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 hospitals emergency department. The amendment deletes all ICD-10-CM references due to delayed national implementation and the Agencys 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.
SUMMARY: The agency is proposing amendments to Rules 59E-7.021 and 59E-7.028, F.A.C., which modifies inpatient reporting codes; delete all ICD-10 references, correct reporting of nursery 179 revenue codes, and add a new element Special Indicator Code field.
SUMMARY OF STATEMENT OF ESTIMATED REGULATORY COSTS: No Statement of Estimated Regulatory Cost was prepared.
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.
SPECIFIC 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:
DATE AND TIME: Monday September 27, 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 (850)412-3757. 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: Patrick Kennedy at (850)412-3757
THE FULL TEXT OF THE PROPOSED RULE 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 Physicians Office. The patient was admitted to this facility from a clinic or physicians 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 facilitys 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) through (17) No change.
(18) Patient Discharge Status.
(a) through (h) No change.
(i) 21 Discharged or transferred to court/law enforcement.
(i) through (p) renumbered (j) through (q) No change.
(19) No change.
(20) Principal Diagnosis Code. Principal diagnosis code must contain a valid ICD-9-CM or ICD-10-CM code for the reporting period.
(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.
(22) No change.
(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.
(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.
(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.
(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) 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 performed.
(31) No change.
(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.
(33) No change.
(34) Nursery Level I Charges. Report charges for revenue code 170 and 171, or 179 if applicable, as used in the UB-04.
(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.
(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) No change.
(59) Infant Linkage Identifier. Zero fill No entry is permitted if the patient is two (2) years of age or older. A required entry.
(60) Admitting Diagnosis. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period.
(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 (63) No change.
(64) Special Indicator Code. A two-character code that describes patients admitted to the inpatient facility after receiving treatment in the facilitys emergency department. Do not use this code for patients admitted to the hospital through the ED when the registration department is closed. Report using the two-character indicator code P7. Otherwise zero fill using 00. A required field.
(65)(64) No change.
Rulemaking Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. HistoryNew 1-1-10, Amended__________.
Editorial note: see former rule 59E-7.014.
