The agency is proposing this rule amendment to remove the ambulatory exception provision upon recommendation of the State Consumer Health Information and Policy Advisory Council. This change will require that all ambulatory facilities report ...

AGENCY FOR HEALTH CARE ADMINISTRATION
Cost Management and Control

Rule No.: RULE TITLE
59B-9.031: Definitions
59B-9.032: Ambulatory and Emergency Department Data Reporting and Audit Procedures
59B-9.034: Reporting Instructions
59B-9.038: Ambulatory Data Elements, Codes and Standards
PURPOSE AND EFFECT: The agency is proposing this rule amendment to remove the ambulatory exception provision upon recommendation of the State Consumer Health Information and Policy Advisory Council. This change will require that all ambulatory facilities report regardless of low patient volume. This amendment will also modify existing ambulatory data element codes to align with recent revision in the CMS Health Insurance Claim Form (UB04) and its electronic equivalent. The amendment deletes all ICD-10-CM references due to delayed national implementation and the Agency’s inability to receive an ICD-10-CM format. Additional revisions are amended for clarification.
SUBJECT AREA TO BE ADDRESSED: Ambulatory and Emergency Department Data Collection.
SPECIFIC AUTHORITY: 408.15(8) FS.
LAW IMPLEMENTED: 408.061, 408.062 FS.
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 [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 DEVELOPMENT AND A COPY OF THE PRELIMINARY DRAFT, IF AVAILABLE, IS: Patrick Kennedy at [phone]

THE PRELIMINARY TEXT OF THE PROPOSED RULE DEVELOPMENT IS:

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 and an Emergency Department.

(2) through (3) No change.

(4) “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 or ICD-10-CM manual and the conventions of coding.

(5) through (12) No change.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended_________.

 

Editorial note: see former Rule 59B-9.010.

 

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) through (b) No change.

(c) All Emergency Departments licensed under Section 395, F.S.;

(c) through (d) renumbered (d) through (e) No change.

(2) Each facility in paragraph (1)(a)(b) above shall submit a separate report for each location per Section 408.061(3), F.A.C.

(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 receiving 200 or more patient visits during the reporting quarter periods outlined in Rule 59B-9.033, F.A.C., are required to report data as specified in Rules 59B-9.037 and 59B-9.038, F.A.C.

(5) Ambulatory Surgical Centers (ASC) receiving fewer than 200 patient visits during the reporting quarter periods outlined in Rule 59B-9.033, F.A.C., may request an exemption from a quarters reporting requirement. To request an exemption, the ASC shall send a letter on facility letterhead stating the number of patient visits for the reporting quarter and signed by the entity’s chief executive officer or director. The exemption letter shall be received at the Agency office in Tallahassee on or prior to the deadline for submission of the quarterly report. This is not a onetime letter, but must be submitted for each quarter with fewer than 200 visits.

(4)(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.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063, 408.07, 408.08, 408.15(11) FS. History–New 1-1-10, Amended________.

 

Editorial note: see former Rule 59B-9.011.

 

59B-9.034 Reporting Instructions.

(1) Ambulatory Surgical centers shall report data for:

(a) No change.

1. through 3. No change

4. 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(11), F.A.C.

(2) Emergency Departments (ED) shall report data for: an Emergency Department Evaluation and Management Procedure code representing the patient’s acuity as part of the emergency department visit.

(a) Report all Eemergency 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) The CPT-HCPCS codes representing the services provided as part of the emergency department visit. CPT-HCPCS codes are reported in the ‘OTHER CPT-HCPCS’ fields (1-30) and are not restricted to the CPT-HCPCS reportable range defined in paragraph 59B-9.034(1)(a), F.A.C., for an ambulatory surgical center.

(c) An Emergency Department Evaluation and Management Procedure code representing the patient’s acuity as part of the emergency department visit.

(b) through (c) renumbered (d) through (e) No change.

(3) Hospitals 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 Section 408.061(3), F.S. 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(11), F.A.C.

(4) through (5) No change.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History– New 1-1-10, Amended________.

 

Editorial note: see former Rule 59B-9.015.

 

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

(1) No change.

(2) Patient Control Number. The ‘Patient Control Number’ is defined as ‘Record id’ in the schema. 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. A required field.

(3) through (9) No change.

(10) Patient Country Code. 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”. A required entry for type of service “2”.

(11) No change.

(12) Source or Point of Origin of Admission. No change.

(a) 01 – Non-health care facility point source of origin – The patient presented to this facility for outpatient services. Includes 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 or Physician’s Office. The patient presented was referred to this facility for outpatient services from a clinic or physician’s office or referenced diagnostic procedures.

(c) through (e) No change.

(f) 07 – Emergency Room. The patient received unscheduled services in this facility’s 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) through (k) renumbered (f) through (j) No change.

(14) Principal Diagnosis Code. 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 not space filled, must contain a valid ICD-9-CM diagnosis code or valid ICD-10-CM diagnosis code for the reporting period.

(15) Other Diagnosis Code. If not space filled, must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period.

(16) Evaluation and Management Code (1), Less than five entries is permitted. Ambulatory surgical centers, type of service “‘1”, should not report Evaluation and Management codes. A required field.

(17) through (39) No change.

(40) Patient Visit Ending 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) through (42) No change.

(43) Patient’s Reason for Visit ICD-CM Code (Admitting Diagnosis). The code representing the patient’s chief complaint or stated reason for seeking care in the Emergency Department. 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.

(44) Principal ICD-CM Procedure Code. 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), 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. If not space filled, must be a valid ICD-9-CM or ICD-10-CM cause of injury code for the reporting period. Alpha characters must be in upper case.

(47) No change.

(48) Patient Status.

(a) through (h) No change.

(i) 21 – Discharged or transferred to jail.

(i) through (p) renumbered (j) through (q) No change.

(49) No change.

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History– New 1-1-10, Amended________.

 

Editorial note: see former Rule 59B-9.018.