Inpatient Data Elements, Codes and Standards.

AGENCY FOR HEALTH CARE ADMINISTRATION
Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals

RULE NO: RULE TITLE
59E-7.028: Inpatient 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.

59E-7.028 Inpatient Data Elements, Codes and Standards.

Beginning with the inpatient data reporting for the 1st quarter of the year 2010, all All hospitals submitting data in compliance with Rules 59E-7.021 through 59E-7.030, F.A.C., shall report the required data elements and data element codes listed below as stipulated by the Agency and described in the National Uniform Billing Committee Official UB-04 Data Specifications Manual and as stipulated by the Agency.

(1) AHCA Facility Hospital Number. Enter the identification number of the facility hospital as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than ten (10) digits. A required field.

(2) through (5) No change.

(6) Patient Race. Self-designated by the patient, patient’s parent or guardian.  Use “Unknown”  where efforts to obtain the information from the patient or from the patient’s parent or guardian have been unsuccessful. The patient’s 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 Alaska 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 (10) character field in the format YYYY-MM-DD where MM represents the numbered months of the year from 01 to 12, DD represents numbered days of the month from 01 to 31, and YYYY represents the year in four (4) digits. Unknown birthdates should use the default of 1880 YYYY-01-01 where the year is based on approximate age. A birth date after the discharge date is not permitted. A required entry.

(8) No change.

(9) Patient Zip Code. The numeric five (5) 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 International Standard for Organization country code list, ISO 3166 or latest release. A required entry. Use 99 where the country of residence is unknown or where efforts to obtain the information have been unsuccessful.

(11) Type of Service Code. A code designating the type of discharges as either acute inpatient, long term care, short term and long term psychiatric, or comprehensive rehabilitation. A required entry. Must be a one digit code as follows:

(a) 1 – Inpatient, as described in Rule paragraph 59E-7.022(1), F.A.C.

(b) 2 – Comprehensive Rehabilitation, as described in subsection 59E-7.021(2)(3), F.A.C.

(12) Priority of Admission. No change.

(a) through (c) No change.

(d) 4 – Newborn. A baby born within the facility or the initial admission of an infant to any acute care facility within 24 hours of birth, as described in subsection 59E-7.021(7), F.A.C. Use of this code requires the use of a special Point of Origin for Admission code.

(e) No change.

(13) Source or Point of Origin for Admission. Must be a one (1) character alpha code or two (2) digit numeric code indicating the direct source of patient origin for the admission or visit. Codes 10 or through 13 are to be used only for newborn admissions. A required entry. Alpha characters must use upper case.

(a) through (m) No change.

(14) through (18) No change.

(19) Principal Payer Code. Describes the expected primary source of reimbursement for services rendered based on the patient’s status at discharge or the time of reporting. Report charity as defined in subsection 59E-7.021(2), 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 – Commercial 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.

(m)(n) No change.

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

(20) through (29) No change.

(30) Operating or Performing Practitioner National Provider Identification (NPI). An unique ten (10) character identification number assigned to a provider who had primary responsibility for the Principal Procedure. A required identification number 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. No entry is permitted if no principal procedure is reported.

(31) No change.

(32) Other Operating or Performing Practitioner National Provider Identification (NPI). An unique ten (10) character identification number assigned to a provider who assisted the operating or performing practitioner or performed a secondary procedure. A required identification number 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. No entry is permitted if no principal procedure is reported.

(32) through (33) renumbered (33) through (34) No change.

(35)(34) Nursery Level II Charges. Accommodation charges for services which include provision of ventilator services and at least 6 hours of nursing care per day. Restricted to neonates of 1000 grams birth weight and over with the exception of those neonates awaiting transfer to Level III. Report charges for revenue code 172 as 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 Level II Nursery Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(36)(35) Nursery Level III Charges. Accommodation charges for services which include the provision of continuous cardiopulmonary support services 12 or more hours of nursing care per day, complex pediatric surgery, neonatal cardiovascular surgery, pediatric neurology and neurosurgery, and pediatric cardiac catheterization. Report charges for revenue code 173 (Level III) as 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 Level III Nursery Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(36) through (56) renumbered (37) through (57) No change.

(58)(57) Total Gross Charges. The total of undiscounted charges for services rendered by the hospital. Include charges for services rendered by the hospital excluding professional fees. The sum of all charges reported above in paragraphs (33) through (57) must equal total charges, plus or minus thirteen (13) ten (10) dollars. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Zero (0) or negative amounts are not permitted unless verified separately by the reporting entity. A required entry.

(59)(58) Infant Linkage Identifier. The social security number of the patient’s birth mother where the patient is less than two (2) years of age. A nine (9) digit field to facilitate retrieval of individual case records, to be used to link infant and mother records, and for medical research. Reporting 777777777 for the mother’s SSN is acceptable for those patients where efforts to obtain the mother’s SSN have been unsuccessful or the mother is not known to be from a country other than the United States. Infants in the custody of the State of Florida or adoptions, use 333333333 if the birth mother’s SSN is not available. A required field for patients whose age is less than two (2) years of age at admission. No entry is permitted if the patient is two (2) years of age or older. A required entry.

(60)(59) No change.

(61)(60) 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 appropriate E-codes 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. 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 hospitalization 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.

(61) through (63) renumbered (62) through (64) No change.