first steps to support v5.0 misc billing form (#869)

* first steps to support v5.0 misc billing * corrections from brady * 837 fix added * minor fix
openemr · Jun 20, 2017 · 5f30cbe · 5f30cbe
1 parent 7de2ad9
commit 5f30cbe
Show file tree

Hide file tree

Showing 5 changed files with 97 additions and 102 deletions.
diff --git a/interface/forms/misc_billing_options/date_qualifier_options.php b/interface/forms/misc_billing_options/date_qualifier_options.php
@@ -23,6 +23,37 @@
  * @author  Kevin Yeh <kevin.y@integralemr.com>
  * @link    http://www.open-emr.org
  */
+function generateDateQualifierSelect($name,$options,$obj)
+{
+    echo     "<select name='".attr($name)."'>";
+    for($idx=0;$idx<count($options);$idx++)
+    {
+        echo "<option value='".attr($options[$idx][1])."'";
+        if($obj[$name]==$options[$idx][1]) echo " selected";
+        echo ">".text($options[$idx][0])."</option>";
+    }
+    echo     "</select>";
+
+}
+function genProviderSelect($selname, $toptext, $default=0, $disabled=false) {
+  $query = "SELECT id, lname, fname FROM users WHERE " .
+    "( authorized = 1 OR info LIKE '%provider%' ) AND username != '' " .
+    "AND active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " .
+    "ORDER BY lname, fname";
+  $res = sqlStatement($query);
+  echo "   <select name='" . attr($selname) . "'";
+  if ($disabled) echo " disabled";
+  echo ">\n";
+  echo "    <option value=''>" . text($toptext) . "\n";
+  while ($row = sqlFetchArray($res)) {
+    $provid = $row['id'];
+    echo "    <option value='" . attr($provid) . "'";
+    if ($provid == $default) echo " selected";
+    echo ">" . text($row['lname'] . ", " . $row['fname']) . "\n";
+  }
+  echo text($provid);
+  echo "   </select>\n";
+}
 
 $box_14_qualifier_options=array(array(xl("Onset of Current Symptoms or Illness"),"431"),
                                             array(xl("Last Menstrual Period"),"484"));

diff --git a/interface/forms/misc_billing_options/new.php b/interface/forms/misc_billing_options/new.php
@@ -1,39 +1,23 @@
 <?php
 /*
- * new.php for the creation of the misc_billing_form
- *
  * This program creates the misc_billing_form
  *
  * Copyright (C) 2007 Bo Huynh
  * Copyright (C) 2016 Terry Hill <terry@lillysystems.com>
  * Copyright (C) 2017 Brady Miller <brady.g.miller@gmail.com>
  *
- * LICENSE: This program is free software; you can redistribute it and/or
- * modify it under the terms of the GNU General Public License
- * as published by the Free Software Foundation; either version 3
- * of the License, or (at your option) any later version.
- * This program is distributed in the hope that it will be useful,
- * but WITHOUT ANY WARRANTY; without even the implied warranty of
- * MERCHANTABILITY or FITNESS FOR A PARTICULAR PURPOSE. See the
- * GNU General Public License for more details.
- * You should have received a copy of the GNU General Public License
- * along with this program. If not, see http://opensource.org/licenses/gpl-license.php.
- *
  * @package OpenEMR
  * @author Terry Hill <terry@lilysystems.com>
  * @author Brady Miller <brady.g.miller@gmail.com>
  * @link http://www.open-emr.org
- *
+ * @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3
  */
 
-
-
 require_once("../../globals.php");
 require_once("$srcdir/options.inc.php");
 require_once("$srcdir/api.inc");
 require_once("date_qualifier_options.php");
 
-
 if (! $encounter) { // comes from globals.php
  die(xlt("Internal error: we do not seem to be in an encounter!"));
 }
@@ -42,68 +26,46 @@
 $obj = $formid ? formFetch("form_misc_billing_options", $formid) : array();
 
 formHeader("Form: misc_billing_options");
-function generateDateQualifierSelect($name,$options,$obj)
-{
-    echo     "<select name='".attr($name)."'>";
-    for($idx=0;$idx<count($options);$idx++)
-    {
-        echo "<option value='".attr($options[$idx][1])."'";
-        if($obj[$name]==$options[$idx][1]) echo " selected";
-        echo ">".text($options[$idx][0])."</option>";
-    }
-    echo     "</select>";
-
-}
-function genProviderSelect($selname, $toptext, $default=0, $disabled=false) {
-  $query = "SELECT id, lname, fname FROM users WHERE " .
-    "( authorized = 1 OR info LIKE '%provider%' ) AND username != '' " .
-    "AND active = 1 AND ( info IS NULL OR info NOT LIKE '%Inactive%' ) " .
-    "ORDER BY lname, fname";
-  $res = sqlStatement($query);
-  echo "   <select name='" . attr($selname) . "'";
-  if ($disabled) echo " disabled";
-  echo ">\n";
-  echo "    <option value=''>" . text($toptext) . "\n";
-  while ($row = sqlFetchArray($res)) {
-    $provid = $row['id'];
-    echo "    <option value='" . attr($provid) . "'";
-    if ($provid == $default) echo " selected";
-    echo ">" . text($row['lname'] . ", " . $row['fname']) . "\n";
-  }
-  echo text($provid);
-  echo "   </select>\n";
-}
 ?>
 <html>
 <head>
 <?php html_header_show(); ?>
-
 <link rel="stylesheet" href="<?php echo $css_header;?>" type="text/css">
 <link rel="stylesheet" href="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.min.css">
-
 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-min-3-1-1/index.js"></script>
 <script type="text/javascript" src="<?php echo $GLOBALS['webroot'] ?>/library/textformat.js?v=<?php echo $v_js_includes; ?>"></script>
 <script type="text/javascript" src="<?php echo $GLOBALS['assets_static_relative']; ?>/jquery-datetimepicker-2-5-4/build/jquery.datetimepicker.full.min.js"></script>
-
 </head>
 <body class="body_top">
 <form method=post <?php echo "name='my_form' " .  "action='$rootdir/forms/misc_billing_options/save.php?id=" . attr($formid) . "'>\n";?>
 
 <span class="title"><?php echo xlt('Misc Billing Options for HCFA-1500'); ?></span><br><br>
 <span class=text><?php echo xlt('Checked box = yes ,  empty = no');?><br><br>
-<label><span class=text><?php echo xlt('BOX 10 A. Employment related '); ?>: </span><input type=checkbox name="employment_related" value="1" <?php if ($obj['employment_related'] == "1") echo "checked";?>></label><br><br>
-<label><span class=text><?php echo xlt('BOX 10 B. Auto Accident '); ?>: </span><input type=checkbox name="auto_accident" value="1" <?php if ($obj['auto_accident'] == "1") echo "checked";?>></label>
+<label><span class=text><?php echo xlt('Box 10 A. Employment related '); ?>: </span><input type=checkbox name="employment_related" value="1" <?php if ($obj['employment_related'] == "1") echo "checked";?>></label><br><br>
+<label><span class=text><?php echo xlt('Box 10 B. Auto Accident '); ?>: </span><input type=checkbox name="auto_accident" value="1" <?php if ($obj['auto_accident'] == "1") echo "checked";?>></label>
 <span class=text><?php echo xlt('State'); ?>: </span><input type=entry name="accident_state" size=1 value="<?php echo attr($obj{"accident_state"});?>" ><br><br>
-<label><span class=text><?php echo xlt('BOX 10 C. Other Accident '); ?>: </span><input type=checkbox name="other_accident" value="1" <?php if ($obj['other_accident'] == "1") echo "checked";?>></label><br><br>
-<span class=text><?php echo xlt('BOX 10 D. EPSDT Referral Code');?> </span><input type=entry style="width: 25px;" size=2 name="medicaid_referral_code" value="<?php echo attr($obj{"medicaid_referral_code"});?>" >&nbsp;&nbsp;&nbsp;&nbsp;
+<label><span class=text><?php echo xlt('Box 10 C. Other Accident '); ?>: </span><input type=checkbox name="other_accident" value="1" <?php if ($obj['other_accident'] == "1") echo "checked";?>></label><br><br>
+<span class=text><?php echo xlt('Box 10 D. EPSDT Referral Code');?> </span><input type=entry style="width: 25px;" size=2 name="medicaid_referral_code" value="<?php echo attr($obj{"medicaid_referral_code"});?>" >&nbsp;&nbsp;&nbsp;&nbsp;
 <label><span class=text><?php echo xlt('EPSDT'); ?> : </span><input type=checkbox name="epsdt_flag" value="1" <?php if ($obj['epsdt_flag'] == "1") echo "checked";?>></label><br><br>
-<span class="text" title="<?php echo xla("For HCFA 02/12 Onset date specified on the Encounter Form needs a qualifier");?>"></span>
-<span class=text title="<?php echo xla('For HCFA 02/12 Box 15 is Other Date with a qualifier to specify what the date indicates');?>"></span>
  <tr>
-  <td><span class=text><?php echo xlt('BOX 14. Is Populated from the Encounter Screen as the Onset Date');?>.</span></td>
+  <td><span class=text><?php echo xlt('Box 14. Populated from the Encounter Screen as the Onset Date needs a qualifier.');?>
+    <?php generateDateQualifierSelect("box_14_date_qual",$box_14_qualifier_options,$obj); ?>
+  </span></td>
+ </tr><br><br>
+ <tr>
+   <td><span class=text><?php echo xlt('Box 15. Other Date with a qualifier to specify what the date indicates.');?>
+     <?php $date_initial_treatment = $obj{"date_initial_treatment"}; ?>
+       <input type=text style="width: 70px;" size=10 class='datepicker' name='date_initial_treatment' id='date_initial_treatment'
+       value='<?php echo attr($date_initial_treatment); ?>'
+       title='<?php echo xla('yyyy-mm-dd'); ?>' />
+   </span></td>
+   <td>
+        <?php generateDateQualifierSelect("box_15_date_qual",$box_15_qualifier_options,$obj); ?>
+   </td>
+
  </tr><br><br>
  <tr>
-  <td><span class=text><?php echo xlt('BOX 16. Date unable to work from');?>:</span></td>
+  <td><span class=text><?php echo xlt('Box 16. Date unable to work from');?>:</span></td>
   <td><?php $off_work_from = $obj{"off_work_from"}; ?>
     <input type=text style="width: 70px;" size=10 class='datepicker' name='off_work_from' id='off_work_from'
     value='<?php echo attr($off_work_from); ?>'
@@ -112,7 +74,7 @@ function genProviderSelect($selname, $toptext, $default=0, $disabled=false) {
  </tr>
  &nbsp;&nbsp;
 <tr>
- <td><span class=text><?php echo xlt('BOX 16. Date unable to work to');?>:</span></td>
+ <td><span class=text><?php echo xlt('Box 16. Date unable to work to');?>:</span></td>
   <td><?php $off_work_to = $obj{"off_work_to"}; ?>
     <input type=text style="width: 70px;" size=10 class='datepicker' name='off_work_to' id='off_work_to'
     value='<?php echo attr($off_work_to); ?>'
@@ -121,18 +83,18 @@ function genProviderSelect($selname, $toptext, $default=0, $disabled=false) {
  </tr>
     <br><br>
 
-    <td class='label_custom'><?php echo xlt('BOX 17. Provider') ?>:</td>
+    <td class='label_custom'><?php echo xlt('Box 17. Provider') ?>:</td>
     <td><?php  # Build a drop-down list of providers. # Added (TLH)
                genProviderSelect('provider_id', '-- '.xl("Please Select").' --',$obj{"provider_id"});
 		?></td>&nbsp;&nbsp;
-	<td><span class=text><?php  echo xlt('BOX 17. Provider Qualifier'); ?>: </span>
+	<td><span class=text><?php  echo xlt('Box 17. Provider Qualifier'); ?>: </span>
 	<tr><td><?php
                 echo generate_select_list('provider_qualifier_code', 'provider_qualifier_code',$obj{"provider_qualifier_code"}, 'Provider Qualifier Code');
             ?></td>
 	</tr></td>
 <br><br>
 <tr>
- <td><span class=text><?php echo xlt('BOX 18. Hospitalization date from');?>:</span></td>
+ <td><span class=text><?php echo xlt('Box 18. Hospitalization date from');?>:</span></td>
  <td><?php $hospitalization_date_from = $obj{"hospitalization_date_from"}; ?>
     <input type=text style="width: 70px;" size=10 class='datepicker' name='hospitalization_date_from' id='hospitalization_date_from'
     value='<?php echo attr($hospitalization_date_from); ?>'
@@ -141,19 +103,19 @@ function genProviderSelect($selname, $toptext, $default=0, $disabled=false) {
  </tr>
  &nbsp;&nbsp;
  <tr>
-  <td><span class=text><?php echo xlt('BOX 18. Hospitalization date to');?>:</span></td>
+  <td><span class=text><?php echo xlt('Box 18. Hospitalization date to');?>:</span></td>
   <td><?php $hospitalization_date_to = $obj{"hospitalization_date_to"}; ?>
     <input type=text style="width: 70px;" size=10 class='datepicker' name='hospitalization_date_to' id='hospitalization_date_to'
     value='<?php echo attr($hospitalization_date_to); ?>'
     title='<?php echo xla('yyyy-mm-dd'); ?>' />
   </td>
  </tr>
     <br><br>
-<span class=text><?php echo xlt('BOX 20. Is Outside Lab used?'); ?>: </span><input type=checkbox name="outside_lab" value="1" <?php if ($obj['outside_lab'] == "1") echo "checked";?>>
+<span class=text><?php echo xlt('Box 20. Is Outside Lab used?'); ?>: </span><input type=checkbox name="outside_lab" value="1" <?php if ($obj['outside_lab'] == "1") echo "checked";?>>
 <span class=text><?php echo xlt('Amount Charges'); ?>: </span><input type=entry size=7 align='right' name="lab_amount" value="<?php echo attr($obj{"lab_amount"});?>" ><br><br>
-<span class=text><?php echo xlt('BOX 22. Medicaid Resubmission Code (ICD-9) ');?></span><input type=entry size=9 name="medicaid_resubmission_code" value="<?php echo attr($obj{"medicaid_resubmission_code"});?>" >
+<span class=text><?php echo xlt('Box 22. Medicaid Resubmission Code (ICD-9) ');?></span><input type=entry size=9 name="medicaid_resubmission_code" value="<?php echo attr($obj{"medicaid_resubmission_code"});?>" >
 <span class=text><?php echo xlt(' Medicaid Original Reference No. ');?></span><input type=entry size=15 name="medicaid_original_reference" value="<?php echo attr($obj{"medicaid_original_reference"});?>" ><br><br>
-<span class=text><?php echo xlt('BOX 23. Prior Authorization No. ');?></span><input type=entry size=15 name="prior_auth_number" value="<?php echo attr($obj{"prior_auth_number"});?>" ><br><br>
+<span class=text><?php echo xlt('Box 23. Prior Authorization No. ');?></span><input type=entry size=15 name="prior_auth_number" value="<?php echo attr($obj{"prior_auth_number"});?>" ><br><br>
 <label><span class=text><?php echo xlt('X12 only: Replacement Claim '); ?>: </span><input type=checkbox name="replacement_claim" value="1" <?php if ($obj['replacement_claim'] == "1") echo "checked";?>></label><br><br>
 <span class=text><?php echo xlt('X12 only ICN resubmission No.');?> </span><input type=entry size=35 name="icn_resubmission_number" value="<?php echo attr($obj{"icn_resubmission_number"});?>" ><br><br>
 

diff --git a/library/Claim.class.php b/library/Claim.class.php
@@ -1,11 +1,11 @@
 <?php
-// Copyright (C) 2007-2009 Rod Roark <rod@sunsetsystems.com>
-//
-// This program is free software; you can redistribute it and/or
-// modify it under the terms of the GNU General Public License
-// as published by the Free Software Foundation; either version 2
-// of the License, or (at your option) any later version.
-
+/** @package OpenEMR
+ *  @link http://www.open-emr.org
+ *  @author Rod Roark <rod@sunsetsystems.com>
+ *  @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
+ *  @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 
+ */
+ 
 require_once(dirname(__FILE__) . "/invoice_summary.inc.php");
 
 // This enforces the X12 Basic Character Set. Page A2.
@@ -1089,14 +1089,14 @@ function dateInitialTreatment() {
     return cleanDate($this->billing_options['date_initial_treatment']);
   }
 
-  function box14qualifier()
+  function box14Qualifier()
   {
       // If no box qualifier specified use "431" indicating Onset
       return empty($this->billing_options['box_14_date_qual']) ? '431' :
               $this->billing_options['box_14_date_qual'];
   }
 
-  function box15qualifier()
+  function box15Qualifier()
   {
       // If no box qualifier specified use "454" indicating Initial Treatment
       return empty($this->billing_options['box_15_date_qual']) ? '454' :

diff --git a/library/gen_hcfa_1500.inc.php b/library/gen_hcfa_1500.inc.php
@@ -1,10 +1,10 @@
 <?php
-// Copyright (C) 2008-2011 Rod Roark <rod@sunsetsystems.com>
-//
-// This program is free software; you can redistribute it and/or
-// modify it under the terms of the GNU General Public License
-// as published by the Free Software Foundation; either version 2
-// of the License, or (at your option) any later version.
+/** @package OpenEMR
+ *  @link http://www.open-emr.org
+ *  @author Rod Roark <rod@sunsetsystems.com>
+ *  @copyright Copyright (c) 2011 Rod Roark <rod@sunsetsystems.com>
+ *  @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 
+ */
 
 require_once("Claim.class.php");
 require_once("gen_hcfa_1500_02_12.inc.php");
@@ -346,15 +346,15 @@ function gen_hcfa_1500_page($pid, $encounter, &$log, &$claim) {
   if(hcfa_1500_version_02_12() && !empty($tmp))
   {
     // Only include the Box 14 qualifier if there we are using version 02/12 and there is a Box 14 date.
-    put_hcfa(32, 16, 3, $claim->box14qualifier());
+    put_hcfa(32, 16, 3, $claim->box14Qualifier());
 
   }
   // Box 15. First Date of Same or Similar Illness, if applicable
   $tmp = $claim->dateInitialTreatment();
   if(hcfa_1500_version_02_12() && !empty($tmp))
   {
     // Only include the Box 15 qualifier if there we are using version 02/12 and there is a Box 15 date.
-    put_hcfa(32, 31, 3, $claim->box15qualifier());
+    put_hcfa(32, 31, 3, $claim->box15Qualifier());
   }
 
 

diff --git a/library/gen_x12_837.inc.php b/library/gen_x12_837.inc.php
@@ -1,10 +1,10 @@
 <?php
-// Copyright (C) 2007-2011 Rod Roark <rod@sunsetsystems.com>
-//
-// This program is free software; you can redistribute it and/or
-// modify it under the terms of the GNU General Public License
-// as published by the Free Software Foundation; either version 2
-// of the License, or (at your option) any later version.
+/** @package OpenEMR
+ *  @link http://www.open-emr.org
+ *  @author Rod Roark <rod@sunsetsystems.com>
+ *  @copyright Copyright (c) 2009 Rod Roark <rod@sunsetsystems.com>
+ *  @license https://github.com/openemr/openemr/blob/master/LICENSE GNU General Public License 3 
+ */
 
 require_once("Claim.class.php");
 function stripZipCode($zip)
@@ -559,24 +559,26 @@ function gen_x12_837($pid, $encounter, &$log, $encounter_claim=false) {
       "~\n";
   }
 
-  if ($claim->dateInitialTreatment() && ($claim->onsetDateValid())) {
+  // Segment DTP*454 (Initial Treatment Date)
+  // Segment DTP*304 (Last Seen Date)
+  // Segment DTP*453 (Acute Manifestation Date)
+  // Segment DTP*439 (Accident Date)
+  // Segment DTP*484 (Last Menstrual Period Date)
+  // Segment DTP*455 (Last X-Ray Date)
+  // Segment DTP*471 (Hearing and Vision Prescription Date)
+  // Segment DTP     (Disability Dates)
+  // Segment DTP*297 (Last Worked Date)
+  // Segment DTP*296 (Authorized Return to Work Date)
+
+  if ($claim->dateInitialTreatment() && ($claim->box15Qualifier())) {
     ++$edicount;
-    $out .= "DTP" .       // Date of Initial Treatment
-      "*454" .
+    $out .= "DTP" .       // Date Last Seen
+      "*" . $claim->box15Qualifier() .
       "*D8" .
       "*" . $claim->dateInitialTreatment() .
       "~\n";
   }
 
-  // Segment DTP*304 (Last Seen Date) omitted.
-  // Segment DTP*453 (Acute Manifestation Date) omitted.
-  // Segment DTP*439 (Accident Date) omitted.
-  // Segment DTP*484 (Last Menstrual Period Date) omitted.
-  // Segment DTP*455 (Last X-Ray Date) omitted.
-  // Segment DTP*471 (Hearing and Vision Prescription Date) omitted.
-  // Segments DTP (Disability Dates) omitted.
-  // Segment DTP*297 (Last Worked Date) omitted.
-  // Segment DTP*296 (Authorized Return to Work Date) omitted.
 
   if (strcmp($claim->facilityPOS(),'21') == 0 && $claim->onsetDateValid() ) {
     ++$edicount;