The agency is proposing this rule amendment to modify existing inpatient data element codes to align with recent revision in the CMS Health Insurance Claim Form (UB04). The proposed inpatient amendment will incorporate a new P7 data element to ...

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

Rule No.: RULE TITLE
59E-7.021: Definitions
59E-7.028: Inpatient Data Elements, Codes and Standards.
PURPOSE AND EFFECT: The agency is proposing this rule amendment to modify existing inpatient data element codes to align with recent revision in the CMS Health Insurance Claim Form (UB04). The proposed inpatient amendment will incorporate a new P7 data element to explicitly flag inpatient admissions from a hospital’s emergency department. 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. Nursery Level I, II, and III Charge data elements are modified to include acceptable revenue codes previously omitted in error. Additional revisions are amended for clarification and correction.
SUBJECT AREA TO BE ADDRESSED: Inpatient and Comprehensive Rehabilitative Data Collection.
SPECIFIC AUTHORITY: 408.15(8) FS.
LAW IMPLEMENTED: 408.061, 408.062 FS.
IF REQUESTED IN WRITING AND NOT DEEMED UNNECESSARY BY THE AGENCY HEAD, A RULE DEVELOPMENT WORKSHOP WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW:
TIME AND DATE: August 9, 2010, 2:00 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 [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:

59E-7.021 Definitions.

(1) through (3) No change.

(4) “E-code” means a Supplementary Classification of External Causes of Injury and Poisoning, ICD-9-CM or ICD-10-CM, 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 (10) No change.

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

Editorial note: see former rule 59E-7.011.

 

59E-7.028 Inpatient 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. The facility must maintain a key list to locate actual records upon request by AHCA. A required field.

(3) through (12) No change.

(13) Source or Point of Origin for Admission. No change.

(a) 01 – Non-health care facility point source of origin. The patient was admitted to this facility. upon an order of a physician. Includes a patient coming from home, physician office or workplace.

(b) 02 – Clinic or Physician’s Office. The patient was admitted to this facility from a clinic or physician’s office as a transfer or referral from a freestanding or non-freestanding clinic.

(c) through (e) No change.

(f) 07 – Emergency Room. The patient was admitted to this facility after receiving services in this facility’s emergency department. Excludes patients who came to the emergency room from another health care facility.

(g) through (k) renumbered (f) through (j) No change.

(4) Codes required for newborn admissions (Priority of Admission=4):

(l) through (m) renumbered (k) through (l) No change.

(14) Direct Inpatient Admission From Emergency Room. A two-character code that describes patients admitted to the inpatient facility after admission to or treatment in the facility’s emergency department. Must be reported using the two-character condition code ‘P7’. Otherwise zero fill using “00.” A required field.

(14) through (17) renumbered (15) through (18) No change.

(19)(18) Patient Discharge Status.

(a) through (h) No change.

(i) 21 – Discharged or transferred to jail.

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

(20)(19) No change.

(21)(20) Principal Diagnosis Code. Principal diagnosis code must contain a valid ICD-9-CM or ICD-10-CM code for the reporting period.

(22)(21) Other Diagnosis Code (1), Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Alpha characters must be in upper case.

(23)(22) No change.

(24)(23) Principal 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.

(25)(24) Principal Procedure Date. The principal procedure date must be less than seven (7) days four (4) days prior to the admission date and not later than the discharge date.

(26)(25) Other 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.

(27)(26) Other Procedure Code Date (1), The procedure date must be less than seven (7) days four (4) prior to the admission date and not later than the discharge date.

(27) through (29) renumbered (28) through (30) No change.

(31)(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 performed.

(32)(31) No change.

(33)(32) Other Operating or Performing Practitioner National Provider Identification (NPI). A unique ten (10) character identification number assigned to a provider who assisted the operating or performing practitioner or performed a secondary procedure who had primary responsibility for the Principal Procedure.

(34)(33) No change.

(35)(34) Nursery Level I Charges. Report charges for revenue code 170 and 171, or 179 if applicable, as used in the UB-04.

(36)(35) Nursery Level II Charges. Accommodation charges for services which include provision of ventilator services. Report charges for revenue code 172, or 179 if applicable, as used in the UB-04.

(37)(36) Nursery Level III Charges. Report charges for revenue code 173 and 174, or 179 if applicable, (Level III) as used in the UB-04.

(37) through (58) renumbered (38) through (59) No change.

(60)(59) Infant Linkage Identifier. Zero fill No entry is permitted if the patient is two (2) years of age or older. A required entry.

(61)(60) Admitting Diagnosis. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period.

(62)(61) External Cause of Injury Code (1), 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.

(62) through (64) renumbered (63) through (65) No change.

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________.

 

Editorial note: see former Rule 59E-7.014.