or template |  |  |
`http://loinc.org` | 46212-7 | Pre operative photo |  |  |
`http://loinc.org` | 52459-5 | CMS certification number (CCN) Provider |  |  |

Description of the above table(s).