59B-9.010: Purpose of Ambulatory Patient Data Reporting
59B-9.011: Submission of Ambulatory Patient Data
59B-9.013: Definitions
59B-9.014: Schedule for Submission of Ambulatory Patient Data and Extensions
59B-9.015: Reporting Instructions
59B-9.016: Notice of Reporting Deficiencies and Response
59B-9.017: Certification and Audit Procedures
59B-9.018: Ambulatory Patient Data Format - Data Elements, Codes and Standards
59B-9.022: Penalties for Ambulatory Patient Data Reporting Deficiencies
59B-9.023: Ambulatory Patient Data Release
59B-9.030: Purpose of Ambulatory and Emergency Department Patient Data Reporting
59B-9.031: Definitions
59B-9.032: Ambulatory and Emergency Department Data Reporting and Audit Procedures
59B-9.033: Schedule for Submission of Ambulatory and Emergency Department Patient Data and Extensions
59B-9.034: Reporting Instructions
59B-9.035: Certification, Audits, and Resubmission Procedures
59B-9.036: Penalties for Ambulatory Patient Data Reporting and Deficiencies
59B-9.037: Header Record
59B-9.038: Ambulatory Data Elements, Codes and Standards
59B-9.039: Public Records
PURPOSE AND EFFECT: The new rules alighn ambulatory data reporting standards with the uniform bill for institutional facilities (UB-04), modify data elements and codes, definition of submission requirements and other clarifications.
SUMMARY: The agency is proposing amendments to Rules 59B-9.010 through 59B-9.023, F.A.C., that modify ambulatory and emergency department reporting requirements.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.
SPECIFIC AUTHORITY: 408.15(8) FS.
LAW IMPLEMENTED: 408.061, 408.062, 408.063 FS.
IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE,TIME AND PLACE SHOWN BELOW(IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):
DATE AND TIME: January 23, 2009, 1:00 p.m.
PLACE: Agency for Health Care Administration, First Floor Conference Room A, Building 3, 2727 Mahan Drive, Tallahassee, Florida 32308
Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Patrick Kennedy at (850)922-5531. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).
THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Patrick Kennedy at (850)922-5531
THE FULL TEXT OF THE PROPOSED RULE IS:
59B-9.010 Purpose of Ambulatory Patient Data Reporting.
The reporting of ambulatory patient data will provide a statewide integrated database that includes ambulatory surgery and hospital emergency department services for the assessment of variations in utilization, disease surveillance, access to care and cost trends. The amendments appearing herein are effective with the reporting period starting January 1, 2005.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew 9-6-93, Formerly 59B-7.010, Amended 6-29-95, Amended 12-28-98, 2-25-02, 4-18-04, Repealed ________.
59B-9.011 Submission of Ambulatory Patient Data.
(1) The following entities shall submit ambulatory patient data and reports to the Agency for Health Care Administration (AHCA or agency):
(a) All licensed short-term acute care hospitals;
(b) All licensed ambulatory surgical centers as defined in Section 395.002(3), F.S.;
(c) All lithotripsy centers defined in Section 408.07, F.S.;
(d) All cardiac catheterization laboratories defined in Section 408.07, F.S.
(2) For purposes of Rules 59B-9.010 through 59B-9.023, F.A.C., ambulatory centers refers to the ambulatory patient data reporting facilities and providers in subsection (1) above.
(3) Each facility in paragraph (1)(a) above shall submit a separate report for each location per Rule 59A-3.203, F.A.C. Each facility in paragraph (1)(b) above shall submit a separate report for each location per Rule 59A-5.003, F.A.C. Each facility or provider in paragraph (1)(c) or (1)(d) above shall submit a separate report for each separate location.
(4) All ambulatory centers performing the services set forth in Rules 59B-9.011 through 59B-9.023, F.A.C., shall submit ambulatory patient data as set forth in Rules 59B-9.018 and 59B-9.019, F.A.C., unless the reporting entity meets the criteria listed in subsection 59B-9.011(6), F.A.C., below.
(5) Any ambulatory center which has a total of 200 or more patient visits per Rule 59B-9.014, F.A.C., for the reporting period is required to report data as set forth in Rules 59B-9.018 and 59B-9.019, F.A.C.
(6) Ambulatory Centers with fewer than 200 patient visits in a quarter, must have the entitys Chief Executive Officer certify to the Agency in writing, that the ambulatory center has fewer than 200 patient visits per Rule 59B-9.014, F.A.C., for the reporting period, and the certification is to be received at the Agency office in Tallahassee on or prior to the deadline for submission of the report. This is not a one time letter, but must be submitted for each quarter where there were fewer than 200 visits.
(7) If requested by Agency staff, all ambulatory centers shall provide access to or at the option of Agency staff, information from the medical records underlying and documenting the ambulatory patient data submitted, as well as other patient related documentation deemed necessary by the Agency to conduct complete ambulatory patient data audits subject to the limitations as set forth in Section 408.061(1)(d), F.S.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.07, 408.08 FS. HistoryNew 9-6-93, Formerly 59B-7.011, Amended 6-29-95, 12-28-98, 7-11-01, 2-25-02, Repealed ________.
59B-9.013 Definitions.
(1) CPT means Current Procedural Terminology and refers to a coding system established by the American Medical Association to describe physician services which is published annually in Physicians Current Procedural Terminology manual which is incorporated by reference.
(2) HCPCS means Health Care Financing Administration Common Procedure Coding System which is published annually by the United States Department of Health and Human Services and is required by the Federal Government for Medicare reporting purposes.
(3) Charity means medical care provided by a health care entity to a person who has insufficient resources or assets to pay for needed medical care without utilizing his resources which are required to meet his basic need for shelter, food, or clothing. No patient shall be considered charity care whose family income, as applicable for the twelve (12) months preceding the determination, exceeds 150 percent of the federal poverty guidelines, unless the amount of health care charges due from the patient exceeds 25 percent of annual family income.
(4) Inpatient means a patient who has an admission order given by a licensed physician or other individual who has been granted admitting privileges by the hospital. Observation patients are excluded unless they are admitted.
(5) Visit means a face to face encounter between a health care provider and a patient who is not formally admitted as an inpatient in an acute care hospital setting at the time of the encounter or who is not admitted to the same facilitys acute care hospital setting immediately following the encounter as described in subsection 59B-9.015(3), F.A.C. Visits which require the patient to appear in an ambulatory setting prior to the actual procedure (even if this occurs one or more days before the procedure) shall be counted as one visit.
(6) Each Ambulatory Center is required to report ambulatory patient data. For the purposes of this rule, ambulatory center includes freestanding ambulatory surgery centers, short-term acute care hospitals, lithotripsy centers, and cardiac catheterization laboratories.
(7) Attending Physician means a licensed medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who has primary responsibility for the patients medical care and treatment during the visit or who certifies as to the medical necessity of the services rendered. The attending physician may be the operating or performing physician. The attending physician may be an emergency room physician or other specialist.
(8) Operating or Performing Physician means a licensed medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who has primary responsibility for the surgery or procedure performed. The operating or performing physician may be the attending physician.
(9) Other Physician means a licensed medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who rendered care to the patient other than the attending physician or the operating or performing physician.
(10) Short-Term Acute Care Hospitals means a hospital as defined in Section 395.002(12), F.S.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew 9-6-93, Formerly 59B-7.013, Amended 6-29-95, 12-28-98, 7-11-01, 2-25-02, 4-18-04, Repealed ________.
59B-9.014 Schedule for Submission of Ambulatory Patient Data and Extensions.
(1) Ambulatory centers shall report ambulatory patient data, as described in subsection 59B-9.015(2) and Rule 59B-9.018, F.A.C., according to the following schedule:
(a) Each report covering patient visits ending between January 1 and March 31, inclusive of each year, shall be submitted no later than June 10 of the calendar year during which the visit occurred.
(b) Each report covering patient visits ending between April 1 and June 30, inclusive of each year, shall be submitted no later than September 10 of the calendar year during which the visit occurred.
(c) Each report covering patient visits ending between July 1 and September 30, inclusive of each year, shall be submitted no later than December 10 of the calendar year during which the visit occurred.
(d) Each report covering patient visits ending between October 1 and December 31, inclusive of each year, shall be submitted no later than March 10 of the calendar year following the year in which the visit occurred.
(2) Extensions to the due dates in subsection 59B-9.014(1), F.A.C., above shall be granted by Agency staff for thirty (30) days in response to a written request if received prior to the due date, and provided that the delay is due to unforeseen and unforeseeable factors beyond the control of the reporting entity. These factors must be specified in the letter requesting the extension together with documentation of efforts undertaken to meet the filing requirements. For re-submissions, a fourteen (14) calendar day extension will be granted if requested in writing prior to the due date as specified in the letter accompanying the resubmitted request.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.15(11) FS. HistoryNew 9-6-93, Formerly 59B-7.014, Amended 6-29-95, 4-18-04, Repealed ________.
59B-9.015 Reporting Instructions.
(1) Ambulatory centers shall submit ambulatory patient data according to Rule 59B-9.018, F.A.C.
(2) Ambulatory centers shall report data for:
(a) All non-emergency visits in which surgery services were performed and the services provided correspond to a Current Procedural Terminology (CPT) code 10000 through 69999 or 93500 through 93599. Codes must be valid in the current or the immediately preceding years code book to be accepted.
(b) All emergency department visits in which emergency department registration occurs and the patient is not admitted for inpatient care at the reporting entity. Include all visits for which a billing record is created.
(3) Ambulatory centers shall exclude records of any patient visit in which the outpatient and inpatient billing record is combined because the patient was admitted to inpatient care within a facility at the same location per Rule 59A-3.203, F.A.C. Report one record for each visit, except pre-operation visits may be combined with the record of the associated ambulatory surgery visit. See subsection 59B-9.013(5), F.A.C.
(4) For each patient visit, ambulatory centers shall report all services provided using procedural codes specified in subsection 59B-9.018(2), F.A.C.
(5) Ambulatory centers shall submit ambulatory patient data reports to the agency using one of the following methods described in paragraph (a) or in (b) below except that for patient visits ending on or after January 1, 2006, the methods described in paragraph (b) must not be used unless an exception is requested by the ambulatory center due to extraordinary or hardship circumstances and use of method (b) is approved by the agency. Use of method (a) must be approved by the agency for any patient visits ending prior to January 1, 2006.
(a) Internet Transmission. The Internet address established for receipt of ambulatory patient data is www.fdhc.state.fl.us. Reports sent to the Internet address shall be electronically transmitted with the ambulatory data in a text (XML) file using the Ambulatory Patient Data XML Schema available at www.fdhc.state.fl.us. The Ambulatory Patient Data XML Schema is incorporated by reference. The data in the text file shall contain the data elements, codes, and standards required in Rule 59B-9.018, F.A.C.
(b) CD-ROM or diskettes shall be sent to the agencys mailing address: Agency for Health Care Administration, 2727 Mahan Drive, Tallahassee, Florida 32308. Attention: Florida Center for Health Information and Policy Analysis. Electronic media specifications are:
1. MS-DOS formatted.
2. Text File (XML) using the Ambulatory Patient Data XML Schema available at www.fdhc.state.fl.us.
3. Type: 3.5'' diskette, 1.4MB, hd; or CD-ROM.
4. FILENAME: (e.g., AS10QYY.XML) The 5th position shall contain the quarter (1-4) and the 6th and 7th position shall contain the year. XML indicates an XML text file.
5. Only one (1) file per diskette set or CD-ROM is allowable. Data requiring more than one diskette shall have the same internal file name. Data requiring more than one (1) diskette shall be externally labeled 1 of x, 2 of x, etc. (x = total number of diskettes).
(6) Ambulatory centers submitting diskettes shall affix the following external identification, or for CD-ROM, use a standard CD-ROM external label with the following information:
(a) Ambulatory center name;
(b) AHCA ambulatory center identification number in the AHCA format;
(c) Reporting period;
(d) Number of records excluding the header record and the trailer record;
(e) Diskette or CD-ROM Filename as in subsection 59B-9.015(5), F.A.C., above; and
(f) The description: AMBULATORY PATIENT DATA.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew 9-6-93, Formerly 59B-7.015, Amended 6-29-95, 12-28-98, 1-4-00, 7-11-01, 2-25-02, 4-18-04, Repealed________.
59B-9.016 Notice of Reporting Deficiencies and Response.
(1) Within sixty (60) days after the due date or date of receipt, whichever is later of ambulatory patient data, agency staff shall determine and notify the ambulatory center whether the report is complete and conforms to the applicable rule instructions and data standards per Rules 59B-9.018-.020, F.A.C.
(2) Written notification shall be provided by certified mail, electronic mail, or FAX to an ambulatory center in the event the staff determines the data is incomplete or nonconforming. The notice shall clearly indicate the deficiencies found, and the time by which a corrected or modified report must be received in the agencys office.
(3) An ambulatory center shall have fourteen (14) calendar days following receipt of notice, to return to the agencys office the requested corrected data or completed certification pages.
Specific Authority 408.15(8) FS. Law Implemented 408.006(5), 408.061 FS. HistoryNew 9-6-93, Formerly 59B-7.016, Amended 6-29-95, 7-11-01, Repealed________.
59B-9.017 Certification and Audit Procedures.
(1) All ambulatory centers submitting data in compliance with Rules 59B-9.010 through 59B-9.022, F.A.C., shall certify that the data submitted for each reporting period is accurate. These certification pages are sent by the agency to the reporting entity with summary reports generated by the agency using submitted data. The certification shall be submitted to the agencys office at the address in subsection (3) below using the Certification of Ambulatory Patient Data Form described in subsection (3) below or the Certification of Ambulatory Patient Data Form shall be submitted by electronic mail to SCHSdata@fdhc.state.fl.us using an agency authorized electronic signature.
(2) The Chief Executive Officer and Chief Financial Officer shall state in writing that a complete review was accomplished to assure the accuracy of the data and that to the best of their knowledge and belief, the data submitted are accurate and complete.
(3) Form APD1 is titled Certification of Ambulatory Patient Data, may be obtained by writing to The Agency for Health Care Administration, Ambulatory Patient Data Section, 2727 Mahan Drive, Fort Knox Building #3, Tallahassee, Florida 32308-5403. The effective date of the form is July 1, 1995. Form APD1 is incorporated by reference.
(4) The agency shall to the extent practical, apply the same audit standards and use the same audit procedures for all ambulatory centers or audit a random sample of ambulatory centers. The agency will notify each ambulatory center of any possible errors discovered by audit and request that the ambulatory center either correct the data or verify that the data is complete and correct. The notice shall indicate that the ambulatory center must return corrected data if there are errors and certify the data within ninety (90) days of receipt of the notice, or the ambulatory center Chief Executive Officer must verify by signature that the previously submitted and certified data is complete and correct within ninety (90) days of receipt of the notice. The notice shall clearly indicate that the ambulatory center may be subject to penalties pursuant to Rule 59B-9.022, F.A.C.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.08(1), 408.08(5), 408.15(11) FS. HistoryNew 9-6-93, Formerly 59B-7.017, Amended 6-29-95, 7-11-01, Repealed________.
59B-9.018 Ambulatory Patient Data Format Data Elements, Codes and Standards.
(1) Header Record: The first record in the data file shall be a header record, containing the information described below. If diskettes are submitted, the header record must be placed as the first record on the first diskette of the data set.
(a) Transaction Code Enter Q for a calendar quarter report or S for a report period other than a calendar quarter where the special report is requested or authorized by the agency to receive data corrections.
(b) Report Year Enter the year of the data in the format YYYY.
(c) Report Quarter Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year.
(d) Data Type Enter AS10 for Ambulatory Data.
(e) Submission Type Enter I, R, or C where I indicates an initial submission of data or resubmission of previously rejected data, R indicates a replacement submission of previously processed and accepted ambulatory patient data, and C indicates an individual record correction or set of individual record corrections where submission of a correction or corrections is requested or authorized by the agency.
(f) Processing Date Enter the date that the data file was created in the format YYYY-MM-DD where MM represents numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits.
(g) AHCA Ambulatory Center Number Enter the identification number of the ambulatory center as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight digits and no more than 10 digits.
(h) Organization Name Enter the name of the ambulatory center that performed the ambulatory services represented by the data, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty character field.
(i) Contact Person Name Enter the name of the contact person at the ambulatory center. Submit name in the Last, First format. Up to a twenty-five character field.
(j) Contact Person Telephone Number The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact person telephone number in the format (AAA)XXX-XXXX-EEEEE where AAA is the area code, and EEEEE is the extension. Blank fill if no extension.
(k) Contact Person E-Mail Address The e-mail address of the contact person.
(l) Contact Person Address Enter the mailing address of the contact person. Up to a forty character field.
(m) Mailing Address City Enter the city of the address of the contact person. Up to a twenty-five character field.
(n) Mailing Address State Enter the state of the address of the contact person using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for Florida.
(o) Mailing Address Zip Code Enter the zip code of the address of the contact person in the format XXXXX-XXXX. Blank fill if no extension.
(2) Individual Data Records: All data elements and data element codes listed below shall be reported consistent with the records of the reporting entity. Data elements and codes are listed with a description of the data to be reported and data standards.
(a) AHCA Ambulatory Center Number An identification number assigned by AHCA for reporting purposes. The number must match the ambulatory center number recorded on the CD-ROM or diskette external label and header record. A valid identification number must contain at least eight digits and no more than 10 digits. A required entry.
(b) Record Identification Number An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate storage and retrieval of individual case records. Up to seventeen characters. A required entity. Duplicate record identification numbers are not permitted.
(c) Patient Social Security Number The social security number (SSN) of the patient. A nine digit field to facilitate retrieval of individual case records, to be used to track multiple patient visits, and for medical research. Reporting 000000000 is acceptable for newborns and infants up to 2 years of age who do not have a SSN. For patients not from the United States, use 555555555 if a SSN is not assigned. For those patients where efforts to obtain the SSN have been unsuccessful or where one is unavailable, and the patient is 2 years of age or older and not known to be from a country other than the United States, use 777777777. A required entry.
(d) Patient Race or Ethnicity Self-designated by the patient or patients parent or guardian except code 8 indicating no response may be reported where efforts to obtain the information have been unsuccessful. A required entry. Must be a one digit code as follows:
1. 1 American Indian or Alaska Native.
2. 2 Asian or Pacific Islander.
3. 3 Black or African American.
4. 4 White.
5. 5 White Hispanic.
6. 6 Black Hispanic.
7. 7 Other. Use if the patients self-designated race or ethnicity is not described by the above categories.
8. 8 No response. Use if the patient refuses or fails to disclose.
(e) Patient Birth Date The date of birth of the patient. A ten character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Use 9999-99-99 where type of service is 2 and efforts to obtain the patients birth date have been unsuccessful. Age greater than 120 years is not permitted unless verified by the reporting entity. A birth date after the patient visit ending date is not permitted. A required entry.
(f) Patient Sex The gender of the patient. A required entry. Must be a one digit code as follows:
1. 1 Male.
2. 2 Female.
3. 3 Unknown shall be reported where efforts to obtain the information have been unsuccessful or where the patients sex cannot be determined due to a medical condition.
(g) Patient Zip Code The five digit United States Postal Service ZIP Code of the patients permanent residence. Use 00009 for foreign residences. Use 00007 for homeless patients. Use 00000 where efforts to obtain the information have been unsuccessful. A required entry.
(h) Type of Service Code A code designating the type of service, either ambulatory surgery or emergency department visit. A required entry. Must be a one digit code as follows:
1. 1 Ambulatory surgery, as described in paragraph 59B-9.015(2)(a), F.A.C.
2. 2 Emergency department visit, as described in paragraph 59B-9.015(2)(b), F.A.C.
(i) Principal Payer Code Describes the primary source of expected reimbursement for services rendered. A required entry. Must be a one character field using upper case as follows:
1. A Medicare.
2. B Medicare HMO.
3. C Medicaid.
4. D Medicaid HMO.
5. E Commercial Insurance.
6. F Commercial HMO.
7. G Commercial PPO.
8. H Workers Compensation.
9. I CHAMPUS.
10. J VA.
11. K Other State/Local Government.
12. L Self Pay. No third party coverage.
13. M Other.
14. N Charity.
15. O KidCare. Includes Healthy Kids, MediKids and Childrens Medical Services.
16. P Unknown. Unknown shall be reported if principal payer information is not available and type of service is 2 and patient status is 07.
(j) Principal Diagnosis Code The code representing the diagnosis chiefly responsible for the services performed during the visit. Must contain a valid ICD-9-CM or ICD-10-CM diagnosis code if type of service is 1 indicating ambulatory surgery. Must contain a valid ICD-9-CM or ICD-10-CM diagnosis code if type of service is 2 indicating an emergency department visit unless patient status is 07 indicating that the patient left against medical advice or discontinued care. A blank field is permitted if type of service is 2 and patient status is 07 consistent with the records of the reporting entity. If not space filled, must contain a valid ICD-9-CM diagnosis code or valid ICD-10-CM diagnosis code for the reporting period. Inconsistency between the principal diagnosis code and patient sex must be verified by the reporting entity. Inconsistency between the principal diagnosis code and patient age must be verified by the reporting entity. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(k) Other Diagnosis Code (1), Other Diagnosis (2), Other Diagnosis (3), Other Diagnosis (4), Other Diagnosis (5), Other Diagnosis (6), Other Diagnosis (7), Other Diagnosis (8), Other Diagnosis (9) A code representing a diagnosis related to the services provided during the visit. If no principal diagnosis code is reported, another diagnosis code must not be reported. No more than nine other diagnosis codes may be reported. Less than nine entries or no entry is permitted consistent with the records of the reporting entity. If not space filled, must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Inconsistency between the diagnosis code and patient sex must be verified by the reporting entity. Inconsistency between the diagnosis code and patient age must be verified by the reporting entity. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(l) Principal CPT or HCPCS Procedure Code A code representative of the services provided or procedures performed. Must contain a valid CPT code between 10000 and 69999, inclusive, or between 93500 and 93599, inclusive if type of service is 1 indicating ambulatory surgery. Must contain a valid HCPCS or CPT evaluation and management code if type of service is 2 indicating an emergency department visit and patient status is not 07. Must contain a valid HCPCS or CPT evaluation and management code, or a blank field, consistent with the records of the reporting entity, if type of service is 2 indicating an emergency department visit and patient status is 07 indicating that the patient left against medical advice or discontinued care. If not space filled, must contain a valid CPT or HCPCS procedure code. Inconsistency between the principal procedure code and patient sex must be verified by the reporting entity. Inconsistency between the principal procedure code and patient age must be verified by the reporting entity. The code must be five digits and valid for the reporting period.
(m) Other CPT or HCPCS Procedure Code (1), Other CPT or HCPCS Procedure Code (2), Other CPT or HCPCS Procedure Code (3), Other CPT or HCPCS Procedure Code (4), Other CPT or HCPCS Procedure Code (5), Other CPT or HCPCS Procedure Code (6), Other CPT or HCPCS Procedure Code (7), Other CPT or HCPCS Procedure Code (8), Other CPT or HCPCS Procedure Code (9) A code representing a procedure or service provided during the visit. If no principal CPT or HCPCS procedure is reported, another CPT or HCPCS procedure code must not be reported. No more than nine other CPT or HCPCS procedure codes may be reported. Less than nine entries or no entry is permitted consistent with the records of the reporting entity. If not space filled, must be a valid CPT or HCPCS code. Inconsistency between the procedure code and patient sex must be verified by the reporting entity. Inconsistency between the procedure code and patient age must be verified by the reporting entity. The code must be five digits and valid for the reporting period.
(n) Attending Physician Identification Number The Florida license number of the attending physician as defined in subsection 59B-9.013(7), F.A.C. Report the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who had primary responsibility for the patients care during the visit. An alpha-numeric field of up to eleven characters. For military physicians not licensed in Florida, use US. Use NA if the patient was not treated by a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner. A required entry.
(o) Operating or Performing Physician Identification Number The Florida license number of the operating or performing physician as defined in subsection 59B-9.013(8), F.A.C. Report the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who had primary responsibility for the surgery or procedure performed. The operating or performing physician may be the person reported in paragraph (n) above. An alpha-numeric field of up to eleven characters. For military physicians not licensed in Florida, use US. A blank or no entry is permitted consistent with the records of the reporting entity.
(p) Other Physician Identification Number The Florida license number of another physician as defined in subsection 59B-9.013(9), F.A.C. Report a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who rendered care to the patient other than the person reported in paragraph (n) or (o) above. An alpha-numeric field of up to eleven characters. For military physicians not licensed in Florida, use US. A blank or no entry is permitted consistent with the records of the reporting entity.
(q) Pharmacy Charges Charges for medication, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(r) Medical and Surgical Supply Charges Charges for supply items required for patient care, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(s) Laboratory Charges Charges for the performance of diagnostic and routine clinical laboratory tests, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(t) Radiology and Other Imaging Charges Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no radiology or computed tomography charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(u) Cardiology Charges Facility charges for cardiac procedures rendered such as heart catheterization, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no cardiology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(v) Operating Room Charges Charges for the use of the operating room, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no operating room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(w) Anesthesia Charges Charges for anesthesia services by the facility, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no anesthesia charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(x) Recovery Room Charges Charges for the use of the recovery room, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(y) Emergency Room Charges Charges for medical examinations and emergency treatment, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(z) Treatment or Observation Room Charges Charges for use of a treatment room or for the room charge associated with observation services, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(aa) Other Charges Other facility charges not included in paragraphs (q) to (z) above, reported in dollars numerically without dollar signs or commas, excluding cents. Report 0 (zero) if there are no other charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(bb) Total Gross Charges The total of undiscounted charges for services rendered by the reporting entity, reported in dollars numerically without dollar signs or commas, excluding cents. Include charges for services rendered by the ambulatory center excluding professional fees. Zero (0) or negative amounts are not permitted unless verified separately by the reporting entity. Amounts exceeding 50000 must be verified separately by the reporting entity if type of service is 1 indicating ambulatory surgery. Amounts exceeding 100000 must be verified separately by the reporting entity if type of service is 2 indicating an emergency department visit. The sum of pharmacy charges, medical and surgical supply charges, laboratory charges, radiology and other imaging charges, cardiology charges, operating room charges, anesthesia charges, recovery room charges, emergency room charges, treatment or observation room charges, and other charges must equal total charges, plus or minus 10. A required entry.
(cc) Patient Visit Beginning Date The date at the beginning of the patients visit for ambulatory surgery or the date at the time of registration in the emergency department. A ten character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit beginning date must equal or precede the patient visit ending date. A required entry.
(dd) Patient Visit Ending Date The date at the end of the patients visit. A ten character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit ending date must equal or follow the patient visit beginning date. Patient visit ending date must occur within the calendar quarter recorded on the CD-ROM or diskette external label and header record. A visit exceeding 2 days as determined by the patient visit beginning date and patient visit ending date must be verified by the reporting entity. A blank field is not permitted unless type of service is 2 indicating an emergency department visit and patient status is 07 indicating the patient left against medical advice or discontinued care.
1. 00 12:00 midnight to 12:59(ee) Hour of Arrival The hour on a 24-hour clock during which the patients visit for ambulatory surgery began or during which registration in the emergency department occurred. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
2. 01 01:00 to 01:59
3. 02 02:00 to 02:59
4. 03 03:00 to 03:59
5. 04 04:00 to 04:59
6. 05 05:00 to 05:59
7. 06 06:00 to 06:59
8. 07 07:00 to 07:59
9. 08 08:00 to 08:59
10. 09 09:00 to 09:59
11. 10 10:00 to 10:59
12. 11 11:00 to 11:59
13. 12 12:00 noon to 12:59
14. 13 01:00 to 01:59
15. 14 02:00 to 02:59
16. 15 03:00 to 03:59
17. 16 04:00 to 04:59
18. 17 05:00 to 05:59
19. 18 06:00 to 06:59
20. 19 07:00 to 07:59
21. 20 08:00 to 08:59
22. 21 09:00 to 09:59
23. 22 10:00 to 10:59
24. 23 11:00 to 11:59
25. 99 Unknown.
(ff) Patients Reason for Visit ICD-CM Code (Admitting Diagnosis) The code representing the patients chief complaint or stated reason for seeking care. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period if type of service is 2 indicating an emergency department visit unless the patient fails to disclose or the information is unavailable. A blank field is permitted if the patient fails to disclose or efforts to obtain the information have been unsuccessful consistent with the records of the reporting entity. If not space filled, must contain a valid ICD-9-CM or ICD-10-CM diagnosis code. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. Space fill if type of service is 1 indicating ambulatory surgery.
(gg) Principal ICD-CM Procedure Code The code representing the procedure or service most related to the principal diagnosis. A blank field is permitted if type of service is 1 indicating ambulatory surgery. A blank or no entry is permitted consistent with the records of the reporting entity if type of service is 2 indicating an emergency department visit. If not space filled, must contain a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. Inconsistency between the principal procedure code and patient sex must be verified by the reporting entity. Inconsistency between the principal procedure code and patient age must be verified by the reporting entity. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(hh) Other ICD-CM Procedure Code (1), Other ICD-CM Procedure Code (2), Other ICD-CM Procedure Code (3), Other ICD-CM Procedure Code (4) A code representing a procedure or service provided during the visit. If no principal ICD-CM procedure is reported, another ICD-CM procedure code must not be reported. No more than four other ICD-CM procedure codes may be reported. A blank or no entry is permitted if type of service is 1. Less than four or no entry is permitted if type of service is 2 consistent with the records of the reporting entity. If not space filled, must be a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. Inconsistency between the procedure code and patient sex must be verified by the reporting entity. Inconsistency between the procedure code and patient age must be verified by the reporting entity. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(ii) External Cause of Injury Code (1), External Cause of Injury Code (2), and External Cause of Injury Code (3) A code representing circumstances or conditions as the cause of the injury, poisoning, or other adverse effects recorded as a diagnosis. No more than three external cause of injury codes may be reported. Less than three or no entry is permitted consistent with the records of the reporting entity. If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause of injury code for the reporting period. An external cause of injury code cannot be used more than once for each visit reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(jj) Patient Status - Patient disposition at end of visit. A required entry. Must be a two digit code as follows:
1. 01 Discharged to home or self care (with or without planned outpatient medical care).
2. 02 Transferred to a short-term general hospital.
3. 03 Transferred to a skilled nursing facility.
4. 04 Transferred to an intermediate care facility.
5. 05 Transferred to another type of institution (psychiatric, cancer or childrens hospital or distinct part unit).
6. 06 Discharged to home under care of home health care organization.
7. 07 Left against medical advice or discontinued care.
8. 08 Discharged to home under care of home IV provider.
9. 20 Expired.
10. 50 Discharged to hospice home.
11. 51 Transferred to hospice medical facility.
12. 62 Transferred to an inpatient rehabilitation facility including distinct part units of a hospital.
(3) Trailer Record: The last record in the data file shall be a trailer record and must accompany each data set. If diskettes are submitted, the trailer record must be placed as the last record on the last diskette of the data set. One data element, number of records, must be entered in the trailer record. Report the total number of patient data records contained in the file, excluding header and trailer records. The number entered must equal the number of records processed.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew 9-6-93, Formerly 59B-7.018, Amended 6-29-95, 12-28-98, 7-11-01, 2-25-02, 4-18-04, Repealed ________.
59B-9.022 Penalties for Ambulatory Patient Data Reporting Deficiencies.
(1) For purposes of this rule, a report or other information is incomplete when it does not contain all data required by the agency or when it contains inaccurate data and the report is not corrected by the ambulatory center and certified timely pursuant to Rule 59B-9.017, F.A.C. A report or other information is false if done or made with the knowledge of the preparer or an administrator that it contains information or data which is not true or accurate.
(2) An ambulatory center which refuses to file, fails to timely file, or files false or incomplete reports or other information required to be filed under the provisions of Section 408.08, F.S., other Florida Law, or a rule adopted thereunder, shall be subject to administrative fines pursuant to Section 408.08(14), F.S.
(3) Reports are deemed delinquent on the first working day following the due date.
(4) Delinquent report notices will be sent via certified mail to the attention of chief executive officer.
(5) The penalty period will begin on the first working day following the due date for purposes of penalty assessments.
(6) Any ambulatory center which is delinquent for a reporting deficiency other than submission of a false report shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1000 per day of violation for the third or subsequent violations to be fixed, imposed, and collected by the agency. Any ambulatory center which files a false report with the agency or provides false information to the agency shall be subject to a fine of $1000 per day to be fixed, imposed and collected by the agency.
Specific Authority 408.15(8) FS. Law Implemented 408.006(5), 408.061, 408.08(14) FS. HistoryNew 9-6-93, Formerly 59B-7.022, Amended 6-29-95, Repealed________.
59B-9.023 Ambulatory Patient Data Release.
(1) Agency records, public records under Chapter 119, F.S., (Floridas Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying. ($0.15 per one-sided page or $0.20 per two-sided page.)
(2) Patient-specific records collected by the Agency pursuant to Rules 59B-9.010 through 59B-9.022, F.A.C., are exempt from disclosure pursuant to Section 408.061(8), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).
(a) The patient-specific record shall be modified to protect patient confidentiality as follows:
1. Record ID Number Delete or Substitute Sequential Number
2. Patient Social Delete or Substitute a Record Linkage
Number Security Number
3. Patient Birth Date Substitute Age
4. Patient Zip Code If less than 500 population for zip code
per U.S. census, report a code representing
a combination set of zip codes; if
out of state, report state, U.S. territory
or out of country code.
5. Patient Visit Substitute Month Indicator (01-12)
(b) A record linkage number shall be assigned which does not identify an individual patient and cannot reasonably be used to identify individual patients through use of data available through the Agency.
(c) The modified data records described in paragraph (2)(a) shall be released as a set of all records occurring in one calendar quarterly period based on date of visit.
(3) Aggregate reports derived from patient-specific records collected pursuant to Rules 59B-9.010 through 59B-9.022, F.A.C., are public records and shall be released as described in subsections (1) and (4) of this rule, provided the aggregate reports do not include record ID number, patient birth date, patient visit date, patient social security number, or patient zip code or provided the aggregate reports contain the combination of five or more records for any data disclosed.
(4) Requests shall be submitted by users sufficiently in advance to permit the staff to respond without disruption of its duties as provided in Section 119.07(1)(b), F.S.
Specific Authority 408.15(8) FS. Law Implemented 119.07, 120.53(2)(a), 408.061 FS. HistoryNew 9-6-93, Formerly 59B-7.023, Amended 6-29-95, Repealed ________.
59B-9.030 Purpose of Ambulatory and Emergency Department Patient Data Reporting.
The reporting of ambulatory patient data will provide a statewide integrated database that includes hospital based and free standing ambulatory surgery centers, and hospital emergency department services for the assessment of variations in utilization, disease surveillance, access to care and cost trends. The amendments appearing herein are effective with the reporting period starting January 1, 2010.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew________.
Editorial note: see former Rule 59B-9.010.
59B-9.031 Definitions.
(1) Ambulatory Center. For the purposes of this rule, an ambulatory center means a freestanding ambulatory surgery center and a short-term acute care hospital facility.
(2) Ambulatory Surgical Center means a facility licensed as an ambulatory surgical center under Chapter 395, F.S.
(3) Charity means medical care provided by a health care entity to a person who has insufficient resources or assets to pay for needed medical care without utilizing his resources which are required to meet his basic need for shelter, food, or clothing. No patient shall be considered charity care whose family income, as applicable for the twelve (12) months preceding the determination, exceeds 200 percent of the federal poverty guidelines, unless the amount of health care charges due from the patient exceeds 25 percent of annual family income. However, in no case shall the facility charges for a patient whose family income exceeds four times the federal poverty level for a family of four be considered charity. This information should be provided based on the patients status at time of reporting.
(4) CPT means Current Procedural Terminology and refers to a coding system established by the American Medical Association to describe physician services which is published annually in Physicians Current Procedural Terminology manual which is incorporated by reference.
(5) E-code means a Supplementary Classification of External Causes of Injury and Poisoning ICD-9-CM codes where environmental events, circumstances, and conditions are the cause of injury, poisoning and other adverse effects as specified in the ICD-9-CM manual and the conventions of coding.
(6) Executive Officer means a reporting facilitys chief executive officer, president or any vice president of the facility in charge of a principal business unit, division or function (administration or finance).
(7) HCPCS means Health Care Common Procedure Coding System which is published annually by the United States Department of Health and Human Services and is required by the Federal Government for Medicare reporting purposes.
(8) Inpatient means a patient who has an admission order given by a licensed physician or other individual who has been granted admitting privileges by the hospital.
(9) NUBC means National Uniform Billing Committee. A national body that defines the data fields that are reported on the Uniform Bill UB-04 which is published annually.
(10) NUCC means the National Uniform Claims Committee. A national body that define the data fields that are reported on the HCFA 1500 which is published annually.
(11) NPI means National Provider Identification. A unique identification number assigned to a provider by the Centers for Medicare & Medicaid Services.
(12) Short-Term Acute Care Hospital means a hospital as defined in Section 395.002(12), F.S.
(13) Visit means a face to face encounter between a health care provider and a patient who is not formally admitted as an inpatient in an acute care hospital setting at the time of the encounter or who is not admitted to the same facilitys acute care hospital setting immediately following the encounter as described in subsections 59B-9.032(1), 59B-9.032(3), F.A.C. Visits which require the patient to appear in an ambulatory setting prior to the actual procedure (even if this occurs one or more days before the procedure) shall be counted as one visit. The admit date in these instances should be the day of the procedure.
(14) ISO 3166 International Standard for Organization is a standardized list of country names and codes first published in 1974 and updated 2008. ISO 3166 is available at: http://www.iso.org/iso/english_country_names_and_code_elements.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew_______.
Editorial note: see former Rule 59B-9.013.
59B-9.032 Ambulatory and Emergency Department Data Reporting and Audit Procedures.
(1) The following entities shall submit patient data reports to the Agency for Health Care Administration (AHCA or Agency):
(a) All licensed short-term acute care hospitals licensed under Chapter 395, F.S.;
(b) All licensed ambulatory surgical centers as defined in Section 395.002(3), F.S.;
(2) Each facility in paragraph (1)(a) above shall submit a separate report for each location per Rule 59A-3.203, F.A.C. Each facility in paragraph (1)(b) above shall submit a separate report for each location per Rule 59A-5.003, F.A.C. Each facility in paragraph (1)(a) or (1)(b) above shall submit a separate report for each separate location.
(3) All ambulatory centers performing the services set forth in Rules 59B-9.030 through 59B-9.039, F.A.C., shall submit ambulatory patient data as set forth in Rules 59B-9.037 and 59B-9.038, F.A.C., unless the reporting entity meets the criteria listed in subsection 59B-9.032(5), F.A.C., below.
(4) Any Ambulatory Surgical Center which has a total of 200 or more patient visits per Rule 59B-9.033, F.A.C., for the reporting period is required to report data as set forth in Rules 59B-9.037 and 59B-9.038, F.A.C.
(5) Ambulatory Surgical Centers with fewer than 200 patient visits in a quarter, must have the entitys chief executive officer or director to certify to the Agency in writing, that the ambulatory center has fewer than 200 patient visits per Rule 59B-9.033, F.A.C., for the reporting period, and the certification is to be received at the Agency office in Tallahassee on or prior to the deadline for submission of the report. This is not a one time letter, but must be submitted for each quarter where there were fewer than 200 visits.
(6) Upon notification by the Agency staff, all facilities shall provide access to all required information from the medical records and billing documents underlying and documenting the ambulatory patient data submitted, as well as other patient related documentation deemed necessary by the Agency to conduct complete ambulatory patient data audits subject to the limitations as set forth in Section 408.061(1)(d), F.S. No patient records that support patient data are exempt from disclosure to AHCA for audit purposes.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.07, 408.08, 408.15(11) FS. HistoryNew ________.
Editorial note: see former Rule 59B-9.011.
59B-9.033 Schedule for Submission of Ambulatory and Emergency Department Patient Data and Extensions.
(1) Ambulatory centers and Emergency Departments shall report patient data according to the provisions in Rules 59B-9.030 through 59B-9.039, F.A.C.
(a) Each report covering patient visits ending between January 1 and March 31, inclusive of each year, shall be submitted no later than June 10 of the calendar year during which the visit occurred. This is considered to be the first quarter, regardless of the facility fiscal year. First quarter reports must be certified by August 31 of the same calendar year.
(b) Each report covering patient visits ending between April 1 and June 30, inclusive of each year, shall be submitted no later than September 10 of the calendar year during which the visit occurred. This is considered to be the second quarter, regardless of the facility fiscal year. Second quarter reports must be certified by November 30 of the same calendar year.
(c) Each report covering patient visits ending between July 1 and September 30, inclusive of each year, shall be submitted no later than December 10 of the calendar year during which the visit occurred. This is considered to be the third quarter, regardless of the facility fiscal year. Third quarter reports must be certified by February 28 of the following calendar year.
(d) Each report covering patient visits ending between October 1 and December 31, inclusive of each year, shall be submitted no later than March 10 of the calendar year following the year in which the visit occurred. This is considered to be the fourth quarter, regardless of the facility fiscal year. Fourth quarter reports must be certified by May 31 of the next calendar year.
(2) Extensions to the initial due dates in subsection 59B-9.033(1), F.A.C., above shall be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or Agency designee for a maximum of thirty (30) days from the initial submission due date in response to a written request signed by the hospitals chief executive officer, ambulatory center director or authorized executive officer designee if received prior to the initial due date, and provided that the delay is due to unforeseen factors beyond the control of the reporting facility. These factors must be specified in the letter requesting the extension together with documentation of efforts undertaken to meet the filing requirements. Extensions shall not be granted verbally.
(3) Failure to file the report on or before the initial submission due date as specified in paragraphs 59B-9.033(1)(a)-(d), F.A.C., without an extension, and failure to correct a report which has been filed but contains errors or deficiencies by the certification deadline is punishable by fine pursuant to Rule 59B-9.036, F.A.C. The agency shall send a notification of errors or deficiencies by certified mail, electronic mail, or fax. Rejected reports must be corrected, resubmitted and certified by the certification due date.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.08(1)(2),408.15(11) FS. HistoryNew ________.
Editorial note: see former Rule 59B-9.014.
59B-9.034 Reporting Instructions.
(1) Ambulatory centers shall report data for:
(a) All non-emergency visits for surgical procedures or services performed in the operating room, ambulatory surgical care, cardiology (cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)), gastro intestinal, extra-corporeal shock wave treatment (lithotripsy) surgery, and endoscopy corresponding to the following Current Procedural Terminology (CPT) and corresponding HCPCS Codes.
1. 10021 through 69999. Includes, but not limited to, surgery, cardiac catheterization, endoscopy procedures, and lithotripsy.
2. 92980 through 92996 and 93500 through 93599. Includes percutaneous transluminal coronary angioplasty (PTCA) and Cardiac Catheterization.
(b) Do not report CPT codes 36415 or 36416.
3. Exclude visits where the primary reason for the visit is venipuncture for laboratory services.
(2) Emergency Departments shall report an Emergency Department Evaluation and Management Procedure code representing the patients acuity as part of the emergency department visit.
(a) Report all emergency department visits in which emergency department registration occurs for the purpose of seeking emergency care services, including observation, and the patient is not admitted for inpatient care at the reporting entity.
(b) An ED visit occurs even if the only service provided to a registered patient is triage or screening. If the registered patient leaves prior to being seen by a physician, report the discharge status as 07 AMA/discontinued care and charges. Report zero if charges are not incurred.
(c) Do not include visits for registrations that occur in the Emergency Department when the hospital central registration department is closed unless emergency services are provided.
(3) Ambulatory centers shall exclude records of any patient visit in which the outpatient and inpatient billing record is combined because the patient was admitted to inpatient care within a facility at the same location per Rule 59A-3.203, F.A.C. Report one record for each visit, except pre-operation visits may be combined with the record of the associated ambulatory surgery visit. See subsection 59B-9.031(13), F.A.C.
(4) For each patient visit, ambulatory centers shall report all services provided using procedural codes specified in subsections 59B-9.037 and 59B-9.038, F.A.C.
(5) Beginning with the Ambulatory data report for the 1st quarter of the year 2010, reporting facilities must submit a zipped outpatient XML file by Internet according to the specifications in paragraphs (a) through (c) below unless reporting by CD-ROM is approved by the Agency in a case of extraordinary or hardship circumstances.
(a) Internet Transmission. The Internet address for receipt of ambulatory patient data is https://ahcaxnet.fdhc.state.fl.us/patientdata.
(b) Reports sent to the Internet address shall be electronically transmitted with the zipped ambulatory data in a XML file using the Ambulatory Patient Data XML Schema available at http://ahca.myflorida.com/xmlschemas/asc.xsd.
(c) The Ambulatory Patient Data XML Schema is incorporated by reference. The data in the XML file shall contain the data elements, codes and standards required in Rules 59B-9.037 and 59B-9.038, F.A.C.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew________.
Editorial note: see former Rule 59B-9.015.
59B-9.035 Certification, Audits, and Resubmission Procedures.
(1) All ambulatory centers submitting data in compliance with Rules 59B-9.030 through 59B-9.039, F.A.C., shall certify that the data submitted for each quarter period is accurate, complete and verifiable using Certification Form for Ambulatory Patient Data AHCA Form APD1, dated 7/1/95 and incorporated by reference. The completed certification form shall be submitted to the Agency for Health Care Administration, 2727 Mahan Drive, MS #16, Tallahassee, Florida 32308. Attention: Florida Center for Health Information and Policy Analysis or by facsimile to the Agencys office, or a scanned certification submitted by electronic mail.
(2) Facilities not certified within five (5) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59B-9.036, F.A.C. Extensions to this five (5) month period may be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee, for a maximum of 30 days following the certification due date in response to a written request signed by the facilities chief executive officer, ambulatory center director or authorized executive officer designee. A facility will not be penalized for delays caused by AHCA which is documented by the reporting facility to include on-line reporting system downtime or delays in receipt of reports from AHCA.
(3) Changes or corrections to certified data will be accepted from facilities to improve their data quality for a period of eighteen (18) months following the initial submission due date. The Administrator, Office of Data Collection and Quality Assurance or designee may grant approval for resubmitting previously certified data in response to a written request signed by the facilitys chief executive officer, Ambulatory Center director or authorized executive officer designee. The written request must specify the reason for the corrections or changes, explain the cause contributing to the inaccurate reporting, describe a corrective action plan to prevent future errors, the total number of records affected by quarters and years, the data type and the date that the replacement file will be submitted to the Agency. Any changes to a hospitals data after this eighteen-month period shall be subject to penalties pursuant to Rule 59B-9.036, F.A.C. Resubmissons of previously certified data must be certified within thirty (30) days following receipt of the data file from the facility.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08, 408.15(11) FS. HistoryNew________.
Editorial note: see former Rule 59B-9.017.
59B-9.036 Penalties for Ambulatory Patient Data Reporting and Deficiencies.
(1) For purposes of this rule, a report or other information is incomplete when it does not contain all data required by the Agency in this rule and in forms incorporated by reference or when it contains inaccurate data. The Agency shall to the extent practical, apply the same audit standards and use the same audit procedures for all hospitals or audit a random sample of hospitals. The Agency will notify each hospital of any possible errors discovered by audit and request that the hospital either correct the data or verify that the data is complete and correct. A report or other information is false if done or made with the knowledge of the preparer or an administrator that it contains information or data which is not true or accurate.
(2) An ambulatory center which refusile, fails to timely file or files false or incomplete reports or other information required to be filed under the provisions of Section 408.08, F.S. other Florida Law, or a rule adopted thereunder, shall be subject to administrative fines pursuant to Section 408.08, F.S. Failure to comply with reporting requirements will also result in the referral of a facility to the Agencys Bureau of Health Facility Regulation.
(3) Notifications will be sent to reporting facilities who do not submit their data file by the initial due date as specified in Rule 59B-9.033, F.A.C.
(4) The penalty period will begin on the first working day following the due date for purposes of penalty assessments.
(5) Any ambulatory center which is delinquent for a reporting deficiency other than submission of a false report shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1,000 per day of violation for the third or subsequent violations to be fixed, imposed, and collected by the Agency. Any ambulatory center which files a false report with the Agency or provides false information to the Agency shall be subject to a fine of $1,000 per day to be fixed, imposed and collected by the Agency. Violations will be considered those activities which necessitate the issuance of an administrative complaint by the Agency unless the administrative complaint is withdrawn or final order dismissing the administrative complaint is entered. All fines are to be fixed, imposed and collected by the Agency. Any ambulatory center which files a false report with the Agency or provides false information to the Agency shall be subject to a fine of $1000 per day, in addition to any other fine imposed hereunder. The fine shall be fixed, imposed and collected by the Agency.
Specific Authority 408.15(8) FS. Law Implemented 408.08), 408.061 FS. HistoryNew________.
Editorial note: see former Rules 59B-9.022 and 59B-9.016.
59B-9.037 Header Record.
The first record in the data file shall be a header record, containing the information described below.
(1) Transaction Code. Enter Q for a calendar quarter report. A required field.
(2) Report Year. Enter the year of the data in the format YYYY.
(3) Report Quarter. Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year.
(4) Data Type. Enter AS10-1 for Ambulatory Data and Emergency Department Data.
(5) Submission Type. Enter I or R where I indicates an initial submission of a data file or resubmission of a data file prior to certification and R indicates a replacement submission of previously certified patient data where resubmission has been requested or authorized by the Agency. A required entry.
(6) Processing Date. Enter the date that the data file was created in the format YYYY-MM-DD where MM represents numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits.
(7) AHCA Facility Number. Enter the identification number of the ambulatory center as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight digits and no more than 10 digits.
(8) Organization Name. Enter the name of the ambulatory center that performed the ambulatory services represented by the data, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty character field.
(9) Contact Person Name. Enter the name of the contact person at the ambulatory center. Submit name in the Last, First format. Up to a twenty-five character field.
(10) Contact Person Telephone Number. The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact person telephone number in the numeric format (AAA)XXX-XXXX-EEEEE where AAA is the area code, and EEEEE is the extension. Blank fill if no extension.
(11) Contact Person E-Mail Address. The e-mail address of the contact person.
(12) Contact Person Street or P.O. Box Address. Enter the Street or Post Office Box address of the contact person. Up to a forty character field.
(13) Mailing Address City. Enter the city of the address of the contact person. Up to a twenty-five character field.
(14) Mailing Address State. Enter the state of the address of the contact person using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for Florida.
(15) Mailing Address Zip Code. Enter the numeric zip code of the address of the contact person in the format XXXXX-XXXX. Blank fill if no extension.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew________.
Editorial note: see former Rule 59B-9.018.
59B-9.038 Ambulatory Data Elements, Codes and Standards.
All data elements and data element codes listed below shall be reported. All facilities submitting data in compliance with Rules 59B-9.030 through 59B-9.039, F.A.C., shall report the following required data elements as stipulated by the Agency and described in the Official Data Specifications Manual published by the NUBC and NUCC.
(1) AHCA Ambulatory Center Number. An identification number assigned by AHCA for reporting purposes. The number must match the facility number recorded on the header record. A valid identification number must contain at least eight digits and no more than 10 digits. A required entry.
(2) Patient Control Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate retrieval of individuals account of services (accounts receivable) containing the financial billing records and any posting of payment. Up to twenty four (24) characters. A required field. Duplicate patient control numbers are not permitted. The facility must maintain a key list to locate actual records upon request by AHCA.
(3) Medical or Health Record Number. An alpha-numeric code assigned to the patients medical or health record by the facility. The medical/health record number references a file that contains the history of treatment. It should not be substituted for the Patient Control Number which is the financial record associated with a visit. Up to twenty four (24) characters. A required field.
(4) Patient Social Security Number. The social security number (SSN) of the patient. A nine digit field to facilitate retrieval of individual case records, to be used to track multiple patient visits, and for medical research. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful or the patient is under two (2) years of age and does not have a SSN or for patients who are non-U.S. citizens who have not been issued SSNs. A required entry.
(5) Patient Ethnicity. Self-designated by the patient, patients parent or guardian. Use Unknown where efforts to obtain the information from the patient or from the patients parent or guardian have been unsuccessful. The patients ethnic background shall be reported as one choice from the following list of alternatives. A required entry. Must be a two (2) digit code as follows:
a. E1 = Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, Central or South
American or other Spanish culture or origin, regardless of race.
b. E2 = Non-Hispanic or Latino. A person not of any Spanish culture or origin.
c. E7 = Unknown.
(6) Patient Race. Self-designated by the patient, patients parent or guardian. Use Unknown where efforts to obtain the information from the patient or from the patients parent or guardian have been unsuccessful. The patients racial background shall be reported as one choice from the following list of alternatives. A required entry. Must be a one (1) digit code as follows:
(a) 1 American Indian or Alaskan Native. A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition.
(b) 2 Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia or the Indian subcontinent. This area includes, for example, Cambodia, India, Japan, Korea, Malaysia, Pakistan, the Philippine Islands, Thailand and Vietnam.
(c) 3 Black or African American. A person having origins in any of the black racial groups of Africa.
(d) 4 Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa or other Pacific Islands.
(e) 5 White. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
(f) 6 Other. Any other possible options not covered in the above categories, including a patient who has more than one race.
(g) 7 Unknown. Use if the patient refuses or fails to disclose.
(7) Patient Birth Date. The date of birth of the patient. A ten character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Unknown birthdates should use the default of YYYY-01-01 where the year is based on approximate age. A birth date after the patient visit ending date is not permitted. A required entry.
(8) Patient Sex The patient sex at the time of admission. A required entry. Alpha characters must be in upper case. Must be a one (1) digit code as follows:
1. M Male.
2. F Female.
3. U Unknown. Use where efforts to obtain the information have been unsuccessful or where the patients sex cannot be determined due to a medical condition.
(9) Patient Zip Code. The five digit United States Postal Service ZIP Code of the patients permanent residence. Use 00009 for foreign residences. Use 00007 for homeless patients. Use 00000 where efforts to obtain the information have been unsuccessful. A required entry.
(10) Patient Country Code. The country code of residence. A two (2) digit upper case alpha code from the Code for Representation of Names of Countries, ISO 3166 or latest release. A required entry for type of service 2.
(11) Type of Service Code. A code designating the type of service, either ambulatory surgery or emergency department visit. A required entry. Must be a one (1) digit code as follows:
(a) 1 Ambulatory surgery, as described in paragraph 59B-9.032(1), F.A.C.
(b) 2 Emergency department visit, as described in subsection 59B-9.032(2), F.A.C.
(12) Source or Point of Origin of Admission. Must be a one (1) character alpha code or two (2) digit numeric code indicating the direct source or point of patient origin for this visit. A required entry if type of service is 2. Zero fill if type of service is 1. Alpha characters must use upper case.
(a) 01 Non-health care facility source of origin Include patients coming from home, physician office or workplace. The patient presents to this facility with an order from a physician for services or seeks scheduled services for which an order is not required. Includes non-emergent self-referrals.
(b) 02 Clinic. The patient was referred to this facility for outpatient or referenced diagnostic procedures.
(c) 04 Transfer from a hospital. The patient was transferred to this facility as an outpatient from an acute care facility. Transfer must be from a different hospital.
(d) 05 Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF). The patient was referred to this facility as a transfer from a SNF or ICF where the patient was a resident.
(e) 06 Transfer from another health care facility. The patient was referred to this facility for services by (a physician of) another health care facility not defined elsewhere in this code list where he or she was an inpatient or outpatient.
(f) 07 Emergency Room. The patient received unscheduled services in this facilitys emergency department and discharged without an inpatient admission. Includes self-referrals in emergency situations that require immediate medical attention. Excludes patients who came to the emergency room from another health care facility.
(g) 08 Court/Law Enforcement. The patient was referenced to this facility upon the direction of a court of law, or upon the request of a law enforcement agency representative for outpatient or referenced diagnostic services. Includes transfers from incarceration facilities.
(h) 09 Information Not Available. The means by which the patient was referred to this hospitals outpatient department is not known.
(i) D Transfer from one distinct unit of the hospital to another distinct unit of the same hospital resulting in a separate claim. The patient received outpatient services in this facility as a transfer from within this hospital resulting in a separate claim to the payer.
(j) E Transfer from Ambulatory Surgery Center. The patient was referred to this facility for outpatient or referenced diagnostic services from an ambulatory surgery center.
(k) F Transfer from hospice and under a hospice plan of care or enrolled in a hospice program. The patient was referred to this facility for outpatient or referenced diagnostic services from a hospice.
(13) Principal Payer Code. Describes the primary source of expected reimbursement for services rendered based on the patients status at discharge or the time of reporting. Report charity as defined in subsection 59B-9.031(3), F.A.C. A required entry. Must be a one (1) character alpha field using upper case as follows:
(a) A Medicare. Patients covered by Medicare where Centers for Medicare & Medicaid Services is the direct payer.
(b) B Medicare Managed Care. Patients covered by Medicare Advantage plans, Medicare HMO, Medicare PPO, Medicare Private Fee for Service or any other type of Medicare plan where Centers for Medicare & Medicaid Services is not the direct payer.
(c) C Medicaid. Patients covered by state administered, non-managed Florida Medicaid. This would include those Medicaid recipients enrolled in MediPass.
(d) D Medicaid Managed Care. Patients covered by Medicaid HMOs, Medicaid provider sponsored networks (PSNs) or other Medicaid funded plans that are licensed in the state of Florida. This would include any type of program where the patient qualifies for Medicaid but payment is not directly from the State of Florida Medicaid program regardless of whether the hospital has a contract with that plan.
(e) E Commercial Health Insurance. Patients covered by any type of private coverage, including HMO, PPO or self-insured plans.
(f) F Commercial Liability Coverage. Patients whose health care is covered under a liability policy, such as automobile, homeowners or general business.
(g) H Workers Compensation. Patients covered by any type of workers compensation plan, including self insured plans, managed care plans or the State of Florida sponsored workers compensation plan.
(h) I TriCare or Other Federal Government. Patients covered by any federal government program for active and retired military and their families; Black Lung, Section 1011; the Federal Prison System; or any other federal program.
(i) J VA. Patients covered by the Veterans Administration.
(j) K Other State/Local Government. Patients covered by a state program that does not fall into any of the state funded categories listed above. This would include those covered by the Florida Department of Corrections or any county or local corrections department; patients covered by county or local government indigent care programs if the reimbursement is at the patient level; any out-of-state Medicaid programs and county health departments or clinics.
(k) L Self Pay. Patients with no insurance coverage.
(l) M Other. This would include patients covered by any other type of payer not meeting the descriptions in (a)-(k) above or m-n below.
(m) N Charity. Include charity that is known at the time of discharge.
(n) O KidCare. Includes Healthy Kids, MediKids and Childrens Medical Services.
(o) P Unknown. Unknown shall be reported if principal payer information is not available and type of service is 2 and patient status is 07.
(14) Principal Diagnosis Code. The code representing the diagnosis chiefly responsible for the services performed during the visit. Must contain a valid ICD-9-CM or ICD-10-CM diagnosis code if type of service is 1 indicating ambulatory surgery. Must contain a valid ICD-9-CM or ICD-10-CM diagnosis code if type of service is 2 indicating an emergency department visit unless patient status is 07 indicating that the patient left against medical advice or discontinued care. A blank field is permitted if type of service is 2 and patient status is 07. If not space filled, must contain a valid ICD-9-CM diagnosis code or valid ICD-10-CM diagnosis code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. Alpha characters must be in upper case.
(15) Other Diagnosis Code (1), Other Diagnosis (2), Other Diagnosis (3), Other Diagnosis (4), Other Diagnosis (5), Other Diagnosis (6), Other Diagnosis (7), Other Diagnosis (8), Other Diagnosis (9). A code representing a diagnosis related to the services provided during the visit. If no principal diagnosis code is reported, another diagnosis code must not be reported unless the patient discharge status is 07 indicating that the patient left against medical advice or discontinued care. No more than nine other diagnosis codes may be reported. Less than nine entries is permitted. If not space filled, must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. Alpha characters must be in upper case.
(16) Evaluation and Management Code (1), Evaluation and Management Code (2), Evaluation and Management Code (3), Evaluation and Management Code (4), Evaluation and Management Code (5). A code representative of the patient acuity level for the services provided. If type of service is 2, must contain a valid Evaluation and Management (EM) Code range 99281-99285; 99288; 99291-99292; and G0380-G0384, even if the only service provided to a registered patient is triage or screening. No more than five EM codes may be reported. Less than five entries is permitted. A required field.
(17) Principal CPT or HCPCS Procedure Code. A code representative of the primary services provided or procedures performed.
(a) Ambulatory surgery type of service 1 must contain a valid CPT code or HCPCS code as specified in subsection 59B-9.034(1), F.A.C., excluding CPT codes 36415, 36416 representing the reason for the surgery or the encounter.
(b) Emergency Department visits type of service 2 must contain a valid CPT or HCPCS code if the patient discharge status is not 07 indicating that the patient left against medical advice or discontinued care. Must contain either a valid CPT or HCPCS procedure code if type of service is 2 and patient discharge status is 07 indicating that the patient left against medical advice or discontinued care. The code must be five digits and valid for the reporting period. Do not report venipucture codes 36415-36416 as a principal CPT or procedure code.
(18) Other CPT or HCPCS Procedure Codes 1 though 30. A code representing an additional procedure or service provided during the visit. Other CPT or HCPCS procedure code data element fields are desginated specific code ranges. If a principal CPT or HCPCS procedure is not reported, Other CPT or HCPCS Procedure Codes must not be reported unless the patient status is 07 indicating the patient left against medical advice or discontinued care. The code must be five digits and valid for the reporting period. Alpha characters must be in upper case.
(a) Other CPT or HCPCS Procedure Code (1), Other CPT or HCPCS Procedure Code (2), Other CPT or HCPCS Procedure Code (3), Other CPT or HCPCS Procedure Code (4), Other CPT or HCPCS Procedure Code (5), Other CPT or HCPCS Procedure Code (6), Other CPT or HCPCS Procedure Code (7), Other CPT or HCPCS Procedure Code (8), Other CPT or HCPCS Procedure Code (9), Other CPT or HCPCS Procedure Code (10),) Other CPT or HCPCS Procedure Codes 1-10 are designated for CPT procedure code ranges 10021-69999; 92980 through 92996; and 93500 through 93599 and corresponding HCPCS codes. Do not report CPT codes 36415 or 36416. If a principal CPT or HCPCS procedure is not reported, an Other CPT or HCPCS Procedure Code must not be reported. No more than ten other CPT or HCPCS procedure codes may be reported. Less than ten entries or no entry is permitted.
(b) Other CPT or HCPCS Procedure Code (11), Other CPT or HCPCS Procedure Code (12), Other CPT or HCPCS Procedure Code (13), Other CPT or HCPCS Procedure Code (14), Other CPT or HCPCS Procedure Code (15), Other CPT or HCPCS Procedure Code (16), Other CPT or HCPCS Procedure Code (17), Other CPT or HCPCS Procedure Code (18), Other CPT or HCPCS Procedure Code (19), Other CPT or HCPCS Procedure Code (20). Other CPT or HCPCS Procedure Codes 11-20 are designated for radiology services provided during the visit corresponding to CPT procedure code ranges 70000-79999 and associated HCPCS codes. No more than ten other CPT or HCPCS procedure codes may be reported. Less than ten entries or no entry is permitted.
(c) Other CPT or HCPCS Procedure Code (21), Other CPT or HCPCS Procedure Code (22), Other CPT or HCPCS Procedure Code (23), Other CPT or HCPCS Procedure Code (24), Other CPT or HCPCS Procedure Code (25), Other CPT or HCPCS Procedure Code (26), Other CPT or HCPCS Procedure Code (27), Other CPT or HCPCS Procedure Code (28), Other CPT or HCPCS Procedure Code (29), Other CPT or HCPCS Procedure Code (30). Other CPT fields 21-30 are designated to report laboratory services provided during the visit corresponding to CPT procedure code ranges 80000-89999 and associated HCPCS codes. No more than ten other CPT or HCPCS procedure codes may be reported. Less than ten entries or no entry is permitted.
(19) Attending Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who had primary responsibility for the patients care during the visit. An alpha-numeric field of up to eleven characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. Use NA if the patient was not treated by a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner. A required entry.
(20) Attending Practitioner National Provider Identification (NPI). An unique ten (10) character identification number assigned to a provider. A required entry for providers in the US or its territories and providers not in the US or its territories upon mandated HIPAA NPI implementation date.
(21) Operating or Performing Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who had primary responsibility for the principal procedure performed. The operating or performing practitioner may be the attending practitioner. An alpha-numeric field of up to eleven characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. Use NA if the patient was not treated by a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner. A required entry. A blank or no entry is permitted if a principal procedure is not reported.
(22) Operating or Performing Practitioner National Provider Identification (NPI). An unique ten (10) character identification number assigned to a provider. A required entry for providers in the US or its territories and providers not in US or its territories upon mandated HIPAA NPI implementation date.
(23) Other Operating or Performing Practitioner Identification Number. The Florida license number of a different operating or performing practitioner. Report a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who rendered care to the patient other than the person reported in paragraph (19) or (21) above. An alpha-numeric field of up to eleven characters, alpha characters must be in upper case. For military physicians not licensed in Florida, use US999999999. A blank or no entry is permitted.
(24) Pharmacy Charges. Charges for medication. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(25) Medical and Surgical Supply Charges. Charges for supply items required for patient care. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(26) Laboratory Charges. Charges for the performance of diagnostic and routine clinical laboratory tests. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(27) Radiology and Other Imaging Charges. Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no radiology or computed tomography charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(28) Cardiology Charges (Cardiac Cath). Charges for cardiac procedures rendered such as heart catheterization. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no cardiology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(29) Operating Room Charges. Charges for the use of the operating room. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no operating room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(30) Anesthesia Charges. Charges for anesthesia services by the facility. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no anesthesia charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(31) Recovery Room Charges. Charges for the use of the recovery room. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(32) Emergency Room Charges. Charges for medical examinations and emergency treatment. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(33) Trauma Response Charges. Charges for a trauma team activation at a State of Florida licensed Trauma Center. Report charges for revenue code 68X used in the UB-04. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report zero (0) if there are no trauma response charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(34) Treatment or Observation Room Charges. Charges for use of a treatment room or for the room charge associated with observation services. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(35) Gastro-Intestinal (GI) services. Charges for gastro-intestinal procedures rendered such as colonoscopy and endocscopy services. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no GI charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(36) Extra-Corporeal Shock Wave Therapy (Lithotripsy). Charges for Extra-Corporeal Shock Wave Therapy (Lithotripsy) procedures. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no Lithotripsy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(37) Other Charges. Other facility charges not included in paragraphs (24) to (36) above. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report 0 (zero) if there are no other charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(38) Total Gross Charges. The total of undiscounted charges for services rendered by the reporting entity. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Include charges for services rendered by the ambulatory center excluding professional fees. Negative amounts are not permitted unless verified separately by the reporting entity. The sum of pharmacy charges, medical and surgical supply charges, laboratory charges, radiology and other imaging charges, cardiology charges, operating room charges, anesthesia charges, recovery room charges, emergency room charges, treatment or observation room charges, Gastro-Intestinal (GI) services, Extra-Corporeal Shock Wave Therapy (Lithotripsy), and other charges must equal total charges, plus or minus 10. A required entry.
(39) Patient Visit Beginning Date. The date at the beginning of the patients visit for ambulatory surgery or the date at the time of registration in the emergency department. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit beginning date must equal or precede the patient visit ending date. A required entry.
(40) Patient Visit Ending Date. The date at the end of the patients visit. A ten (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 1 to 12, DD represents numbered days of the month from 1 to 31, and YYYY represents the year in four digits. Patient visit ending date must equal or follow the patient visit beginning date. Patient visit ending date must occur within the calendar quarter included in the data report. A blank field is not permitted unless type of service is 2 indicating an emergency department visit and patient status is 07 indicating the patient left against medical advice or discontinued care.
(41) Hour of Arrival. The hour on a 24-hour clock during which the patients visit for ambulatory surgery began or during which registration in the emergency department occurred. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
A.M. HOURS
1. 00 12:00 midnight to 12:59:59
2. 01 01:00 to 01:59:59
3. 02 02:00 to 02:59:59
4. 03 03:00 to 03:59:59
5. 04 04:00 to 04:59:59
6. 05 05:00 to 05:59:59
7. 06 06:00 to 06:59:59
8. 07 07:00 to 07:59:59
9. 08 08:00 to 08:59:59
10. 09 09:00 to 09:59:59
11. 10 10:00 to 10:59:59
12. 11 11:00 to 11:59:59
P.M. HOURS
13. 12 12:00 noon to 12:59:59
14. 13 01:00 to 01:59:59
15. 14 02:00 to 02:59:59
16. 15 03:00 to 03:59:59
17. 16 04:00 to 04:59:59
18. 17 05:00 to 05:59:59
19. 18 06:00 to 06:59:59
20. 19 07:00 to 07:59:59
21. 20 08:00 to 08:59:59
22. 21 09:00 to 09:59:59
23. 22 10:00 to 10:59:59
24. 23 11:00 to 11:59:59
25. 99 Unknown.
(42) ED Hour of Discharge. The hour on a 24-hour clock during which the patient left the emergency department. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
A.M. HOURS
1. 00 12:00 midnight to 12:59:59
2. 01 01:00 to 01:59:59
3. 02 02:00 to 02:59:59
4. 03 03:00 to 03:59:59
5. 04 04:00 to 04:59:59
6. 05 05:00 to 05:59:59
7. 06 06:00 to 06:59:59
8. 07 07:00 to 07:59:59
9. 08 08:00 to 08:59:59
10. 09 09:00 to 09:59:59
11. 10 10:00 to 10:59:59
12. 11 11:00 to 11:59:59
P.M. HOURS
13. 12 12:00 noon to 12:59:59
14. 13 01:00 to 01:59:59
15. 14 02:00 to 02:59:59
16. 15 03:00 to 03:59:59
17. 16 04:00 to 04:59:59
18. 17 05:00 to 05:59:59
19. 18 06:00 to 06:59:59
20. 19 07:00 to 07:59:59
21. 20 08:00 to 08:59:59
22. 21 09:00 to 09:59:59
23. 22 10:00 to 10:59:59
24. 23 11:00 to 11:59:59
25. 99 Unknown.
(43) Patients Reason for Visit ICD-CM Code (Admitting Diagnosis). The code representing the patients chief complaint or stated reason for seeking care. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period if type of service is 2 indicating an emergency department visit. If not space filled, must contain a valid ICD-9-CM or ICD-10-CM diagnosis code. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. Space fill if type of service is 1 indicating ambulatory surgery. Alpha characters must be in upper case.
(44) Principal ICD-CM Procedure Code. The code representing the procedure or service most related to the principal diagnosis. A blank field is permitted if type of service is 1 indicating ambulatory surgery. A blank or no entry is permitted consistent with the records of the reporting entity if type of service is 2 indicating an emergency department visit. Must contain a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(45) Other ICD-CM Procedure Code (1), Other ICD-CM Procedure Code (2), Other ICD-CM Procedure Code (3), Other ICD-CM Procedure Code (4) A code representing a procedure or service provided during the visit. If no principal ICD-CM procedure is reported, another ICD-CM procedure code must not be reported unless the patient status is 07 indicating the patient left against medical advice or discontinued care. No more than four other ICD-CM procedure codes may be reported. A blank or no entry is permitted if type of service is 1. Less than four or no entry is permitted if type of service is 2. Must be a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code.
(46) External Cause of Injury Code. External Cause of Injury Code (1), External Cause of Injury Code (2) and External Cause of Injury Code (3). A code representing circumstances or conditions as the cause of the injury, poisoning or other adverse effects recorded as a diagnosis. Assign the appropriate E-code for all initial encounters or treatments, but not for subsequent occurances. A Place of Occurance E-code (E849.X) should be included to describe where the event occurred. No more than three (3) external cause of injury codes may be reported. Less than three (3) or no entry is permitted. If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause of injury code for the reporting period. An external cause of injury code cannot be used more than once for each encounter reported. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. Alpha characters must be in upper case.
(47) Service Location. For type of service 2, an alpha character upper case designation A-D to identify services performed at facilities whose license includes a free standing emergency department. A required entry for free standing licensed facilities only where A-D correspond to the order of entities on the hospital license.
(48) Patient disposition at end of visit. Patient Status. A required entry. Must be a two (2) digit code as follows:
(a) 01 Discharged to home or self care (routine discharge).
(b) 02 Transferred to a short-term general hospital for inpatient care.
(c) 03 Transferred to a skilled nursing facility with Medicare certification in anticipation of skilled care.
(d) 04 Transferred to an intermediate care facility.
(e) 05 Transferred to a designated cancer center or Childrens Hospital.
(f) 06 Discharged to home under care of home health care organization service in anticipation of covered skilled care.
(g) 07 Left against medical advice or discontinued care.
(h) 20 Expired.
(i) 50 Discharged to hospice home.
(j) 51 . Transferred to hospice. Hospice medical facility (certified) providing hospice level of care.
(k) 62 Transferred to an Inpatient Rehabilitation Facility (IRF) including rehabilitation distinct part units of a hospital.
(l) 63 Discharged or transferred to a Medicare certified long term care hospital.
(m) 64 Discharged or transferred to a Nursing Facility certified under Medicaid but not certified under Medicare.
(n) 65 Discharged or transferred to a psychiatric hospital including psychiatric distinct part units of a hospital.
(o) 66 Discharged or transferred to a Critical Access hospital.
(p) 70 Discharged or transferred to another type of health care institution non defined elsewhere in this code list.
(49) Trailer Record: The last record in the data file shall be a trailer record and must accompany each data set. Report only the total number of patient data records contained in the file, excluding header and trailer records. The number entered must equal the number of records processed. Do not include leading zeros.
Specific Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew_______.
Editorial note: see former Rule 59B-9.018.
59B-9.039 Public Records.
(1) Agency records, public records under Chapter 119, F.S., (Floridas Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying.
(2) Patient-specific records collected by the Agency pursuant to Rules 59B-9.030 through 59B-9.039. F.A.C., are exempt from disclosure pursuant to Section 408.061(8), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).
(a) The patient-specific record shall be modified to protect patient confidentiality as follows:
1. Patient Control Number Delete or Substitute Sequential Number
2. Patient Social Security Number Delete or Substitute a Record Linkage Number
3. Patient Birth Date Substitute Age in years and an indicator of Age <29 Days except for
persons 100 and older, substitute Age > 100 years
4. Visit Date Substitute Quarter Indicator (1-4)
5. Medical or Health Record Number Substitute Sequential Number
(b) A record linkage number shall be assigned which does not identify an individual patient and cannot reasonably be used to identify individual patients through use of data available through the Agency.
(c) The modified data records described in paragraph (2)(a) shall be released as a set of all records occurring in one calendar quarterly period based on date of visit.
(d) The modified data described in paragraph (2)(a) shall be released in accordance with the Limited Data Set requirements of the federal Health Insurance Portability and Accountability Act and shall be made available on or after quarterly data has been certified as accurate by the facility as required by Section 408.061(1)(a), F.S.
(3) Aggregate reports derived from patient-specific records collected pursuant to Rules 59B-9.030 through 59B-9.038, F.A.C., are public records and shall be released as described in subsections (1) and (4) of this rule, provided the aggregate reports do not include patient control number, patient birth date, visit date, patient social security number, medical or health record number or provided the aggregate reports contain the combination of five or more records for any data disclosed.
(4) Requests shall be submitted by users sufficiently in advance to permit the staff to respond without disruption of its duties as provided in Section 119.07(1)(b), F.S.
Specific Authority 408.15(8) FS. Law Implemented 119.07, 120.53(2)(a), 408.061 FS. HistoryNew ________.
Editorial note: see former Rule 59B-9.023.
