The agency is proposing this rule amendment to change all ICD-9-CM references to ICD-10-CM and ICD-10-PCS in accordance with Center for Medicare/Medicaid Services (CMS) implementation of ICD-10 national reporting effective October 1, 2015. The ...

 

AGENCY FOR HEALTH CARE ADMINISTRATION

Hospital and Nursing Home Reporting Systems and Other Provisions Relating to Hospitals

RULE NOS.:RULE TITLES:

59E-7.012Inpatient Data Reporting Instructions

59E-7.021Definitions

59E-7.027Header Record.

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

PURPOSE AND EFFECT: The agency is proposing this rule amendment to change all ICD-9-CM references to ICD-10-CM and ICD-10-PCS in accordance with Center for Medicare/Medicaid Services (CMS) implementation of ICD-10 national reporting effective October 1, 2015. The amendment incorporates modification to the inpatient schema; Data Type; and External Cause of Injury Code (E-CODE) element name to External Cause of Morbidity Code (ECMORB).

SUMMARY: The agency is proposing amendments to Rules 59E-7.012; 59E-7.021; 59E-7.027; 59E-7.028, F.A.C., which modify inpatient reporting schema; delete all ICD-9 references and modify E-Code element name.

SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS AND LEGISLATIVE RATIFICATION: The Agency has determined that this will not have an adverse impact on small business or likely increase directly or indirectly regulatory costs in excess of $200,000 in the aggregate within one year after the implementation of the rule. A SERC has not been prepared by the Agency.

The Agency has determined that the proposed rule is not expected to require legislative ratification based on the statement of estimated regulatory costs or if no SERC is required, the information expressly relied upon and described herein: A checklist was prepared by the Agency to determine the need for a SERC. As there will be no impact on economic growth, job creation or employment, private-sector investment, or business competitiveness and no increase in regulatory costs—no adverse impact is likely.

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.

RULEMAKING AUTHORITY: 408.15(8) FS.

LAW IMPLEMENTED: 408.061, 408.062 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: April 24, 2015, 11:00 a.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: Judy Mathews at [phone]. 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: Nancy Tamariz at [phone]

 

THE FULL TEXT OF THE PROPOSED RULE IS:

 

59E-7.012 Inpatient Data Reporting Instructions.

(1) No change.

(2) Data submitted to the Internet address shall be electronically transmitted with the zipped inpatient data in a XML file using the Inpatient Data XML Schema available at: http://ahca.myflorida.com/xmlschemas/PD10-3.xsd. http://ahca.myflorida.com/xmlschemas/inppoa22.xsd. The Inpatient Data XML Schema (effective 06/22/2009) is incorporated by reference.

(3) No change.

PROPOSED EFFECTIVE DATE: 10-1-15

Rulemaking Authority 408.061(1)(e) FS. Law Implemented 408.061, 408.062, 408.063, 408.08(1), (2) FS. History–New 12-15-96, Amended 1-4-00, 7-11-01, 7-12-05, 5-22-07, 1-1-10, Amended 10-1-15.

 

59E-7.021 Definitions.

(1) through (3) No change.

(4) “ECMORB E-code” means a Supplementary Classification of External Causes of Morbidity Injury and Poisoning, ICD-10-CM ICD-9-CM, where environmental events, circumstances, and conditions are the cause of injury, poisoning, and other adverse effects as specified in the ICD-10-CM ICD-9-CM manual and the conventions of coding.

(5) through (10) No change.

PROPOSED EFFECTIVE DATE: 10-1-15

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. History–New 1-1-10, Amended 12-5-10. Formerly 59E-7.011, F.A.C., Amended 10-1-15.

 

59E-7.027 Header Record.

(1) through (3) No change.

(4) Data Type. Enter PD10-3 PD10-2 for Inpatient Data. A required field.

(5) through (16) No change.

PROPOSED EFFECTIVE DATE: 10-1-15

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Formerly 59E-7.014, F.A.C., Amended 10-1-15.

 

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

(1) through (19) No change.

(20) Principal Diagnosis Code. The code representing the diagnosis established, after study, to be chiefly responsible for occasioning the admission. Principal Prinicpal diagnosis code must contain a valid ICD-10-CM ICD-9-CM code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each hospitalization 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. A required entry. Alpha characters must be in upper case.

(21) Other Diagnosis Code (1), Other Diagnosis Code (2), Other Diagnosis Code (3), Other Diagnosis Code (4), Other Diagnosis Code (5), Other Diagnosis Code (6), Other Diagnosis Code (7), Other Diagnosis Code (8), Other Diagnosis Code (9), Other Diagnosis Code (10), Other Diagnosis Code (11), Other Diagnosis Code (12), Other Diagnosis Code (13), Other Diagnosis Code (14), Other Diagnosis Code (15), Other Diagnosis Code (16), Other Diagnosis Code (17), Other Diagnosis Code (18), Other Diagnosis Code (19), Other Diagnosis Code (20), Other Diagnosis Code (21), Other Diagnosis Code (22), Other Diagnosis Code (23), Other Diagnosis Code (24), Other Diagnosis Code (25), Other Diagnosis Code (26), Other Diagnosis Code (27), Other Diagnosis Code (28), Other Diagnosis Code (29), and Other Diagnosis Code (30). A code representing a condition that is related to the services provided during the hospitalization excluding external cause of morbidity injury codes. Report external cause of morbidity injury codes as described in paragraph (61) below. No more than thirty (30) other diagnosis codes may be reported. Less than thirty (30) entries is permitted. If an Other Diagnosis Code is reported, a valid Principal Diagnosis code must be reported. Must contain a valid ICD-10-CM ICD-9-CM code for the reporting period. An Other Diagnosis Code cannot be used more than once as a principal or other diagnosis 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.

(22) Present on Admission Indicator for Principal Diagnosis Code, Present on Admission for Other Diagnosis Code (1), Present on Admission Indicator for Other Diagnosis Code (2), Present on Admission Indicator for Other Diagnosis Code (3), Present on Admission Indicator for Other Diagnosis Code (4), Present on Admission Indicator for Other Diagnosis Code (5), Present on Admission Indicator for Other Diagnosis Code (6), Present on Admission Indicator for Other Diagnosis Code (7), Present on Admission Indicator for Other Diagnosis Code (8), Present on Admission Indicator for Other Diagnosis Code (9), Present on Admission Indicator for Other Diagnosis Code (10), Present on Admission Indicator for Other Diagnosis Code (11), Present on Admission Indicator for Other Diagnosis Code (12), Present on Admission Indicator for Other Diagnosis Code (13), Present on Admission Indicator for Other Diagnosis Code (14), Present on Admission Indicator for Other Diagnosis Code (15), Present on Admission Indicator for Other Diagnosis Code (16), Present on Admission Indicator for Other Diagnosis Code (17), Present on Admission Indicator for Other Diagnosis Code (18), Present on Admission Indicator for Other Diagnosis Code (19), Present on Admission Indicator for Other Diagnosis Code (20), Present on Admission Indicator for Other Diagnosis Code (21), Present on Admission Indicator for Other Diagnosis Code (22), Present on Admission Indicator for Other Diagnosis Code (23), Present on Admission Indicator for Other Diagnosis Code (24), Present on Admission Indicator for Other Diagnosis Code (25), Present on Admission Indicator for Other Diagnosis Code (26), Present on Admission Indicator for Other Diagnosis Code (27), Present on Admission Indicator for Other Diagnosis Code (28), Present on Admission Indicator for Other Diagnosis Code (29), Present on Admission Indicator for Other Diagnosis Code (30), Present on Admission Indicator for External Cause of Morbidity Injury Code (1), Present on Admission Indicator for External Cause of Morbidity Injury Code (2), and Present on Admission Indicator for External Cause of Morbidity Injury Code (3). A code differentiating whether the condition represented by the corresponding Principal Diagnosis Code (20), Other Diagnosis Code (21), (1) through (30), and External Cause of Morbidity Injury Code (61), (1) through (3), was present on admission or whether the condition developed after admission as determined by the physician, medical record or nature of the condition. A required entry.

(23) Principal Procedure Code. The code representing the procedure most related to the principal diagnosis. No entry is permitted consistent with the records of the reporting entity. Must contain a valid ICD-10-PCS ICD-9-CM procedure code for the reporting period. If a principal procedure date is reported, a valid principal procedure code must be reported. Alpha characters must be in upper case. 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.

(24) No change.

(25) Other Procedure Code (1), Other Procedure Code (2), Other Procedure Code (3), Other Procedure Code (4), Other Procedure Code (5), Other Procedure Code (6), Other Procedure Code (7), Other Procedure Code (8), Other Procedure Code (9), Other Procedure Code (10), Other Procedure Code (11), Other Procedure Code (12), Other Procedure Code (13), Other Procedure Code (14), Other Procedure Code (15), Other Procedure Code (16), Other Procedure Code (17), Other Procedure Code (18), Other Procedure Code (19), Other Procedure Code (20), Other Procedure Code (21), Other Procedure Code (22), Other Procedure Code (23), Other Procedure Code (24), Other Procedure Code (25), Other Procedure Code (26), Other Procedure Code (27), Other Procedure Code (28), Other Procedure Code (29) and Other Procedure Code (30). A code representing a procedure provided during the hospitalization. If a principal procedure is not reported, an Other Procedure Code must not be reported. No more than thirty (30) other procedure codes may be reported. Less than thirty (30) or no entry is permitted. Must be a valid ICD-10-PCS ICD-9-CM procedure code for the reporting period. Alpha characters must be in upper case. 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.

(26) through (59) No change.

(60) Admitting Diagnosis. The diagnosis provided by the admitting physician at the time of admission which describes the patient’s condition upon admission or purpose of admission. Must contain a valid ICD-10-CM ICD-9-CM 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. A required entry. Alpha characters must be in upper case.

(61) External Cause of Morbidity Injury Code (1), External Cause of Morbidity Injury Code (2) and External Cause of Morbidity Injury Code (3). A code representing circumstances or conditions as the cause of the injury, poisoning, or other adverse effects recorded as a diagnosis. External Cause of Morbidity Injury Code (1),  should indicate the nature of the adverse effect. External Cause of Morbidity Injury Codes (2) (3), are used for secondary to the primary code. ssign 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  morbidity injury codes may be reported. Must be a valid ICD-10-CM ICD-9-CM cause of morbidity injury code for the reporting period. An external cause of morbidity 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.

(62) through (65) No change.

PROPOSED EFFECTIVE DATE: 10-1-15

Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended 12-5-10,  Formerly 59E-7.014, F.A.C., Amended 10-1-15.

 

NAME OF PERSON ORIGINATING PROPOSED RULE: Nancy Tamariz at [phone].

NAME OF AGENCY HEAD WHO APPROVED THE PROPOSED RULE: Elizabeth Dudek

DATE PROPOSED RULE APPROVED BY AGENCY HEAD: March 18, 2015

DATE NOTICE OF PROPOSED RULE DEVELOPMENT PUBLISHED IN FAR: 04/03/2014