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

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    AGENCY FOR HEALTH CARE ADMINISTRATION

    Cost Management and Control

    RULE NOS.:RULE TITLES:

    59B-9.031Definitions

    59B-9.034Reporting Instructions

    59B-9.037Header Record

    59B-9.038Ambulatory Data Elements, Codes and Standards

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

    SUMMARY: The agency is proposing amendments to Rules 59B-9.031; 9.034; 9.037, and 9.038, F.A.C., which modify ambulatory and emergency department reporting schema; delete all ICD-9 references, modify E-Code element name; and ambulatory reportable range instruction.

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

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

    Any person who wishes to provide information regarding a statement of estimated regulatory costs, or provide a proposal for a lower cost regulatory alternative must do so in writing within 21 days of this notice.

    RULEMAKING AUTHORITY: 408.15(8) FS.

    LAW IMPLEMENTED: 408.061, 408.062 FS.

    IF REQUESTED WITHIN 21 DAYS OF THE DATE OF THIS NOTICE, A HEARING WILL BE HELD AT THE DATE, TIME AND PLACE SHOWN BELOW (IF NOT REQUESTED, THIS HEARING WILL NOT BE HELD):

    DATE AND TIME: April 24, 2015, 11:00 a.m.

    PLACE: Agency for Health Care Administration, Building Three, Conference Room C, 2727 Mahan Drive, Tallahassee, Florida 32308

    Pursuant to the provisions of the Americans with Disabilities Act, any person requiring special accommodations to participate in this workshop/meeting is asked to advise the agency at least 5 days before the workshop/meeting by contacting: Judy Mathews at (850)412-3763. If you are hearing or speech impaired, please contact the agency using the Florida Relay Service, 1(800)955-8771 (TDD) or 1(800)955-8770 (Voice).

    THE PERSON TO BE CONTACTED REGARDING THE PROPOSED RULE IS: Nancy Tamariz at (850)412-3741

     

    THE FULL TEXT OF THE PROPOSED RULE IS:

     

    59B-9.031 Definitions.

    (1) through (3) No change.

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

    (5)  through (12) No change.

    PROPOSED EFFECTIVE DATE: 10-1-15

    Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended 12-5-10, Formerly 59B-9.013, F.A.C., Amended 10-1-15.

     

    59B-9.034 Reporting Instructions.

    (1) Ambulatory Surgical centers shall report data for all non-emergency visits for surgical procedures or services performed in the operating room, ambulatory surgical care, cardiology (cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)), gastro intestinal, extra-corporeal shock wave treatment (lithotripsy) surgery, and endoscopy corresponding to the following Current Procedural Terminology (CPT) and corresponding HCPCS Codes. For hospitals reporting type of service “1”, ambulatory surgical procedures, report CPT codes in the reportable range defined in paragraph 59B-9.034(1)(a)(b), F.A.C., having revenue charges for 36XX, 48XX, 49XX, 75XX or 79XX as used in the UB-04.  Visits without these revenue charges should not be reported even if the CPT codes are in the reportable range. Type of service “2”, Emergency Room, visits are not restricted to a CPT-HCPCS reportable range and should report all procedure codes.

    (a) through (d) No change.

    (3) through (5) No change.

    (5)(a) No change.

    (b) Data submitted Reports sent to the Internet address shall be electronically transmitted with the zipped ambulatory data in a XML file using the Ambulatory Patient Data XML Schema available at http://ahca.myflorida.com/xmlschemas/AS10-2.xsd. http://ahca.myflorida.com/xmlschemas/asc22.xsd.

    (c) No change.

    PROPOSED EFFECTIVE DATE: 10-1-15

    Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended 12-5-10, Formerly 59B-9.015, F.A.C., Amended 10-1-15.

     

    59B-9.037 Header Record.

    Beginning with the ambulatory data reporting for the 1st quarter of the year 2010, The the first record in the data file

    shall be a header record, containing the information described below.

    (1) through (3) No change.

    (4) Data Type. Enter AS10-2 AS10-1 for Ambulatory Data and Emergency Department Data. A required entry.

    (5) through (16) No change.

    PROPOSED EFFECTIVE DATE: 10-1-15

    Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Formerly 59B-9.018, F.A.C., Amended 10-1-15.

     

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

    (1) through (13) No change.

    (14) Principal Diagnosis Code. The code representing the diagnosis chiefly responsible for the services performed during the visit. Must contain a valid ICD-10-CM ICD-9-CM diagnosis code if type of service is “1” indicating ambulatory surgery. Must contain a valid ICD-10-CM ICD-9-CM diagnosis code if type of service is “2” indicating an emergency department visit unless patient status is “07” indicating that the patient left against medical advice or discontinued care. A blank field is permitted if type of service is “2” and patient status is “07.” If not space filled, must contain a valid ICD-10-CM ICD-9-CM diagnosis code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit 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. Alpha characters must be in upper case.

    (15) Other Diagnosis Code (1), Other Diagnosis (2), Other Diagnosis (3), Other Diagnosis (4), Other Diagnosis (5), Other Diagnosis (6), Other Diagnosis (7), Other Diagnosis (8), Other Diagnosis (9). A code representing a diagnosis related to the services provided during the visit. If no principal diagnosis code is reported, another diagnosis code must not be reported unless the patient discharge status is “07” indicating that the patient left against medical advice or discontinued care. No more than nine other diagnosis codes may be reported. Less than nine entries is permitted. If not space filled, must contain a valid ICD-10-CM ICD-9-CM code for the reporting period. A diagnosis code cannot be used more than once as a principal or other diagnosis for each visit 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.

    (16) through (42) No change.

    (43) Patient’s Reason for Visit ICD-10-CM ICD-9-CM Code (Admitting Diagnosis). The code representing the patient’s chief complaint or stated reason for seeking care in the Emergency Department. Must contain a valid ICD-10-CM ICD-9-CM code for the reporting period if type of service is “2” indicating an emergency department visit. If not space filled, must contain a valid ICD-10-CM ICD-9-CM diagnosis code. 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. Space fill if type of service is “1” indicating ambulatory surgery. Alpha characters must be in upper case.

    (44) Principal ICD-10-PCS ICD-CM Procedure Code. The code representing the procedure or service most related to the principal diagnosis. If not space filled, must contain a valid ICD-10-PCS procedure code for the reporting period. A blank field is permitted if type of service is “1” indicating ambulatory surgery. A blank or no entry is permitted consistent with the records of the reporting entity if type of service is “2” indicating an emergency department visit. Must contain a valid ICD-9-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. Space fill if type of service is “1” indicating ambulatory surgery. Alpha characters must be in upper case.

    (45) Other ICD-10-PCS ICD-CM Procedure Code (1), Other ICD-10-PCS ICD-CM Procedure Code (2), Other ICD-10-PCS ICD-CM Procedure Code (3), Other ICD-10-PCS ICD-CM Procedure Code (4) – A code representing a procedure or service provided during the visit. If no principal ICD-10-PCS ICD-CM procedure is reported, another ICD-10-PCS ICD-CM procedure code must not be reported unless the patient status is “07” indicating the patient left against medical advice or discontinued care. No more than four other ICD-10-PCS ICD-CM procedure codes may be reported. If not space filled, must contain a valid ICD-10-PCS procedure code for the reporting period. Alpha characters must be in upper case. A blank or no entry is permitted if type of service is “1.” Less than four or no entry is permitted if type of service is “2.” Must be a valid ICD-9-CM procedure code for the reporting period. The code must be entered with use of a decimal point that is included in the valid code and without use of a zero or zeros that are not included in the valid code. 

    (46) External Cause of Morbidity Injury Code (1), External Cause of Morbidity Injury Code (2) and External Cause of Morbidity Injury Code (3). A code representing circumstances or conditions as the cause of the injury, poisoning, or other adverse effects recorded as a diagnosis.  Assign the appropriate E-code for all initial encounters or treatments, but not for subsequent occurrences. A Place of Occurrence E-code (E849.X) should be included to describe where the event occurred if documented in the patient medical history. No more than three (3) external cause of morbidity Injury codes may be reported. Less than three (3) or no entry is permitted. If not space filled, must be a valid ICD-10-CM ICD-9-CM cause of morbidity injury code for the reporting period. An external cause of morbidity Injury code cannot be used more than once for each encounter 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.

    (47) through (49) No change.

    PROPOSED EFFECTIVE DATE: 10-1-15

    Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS. History–New 1-1-10, Amended 12-5-10, Formerly 59B-9.018, F.A.C., Amended 10-1-15.

     

    NAME OF PERSON ORIGINATING PROPOSED RULE: Nancy Tamariz at (850)412-3741.

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

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

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

Document Information

Comments Open:
4/1/2015
Effective Date:
3/18/2015
Summary:
The agency is proposing amendments to Rules 59B-9.031; 9.034; 9.037, and 9.038, F.A.C., which modify ambulatory and emergency department reporting schema; delete all ICD-9 references, modify E-Code element name; and ambulatory reportable range instruction.
Purpose:
The agency is proposing this rule amendment to change all ICD-9-CM references to ICD-10-CM and ICD-10-PCS in accordance with Center for Medicare/Medicaid Services (CMS) implementation of ICD-10 national reporting effective October 1, 2015. The amendment incorporates modification to the ambulatory schema; Data Type; External Cause of Injury Code (E-CODE) element name to External Cause of Morbidity Code (ECMORB); and ambulatory reportable range.
Rulemaking Authority:
408.15(8) FS
Law:
408.061, 408.062 FS.
Contact:
Nancy Tamariz at (850) 412-3741.
Related Rules: (4)
59B-9.031. Definitions
59B-9.034. Reporting Instructions
59B-9.037. Header Record
59B-9.038. Ambulatory Data Elements, Codes and Standards