Ambulatory Data Elements, Codes and Standards

AGENCY FOR HEALTH CARE ADMINISTRATION
Cost Management and Control

RULE NO: RULE TITLE
59B-9.038: Ambulatory Data Elements, Codes and Standards

NOTICE OF CHANGE

Notice is hereby given that the following changes have been made to the proposed rule in accordance with subparagraph 120.54(3)(d)1., F.S., published in Vol. 34 No. 53, December 31, 2008 issue of the Florida Administrative Weekly.

59B-9.038 Ambulatory Data Elements, Codes and Standards.

Beginning with the ambulatory data reporting for the 1st quarter of the year 2010, all 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 Facility Number. The identification number of the ambulatory center as assigned by AHCA for reporting purposes. 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) through (5) No change.

(6) Patient Race.

(a) 1 – American Indian or Alaskan Native. A person having origins in any of the original peoples of North America and South America (including Central America), and who maintains cultural identification through tribal affiliation or community recognition.

(b) through (g) No change.

(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. Use 9999-99-99 where type of service is “2” and efforts to obtain the patient’s birth date have been unsuccessful. 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) No change.

(9) Patient Zip Code. The five digit United States Postal Service ZIP Code of the patient’s address 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”. Use 99 where the country of residence is unknown, or where efforts to obtain the information have been unsuccessful, or if type of service is “1”.

(11) Type of Service Code. A code designating the type of service, either an ambulatory center surgery or emergency department visit. A required entry. Must be a one (1) digit code as follows:

(a) through (b) No change.

1 – Ambulatory surgery, as described in subsection 59B-9.034 59B9.032(1), F.A.C.

(b) 2 – Emergency department visit, as described in subsection 59B-9.034 59B9.032(2), F.A.C.

(12) No change.

(13) Principal Payer Code. Describes the primary source of expected reimbursement for services rendered based on the patient’s 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) through (e) No change.

(f) F Commerical Liability Coverage. Patients whose health care is covered under a liability policy, such as automobile, homeowners or general business.

(g) through (i) renumbered (f) through (h) No change.

(i)(j) K – Other State/Local Government. Patients covered by a state program or local government that does not fall into any of the payer 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) through (l) renumbered (j) through (k) No change.

(l)(m) N – Non-Payment Charity. Includes charity, professional courtesy, no charge, research/clinical trial, refusal to pay/bad debt, Hill Burton free care, research/donor that is known at the time of reporting.  Include charity that is known at the time of discharge.

(n) through (o) renumbered (m) through (n) No change.

(o) Q- Commercial Liability Coverage. Patients whose health care is covered under a liability policy, such as automobile, homeowners or general business.

(14) through (15) No change.

(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. If patient discharge status is “07” meaning patient left against medical advice or discontinued care, or where a visit occurs resulting in zero charges, enter default code 99999 to indicate that the patient was not evaluated by a physician. 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 59B-9.034(1) 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 venipuncture codes 36415- 36416 as a principal CPT or procedure code.

(17)(18) 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 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 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 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 designated 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. If not space filled, must be a valid CPT or HCPCS code The code must be five digits and valid for the reporting period. Alpha characters must be in upper case. No more than thirty (30) other CPT or HCPCS procedure codes may be reported. Less than thirty (30) entries or no entry is permitted.

(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) through (21) renumbered (18) through (20) No change.

(21)(22) Operating or Performing Practitioner Pratitioner 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. For military physicians, medical residents, or individuals not required to obtain a NPI number, use 9999999999.

(22)(23) No change.

(23) Other 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. For military physicians, medical residents, or individuals not required to obtain a NPI number, use 9999999999.

(24) through (41) No change.

(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 or type of service is “1”. Must be two digits as follows:

(43) through (45) No change.

(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 occurences. A Place of Occurence E-code (E849.X) should be included to describe where the event occurred if documented in the patient medical history. 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. A code designating services performed at an offsite emergency department location at facilities whose license includes a “offsite” emergency department. For type of service “2”, enter an upper case “A” for services performed at the offsite emergency department location. No entry is permitted if type of service is “1” or for hospitals without an offsite location. For type of service “2”, an alpha character upper case A designation to identify services performed at facilities whose license includes a “offsite” emergency department. A required entry for offsite licensed facilities only where A-D correspond to the order of entities on the hospital license.

(48) through (49) No change.