59E-7.011: Definitions
59E-7.012: Inpatient Data Reporting and Audit Procedures
59E-7.013: Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies
59E-7.014: Inpatient Data Format - Data Elements, Codes and Standards
59E-7.015: Public Records
59E-7.016: General Provisions
59E-7.020: Purpose of Inpatient Data Reporting
59E-7.021: Definitions
59E-7.022: Inpatient Data Reporting and Audit Procedures.
59E-7.023: Schedule for Submission of Inpatient Data and Extensions.
59E-7.024: Reporting Instructions.
59E-7.025: Certification, Audits and Resubmission Procedures.
59E-7.026: Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.
59E-7.027: Header Record.
59E-7.028: Inpatient Data Elements, Codes and Standards.
59E-7.029: Public Records.
59E-7.030: General Provisions.
59E-7.201: Submission of Comprehensive Inpatient Rehabilitation Hospital Patient Data
59E-7.202: Schedule for Submission of Patient Data and Extensions
59E-7.203: Reporting Instructions
59E-7.204: Certification Procedures
59E-7.205: Patient Data Format - Data Elements and Codes
59E-7.206: Patient Data Format - Record Layout
59E-7.207: Data Standards
59E-7.208: Notice of Potential Future Additional Data Requirements
PURPOSE AND EFFECT: The new rules alighn inpatient data reporting standards with the uniform bill for institutional facilities (UB-04), modify inpatient data elements and codes, definition of resubmission requirements and other clarifications, and incoporate collection of rehabilitative discharges.
SUMMARY: The agency is proposing amendments to Rules 59E-7.011 through 59E-7.016, F.A.C.and 59E-7.201 through 59E-7.208, F.A.C., that modify inpatient data and comprehensive rehabilitation
reporting requirements.
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 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: January 23, 2009, 10:00 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: Patrick Kennedy at (850) 922-5531. 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) 922-5531.
THE FULL TEXT OF THE PROPOSED RULE IS:
CHAPTER 59E-7 INPATIENT AND COMPREHENSIVE REHABILITATIVE DATA COLLECTION
59E-7.020 Purpose of Inpatient Data Reporting.
The reporting of inpatient patient data will provide a statewide integrated database that includes acute care hospitals, psychiatric hospitals, rehabilitation hospitals and long term care hospital services for the assessment of variations in utilization, disease surveillance, access to care and cost trends. The amendments appearing herein are effective with the reporting period starting January 1, 2010.
Specific Authority 408.15(8) FS. Law Implemented 408.061 FS.
59E-7.021 Definitions.
As used in Rules 59E-7.021 through 59E-7.030:
(1) Acute Care means inpatient general routine care provided to patients who are in an acute phase of illness, which includes the concentrated and continuous observation and care provided in the intensive care units of an institution.
(2) Charity means medical care provided by a healthcare entity to a person who has insufficient resources or assets to pay for the medical care without utilizing resources which are required to meet the persons basic need for food, shelter, and clothing. No patient shall be considered charity care whose family income, as applicable for (12) months preceding the determination, exceeds 200 percent of the federal poverty guidelines, unless the amount of health care charges due from the patient exceeds 25 percent of annual family income. However, in no case shall the hospital charges for a patient whose family income exceeds four times the federal poverty level for a family of four be considered charity. This information should be provided based on the patients status at time of reporting.
(3) Comprehensive Rehabilitation means services provided in a Specialty Rehabilitation Hospital licensed under Chapter 395, F.S. and services provided in a hospital rehabilitation distinct part unit.
(4) Discharge means an inpatient who is formally released from the care of the hospital; or is transferred within the hospital from one type of care to another type of care; or is transferred to another location for care unless the patient is returned the same day; or leaves the hospital against medical advice without a physicians order; or is a psychiatric patient who is discharged as away without leave (AWOL or elopement); or has died.
(5) Distinct Part Unit means a unique unit or level of care at a hospital requiring the issuance of a separate claim to a payer.
(6) E-code means a Supplementary Classification of External Causes of Injury and Poisoning, ICD-9-CM, where environmental events, circumstances, and conditions are the cause of injury, poisoning, and other adverse effects as specified in the ICD-9-CM manual and the conventions of coding.
(7) "Executive Officer" means a reporting facility's chief executive officer, president or any vice president of the facility in charge of a principal business unit, division or function (administration or finance).
(8) Inpatient means a patient who has an admission order given by a licensed physician or other individual who has been granted admitting privileges by the hospital. Observation patients are excluded.
(9) Newborn means a baby born within the facility or the initial admission of an infant to any acute care facility within 24 hours of birth.
(10) NPI means National Provider Identification. An NPI is a unique identification number assigned to a provider by the Centers for Medicare & Medicaid Services.
(11) NUBC means National Uniform Billing Committee. A national body that defines the data elements that are reported on the Uniform Bill UB-04 and annually publishes an Official UB-04 Data Specifications Manual.
(12) ISO 3166- The International Standard for Organization is a standardized list of country names and codes first published in 1974 and updated 2008. ISO 3166 is available at: http://www.iso.org/iso/english_country_names_and_code_elements.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew
Editorial note: see former rule 59E-7.011.
59E-7.022 Inpatient Data Reporting and Audit Procedures.
(1) Hospitals licensed under Chapter 395, F.S., except state-operated hospitals, in operation for all or any of the reporting periods described in subsection 59E-7.023(1), F.A.C., below, shall submit hospital inpatient discharge data to the Agency according to the provisions in Rules 59E-7.021 through 59E-7.029, F.A.C. The amendments appearing herein are effective with the report period starting January 1, 2010.
(2) Each hospital shall submit a separate report for each location per paragraph 59A-3.066(2)(i), F.A.C.
(3) All acute, intensive care, short term and long term psychiatric, and comprehensive rehabilitation live discharges and deaths, including newborn live discharges and deaths, shall be reported. Submit one record per inpatient discharge, to include all newborn admissions, transfers and deaths. Patients receiving rehabilitation services while in the acute care setting (not discharged or transferred to a distinct part unit) are included in the inpatient record service type 1.
(4) Upon notification by the AHCA Agency staff, all hospitals shall provide access to all required information from the medical records and billing documents underlying and documenting the hospital inpatient discharge reports submitted, as well as other inpatient related documentation deemed necessary to conduct complete inpatient data audits of hospital data, subject to the limitations as set forth in Section 408.061(1)(d), F.S. No inpatient discharge records that support inpatient discharge data are exempt from disclosure to AHCA for audit purposes.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1), (2), 408.15(11) FS. HistoryNew
Editorial note: see former rule 59E-7.012.
59E-7.023 Schedule for Submission of Inpatient Data and Extensions.
(1) All hospitals reporting their inpatient discharge data shall report according to the following schedule commencing with 1st quarter data 2010.
(a) Each report submitted for the 1st quarter covering inpatient discharges occurring between January 1 and March 31, inclusive, of each year, shall be submitted no later than June 1 of the calendar year during which the discharge occurred. This is considered to be the first quarter, regardless of the hospitals fiscal year. First quarter reports must be certified by August 31 of the same calendar year.
(b) Each report submitted for the 2nd quarter covering inpatient discharges occurring between April 1 and June 30, inclusive, of each year, shall be submitted no later than September 1 of the calendar year during which the discharge occurred. This is considered to be the second quarter, regardless of the hospitals fiscal year. Second quarter reports must be certified by November 30 of the same calendar year.
(c) Each report submitted for the 3rd quarter covering inpatient discharges occurring between July 1 and September 30, inclusive, of each year, shall be submitted no later than December 1 of the calendar year during which the discharge occurred. This is considered to be the third quarter, regardless of the hospitals fiscal year. Third quarter reports must be certified by February 28 of the following calendar year.
(d) Each report submitted for the 4th quarter covering inpatient discharges occurring between October 1 and December 31, inclusive, of each year, shall be submitted no later than March 1 of the calendar year following the year in which the discharge occurred. This is considered to be the fourth quarter, regardless of the hospitals fiscal year. Fourth quarter reports must be certified by May 31 of the next calendar year.
(2) Extensions to the due dates in subsection 59E-7.023(1), F.A.C. will be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee for a maximum of 30 days from the initial submission due date in response to a written request signed by the hospitals chief executive officer or chief financial officer or authorized executive officer designee. The request must be received prior to the initial submission due date and the delay must be due to unforeseen factors beyond the control of the reporting hospital. These factors must be specified in the written request for the extension along with documentation of efforts undertaken to meet the filing requirements. Extensions shall not be granted verbally.
(3) Failure to file the report on or before the initial submission due date as specified in 59E-7.023(1)(a-d), F.A.C., without an extension, and failure to correct a report which has been filed but contains errors or deficiencies by the certification deadline is punishable by fine pursuant to Rule 59E-7.026, F.A.C. The Agency shall send notification of errors or deficiencies by certified mail, electronic mail, or fax. Rejected reports must be corrected, resubmitted and certified by the certification due date.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1)(2), 408.15(11) FS. HistoryNew
Editorial note: see former rule 59E-7.012.
59E-7.024 Reporting Instructions.
(1) Beginning with the inpatient data report for the 1st quarter of the year 2010, reporting facilities shall submit a zipped inpatient discharge data file by Internet according to the specifications in paragraphs (a) through (c) below unless reporting by CD-ROM is approved by the Agency in the case of extraordinary or hardship circumstances.
(a) The Internet address for the receipt of inpatient data is https://ahcaxnet.fdhc.state.fl.us/patientdata.
(b) 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/inppoa.xsd. The Inpatient Data XML Schema is incorporated by reference.
(c) The data in the XML file shall contain the data elements, codes and standards required in Rules 59E-7.027, 59E-7.028, and 59E-7.030 , F.A.C.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1)(2), 408.15(11) FS. HistoryNew
Editorial note: see former rule 59E-7.012.
59E-7.025 Certification, Audits and Resubmission Procedures.
(1) All hospitals submitting data in compliance with Rules 59E-7.021 through 59E-7.030, F.A.C., shall certify that the data submitted for each quarter is accurate, complete and verifiable using Certification Form for Inpatient Discharge Data, AHCA Form 4200-002, dated 10/93 and incorporated by reference. The completed Certification Form for Inpatient Discharge Data shall be submitted to the Agency for Health Care Administration, 2727 Mahan Drive, MS #16, Tallahassee, Florida 32308. Attention: Florida Center for Health Information and Policy Analysis or by facsimile to the Agencys office, or a scanned certification submitted by electronic mail.
(2) Hospitals whose data is not certified within five (5) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59E-7.026, F.A.C. Extensions to this five (5) month period may be granted by the Agency Administrator, Office of Data Collection and Quality Assurance Unit or the Agency designee for a maximum of 30 days following the certification due date in response to a written request signed by the hospitals chief executive officer, chief financial officer, or authorized executive officer designee. A facility will not be penalized for delays caused by AHCA which is documented by the reporting facility to include on-line reporting system downtime or delays in receipt of reports from AHCA.
(3) Changes or corrections to certified hospital data will be accepted from hospitals to improve their data quality for a period of eighteen (18) months following the initial submission due date. The Administrator, Office of Data Collection and Quality Assurance, or Agency designee, may grant approval for resubmitting previously certified data in response to a written request signed by the hospitals chief executive officer or chief financial officer, or authorized executive officer designee. The written request must specify the reason for the corrections or changes, explain the cause contributing to the inaccurate reporting, describe a corrective action plan to prevent future errors, the total number of records affected by quarters and years, the data type and the date that the replacement file will be submitted to the Agency. Any changes to a hospitals data after this eighteen-month period shall be subject to penalties pursuant to Rule 59E-7.026, F.A.C. Resubmissons of previously certified data must be certified within thirty (30) days following receipt of the data file from the facility.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1)(2), 408.15(11) FS. HistoryNew
Editorial note: see former rule 59E-7.012.
59E-7.026 Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.
(1) For purposes of this rule, a report or other information is incomplete when it does not contain all data required by the Agency in this rule and in forms incorporated by reference or when it contains inaccurate data. The Agency shall to the extent practical, apply the same audit standards and use the same audit procedures for all hospitals or audit a random sample of hospitals. The Agency will notify each hospital of any possible errors discovered by audit and request that the hospital either correct the data or verify that the data is complete and correct. A report or other information is false if done or made with the knowledge of the preparer or an administrator that it contains information or data which is not true or accurate.
(2) A hospital which refuses to file, fails to timely file, or files false or incomplete reports or other information required to be filed under the provisions of Section 408.08, F.S., other Florida Law, or rules adopted thereunder, shall be subject to administrative fines. Failure to comply with reporting requirements will also result in the referral of a hospital to the Agencys Bureau of Health Facility Regulation.
(3) Notifications will be sent to reporting facilities who do not submit their data file by the initial due date as specified in 59E-7.023 F.A.C.
(4) The penalty period will begin on the first calendar day following the initial due date and the first calendar day following the certification due date for purposes of penalty assessments.
(5) Any hospital which is delinquent for a certification deadline as specified in 59E-7.023 F.A.C., shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1,000 per day of violation for the third and all subsequent violations. Violations will be considered those activities which necessitate the issuance of an administrative complaint by the Agency unless the administrative complaint is withdrawn or final order dismissing the administrative complaint is entered. All fines are to be fixed, imposed, and collected by the Agency. Any hospital which files false information to the Agency shall be subject to a fine of $1,000 per day, in addition to any other fine imposed hereunder. The fine shall be fixed, imposed and collected by the Agency.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.08(2)(3)(4)(5) FS. HistoryNew
Editorial note: see former rule 59E-7.013.
59E-7.027 Header Record.
The first record in the data file shall be a header record containing the information described below.
(1) Transaction Code. Enter Q for a calendar quarter report. A required field.
(2) Report Year. Enter the year of the data in the format YYYY where YYYY represents the year in four (4) digits. A required field.
(3) Report Quarter. Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year. A required field.
(4) Data Type. Enter PD10-2 for Inpatient Data. A required field.
(5) Submission Type. Enter I or R where I indicates an initial submission of a data file or resubmission of a data file prior to certification, R indicates a replacement submission of previously certified inpatient data where resubmission has been requested or authorized by the Agency. A required field.
(6) Processing Date. Enter the date that the data file was created in the format YYYY-MM-DD where MM represents 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. A required field.
(7) AHCA Hospital Number. Enter the identification number of the 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.
(8) Medicare Number. Enter the Medicare number of the facility as assigned by Centers for Medicare & Medicaid Services (CMS). A valid identification number must contain seven (7) numeric digits. A required field.
(9) Organization Name. Enter the name of the hospital from which the patient was discharged, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty-character field. A required field.
(10) Contact Person Name. Enter the name of the contact person for the hospital. Submit name in the Last, First format. Up to a twenty-five-character field. A required field.
(11) Contact Phone Number. The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact persons telephone number in the numeric format (AAA)XXXXXXXEEEE where AAA is the area code, XXXXXXX represents the seven (7) digit phone number and EEEE represents the extension. Zero fill if no extension. A required field.
(12) Contact Person E-Mail Address. Enter the e-mail address of the contact person.
(13) Contact Person Street or P.O. Box Address. Enter the street or post office box address of the contact persons mailing address. Up to a forty-character field. A required field.
(14) Mailing Address City. Enter the city of the contact persons address. Up to a twenty-five character field. A required field.
(15) Mailing Address State. Enter the state of the contact persons address using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for
(16) Mailing Address Zip Code. Enter the numeric zip code of the contact persons address in the format XXXXX-XXXX.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew
Editorial note: see former rule 59E-7.014.
59E-7.028 Inpatient Data Elements, Codes and Standards.
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 described in the National Uniform Billing Committee Official UB-04 Data Specifications Manual and as stipulated by the Agency.
(1) AHCA Hospital Number. Enter the identification number of the 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) Patient Control Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate retrieval of the individuals account of services (accounts receivable) containing the financial billing records and any postings of payment. Up to twenty four (24) characters. Duplicate patient control numbers are not permitted. A required field. The hospital must maintain a key list to locate actual records upon request by AHCA.
(3) Medical or Health Record Number. An alpha-numeric code assigned to the patients medical or health record by the facility. The medical or health record number references a file that contains the history of treatment. It should not be substituted for the Patient Control Number. Up to twenty four (24) characters. A required field.
(4) Patient Social Security Number. The social security number (SSN) of the patient. The SSN is a nine (9) digit number issued by the Social Security Administration used to facilitate retrieval of individual case records, track multiple patient discharges and for medical research. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful or the patient is under two (2) years of age and does not have a SSN or for patients who are non-U.S. citizens who have not been issued SSNs. A required entry.
(5) Patient Ethnicity. Self-designated by the patient or patients parent or guardian. Use Unknown where efforts to obtain the information from the patient or from the patients parent or guardian have been unsuccessful. The patients ethnic background shall be reported as one choice from the following list of alternatives. A required entry. Must be a two (2) digit code as follows:
a. E1 = Hispanic or Latino. A person of Mexican, Puerto Rican, Cuban, Central or South
American or other Spanish culture or origin, regardless of race.
b. E2 = Non-Hispanic or Latino. A person not of any Spanish culture or origin.
c. E7 = Unknown.
(6) Patient Race. Self-designated by the patient, patients parent or guardian. Use Unknown where efforts to obtain the information from the patient or from the patients parent or guardian have been unsuccessful. The patients 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 who maintains cultural identification through tribal affiliation or community recognition.
(b) 2 Asian. A person having origins in any of the original peoples of the Far East, Southeast Asia, or the Indian subcontinent. This area includes, for example,
(c) 3 Black or African American. A person having origins in any of the black racial groups of Africa.
(d) 4 Native Hawaiian or other Pacific Islander. A person having origins in any of the original peoples of Hawaii, Guam, Samoa, or other Pacific Islands.
(e) 5 White. A person having origins in any of the original peoples of Europe, North Africa, or the Middle East.
(f) 6 Other. Any other possible options not covered in the above categories, including a patient who has more than one race.
(g) 7 Unknown. Use if the patient refuses or fails to disclose.
(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 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) Patient Sex. The patient sex at the time of admission. A required entry. Must be a one (1) alpha character in upper case as follows:
1. M Male
2. F Female
3. U Unknown Use where efforts to obtain the information have been unsuccessful or where the patients sex cannot be determined due to a medical condition.
(9) Patient Zip Code. The numeric five (5) digit United States Postal Service ZIP Code of the patients 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.
(11) Type of Service Code. A code designating the type of discharges, either acute inpatient and psychiatric, or comprehensive rehabilitation. A required entry. Must be a one digit code as follows:
(a) 1 Inpatient, as described in paragraph 59E-7.022(1), F.A.C.
(b) 2 Comprehensive Rehabilitation, as described in paragraph 59E-7.021(3), F.A.C.
(12) Priority of Admission. The scheduling priority of the initial admission. A required entry. Must be a one (1) digit code as follows:
(a) 1 Emergency. The patient requires immediate medical intervention as a result of severe, life-threatening or potentially disabling conditions.
(b) 2 Urgent. The patient requires attention for the care and treatment of a physical or mental disorder.
(c) 3 Elective. The patients condition permits adequate time to schedule the services.
(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. Use of this code requires the use of a special Point of Origin for Admission code.
(e) 5 Trauma. Visit to a State of Florida designated hospital trauma center.
(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 through 13 are to be used only for newborn admissions. A required entry. Alpha characters must use upper case.
(a) 01- Non-health care facility 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. The patient was admitted to this facility as a transfer or referral from a freestanding or non-freestanding clinic.
(c) 04 Transfer from a hospital. The patient was admitted to this facility as a transfer from an acute care facility where the patient was an inpatient. Transfer must be from a different hospital. Excludes transfers from hospital inpatients in the same facility.
(d) 05 Transfer from a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF). The patient was admitted to this facility from a SNF or ICF where the patient was a resident.
(e) 06 Transfer from another health care facility. The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list.
(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) 08 Court/Law Enforcement. The patient was admitted upon the direction of a court of law, or upon the request of a law enforcement Agency representative. Includes transfers from incarceration facilities.
(h) 09 Information Not Available. The means by which the patient was admitted to this hospital is not known.
(i) D - Transfer from one distinct unit of the hospital to another distinct unit of the same hospital resulting in a separate claim. The patient was admitted to this facility as a transfer from hospital inpatient within this hospital resulting in a separate claim to the payer. For purposes of this code, Distinct Unit is defined as a unique unit or level of care at the hospital requiring the issuance of a separate claim to the payer.
(j) E Transfer from an
(k) F Transfer from a hospice facility and under a hospice plan of care or enrolled in a hospice program.
Codes required for newborn admissions (Priority of Admission=4):
(l) 10 Born inside this hospital.
(m) 13 Born outside this hospital.
(14) Admission Date. The date the patient was admitted to the initial reporting facility. 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. Admission date must equal or precede the discharge date. A required entry.
(15) Inpatient Admission Time. The hour on a 24-hour clock during which the patients initial inpatient admission to the hospital occurred. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
AM HOURS
1. 00 12:00 midnight to 12:59:59
2. 01 01:00 to 01:59:59
3. 02 02:00 to 02:59:59
4. 03 03:00 to 03:59:59
5. 04 04:00 to 04:59:59
6. 05 05:00 to 05:59:59
7. 06 06:00 to 06:59:59
8. 07 07:00 to 07:59:59
9. 08 08:00 to 08:59:59
10. 09 09:00 to 09:59:59
11. 10 10:00 to 10:59:59
12. 11 11:00 to 11:59:59
PM HOURS
13. 12 12:00 noon to 12:59:59
14. 13 01:00 to 01:59:59
15. 14 02:00 to 02:59:59
16. 15 03:00 to 03:59:59
17. 16 04:00 to 04:59:59
18. 17 05:00 to 05:59:59
19. 18 06:00 to 06:59:59
20. 19 07:00 to 07:59:59
21. 20 08:00 to 08:59:59
22. 21 09:00 to 09:59:59
23. 22 10:00 to 10:59:59
24. 23 11:00 to 11:59:59
25. 99 Unknown
(16) Discharge Date. The date the patient was discharged from the reporting facility. 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. Discharge date must equal or follow the admission date, and discharge date must occur within the reporting period as shown on the header record. A required entry.
(17) Discharge Time. The hour on a 24-hour clock in which the patient was discharged from the discharging hospital. A required entry. Use 99 where efforts to obtain the information have been unsuccessful. Must be two digits as follows:
1. 00 12:00 midnight to 12:59:59
2. 01 01:00 to 01:59:59
3. 02 02:00 to 02:59:59
4. 03 03:00 to 03:59:59
5. 04 04:00 to 04:59:59
6. 05 05:00 to 05:59:59
7. 06 06:00 to 06:59:59
8. 07 07:00 to 07:59:59
9. 08 08:00 to 08:59:59
10. 09 09:00 to 09:59:59
11. 10 10:00 to 10:59:59
12. 11 11:00 to 11:59:59
PM HOURS
13. 12 12:00 noon to 12:59:59
14. 13 01:00 to 01:59:59
15. 14 02:00 to 02:59:59
16. 15 03:00 to 03:59:59
17. 16 04:00 to 04:59:59
18. 17 05:00 to 05:59:59
19. 18 06:00 to 06:59:59
20. 19 07:00 to 07:59:59
21. 20 08:00 to 08:59:59
22. 21 09:00 to 09:59:59
23. 22 10:00 to 10:59:59
24. 23 11:00 to 11:59:59
25. 99 Unknown
(18) Patient Discharge Status. Patient disposition at discharge. A required entry. Must be a two (2) digit code as follows:
(a) 01 Discharged to home or self-care (routine discharge).
(b) 02 Discharged or transferred to a short-term general hospital for inpatient care.
(c) 03 Discharged or transferred to a skilled nursing facility with Medicare certification in anticipation of skilled care.
(d) 04 Discharged or transferred to an intermediate care facility.
(e) 05 Discharged or transferred to a designated cancer center or Childrens Hospital.
(f) 06 Discharged or transferred to home under care of home health care organization service in anticipation of skilled care.
(g) 07 Left the hospital against medical advice (AMA) or discontinued care.
(h)20 Expired.
(i) 50 Hospice-Home.
(j) 51 Hospice Medical Facility (Certified) providing hospice level of care.
(k) 62 Discharged or transferred to an Inpatient Rehabilitation Facility (IRF) including rehabilitation distinct part units of a hospital.
(l) 63 Discharged or transferred to a Medicare certified long term care hospital.
(m) 64 Discharged or transferred to a Nursing Facility certified under Medicaid but not certified under Medicare.
(n) 65 Discharged or transferred to a psychiatric hospital including psychiatric distinct part units of a hospital.
(o) 66 Discharged or transferred to a Critical Access hospital.
(p) 70 Discharged or transferred to another type of health care institution non defined elsewhere in this code list.
(19) Principal Payer Code. Describes the expected primary source of reimbursement for services rendered based on the patients 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) A Medicare. Patients covered by Medicare where Centers for Medicare & Medicaid Services is the direct payer.
(b) B Medicare Managed Care. Patients covered by Medicare Advantage plans, Medicare HMO, Medicare PPO, Medicare Private Fee for Service or any other type of Medicare plan where Centers for Medicare & Medicaid Services is not the direct payer.
(c) C Medicaid. Patients covered by state administered Florida Medicaid where the payment is directly from the State of Florida Medicaid program.
(d) D Medicaid Managed Care. Patients covered by Medicaid funded capitated plans. This would include any program where the patient is enrolled in the Medicaid program but the payment is not directly from the state of Florida Medicaid program. This designation is to be used regardless of whether the hospital has a contract with that plan.
(e) E Commercial Health Insurance. Patients covered by any type of private coverage, including HMO, PPO, self-insured plans.
(f) F Commercial Liability Coverage. Patients whose health care is covered under a liability policy, such as automobile, homeowners or general business.
(g) H Workers Compensation. Patients covered by any type of workers compensation plan, including self insured plans, managed care plans or the State of Florida sponsored workers compensation plan.
(h) I TriCare or Other Federal Government. Patients covered by any federal government program for active and retired military and their families, Black Lung, Section 1011, the Federal Prison System, or any other federal program.
(i) J VA. Patients covered by the Veterans Administration.
(j) K Other State/Local Government. Patients covered by a state program that does not fall into any of the 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) L Self Pay. Patients with no insurance coverage.
(l) M Other. This would include patients covered by any other type of payer not meeting the descriptions in a-k above or m-n below.
(m) N Charity. Include charity that is known at the time of discharge.
(n) O KidCare. Includes Healthy Kids, MediKids and Childrens Medical Services.
(20) Principal Diagnosis Code. The code representing the diagnosis established, after study, to be chiefly responsible for occasioning the admission. Prinicpal diagnosis code must contain a valid ICD-9-CM or ICD-10-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 injury codes. Report external cause of 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-9-CM code or valid ICD-10-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 Injury Code (1), Present on Admission Indicator for External Cause of Injury Code (2), and Present on Admission Indicator for External Cause of 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 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. Present on Admission Indicator must be a one (1) character alpha-numeric upper case code as follows:
1. Y Yes. Present at the time that the order for inpatient admission occurs.
2. N No. Not present at the time that the order for inpatient admission occurs.
3. U Unknown. Documentation is insufficient to determine if condition is present on admission.
4. W Clinically Undetermined. Provider is unable to clinically determine whether condition was present on admission or not.
5. 1 Exempt. A condition that is included on the current Centers for Medicare & Medicaid Services ICD-CM Exempt from Reporting list.
(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-9-CM or ICD-10-CM procedure code for the reporting period. If a principal procedure date is reported, a valid principal procedure code must be 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.
(24) Principal Procedure Date. The date when the principal procedure was performed. If a principal procedure is reported, a principal procedure date must be reported. No entry is permitted if no principal procedure is reported. 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. The principal procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.
(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-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), Other Procedure Code Date (2), Other Procedure Code Date (3), Other Procedure Code Date (4), Other Procedure Code Date (5), Other Procedure Code Date (6), Other Procedure Code Date (7), Other Procedure Code Date (8), Other Procedure Code Date (9), Other Procedure Code Date (10), Other Procedure Code Date (11), Other Procedure Code Date (12), Other Procedure Code Date (13), Other Procedure Code Date (14), Other Procedure Code Date (15), Other Procedure Code Date (16), Other Procedure Code Date (17), Other Procedure Code Date (18), Other Procedure Code Date (19), Other Procedure Code Date (20), Other Procedure Code Date (21), Other Procedure Code Date (22), Other Procedure Code Date (23), Other Procedure Code Date (24), Other Procedure Code Date (25), Other Procedure Code Date (26), Other Procedure Code Date (27), Other Procedure Code Date (28), Other Procedure Code Date (29) and Other Procedure Code Date (30). The date when the procedure was performed. A required entry if a corresponding procedure code (26), (1) through (30) is reported. 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. The procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.
(27) Attending Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who had primary responsibility for the patients medical care and treatment or who certified as to the medical necessity of the services rendered. For military physicians not licensed in Florida, use US999999999. An alpha-numeric field of up to eleven characters. A required entry. Alpha characters must be in upper case.
(28) Attending Practitioner National Provider Identification (NPI). An unique ten (10) character identification number assigned to a provider. A required entry for providers in the US or its territories and providers not in the US or its territories upon mandated HIPAA NPI implementation date.
(29) Operating or Performing Practitioner Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who had primary responsibility for the principal procedure performed. The operating or performing practitioner may be the attending practitioner. For military physicians not licensed in Florida, use US999999999. No entry is permitted if no principal procedure is reported. Alpha characters must be in upper case.
(30) Operating or Performing Pracitioner 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. No entry is permitted if no principal procedure is reported.
(31) Other Operating or Performing Practitioner Identification Number. The Florida license number of a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor or advanced registered nurse practitioner who assisted the operating or performing practitioner or performed a secondary procedure. The other operating or performing practitioner must not be reported as the operating or performing practitioner. The other operating or performing practitioner may be the attending practitioner. For military physicians not licensed in Florida, use US999999999. No entry is permitted consistent with the records of the reporting entity.
(32) Room and Board Charges. Routine service charges incurred for accommodations. Report charges for revenue codes 11X through 16X 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 Room and Board Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(33) Nursery Level I Charges. Accommodation charges for well-baby care services which include sub-ventilation care, intravenous feedings and gavage to neonates. Report charges for revenue code 170 and 171, 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 Nursery Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(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 Nursery Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(35) Nursery Level III Charges. Accommodation charges for services which include the provision of continous 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) Intensive Care Charges. Routine service charges for medical or surgical care provided to patients who require a more intensive level of care than is rendered in the general medical or surgical unit. Exclude neonatal intensive care charges reported as a Level III Nursery Charge. Report charges for revenue code 20X 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 intensive care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(37) Coronary Care Charges. Routine service charges for medical care provided to patients with coronary illness who require a more intensive level of care than is rendered in the general medical unit. Report charges for revenue code 21X 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 coronary care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(38) Pharmacy Charges. Charges for medication. Report charges for revenue codes 25X and 63X 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 pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(39) Medical and Surgical Supply Charges. Charges for supply items required for patient care. Report charges for revenue codes 27X and 62X 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 medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(40) Laboratory Charges. Charges for the performance of diagnostic and routine clinical laboratory tests and for diagnostic and routine tests in tissues and culture. Report charges for revenue codes 30X and 31X 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 laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(41) Radiology or Other Imaging Charges. Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances. Report charges for revenue codes 32X through 35X, 40X and 61X 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 radiology or other imaging charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(42) Cardiology Charges. Facility charges for cardiac procedures rendered such as, but not limited to, heart catheterization or coronary angiography. Report charges for revenue code 48X 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 cardiology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(43) Respiratory Services or Pulmonary Function Charges. Charges for administration of oxygen, other inhalation services, and tests that evaluate the patients respiratory capacities. Report charges for revenue codes 41X and 46X 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 respiratory service or pulmonary function charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(44) Operating Room Charges. Charges for the use of the operating room. Report charges for revenue code 36X 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 operating room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(45) Anesthesia Charges. Charges for anesthesia services by the facility. Report charges for revenue code 37X 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 anesthesia charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(46) Recovery Room Charges. Charges for the use of the recovery room. Report charges for revenue code 71X 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 recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(47) Labor Room Charges. Charges for labor and delivery room services. Report charges for revenue code 72X 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 labor room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(48) Emergency Room Charges. Charges for medical examinations and emergency treatment. Report charges for revenue code 45X 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 emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(49) Trauma Response Charges. Charges for a trauma team activation at a State of Florida licensed trauma center. Report charges for revenue code 68X 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 trauma response charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(50) Treatment or Observation Room Charges. Charges for use of a treatment room or for the room charge associated with observation services. Report charges for revenue code 76X 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 treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(51) Behavioral Health Charges. Charges for behavioral health treatment and services. Report charges for revenue codes 90X though 91X and 100X 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 charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(52) Oncology. Charges for treatment of tumors and related diseases. Excludes therapeutic radiology services reported in radiology and other imaging services in paragraph (42). Report charges for revenue code 28X 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 oncology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(53) Physical Therapy Charges. Charges for physical therapy in revenue codes 42X 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 charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(54) Occupational Therapy Charges. Charges for occupational therapy for revenue code 43X 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 charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(55) Speech Therapy or Language Pathology Charges. Charges for speech therapy or language pathology therapy for revenue code 44X 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 charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(56) Other Charges. Other facility charges not included in paragraphs (33) to (56) above. Include charges that are not reflected in any of the preceding specific revenue accounts in the UB-04. DO NOT include charges from revenue codes 96X, 97X, 98X, or 99X in the UB-04 for professional fees and personal convenience items. Report in dollars rounded to the nearest whole dollar, without dollar signs or commas, excluding cents. Report zero (0) if there are no other charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(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 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.
(58) Infant Linkage Identifier. The social security number of the patients 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 mothers SSN is acceptable for those patients where efforts to obtain the mothers 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 mothers 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.
(59) Admitting Diagnosis. The diagnosis provided by the admitting physician at the time of admission which describes the patients condition upon admission or purpose of admission. Must contain a valid ICD-9-CM code or valid ICD-10-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.
(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 appropiate E-codes for all initial encounters or treatments, but not for subsequent occurances. A Place of Occurance E-code (E849.X) should be included to describe where the event occurred. 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) Emergency Date of Arrival. The date the patient registered in the Emergency Department if the visit results in an inpatient admission to the reporting facility. 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. Admission date must equal or precede the discharge date. Use 0000-00-00 for patients not admitted through the Emergency Department. A required entry.
(62) Emergency Department Hour of Arrival. The hour on a 24-hour clock during which the patients registration in the emergency department occurred. A required entry. Use 99 where the patient was not admitted through the emergency department or where efforts to obtain the information have been unsuccessful. Must be two (2) digits as follows:
AM HOURS
1. 00 12:00 midnight to 12:59:59
2. 01 01:00 to 01:59:59
3. 02 02:00 to 02:59:59
4. 03 03:00 to 03:59:59
5. 04 04:00 to 04:59:59
6. 05 05:00 to 05:59:59
7. 06 06:00 to 06:59:59
8. 07 07:00 to 07:59:59
9. 08 08:00 to 08:59:59
10. 09 09:00 to 09:59:59
11. 10 10:00 to 10:59:59
12. 11 11:00 to 11:59:59
PM HOURS
13. 12 12:00 noon to 12:59:59
14. 13 01:00 to 01:59:59
15. 14 02:00 to 02:59:59
16. 15 03:00 to 03:59:59
17. 16 04:00 to 04:59:59
18. 17 05:00 to 05:59:59
19. 18 06:00 to 06:59:59
20. 19 07:00 to 07:59:59
21. 20 08:00 to 08:59:59
22. 21 09:00 to 09:59:59
23. 22 10:00 to 10:59:59
24. 23 11:00 to 11:59:59
25. 99 Unknown.
(63) TRAILER RECORD. The last record in the data file shall be a trailer record and must accompany each data set. Report only the total number of patient data records contained in the file, excluding header and trailer records. The number entered must equal the number of records processed. Do not include leading zeros.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew
Editorial note: see former rule 59E-7.014.
59E-7.029 Public Records.
(1) Agency records, public records under Chapter 119, F.S. (Floridas Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying.
(2) Patient-specific records collected by the Agency pursuant to Rules 59E-7.021-7.030, F.A.C., are exempt from disclosure pursuant to Section 408.061(8), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).
(a) The patient-specific record shall be modified to protect patient confidentiality as follows:
1. Patient Control Number as assigned by the facility. Substitute sequential number.
2. Patient Social Security Number. Deleted. Indicators of readmission at any
3. Patient Birth Date. Substitute age in years and an indicator of Age < 29 Days except for persons 100 and older, substitute age > 100 years.
4. Admission Date. Substitute quarters 1-4. (admit month cannot be substituted)
5. Discharge Date. Length of Stay (LOS) will be substituted. (discharge month cannot be substituted)
6. Principal Procedure Date. Days from admission to Principal Procedure will be substituted.
7. Other Procedure Date. Days from admission to Other Procedure will be substituted.
8. Infant Linkage ID. Deleted.
9. Medical or Health Record Number. Substitute sequential number.
10. ED Date of Arrival. Boarding time (BT) will be substituted.
(b) A record linkage number shall be assigned which does not identify an individual patient and cannot reasonably be used to identify an individual patient through use of data available through the Agency for Health Care Administration, but which can be used for confidential data output for bona fide research purposes.
(c) The modified data records described in paragraph (2)(a) shall be released as a set of all records occurring in one calendar quarter based on date of discharge.
(d) The modified data described in paragraph (2)(a) shall be released in accordance with the Limited Data Set requirements of the federal Health Insurance Portability and Accountability Act and shall be made available on or after quarterly data has been certified as accurate by the hospitals as required by Section 408.061(1)(a), F.S.
(3) Aggregate reports derived from patient-specific hospital records collected pursuant to Rules 59E-7.021 through 7.030, F.A.C., are public records and shall be released as described in this rule, provided that the aggregate reports do not include the patient control number as assigned by the facility, patient social security number, record linkage number, patient birth date, admission date, discharge date, principal procedure date, other procedure date, infant linkage identifier or medical or health record number and provided the aggregate reports contain the combination of five or more records for any data disclosed.
(4) Requests for inpatient data shall be submitted by users sufficiently in advance of the desired delivery date to permit the Agency staff to respond without disruption of their duties.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 119.07(1)(a), (2)(a), 408.061(8) FS. HistoryNew
Editorial note: see former rule 59E-7.015.
59E-7.030 General Provisions.
Hospitals submitting inpatient discharge data pursuant to the provisions contained in these rules shall be directed by the following specific general provisions for inpatient data reporting:
(1) Any inpatient who is transferred or discharged from the acute care setting into a rehabilitative care distinct part unit or free standing unit, must be reported as a separate record from the patients acute care record. The acute care discharge record is assigned data type one (1), and the comprenhensive rehabilitative therapy discharge record is assigned data type two (2).
(2) If inpatients are administratively transferred or formally discharged from the acute care setting into a distinct-part Medicare certified skilled nursing unit or hospice of a hospital, reporting accountability ceases at the time of discharge or transfer. Patients receiving sub-acute care in these setting are excluded from inpatient reporting requirements.
(3) Observation patients are not included in the inpatient reported unless admitted to the hospital as an inpatient.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew
Editorial note: former rule 59E-7.016.
59E-7 PATIENT DATA COLLECTION
59E-7.011 Definitions.
As used in Rules 59E-7.011 through 59E-7.016, F.A.C.:
(1) Acute Care means inpatient general routine care provided to patients who are in an acute phase of illness, which includes the concentrated and continuous observation and care provided in the intensive care units of an institution.
(2) Charity means medical care provided by a healthcare entity to a person who has insufficient resources or assets to pay for the medical care without utilizing resources which are required to meet the persons basic need for food, shelter, and clothing. No patient shall be considered charity care whose family income, as applicable for (12) months preceding the determination, exceeds 150 percent of the federal poverty guidelines, unless the amount of health care charges due from the patient exceeds 25 percent of annual family income. However, in no case shall the hospital charges for a patient whose family income exceeds four times the federal poverty level for a family of four be considered charity. This is information which should be provided based on the patients status at time of reporting.
(3) E-coding, meaning Supplementary Classification of External Causes of Injury and Poisoning, ICD-9-CM, is to be reported in all cases where environmental events, circumstances, and conditions are the cause of injury, poisoning, and other adverse effects as specified in the ICD-9-CM manual and the conventions of coding.
(4) Inpatient means a patient who has an admission order given by a licensed physician or other individual who has been granted admitting privileges by the hospital. Observation patients are excluded unless they are admitted.
(5) Newborn means a newborn baby born within the facility or the initial admission of an infant to any acute care facility within 24 hours of birth.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew 12-15-96, Amended 7-11-01.
59E-7.012 Inpatient Data Reporting and Audit Procedures.
(1) Hospitals licensed under Chapter 395, F.S., except state-operated hospitals and specialty rehabilitation hospitals as defined in subparagraph 59A-3.252(1)(c)2., F.A.C. (hereinafter referred to as hospital/hospitals), in operation for all or any of the reporting periods described in subsection 59E-7.012(5), F.A.C., below, shall submit hospital inpatient discharge data to the Agency according to the provisions in Rules 59E-7.011 through 59E-7.016, F.A.C. The amendments appearing herein are effective with the report period starting January 1, 2006 except the provisions in paragraph 59E-7.014(2)(p), F.A.C., are effective with the report period starting January 1, 2007.
(2) Each hospital shall submit a separate report for each location per paragraph 59A-3.066(2)(i), F.A.C.
(3) All acute, intensive care, and psychiatric live discharges and deaths including newborn live discharges and deaths shall be reported. Submit one record per inpatient discharge, to include all newborn admissions, transfers and deaths.
(4) Upon notification by the AHCA Agency staff, all hospitals shall provide access to all required information from the medical records and billing documents underlying and documenting the hospital inpatient discharge reports submitted, as well as other inpatient related documentation deemed necessary to conduct successful inpatient data audits of hospital data, regardless of reporting format. No inpatient discharge records that support inpatient discharge data are exempt from disclosure to AHCA for audit purposes.
(5) All hospitals reporting their inpatient discharge data shall report according to the following schedule commencing with 1st quarter data 1997 (01/01/97-03/31/97):
(a) Each report submitted for the 1st quarter covering inpatient discharges occurring between January 1 and March 31, inclusive, of each year, shall be submitted no later than June 1 of the calendar year during which the discharge occurred. This is considered to be the first quarter, regardless of the hospitals fiscal year.
(b) Each report submitted for the 2nd quarter covering inpatient discharges occurring between April 1 and June 30, inclusive, of each year, shall be submitted no later than September 1 of the calendar year during which the discharge occurred. This is considered to be the second quarter, regardless of the hospitals fiscal year.
(c) Each report submitted for the 3rd quarter covering inpatient discharges occurring between July 1 and September 30, inclusive, of each year, shall be submitted no later than December 1 of the calendar year during which the discharge occurred. This is considered to be the third quarter, regardless of the hospitals fiscal year.
(d) Each report submitted for the 4th quarter covering inpatient discharges occurring between October 1 and December 31, inclusive, of each year, shall be submitted no later than March 1 of the calendar year following the year in which the discharge occurred. This is considered to be the fourth quarter, regardless of the hospitals fiscal year.
(6) Extensions to the initial submission due date will be granted by the Administrator, Office of Data Collection Section of the Agency staff, for a maximum of 30 days from the initial submission due date in response to a written request signed by the hospitals chief executive officer or chief financial officer. The request must be received prior to the initial submission due date and the delay must be due to unforeseen and unforeseeable factors beyond the control of the reporting hospital. These factors must be specified in the written request for the extension along with documentation of efforts undertaken to meet the filing requirements. Extensions shall not be granted verbally.
(7) Failure to file the report on or before the due date without an extension, and failure to correct a report which has been filed but contains errors or deficiencies within 10 working days from notification of errors or deficiencies, is punishable by fine pursuant to Rule 59E-7.013, F.A.C. The agency shall send notification of errors or deficiencies by certified mail, electronic mail, or fax.
(8) Beginning with the inpatient data report for the 1st Quarter of the year 2006 (January 1, 2006 through March 31, 2006), reporting facilities shall submit inpatient discharge data by Internet according to the specifications in paragraphs (a) through (c) below unless reporting by CD-ROM is approved by the Agency in a case of extraordinary or hardship circumstances.
(a) The Internet address for the receipt of inpatient data is https://ahcaxnet.fdhc.state.fl.us/patientdata.
(b) Data submitted to the Internet address shall be electronically transmitted with the inpatient data in XML file using the Inpatient Data XML Schema available at http://ahca.myflorida.com/SCHS/hpdunit.shtml dated 11-01-06. The Inpatient Data XML Schema is incorporated by reference.
(c) The data in the XML file shall contain the data elements, codes, and standards required in Rules 59E-7.014 and 59E-7.016, F.A.C.
(9) All hospitals submitting data in compliance with Rules 59E-7.011 through 59E-7.014, F.A.C., shall certify that the data submitted for each quarter is accurate, complete, and verifiable using Certification Form for Inpatient Discharge Data, AHCA Form 4200-002, dated 10/93 and incorporated by reference. AHCA Form 4200-002 can be obtained from the Agencys office at the Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, 2727 Mahan Drive, Building 3, Tallahassee, Florida 32308. The completed Certification Form for Inpatient Discharge Data shall be submitted to the Agencys office at the above address or shall be submitted by electronic mail to SCHSdata@fdhc.state.fl.us using an Agency authorized digital signature.
(10) Hospitals not certified within six (6) calendar months following the last day of the reporting quarter shall be subject to penalties pursuant to Rule 59E-7.013, F.A.C. Extensions to this six (6) month period will not be granted.
(11) Changes or corrections to hospital data will be accepted from hospitals to improve their data quality for a period of eighteen (18) months following the initial submission of data. The Administrator, Office of Data Collection, may grant approval for resubmitting previously certified data in response to a written request signed by the hospitals chief executive officer or chief financial officer. The reason for the changes or corrections must be specified in the written request. Any changes to a hospitals data after this eighteen-month period shall be subject to penalties pursuant to Rule 59E-7.013, F.A.C.
(12) The agency shall to the extent practical, apply the same audit standards and use the same audit procedures for all hospitals or audit a random sample of hospitals. The agency will notify each hospital of any possible errors discovered by audit and request that the hospital either correct the data or verify that the data is complete and correct. The notice shall indicate that the hospital must return corrected data if there are errors and certify the data within ninety (90) days of receipt of the notice, or the hospital Chief Executive Officer must verify by signature that the previously submitted and certified data is complete and correct within ninety (90) days of receipt of the notice. The notice shall clearly indicate that the hospital may be subject to penalties pursuant to Rule 59E-7.013, F.A.C.
Specific Authority 408.08(1)(e), 408.15(8) FS. Law Implemented 408.061, 408.08(1), (2), 408.15(11) FS. HistoryNew 12-15-96, Amended 1-4-00, 7-11-01, 7-12-05, 5-22-07.
59E-7.013 Penalties for Hospital Inpatient Discharge Data Reporting Discrepancies.
(1) For purposes of this rule, a report or other information is incomplete when it does not contain all data required by the Agency in this rule and in forms incorporated by reference or when it contains inaccurate data and the report is not corrected by the hospital and certified timely per Rule 59E-7.012, F.A.C. A report or other information is false if done or made with the knowledge of the preparer or an administrator that it contains information or data which is not true or accurate.
(2) A hospital which refuses to file, fails to timely file, or files false or incomplete reports or other information required to be filed under the provisions of s. 408.08(13), F.S., other Florida Law, or rules adopted thereunder, shall be subject to administrative penalties. Failure to comply with reporting requirements will also result in the referral of a hospital to the Agencys Bureau of Health Facility Regulation.
(3) Delinquent report notices will be sent via certified mail to the attention of Chief Executive Officer.
(4) The penalty period will begin on the first working day following the due date for purposes of penalty assessments.
(5) In addition, any hospital which is delinquent for a reporting deficiency shall be subject to a fine of $100 per day of violation for the first violation, $350 per day of violation for the second violation, and $1000 per day of violation for the third and all subsequent violations. Violations will be considered those activities which necessitate the issuance of an administrative complaint by the agency unless the administrative complaint is withdrawn or final order dismissing the administrative complaint is entered. All fines are to be fixed, imposed, and collected by the Agency. Any hospital which files false information to the Agency shall be subject to a fine of $1000 per day, in addition to any other fine imposed hereunder. The fine shall be fixed, imposed, and collected by the Agency.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.08(13), (16) FS. HistoryNew 12-15-96.
59E-7.014 Inpatient Data Format - Data Elements, Codes and Standards.
(1) HEADER RECORD. The first record in the data file shall be a header record containing the information described below.
(a) Transaction Code. Enter Q for a calendar quarter report or S for a report period other than a calendar quarter where the special report is requested or authorized by the Agency to receive data corrections. A required field.
(b) Report Year. Enter the year of the data in the format YYYY where YYYY represents the year in four (4) digits. A required field.
(c) Report Quarter. Enter the quarter of the data, 1, 2, 3 or 4, where 1 corresponds to the first quarter of the calendar year, 2 corresponds to the second quarter of the calendar year, 3 corresponds to the third quarter of the calendar year, and 4 corresponds to the fourth quarter of the calendar year. A required field.
(d) Data Type. Enter PD10-1 for Inpatient Data. A required field.
(e) Submission Type. Enter I or R where I indicates an initial submission or resubmission of previously rejected data, R indicates a replacement submission of previously processed and accepted inpatient data where resubmission has been requested or authorized by the Agency. A required field.
(f) Processing Date. Enter the date that the data file was created in the format YYYY-MM-DD where MM represents 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. A required field.
(g) AHCA Hospital Number. Enter the identification number of the hospital as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than twelve (12) digits. A required field.
(h) Organization Name. Enter the name of the hospital that performed the inpatient service(s) represented by the data, and which is responsible for reporting the data. All questions regarding data accuracy and integrity will be referred to this entity. Up to a forty-character field. A required field.
(i) Contact Person Name. Enter the name of the contact person for the hospital. Submit name in the Last, First format. Up to a twenty-five-character field. A required field.
(j) Contact Phone Number. The area code, business telephone number, and if applicable, extension for the contact person. Enter the contact persons telephone number in the format (AAA)XXXXXXXEEEE where AAA is the area code, XXXXXXX represents the seven (7) digit phone number and EEEE represents the extension. Zero fill if no extension. A required field.
(k) Contact Person E-Mail Address. Enter the e-mail address of the contact person.
(l) Contact Person Street or P.O. Box Address. Enter the street or post office box address of the contact persons mailing address. Up to a forty-character field. A required field.
(m) Mailing Address City. Enter the city of the contact persons address. Up to a twenty-five character field. A required field.
(n) Mailing Address State. Enter the state of the contact persons address using the U.S. Postal Service state abbreviation in the format XX. Use the abbreviation FL for Florida. A required field.
(o) Mailing Address Zip Code. Enter the zip code of the contact persons address in the format XXXXX-XXXX.
(2) INDIVIDUAL DATA RECORDS. All data elements and data element codes listed below shall be reported consistent with the records of the reporting entity. Data elements and codes are listed with a description of the data to be reported and data standards.
(a) AHCA Hospital Number. Enter the identification number of the hospital as assigned by AHCA for reporting purposes. A valid identification number must contain at least eight (8) digits and no more than twelve (12) digits. A required field.
(b) Record Identification Number. An alpha-numeric code containing standard letters or numbers assigned by the facility as a unique identifier for each record submitted in the reporting period to facilitate storage and retrieval of individual case records. Up to seventeen (17) characters. Duplicate record identification numbers are not permitted. A required field. The hospital must maintain a key list to locate actual records upon request by AHCA.
(c) Patient Social Security Number. Enter the social security number (SSN) of the patient receiving treatment. The SSN is a nine (9) digit number issued by the Social Security Administration. Reporting 000000000 is acceptable for newborns and infants up to two (2) years of age at admission who do not have a SSN. Reporting 777777777 is acceptable for those patients where efforts to obtain the SSN have been unsuccessful and the patient is two (2) years of age or older and not known to be from a country other than the United States (U.S.). Reporting 555555555 is acceptable for non-U.S. citizens who have not been issued SSNs. One SSN; one inpatient. DO NOT share SSNs in this field. A required entry.
(d) Patient Race or Ethnicity. Self-designated by the patient or patients parent or guardian except code 8 indicating no response may be reported where efforts to obtain the information from the patient or from the patients parent or guardian have been unsuccessful. A required entry. Must be a one (1) digit code as follows:
1. 1 American Indian or Alaska Native
2. 2 Asian or Pacific Islander
3. 3 Black or African American
4. 4 White
5. 5 White Hispanic
6. 6 Black Hispanic
7. 7 Other-Use if the patients self-designated race or ethnicity is not described by the above categories.
8. 8 No Response-Use if the patient refuses or fails to disclose.
(e) 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. Age greater than one hundred twenty (120) years is not permitted unless verified by the reporting entity. A birth date after the discharge date is not permitted. A required entry.
(f) Patient Gender. The gender of the patient at admission. A required entry. Must be a one (1) digit code as follows:
1. 1 Male
2. 2 Female
3. 3 Unknown Use where efforts to obtain the information have been unsuccessful or where the patients gender cannot be determined due to a medical condition.
(g) Patient Zip Code. The five (5) digit United States Postal Service ZIP Code of the patients 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.
(h) Type of Admission. The scheduling priority of the admission. A required entry. Must be a one (1) digit code as follows:
1. 1 Emergency The patient requires immediate medical intervention as a result of severe, life- threatening or potentially disabling conditions.
2. 2 Urgent The patient requires attention for the care and treatment of a physical or mental disorder.
3. 3 Elective The patients condition permits adequate time to schedule the availability of a suitable accommodation.
4. 4 Newborn Use of this code requires the use of special Source of Admission codes. (See also subparagraphs 59E-7.014(2)(i)10.-13., F.A.C.)
5. 5 Trauma Center Trauma activation at a State of Florida designated trauma center.
(i) Source of Admission. Must be a two (2) digit code as follows, where codes 10 through 13 are to be used for newborn admissions, codes 1 through 8 are to be used for any admission that is not a newborn, code 9 is used where the source of admission is not known, and code 14 is used where the Source of Admission is other than code 1 through code 13. A required field.
1. 01 Physician referral The patient was admitted to this facility upon the recommendation of the patients personal physician.
2. 02 Clinic referral The patient was admitted to this facility upon recommendation of this facilitys clinic physician.
3. 03 HMO referral The patient was admitted to this facility upon the recommendation of a health maintenance organization physician.
4. 04 Transfer from a hospital The patient was admitted to this facility as a transfer from an acute care facility where the patient was an inpatient.
5. 05 Transfer from a skilled nursing facility The patient was admitted to this facility from a skilled nursing facility where the patient was at a skilled level of care.
6. 06 Transfer from another health care facility The patient was admitted to this facility as a transfer from a health care facility other than an acute care facility or a skilled nursing facility.
7. 07 Emergency Room The patient was admitted to this facility through the emergency room upon recommendation of an emergency room physician or other physician.
8. 08 Court/Law Enforcement The patient was admitted upon the direction of a court of law, or upon the request of a law enforcement agency representative.
9. 09 Information Not Available The means by which the patient was admitted to this hospital is not known.
Codes required for newborn admissions (Type of Admission=4):
10. 10 Normal delivery A baby delivered without complications.
11. 11 Premature delivery A baby delivered with time or weight factors qualifying it for premature status.
12. 12 Sick Baby A baby delivered with medical complications, other than those relating to premature status.
13. 13 Extramural A newborn born in a non-sterile environment.
14. 14 Other The source of admission is not described by subparagraphs 1. through 13., above.
(j) Admission Date. The date the patient was admitted to the reporting facility. 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. Admission date must equal or precede the discharge date. A required entry.
(k) Discharge Date. The date the patient was discharged from the reporting facility. 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. Discharge date must equal or follow the admission date, and discharge date must occur within the reporting period as shown on the header record. A required entry.
(l) Patient Discharge Status. Patient disposition at discharge. A required entry. Must be a two (2) digit code as follows:
1. 01 Discharged to home or self-care (with or without planned outpatient medical care)
2. 02 Discharged to a short-term general hospital
3. 03 Discharged to a skilled nursing facility
4. 04 Discharged to an intermediate care facility
5. 05 Discharged to another type of institution (cancer or childrens hospital or distinct part unit)
6. 06 Discharged to home under care of home health care organization
7. 07 Left this hospital against medical advice (AMA) or discontinued care
8. 08 Discharged home under care of home IV provider on IV medications
9. 20 Expired
10. 50 Discharged to hospice home
11. 51 Discharged to hospice medical facility
12. 62 Discharged to an inpatient rehabilitation facility including rehabilitation distinct part units of a hospital.
13. 63 Discharged to a Medicare certified long term care hospital.
14. 65 Discharged to a psychiatric hospital including psychiatric distinct part units of a hospital.
(m) Principal Payer Code. Describes the expected primary source of reimbursement for services rendered based on the patients status at discharge or the time of reporting. Report charity as defined in subsection 59E-7.011(2), F.A.C. A required entry. Must be a one (1) character alpha field using upper case as follows:
1. A Medicare
2. B Medicare HMO or Medicare PPO
3. C Medicaid
4. D Medicaid HMO
5. E Commercial Insurance
6. F Commercial HMO
7. G Commercial PPO
8. H Workers Compensation
9. I CHAMPUS
10. J VA
11. K Other State/Local Government
12. L Self Pay/Under-insured No third party coverage or less than 30% estimated insurance coverage.
13. M Other
14. N Charity
15. O KidCare Includes Healthy Kids, MediKids and Childrens Medical Services.
(n) Principal Diagnosis Code. The code representing the diagnosis established, after study, to be chiefly responsible for occasioning the admission. Principal diagnosis code must contain a valid ICD-9-CM or ICD-10-CM code for the reporting period. Inconsistency between the principal diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the principal diagnosis code and patient age must be verified by the reporting entity. 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.
(o) 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 injury codes. Report external cause of injury codes as described in paragraph (ww) below. No more than thirty (30) other diagnosis codes may be reported. Less than thirty (30) entries or no entry is permitted consistent with the records of the reporting entity. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Inconsistency between the other diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the other diagnosis code and patient age must be verified by the reporting entity. 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.
(p) 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 (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 Injury Code (1), Present on Admission Indicator for External Cause of Injury Code (2), and Present on Admission Indicator for External Cause of Injury Code (3). A code differentiating whether the condition represented by the corresponding Principal Diagnosis Code (n), Other Diagnosis Code (o)(1) through (30), and External Cause of Injury Code (ww)(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 if the corresponding code is reported or a blank field may be reported when present on admission is not applicable. Present on Admission Indicator must be a one (1) character alpha code as follows:
1. Y Yes Present at the time that the order for inpatient admission occurs.
2. N No Not present at the time that the order for inpatient admission occurs.
3. U Unknown Documentation is insufficient to determine if condition is present on admission.
4. W Clinically Undetermined Provider is unable to clinically determine whether condition was present on admission or not.
(q) 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-9-CM or ICD-10-CM procedure code for the reporting period. If a principal procedure date is reported, a valid principal procedure code must be reported. Inconsistency between the principal procedure code and patient gender must be verified by the reporting entity. Inconsistency between the principal procedure code and patient age must be verified by the reporting entity. 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.
(r) Principal Procedure Date. The date when the principal procedure was performed. If a principal procedure is reported, a principal procedure date must be reported. No entry is permitted if no principal procedure is reported. 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. The principal procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.
(s) 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 no principal procedure is 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 consistent with the records of the reporting entity. Must be a valid ICD-9-CM or ICD-10-CM procedure code for the reporting period. Inconsistency between the procedure code and patient gender must be verified by the reporting entity. Inconsistency between the procedure code and patient age must be verified by the reporting entity. 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.
(t) Other Procedure Code Date (1), Other Procedure Code Date (2), Other Procedure Code Date (3), Other Procedure Code Date (4), Other Procedure Code Date (5), Other Procedure Code Date (6), Other Procedure Code Date (7), Other Procedure Code Date (8), Other Procedure Code Date (9), Other Procedure Code Date (10), Other Procedure Code Date (11), Other Procedure Code Date (12), Other Procedure Code Date (13), Other Procedure Code Date (14), Other Procedure Code Date (15), Other Procedure Code Date (16), Other Procedure Code Date (17), Other Procedure Code Date (18), Other Procedure Code Date (19), Other Procedure Code Date (20), Other Procedure Code Date (21), Other Procedure Code Date (22), Other Procedure Code Date (23), Other Procedure Code Date (24), Other Procedure Code Date (25), Other Procedure Code Date (26), Other Procedure Code Date (27), Other Procedure Code Date (28), Other Procedure Code Date (29), and Other Procedure Code Date (30). The date when the procedure was performed. A required entry if a corresponding procedure code (s)(1) through (30) is reported. No entry is permitted if no procedure is reported consistent with the records of the reporting entity. 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. The procedure date must be less than four (4) days prior to the admission date and not later than the discharge date.
(u) Attending Physician Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who had primary responsibility for the patients medical care and treatment or who certified as to the medical necessity of the services rendered. For military physicians not licensed in Florida, use US. A required entry.
(v) Operating or Performing Physician Identification Number. The Florida license number of the medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who had primary responsibility for the principal procedure performed. The operating or performing physician may be the attending physician. For military physicians not licensed in Florida, use US. No entry is permitted if no principal procedure is reported consistent with the records of the reporting entity.
(w) Other Operating or Performing Physician Identification Number. The Florida license number of a medical doctor, osteopathic physician, dentist, podiatrist, chiropractor, or advanced registered nurse practitioner who assisted the operating or performing physician or performed a secondary procedure. The other operating or performing physician must not be reported as the operating or performing physician. The other operating or performing physician may be the attending physician. For military physicians not licensed in Florida, use US. No entry is permitted consistent with the records of the reporting entity.
(x) Room and Board Charges. Routine service charges incurred for accommodations. Report charges for revenue codes 11X through 16X as used in the UB-92 or UB-04. Charges to be reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no Room and Board Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(y) Nursery Charges. Accommodation charges for nursing care to newborn and premature infants in nursery. Report charges for revenue code 17X as used in the UB-92 or UB-04 excluding Level III charges. Charges to be reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no Nursery Charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(z) Level III Nursery Charges. Accommodation charges for nursing care to newborn and premature infants for Level III nursery charges. Report charges for revenue code 173 (Level III) as used in the UB-92 or UB-04. Charges to be reported in dollars numerically, 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.
(aa) Intensive Care Charges. Routine service charges for medical or surgical care provided to patients who require a more intensive level of care than is rendered in the general medical or surgical unit. Exclude neonatal intensive care charges reported as a Level III Nursery Charge. Report charges for revenue code 20X as used in the UB-92 or UB-04. Reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no intensive care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(bb) Coronary Care Charges. Routine service charges for medical care provided to patients with coronary illness who require a more intensive level of care than is rendered in the general medical unit. Report charges for revenue code 21X as used in the UB-92 or UB-04. Reported in dollars numerically, without dollar signs or commas, excluding cents. Report zero (0) if there are no coronary care charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(cc) Pharmacy Charges. Charges for medication. Report charges for revenue codes 25X and 63X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no pharmacy charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(dd) Medical and Surgical Supply Charges. Charges for supply items required for patient care. Report charges for revenue codes 27X and 62X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no medical and surgical supply charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(ee) Laboratory Charges. Charges for the performance of diagnostic and routine clinical laboratory tests and for diagnostic and routine tests in tissues and culture. Report charges for revenue codes 30X and 31X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no laboratory charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(ff) Radiology or Other Imaging Charges. Charges for the performance of diagnostic and therapeutic radiology services including computed tomography, mammography, magnetic resonance imaging, nuclear medicine, and chemotherapy administration of radioactive substances. Report charges for revenue codes 32X through 35X, 40X and 61X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no radiology or other imaging charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(gg) Cardiology Charges. Facility charges for cardiac procedures rendered such as, but not limited to, heart catheterization or coronary angiography. Reported in dollars numerically without dollar signs or commas, excluding cents. Report charges for revenue code 48X as used in the UB-92 or UB-04. Report zero (0) if there are no cardiology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(hh) Respiratory Services or Pulmonary Function Charges. Charges for administration of oxygen, other inhalation services, and tests that evaluate the patients respiratory capacities. Report charges for revenue codes 41X and 46X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no respiratory service or pulmonary function charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(ii) Operating Room Charges. Charges for the use of the operating room. Report charges for revenue code 36X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no operating room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(jj) Anesthesia Charges. Charges for anesthesia services by the facility. Report charges for revenue code 37X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no anesthesia charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(kk) Recovery Room Charges. Charges for the use of the recovery room. Report charges for revenue code 71X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no recovery room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(ll) Labor Room Charges. Charges for labor and delivery room services. Report charges for revenue code 72X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no labor room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(mm) Emergency Room Charges. Charges for medical examinations and emergency treatment. Report charges for revenue code 45X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no emergency room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(nn) Trauma Response Charges. Charges for a trauma team activation. Report charges for revenue code 68X used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no trauma response charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(oo) Treatment or Observation Room Charges. Charges for use of a treatment room or for the room charge associated with observation services. Report charges for revenue code 76X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no treatment or observation room charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(pp) Behavioral Health Charges. Charges for behavioral health treatment and services. Report charges for revenue codes 90X though 91X and 100X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(qq) Oncology. Charges for treatment of tumors and related diseases. Excludes therapeutic radiology services reported in radiology and other imaging services (ff). Report charges for revenue code 28X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no oncology charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(rr) Physical and Occupational Therapy Charges. Report charges for physical, occupational or speech therapy in revenue codes 42X through 44X as used in the UB-92 or UB-04. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(ss) Other Charges. Other facility charges not included in paragraphs (x) to (rr) above. Include charges that are not reflected in any of the preceding specific revenue accounts in the UB-92 or UB-04. DO NOT include charges from revenue codes 96X, 97X, 98X, or 99X in the UB-92 or UB-04 for professional fees and personal convenience items. Reported in dollars numerically without dollar signs or commas, excluding cents. Report zero (0) if there are no other charges. Negative amounts are not permitted unless verified separately by the reporting entity. A required entry.
(tt) 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 (x) through (ss) must equal total charges, plus or minus ten (10) dollars. Reported in dollars numerically 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.
(uu) Infant Linkage Identifier. The social security number of the patients 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 mothers SSN is acceptable for those patients where efforts to obtain the mothers SSN have been unsuccessful and the mother is not known to be from a country other than the United States. Reporting 555555555 is acceptable if the infants mother is not a U.S. Citizen and has not been issued a SSN. Infants in the custody of the State of Florida or adoptions, use 333333333 if the birth mothers SSN is not available. A required field for patients whose age is less than two (2) years of age at admission. If the patient is two (2) years of age or older, the field is zero filled. A required entry.
(vv) Admitting Diagnosis. The diagnosis provided by the admitting physician at the time of admission which describes the patients condition upon admission or purpose of admission. Must contain a valid ICD-9-CM code or valid ICD-10-CM code for the reporting period. Inconsistency between the admitting diagnosis code and patient gender must be verified by the reporting entity. Inconsistency between the admitting diagnosis code and patient age must be verified by the reporting entity. 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.
(ww) 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. No more than three (3) external cause of injury codes may be reported. Less than three (3) or no entry is permitted consistent with the records of the reporting entity. Entry 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.
(xx) Emergency Department Hour of Arrival. The hour on a 24-hour clock during which the patients registration in the emergency department occurred. A required entry. Use 99 where the patient was not admitted through the emergency department or where efforts to obtain the information have been unsuccessful. Must be two (2) digits as follows:
1. 00 12:00 midnight to 12:59
2. 01 01:00 to 01:59
3. 02 02:00 to 02:59
4. 03 03:00 to 03:59
5. 04 04:00 to 04:59
6. 05 05:00 to 05:59
7. 06 06:00 to 06:59
8. 07 07:00 to 07:59
9. 08 08:00 to 08:59
10. 09 09:00 to 09:59
11. 10 10:00 to 10:59
12. 11 11:00 to 11:59
13. 12 12:00 noon to 12:59
14. 13 01:00 to 01:59
15. 14 02:00 to 02:59
16. 15 03:00 to 03:59
17. 16 04:00 to 04:59
18. 17 05:00 to 05:59
19. 18 06:00 to 06:59
20. 19 07:00 to 07:59
21. 20 08:00 to 08:59
22. 21 09:00 to 09:59
23. 22 10:00 to 10:59
24. 23 11:00 to 11:59
25. 99 Unknown.
(3) TRAILER RECORD. The last record in the data file shall be a trailer record and must accompany each data set. Report only the total number of patient data records contained in the file, excluding header and trailer records. The number entered must equal the number of records processed.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew 12-15-96, Amended 7-11-01. 7-12-05, 5-22-07.
59E-7.015 Public Records.
(1) Agency records, public records under Chapter 119, F.S. (Floridas Public Records Law), are available for public inspection during normal business hours. Copies of such records may be obtained upon request and upon payment of the cost of copying.
(2) Patient-specific records collected by the Agency pursuant to Rules 59E-7.011-.016, F.A.C., are exempt from disclosure pursuant to Section 408.061(8), F.S., and shall not be released unless modified to protect patient confidentiality as described in paragraph (2)(a) below and released in the manner described in paragraphs (2)(c) and (2)(d).
(a) The patient-specific record shall be modified to protect patient confidentiality as follows:
1. Patients Record ID Number as assigned by the facility. Substitute Sequential Number.
2. Patient Social Security Number. Deleted. Indicators of readmission at any Florida reporting hospital within 30 days of discharge will be substituted when available. Readmission data will not be released for any quarter until each subsequent quarter is 100 percent certified.
3. Patient Birth Date. Substitute Age in Years and an indicator of Age <29 Days.
4. Admission Date. Deleted.
5. Discharge Date. Length of Stay (LOS) will be substituted.
6. Principal Procedure Date. Days from Admission to Principal Procedure will be substituted.
7. Other Procedure Date. Days from Admission to Other Procedure will be substituted.
8. Infant Linkage ID. Deleted.
(b) A record linkage number shall be assigned which does not identify an individual patient and cannot reasonably be used to identify an individual patient through use of data available through the Agency for Health Care Administration, but which can be used for confidential data output for bona fide research purposes.
(c) The modified data records described in paragraph (2)(a) shall be released as a set of all records occurring in one calendar quarter based on date of discharge.
(d) The modified data described in paragraph (2)(a) shall be released in accordance with the Limited Data Set requirements of the federal Health Insurance Portability and Accountability Act and shall be made available on or after quarterly data has been certified as accurate by the hospitals as required by Section 408.061(1)(a), F.S.
(3) Aggregate reports derived from patient-specific hospital records collected pursuant to Rules 59E-7.011-.016, F.A.C., are public records and shall be released as described in this rule, provided that the aggregate reports do not include the patients record ID number as assigned by the facility, patient social security number, record linkage number, patient birth date, admission date, discharge date, principal procedure date, other procedure date, or infant linkage identifier; and provided the aggregate reports contain the combination of five or more records for any data disclosed.
(4) Requests for inpatient data shall be submitted by users sufficiently in advance to permit the staff to respond without disruption of their duties.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 119.07(1)(a), (2)(a), 408.061(8) FS. HistoryNew 12-15-96, Amended 7-12-05.
59E-7.016 General Provisions.
Hospitals submitting inpatient discharge data pursuant to the provisions contained in these rules shall be directed by the following specific general provisions for inpatient data reporting:
(1) Hospitals are not required nor expected to submit inpatient discharge data on inpatients undergoing rehabilitative therapy if the therapy is not directly related to specific acute care reasons for the hospitalization being reported, (e.g., conduct of initial rehabilitative therapy during the period of the acute care phase of treatment for a broken leg to facilitate inpatient post-discharge mobility). Any inpatient who is transferred or discharged from the acute care setting into a strictly rehabilitative therapy mode of treatment, must be dropped from acute care accountability regardless of the category of administrative movement of the inpatients records. Any rehabilitation other than acute care cause specific treatment of short term duration will be questioned, and will be dropped from the AHCA data base if not acute care therapy in the strictest sense. This definition is applicable regardless of whether an inpatient transfers into a hospital internal rehabilitation therapy unit licensed for that purpose, or into a freestanding unit for continued therapy. A rule of thumb definition for application is that if it is not in conjunction with the acute care phase of inpatient treatment in the hospital, it is not applicable as reportable treatment reported as Inpatient Discharge Data as established and required by this rule. See also separate rules regarding Comprehensive Rehabilitation Discharge Inpatient Data reporting.
(2) If inpatients are administratively transferred or formally discharged from the acute care setting into a distinct-part Medicare certified skilled nursing unit of a hospital, acute care accountability ceases at the time of discharge/transfer, and the inpatient must be carried as a sub-acute care inpatient in other reporting modes. Sub-acute care is not reported as a part of inpatient discharge data.
Specific Authority 408.061(1)(e), 408.15(8) FS. Law Implemented 408.061 FS. HistoryNew 12-15-96, Amended 7-11-01, 7-12-05.
CHAPTER 59E-7 PART II DATA COLLECTION COMPREHENSIVE REHABILITATION
59E-7.201 Submission of Comprehensive Inpatient Rehabilitation Hospital Patient Data.
(1) All comprehensive inpatient rehabilitation hospitals, in operation for any of the reporting periods described in subsection 59E-7.202(1), F.A.C., below, shall submit hospital patient discharge data and reports to the agency.
(2) For purposes of submission of rehabilitation hospital patient data, a comprehensive inpatient rehabilitation hospital shall be any hospital licensed as a class III special rehabilitation hospital, with comprehensive medical rehabilitation beds, meeting the definition of rehabilitation hospital of subsections 59A-3.152(9) and 59A-3.168(1)-(5), F.A.C.
(3) All comprehensive inpatient rehabilitation hospitals shall make reasonably available for onsite inspection information from the medical records underlying, documenting, or supporting the patient data reports submitted by the hospital, as well as other patient related documentation deemed necessary to carry out the agencys regulatory duties. Inspections will be made at reasonable times and under reasonable circumstances.
(4) All comprehensive inpatient medical rehabilitation hospital patient data collected under Part III of Chapter 59E-7, F.A.C., shall not include specific provider contract reimbursement information, and any such data shall be considered proprietary. However, such specific provider reimbursement data shall be reasonably available for onsite inspection necessary to carry out the agencys regulatory duties. Any such data obtained by the agency as a result of onsite inspections may not be used by the state for purposes of direct provider contracting and shall not be disclosed to the public.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a) -(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
59E-7.202 Schedule for Submission of Patient Data and Extensions.
(1) The first report of comprehensive inpatient rehabilitation hospital patient data covering patient discharges occurring between July 1 and September 30, 1993 and between October 1 and December 31, 1993, shall be submitted no later than May 1, 1994. Subsequently, all comprehensive inpatient rehabilitation hospitals shall report according to the following schedule:
(a) Each report covering patient discharges occurring between January 1 and March 31, inclusive, of each year, shall be submitted no later than June 1 of the calendar year during which the discharge occurred. This is considered to be the first quarter, regardless of the hospitals fiscal year.
(b) Each report covering patient discharges occurring between April 1 and June 30, inclusive, of each year, shall be submitted no later than September 1 of the calendar year during which the discharge occurred. This is considered to be the second quarter, regardless of the hospitals fiscal year.
(c) Each report covering patient discharges occurring between July 1 and September 30, inclusive, of each year, shall be submitted no later than December 1 of the calendar year during which the discharge occurred. This is considered to be the third quarter, regardless of the hospitals fiscal year.
(d) Each report covering patient discharges occurring between October 1 and December 31, inclusive, of each year, shall be submitted no later than March 1 of the calendar year following which the discharge occurred. This is considered to be the fourth quarter, regardless of the hospitals fiscal year.
(2) Hospitals must certify each calendar quarters data at the time the report is submitted. This certification of data is pursuant to Rule 59E-7.204, F.A.C. Extensions to this period may be granted pursuant to Subsection (3).
(3) Extensions to processing due dates will be granted by the agency staff for a maximum of 10 working days from original submission due date in response to a written request by the hospitals Chief Executive Officer if received prior to the due date and provided that the delay is due to unforeseen factors beyond the control of the reporting hospital. These factors must be specified in the letter requesting the extension together with documentation of efforts undertaken to meet the filing requirements.
(4) Failure to file the report on or before the due date without an extension, and failure to correct a report which has been filed but contains errors or deficiencies within 10 days from notification of errors or deficiencies, is punishable by a fine pursuant to Rules 59E-2.024 and 59E-2.025, F.A.C.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. HistoryNew 3-31-94.
59E-7.203 Reporting Instructions.
The following instructions apply to comprehensive inpatient rehabilitation hospitals reporting in the tape/diskette format pursuant to Rule 59E-7.205, F.A.C., Patient Data Format Data Elements and Codes:
(1) Submit agency rehabilitation patient data reports according to the agency data format only (See Rule 59E-7.205, F.A.C., Patient Data Format Data Elements and Codes).
(2) All inpatient rehabilitation discharges or deaths shall be reported.
(3) Tape/Diskette specifications are:
(a) Tape:
1. Density 1600 or 6250 BPI, 9 track
2. Collating Sequence EBCDIC or ASCII.
3. Data Record Length 320 characters, fixed
4. Blocking Unblocked
5. Labeling Standard IBM label (non-labeled tapes are accepted)
(b) Diskette:
1. MS-DOS formatted
2. PC Text File (ASCII)
3. Record Length 320 characters, fixed
4. 51/4´´ diskette, 1.2 MB, MD2HD or
5. 3.5´´ diskette, 1.4 MB, MF2HD
6. FILENAME:(e.g., 1QTR92.TXT)
The first position must be a number from 1 through 4 indicating the quarter of the data submitted, followed by QTR in the second through fourth positions. The fifth and sixth positions indicate the calendar year of the data submitted. The seventh position is a period. The eighth through tenth positions are TXT which indicates a text file, (see example in 6. above).
(4) Hospitals shall submit tapes or diskettes, with the following external identification affixed via a label:
(a) Hospital Name
(b) AHCA Number in the AHCA 6 digit format
(c) Reporting period for discharges
(d) Number of records
(e) Tape Density: 1600/6250 BPI
(f) Collating Sequence: (TAPES)
(g) Filename: (DISKETTES) As in 7.203(3)(b)6. above
(h) Capacity: 1.2 MB or 1.4 MB (DISKETTES)
(i) The Description: Comprehensive Inpatient Rehabilitation Patient Data
(5) Submit one record per discharge.
(6) The data report, when submitted on tape or diskette, shall be accompanied by an agency Data File Submission Form, number AHCA-2000-MIS-93-01, which was adopted by the agency January 4, 1993 and is incorporated by reference to this rule, indicating name and AHCA number of the hospital, and the name and telephone number of the individual to contact in case of any problems with the data. Form AHCA-2000-MIS-93-01 can be obtained from The Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, Hospital Patient Data Section, 325 John Knox Road, Suite 301 the Atrium, Tallahassee, Florida 32303, (850) 488-1295. Electronically transmitted data will be accompanied by a file containing the same information.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
59E-7.204 Certification Procedures.
(1) All hospitals submitting data in compliance with Rules 59E-7.201-7.208, F.A.C., shall certify that the data submitted for each quarter is accurate using form number AHCA-4200-0003-10/93, Rehabilitation Hospital Patient Data Report Certification Form, which was adopted by the agency October 22, 1993 and is incorporated by reference to this rule.
(2) The Chief Executive Officer and Chief Financial Officer shall certify in writing that a complete review was accomplished to assure the accuracy of the report and that to the best of their knowledge and belief, the data submitted are accurate and complete.
(3) Each hospital must certify each calendar quarters data at the time that the data are submitted pursuant to Rule 59E-7.202, F.A.C. Extensions to this period will not be permitted.
(4) Form AHCA-4200-0003-10/93 can be obtained from the agencys office at The Agency for Health Care Administration, Florida Center for Health Information and Policy Analysis, Hospital Patient Data Section, 325 John Knox Road, 301 The Atrium, Tallahassee, Florida, 32303, (850) 488-1295.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.08(9), 408.085 FS. HistoryNew 3-31-94.
59E-7.205 Patient Data Format - Data Elements and Codes.
(1) HEADER RECORD:
The first record in the data file shall be a header record with a logical record length of 320 characters, containing the following information in the prescribed format.
DATA ELEMENT DESCRIPTION
(a) Transaction Code H for header record in the first position.
(b) Reporting Year A 4 digit field specifying the year of the
data.
(c) Reporting Quarter A 1 digit field specifying the quarter that
the data pertains to:
1 = Jan. 1 through Mar. 31
2 = Apr. 1 through Jun. 30
3 = Jul. 1 through Sep. 30
4 = Oct. 1 through Dec. 31
(d) Data Type CR100 to specify comprehensive
inpatient rehabilitation patient data.
(e) Submission Type A 1 character field for submission type:
I = Initial. This is the first submission for
the time period. All data set action codes
must be A. This code is also used when
replacing previously rejected files.
M = Maintenance. All submissions which
are not I or R. Data set action codes
must be A, D or U.
R = Re-submission. This code is used to
replace all accepted or partially accepted
records for the specified time period. All
data set action codes must be A. All
existing data for the time period will be
deleted and replaced with the new data set.
(f) Processing Date CCYYMMDD, the date that the data file
was created by the submitter.
(g) AHCA Number A 6 digit hospital identification number
assigned by AHCA for reporting purposes.
(h) Florida License Number A 10 digit license number assigned by
AHCA Division of Health Quality
Assurance.
(i) Provider Medicaid Number A 7 digit number provided for Medicaid
providers. If not a Medicaid provider, zero
fill.
(j) Provider Medicare Number A 7 digit number provided for Medicare
providers. If not Medicare provider, zero
fill.
(k) Provider Organization Name The name of the Comprehensive Inpatient
Rehabilitation Hospital reporting the
patient data records.
(l) Provider Contact Person Name The name of the contact person at the
Comprehensive Inpatient Rehabilitation
Hospital providing the patient data records.
(m) Provider Contact Person Telephone The area code, telephone number, and if
Numberrequired, extension for the contact person
at the Comprehensive Inpatient
Rehabilitation Hospital providing the
patient data records.
(n) Submitter Organization Name The name of the organization that
produced the data file
that is being submitted.
(o) Submitter Contact Person Name The name of the person at the submitting
organization responsible for submitting the
data file.
(p) Submitter Contact Person Telephone The area code, telephone number, and if
Numberrequired, extension for the contact person
at the organization submitting the data file.
(q) Filler A field of 102 spaces, to be left blank.
(2) INDIVIDUAL DATA RECORDS:
DATA ELEMENT DESCRIPTION
(a) Data Type CR100 for all Comprehensive Inpatient
Rehabilitation Hospital Patient Data.
(b) Action Code A 1 character field identifying type of
record:
A Add New Record
U Update Existing Record
D Delete Existing Record
(c) Reporting Quarter A 1 digit field specifying the quarter that
the data pertains to:
1 Jan. 1 through Mar. 31
2 Apr. 1 through Jun. 30
3 Jul. 1 through Sep. 30
4 Oct. 1 through Dec. 31
(d) Reporting Year CCYY, a 4 digit field.
(e) AHCA Number A 6 digit hospital identification number
assigned by AHCA for reporting purposes.
(f) Date Submitted CCYYMMDD, an 8 digit field.
(g) Reserved Field Left blank, 20 spaces.
(h) Record Identification Code A 17 character alpha-numeric code
assigned by the hospital at the time of
reporting as a unique identifier for each
record submitted for each reporting period,
to facilitate storage and retrieval of
individual case records.
(i) Patient Social Security Number The social security number of the patient
who received the treatment/services during
this hospital stay. A 9 digit field to
facilitate retrieval of individual case
records, to be used to track patient
readmissions, and for patient outcomes
research. Fill with all zeros if not available.
(j) Patient Racial Background A 1 digit code as follows:
1 American Indian/Eskimo/Aleut
2 Asian or Pacific Islander
3 Black
4 White
5 White Hispanic
6 Black Hispanic
7 Other
8 No Response
(k) Patient Birth Date CCYYMMDD, an 8 digit field.
(l) Patient Sex A 1 digit code as follows:
1 Male
2 Female
(m) Patient Zip Code A 5 digit zip code of the patients
permanent address. use 00009 for foreign
patients who do not have a resident zip
code. use 00000 if unknown.
(n) Source of Admission A 1 digit code as follows:
1 Physician Referral
2 Clinic Referral
3 HMO Referral
4 Transfer from a hospital
5 Transfer from a skilled nursing facility
6 Transfer from another health care facility
7 Emergency Room
8 Court/Law Enforcement
9 Other
(o) Admission Date CCYYMMDD, an 8 digit field.
(p) Discharge Date CCYYMMDD, an 8 digit field.
(q) Patient Discharge Status A 2 digit code as follows:
01 Discharged home
02 Discharged to a short term general hospital
03 Discharged to a skilled nursing facility
04 Discharged to an intermediate care facility
05 Discharged to another type of institution
06 Discharged to home under care of home
health care organization
07 Left against medical advice
08 Home on IV medications
20 Expired
(r) Principal Payer Code A 1 character field as follows:
A Medicare
B Medicare HMO
C Medicaid
D Medicaid HMO
E Commercial Insurance
F Commercial HMO
G Commercial PPO
H Workers Compensation
I Champus
J VA
K Other
State/Local
Government
L Self Pay (No third party coverage)
M Other
(s) Primary Condition Code The code is for the primary condition
requiring treatment. Primary condition,
established after study is found to be
chiefly responsible for occasioning the
admission of the patient to the hospital for
inpatient rehabilitation services. A 2 digit
code:
01 Stroke
02 Spinal Cord Injury
03 Congenital Deformity
04 Amputation
05 Major Multiple Trauma
06 Fracture of the femur (hip fracture)
07 Brain Injury
08 Poly-arthritis, including Rheumatoid
arthritis
09 Neurological disorders, including
multiple sclerosis, motor neuron diseases,
polyneuropathy, muscular dystrophy and
Parkinsons disease.
10 Burns
11 All conditions requiring intensive
rehabilitation services not assigned to
categories 01-10
(t) Attending Physician Identification The physicians Florida License
Number Identification Number as assigned by the
Department of Business and Professional
Regulation. This is the physician who
would normally be expected to have the
primary responsibility for the patients care
and treatment, or who certifies the
comprehensive rehabilitation treatment. An
11 character alpha-numeric field.
(u) Total Gross Charges A required field up to 7 digits. Total dollars
charged to the patient (before any
discounts), rounded to the nearest dollar.
No negative numbers.
(v) Status Code For agency use only. One space, to be left
blank.
(w) Reserved Filler For agency use only, 193 spaces to be left
blank. Errors in the record will be
identified in this field by the agency.
(3) TRAILER RECORD:
DATA ELEMENT DESCRIPTION
(a) Transaction Code T for the trailer record.
(b) AHCA Number A 6 digit hospital identification number
assigned by AHCA for reporting purposes.
(c) Florida License Number A 10 digit license number assigned by the
AHCA Division of Health Quality
Assurance.
(d) Provider Medicaid Number A 7 digit number provided for Medicaid
providers. If not a Medicaid provider, zero
fill.
(e) Provider Medicare Number A 7 digit number provided for Medicare
providers. If not Medicare provider, zero
fill.
(f) Provider Mailing Address The address of the Comprehensive
Inpatient Rehabilitation Hospital providing
the patient data records.
(g) Provider Mailing Address City The city of the address of the
Comprehensive Inpatient Rehabilitation
Hospital providing the patient data records.
(h) Provider Mailing Address State The State of the Comprehensive Inpatient
Rehabilitation Hospital providing the
patient data records.
(i) Provider Mailing Address Zip Code The Zip Code of the Comprehensive
Inpatient Rehabilitation Hospital providing
the patient data records.
(j) Submitter Mailing Address The address of the organization that is
submitting the data file.
(k) Submitter Mailing Address City The City of the organization that is
submitting the data file.
(l) Submitter Mailing Address State The state of the organization submitting the
data file.
(m) Submitter Mailing Address Zip Code The zip code of the organization
submitting the data file.
(n) Number of Records The total number of patient data records
contained in the file, excluding header and
trailer records.
(o) Filler A blank field of 126 spaces.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
59E-7.206 Patient Data Format - Record Layout.
(1) Header Record Layout. Each data file must contain as the first record a header record with a logical record length of 320 characters with the following record layout.
DESCRIPTION LENGTH TYPE POSITIONS COMMENTS
(a) TRANSACTION CODE1A/N1MUST BE H
(b) REPORTING YEAR4N2 5CCYY
(c) REPORTING QUARTER1N61, 2, 3, or 4
(d) DATE TYPE5A/N7 11MUST BE CR100
(e) SUBMISSION TYPE1A12I, M, or R
(f) PROCESSING DATE8N13 20CCYYMMDD
(g) AHCA NUMBER10N21 30RIGHT JUSTIFY
(h) FLORIDA LICENSE NUMBER10A/N31 40LEFT JUSTIFY
(i) PROVIDER MEDICAID10A/N41 50LEFT JUSTIFY
NUMBER
(j) PROVIDER MEDICARE10A/N51 60LEFT JUSTIFY
NUMBER
(k) PROVIDER ORGANIZATION40A/N61 100LEFT JUSTIFY
NAME
(l) PROVIDER CONTACT25A/N101 125LEFT JUSTIFY
PERSON NAME
(m) PROVIDER CONTACT14N126 139LEFT JUSTIFY
PERSON TELEPHONE NUMBER
(n) SUBMITTER40A/N140 179LEFT JUSTIFY
ORGANIZATION NAME
(o) SUBMITTER CONTACT25A/N180 204LEFT JUSTIFY
PERSON NAME
(p) SUBMITTER CONTACT 14 N 205 218 LEFT JUSTIFY
PERSON TELEPHONE NUMBER
(q) FILLER102A/N219 320BLANK SPACES
(2) Rehabilitation Patient Data Record Layout. The data elements for each patient record must have a logical record length of 320 characters with the following record layout.
DESCRIPTION LENGTH TYPE POSITIONS COMMENTS
(a) DATA TYPE5A/N1 5CR100
(b) ACTION CODE1A6A, U, or D
(c) REPORTING QUARTER1N71, 2, 3 or 4
(d) REPORTING YEAR4N8 11CCYY
(e) AHCA NUMBER6N12 17RIGHT JUSTIFY
(f) DATE SUBMITTED8N18 25CCYYMMDD
(g) RESERVED FIELD20N26 45LEFT BLANK
(h) RECORD IDENTIFICATION CODE17A/N46 62RIGHT
JUSTIFIED
(i) PATIENT SOCIAL SECURITY9N63 71
NUMBER
(j) PATIENT RACIAL1N72
BACKGROUND
(k) PATIENT BIRTH DATE 8 N 73 80 CCYYMMDD
(l) PATIENT SEX1N811 or 2
(m) PATIENT ZIP CODE5N82 86
(n) SOURCE OF ADMISSION1N87
(o) ADMISSION DATE8N88 95CCYYMMDD
(p) DISCHARGE DATE8N96 103CCYYMMDD
(q) PATIENT DISCHARGE2N104 105
STATUS
(r) PRINCIPAL PAYER CODE1A106
(s) PRIMARY CONDITION CODE2N107 108
(t) ATTENDING PHYSICIAN LICENSE11A/N109 119FLORIDA
IDENTIFICATION NUMBER
(u) TOTAL GROSS CHARGES7N120 126RIGHT
JUSTIFIED
(v) STATUS CODE1A127SPACE
(w) RESERVED FILLER193A/N128 320SPACES
(3) Trailer Record Layout. Each data file must contain as the last record, a trailer record with a logical record length of 320 characters with the following record layout.
DESCRIPTION LENGTH TYPE POSITIONS COMMENTS
(a) TRANSACTION CODE1A/N1MUST BE T
(b) AHCA NUMBER10N2 11RIGHT JUSTIFY
(c) FLORIDA LICENSE NUMBER10A/N12 21
(d) PROVIDER MEDICAID10A/N22 31LEFT JUSTIFY
NUMBER
(e) PROVIDER MEDICARE10A/N32 41LEFT JUSTIFY
NUMBER
(f) PROVIDER MAILING40A/N42 81LEFT JUSTIFY
ADDRESS
(g) PROVIDER MAILING25A/N82 106LEFT JUSTIFY
ADDRESS CITY
(h) PROVIDER MAILING2A107 108
ADDRESS STATE
(i) PROVIDER MAILING5N109 113
ADDRESS ZIP CODE
(j) SUBMITTER MAILING40A/N114 153LEFT JUSTIFY
ADDRESS
(k) SUBMITTER MAILING25A/N154 178LEFT JUSTIFY
ADDRESS CITY
(l) SUBMITTER MAILING2A179-180
ADDRESS STATE
(m) SUBMITTER MAILING5N181-185
ADDRESS ZIP CODE
(n) NUMBER OF RECORDS9N186-194COUNT
EXCLUDES
HEADER AND
TRAILER RECORDS
(o) FILLER126A/N195-320BLANK SPACES
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
59E-7.207 Data Standards.
Hospitals submitting pursuant to Rule 59E-7.207, F.A.C., shall report data according to the following parameters:
(1) Header Record:
(a) The Transaction Code must be H.
(b) The Reporting Year must be included or the record will be rejected.
(c) The Reporting Quarter must be 1, 2, 3, or 4.
(d) The Data Type must be CR100
(e) The Submission Type must be I, M, or R.
(f) The Processing Date should reflect the date that the data file was created by the submitter.
(g) The AHCA Number must be valid for the facility or the file will be REJECTED.
(h) The Florida License Number must be valid for the facility as licensed by the AHCA Division of Health Quality Assurance.
(i) The Provider Medicaid Number must be valid for the facility. If the facility is not a Medicaid provider, zero fill this field.
(j) The Provider Medicare Number must be valid for this facility. If the facility is not a Medicare provider, zero fill this field.
(k) The Provider Organization Name is the name of the health care provider that the data file reflects.
(l) The Provider Contact Person Name and Telephone Number specify the contact individual at the health care provider organization.
(m) The Submitter Organization Name is the name of the organization that produced the data file being submitted.
(n) The Submitter Contact Person Name and Telephone Number specify a contact person at the submitting organization.
(2) Comprehensive Inpatient Rehabilitation Hospital Patient Data Records:
(a) The Data Type must be CR100, is a required field for each comprehensive inpatient rehabilitation hospital patient data record, and is the first element in each record.
(b) The Action Code must be included for each record or the entire record will be REJECTED.
(c) The Reporting Quarter must be included for each record or the record will be REJECTED.
(d) The Reporting Year must be included for each record or the record will be REJECTED.
(e) The AHCA Number is a required field for each comprehensive inpatient rehabilitation hospital patient data record; must be 6 digits; and must be included on the tape/diskette external label or the entire file will be REJECTED.
(f) The Date Submitted must be included in each record or the record will be REJECTED.
(g) The Reserved Field is to be left blank for agency use.
(h) The Record Identification Code must be provided, each must be a unique identifier, up to 17 characters, and cannot be all spaces. Failure to provide a record identification code will result in REJECTION of the record. Duplication of a record identification code will also result in REJECTION of the record, with the exception of revisions to previously submitted reports, in which case the revised record must have a more current submission date and must have an Action Code of U, indicating that this is an update.
(i) The Patient Social Security number is a 9 digit required field for all patients who have had social security numbers assigned. Those not having social security numbers are expected to be newborn up to two years of age, or foreign or elderly patients who have never had one assigned. If not available, zero fill this field.
(j) The Patient Racial Background is a single digit entry showing: 1 American Indian/Eskimo/Aleut, 2 Asian/Pacific Islander, 3 Black, 4 White, 5 White Hispanic, 6 Black Hispanic, 7 Other, 8 No Response; For use as demographic and epidemiological information, and health planning.
(k) The Patient Birth Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a 4 digit numeric character (e.g., 1963).
(l) The Patient Sex designation must be 1 or 2.
(m) The Patient Zip Code is required and must be 5 digits. use 00009 for foreign patients who do not have a zip code for residence. use 00000 if unknown.
(n) The Source of Admission is required; must be 1-9.
(o) The Admission Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a four digit numeric character (e.g., 1994). The Admission Date must be equal to or precede the Discharge Date.
(p) The Discharge Date is required; must be 8 digits; month must be 01-12; day must be 01-31; and year must be a four digit numeric character (e.g., 1994). The Discharge Date must occur within the specified reporting period as shown on the external label of the tape/diskette: (e.g., 01/01-03/31, 04/01-06/30, 07/01-09/30, 10/01-12/31).
(q) The Patient Discharge Status is required; must be 2 digits; and must be 01-08 or 20.
(r) The Principal Payer Code is required and must be an alphabetic character A through M.
(s) The Primary Condition Code is required and must be a valid code 01-11. The leading zero is required for 01-09. The primary condition reported should be in accordance with the primary diagnosis reported to the Health Care Financing Administration (HCFA). Failure to provide primary condition will result in REJECTION of the record.
(t) The Attending Physician Identification Number is a required entry showing the Florida license number of the physician having primary responsibility for the patients care and treatment.
(u) The Total Gross Charges field is required; must be rounded to the nearest dollar; and must be numeric. A space filled field is not acceptable. A zero filled gross charge is only acceptable if the Discharge Status is 02 (Discharged to short term general hospital), 05 (discharged to another type of institution), or 20 (expired). Since all charges are rounded to the nearest dollar, an allowance for rounding will be accepted.
(v) The Status Code field must be left blank. It will be used by the agency, internally and in a report to the provider, to indicate whether the record has been accepted or rejected.
(w) The Reserved Filler field is to be left blank. This field will be used by the agency, internally and in a report to the provider, to indicate specific errors within the record.
(x) The total discharges reported must equal total discharges for calendar quarter stated on external tape/diskette label, and on the trailer record.
(3) Trailer Record:
(a) The Transaction Code must be T.
(b) The AHCA Number, as issued by AHCA, must be valid for the health care provider facility.
(c) The Florida License Number must be currently valid for the facility licensed by the AHCA Division of Health Quality Assurance.
(d) The Provider Medicaid Number must be the correct number issued to the health care facility.
(e) The Provider Medicare Number must be the correct number issued to the health care facility.
(f) The Provider Address fields specify where correspondence and data files should be sent to the health care provider.
(g) The Submitter Address fields specify where correspondence and data files should be sent to the submitter organization.
(h) The Number of Records must equal the number of patient data records physically on the data exchange file, excluding the header and trailer records.
(i) The Filler field is to be left blank.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
59E-7.208 Notice of Potential Future Additional Data Requirements.
The agency intends to develop additional data requirements and implementation schedules after it receives and analyzes patient level data collected from comprehensive inpatient rehabilitation hospitals. The agency will continue to monitor national developments and evaluate the efficiency and value of supplementing the initial set of eleven primary condition codes with data related to the patients functional status, diagnosis and procedure codes or of refining or expanding the set of primary condition codes.
Specific Authority 408.15(8) FS. Law Implemented 408.005(2), 408.05(2)(f)-(g), 408.05(6), 408.061(1)(a)-(b), 408.061(2)-(3), 408.061(8)-(9), 408.062(1)(f), 408.063(2), 408.07, 408.072, 408.085 FS. HistoryNew 3-31-94.
