NY SPARCS Inpatient Output data dictionary - onetomapanalytics/Meta_Data GitHub Wiki

NY SPARCS - Inpatient Output data dictionary

Inpatient Output data

PRIMARY RECORDS

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Common Portion of All Records

SPARCS Inpatient Segment: Common Detail on Primary Record

Data Element Name: Discharge Sequential Number Record Position: 1 - 14 Format – Length: Numeric – 14 Effective Date: Implemented May 1, 2005 and added to all years’ discharge files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The discharge year, plus an eight digit sequentially assigned number by SPARCS. This data element is used to identify each discharge. It is also used to link the primary and continuation records.

Codes and Values:

An assigned numeric value.

OUTPUT Edits on Element:

Must be a numeric value.
If Abortion Flag equals ‘Y’ then the Discharge Number is reconfigured.

INPUT Edits on Element: Not applicable. This is a derived field.

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SPARCS Inpatient Segment: Common Detail on Primary Record

Data Element Name: Continuation Indicator Record Position: 15 Format – Length: Numeric – 1 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A code which indicates if continuation records exist for this discharge. This is a derived data element.

Codes and Values:

“0” = no continuation records
A value of “1” or greater means this is a continuation record.

OUTPUT Edits on Element:

Must be a numeric value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Common Detail on Primary Record

Data Element Name: Record Sequence Number Record Position: 16 - 18 Format – Length: Numeric - 3 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number assigned by SPARCS to indicate the record's position within a set of records for a particular patient discharge.

This number is sequential (001, 002, etc.). For example, the “Record Sequence” number for the second record in a set of 3 records required to report all the data for a particular patient stay/discharge is set equal to “002”. All primary records will have a record sequence number equal to ‘001’.

Codes and Values:

Right justified and zero filled.
Primary Record = ‘001’
Continuation Records = ‘002’ to ‘092’

OUTPUT Edits on Element:

Must be numeric (‘001’ to ‘0 92 ’).

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Common Detail on Primary Record

Data Element Name: Record Sequence Count Record Position: 19 - 21 Format – Length: Numeric - 3 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of records reported for a particular patient stay/discharge.

This data element is assigned in conjunction with Record Sequence Number.

A patient discharge will result in one primary record and possible continuation records. All primary records will have a Record Sequence Number equal to one. For example, if a patient discharge has a “Record Sequence Count” equal to ‘00 5 ’, this means that there is a total of five records containing information for that patient stay; the primary record and four continuation records.

Codes and Values:

Right justified and zero filled.

OUTPUT Edits on Element:

Must be numeric (‘001’ to ‘016’).

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient Control Number Record Position: 28 - 47 Record Position for Encrypted* 2701 - 2744 Format – Length: Character - 20 Format - Length for Encrypted* Character - 44 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: NO Limited Data Set: YES; Encrypted only Identifiable Data Set: YES Deniable Data Element: Yes

*Patient Control Number is on the Limited Data Set as an Encrypted Data Element.

Description: A patient's unique number assigned by the hospital to facilitate retrieval of individual financial and clinical records and posting of the payment, and for that particular patient’s discharge. This is typically a key element in provider information systems for retrieval of an individual’s records. This number is usually the same as the Patient's Admitting Number.

Codes and Values:

Must have been left justified with no embedded blanks and space filled.
Equals patient control number.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must not have equaled zero or blanks.
Must have been numeric (0-9) and/or alphabetic (A-Z). Special characters were invalid entries.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Medical Record Number Record Position: 48 - 64 Record Position for Encrypted* 2745 - 2788 Format – Length: Character - 17 Format Length for Encrypted* Character - 44 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: NO Limited Data Set: YES; Encrypted only. Identifiable Data Set: YES Deniable Data Element: Yes *Medical Record Number is available on the Limited Data Set as an Encrypted Data Element. Description: The number used by the Medical Records Department to identify the patient's account number for the hospital. This number is not the same as the Patient Control Number. Codes and Values:

Left justified with no embedded blanks and space filled.
Equals Medical Record Number

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must not have equaled zero or blanks
Must have been numeric (0-9) and/or alphabetic (A-Z). Special characters were invalid entries.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Unique Personal Identifier Record Position: 65 - 74 Record Position for Encrypted* 2789 - 2810 Format – Length: Character - 10 Format Length for Encrypted* Character - 22 Effective Date: January 1, 1995 Contained In: De-Identified Data Set: NO Limited Data Set: YES for Encrypted only; otherwise, NO. Identifiable Data Set: YES Deniable Data Element: Yes

*Unique Personal Identifier is available on the Limited Data Set as an Encrypted Data Element.

Description: A composite field composed of portions of the patient's last name, first name, and social security number. This field, in conjunction with the Patient Birth Date and Patient Sex, is designed to provide matching criteria for individual patient records for longitudinal analysis without compromising the confidentiality of the record.

The source of the characters in the 10 positions are:

Composite 1 Position 1-4: First two (2) and last two (2) characters of the patient's last name. The birth name of the patient is preferable if it is available on the facility's information system.

Composite 2 Position 5-6: First two (2) characters of the patient's first name.

Composite 3 Position 7-10: Last four (4) digits of the patient's Social Security number.

Codes and Values:

First and second components must have been UPPERCASE alphabetic characters. If the last name was less than four characters, the first two and the last two characters should have been used even if some characters were repeated.
Social Security number component must have been numeric.

Examples: Patient Information Creating Unique Personal Identifier

Full Name Last 4 SS # Composite 1 Composite 2 Composite 3 Derived as:

Joe Tan 1234 TAAN JO 1234 TAANJO1234 Bill Su Jr. 4321 SUSU BI 4321 SUSUBI4321 E John Smith 0987 SMTH E_[blank] 0987 SMTHEE0987 Bob O'Brien 3456 OBEN BO 3456 OBENBO3456 Sue Jones-Davis unknown JOIS SU 0000 JOISSU0000

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OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Each sub-field must have contained a valid entry.

Unique Personal Identifier cont’d.

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SPARCS Inpatient Segment: Primary Records
PATIENT SEGMENT

**Data Element Name:** Enhanced Unique Personal Identifier
Record Position: 75 - 93
Record Position for Encrypted* 2811 - 2854
Format – Length: Character - 19
Format Length for Encrypted* Character - 44
Effective Date: Implemented June 2012 and added to years 1995 and
forward.
Contained In: De-Identified Data Set: NO
Limited Data Set: YES for Encrypted only; otherwise, NO.
Identifiable Data Set: YES
Deniable Data Element: Yes

*Enhanced Unique Personal Identifier is available on the Limited Data Set as an
Encrypted Data Element.

**Description:**
A composite field composed of portions of the patient's last name, first name, social
security number, the patient’s date of birth, and the sex of the patient as recorded on the
date of the admission or start of care. This field is designed to enhance matching criteria for
individual patient records for longitudinal analysis without compromising the
confidentiality of the record.

The source of the characters are:

Composite 1
Position 1-4: First two (2) and last two (2) characters of the patient's last name. The birth
name of the patient is preferable if it is available on the facility's information system.

Composite 2
Position 5-6: First two (2) characters of the patient's first name.

Composite 3
Position 7-10: Last four (4) digits of the patient's Social Security number.

Composite 4
Position 11- 18 : p atient’s Date of Birth as reported.

Composite 5
Position 19: patient’s S ex as reported.

Examples:
Patient Information Creating Enhanced Unique Personal Identifier

Full Name Last 4 SS # Date of Birth^ Sex^ Composite 1 Composite 2 Composite 3 + 4 +5 Derived as:

Joe Tan 1234 3/15/1991 M TAAN JO 123403151991M TAANJO123403151991M Bill Su Jr. 4321 1/7/1961 M SUSU BI 432101071961M SUSUBI432101071961M E John Smith 0987 6/26/1993 M SMTH EE 098706261993M SMTHEE098706261993M Bob O'Brien 3456 1/15/1951 M OBEN BO 345601151951M OBENBO345601151951M Sue Jones-Davis unknown 11/3/1959 F JOIS SU 000011031959F JOISSU000011031959F

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Codes and Values:

First and second components must have been UPPERCASE alphabetic characters. If the last name was less than four characters, the first two and the last two characters should have been used even if some characters were repeated.
Social Security number component must have been numeric. If no Social Security Number is available, this component must be zeros.
The patient’s date of birth must be valid in accordance with the Date Edit Validation Table in Appendix A, in the format: CCYYMMDD = Century Year Month Day.
The patient’s sex must equal: "M" = Male "F" = Female "U" = Unknown

Inpatient OUTPUT Edit:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted..

INPUT Edits on Element:

Each sub-field must have contained a valid entry.
The patient’s date of birth cannot have been after Admission Date/Start of Care.
For the patient’s gender, there exists multiple relationship edits between Patient Sex and sex-specific diagnosis and procedure codes as defined by the ICD- 9 - CM reference file edit flags.

Enhanced Unique Personal Identifi er cont’d.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient Birth Date Record Position: 94 - 101 Record Position for Encrypted* 2855 - 2876 Format – Length: Character - 8 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and month only Identifiable Data Set: YES Deniable Data Element: Yes

*The entire Patient Birth Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The date of the patient's birth.

Codes and Values:

Format must have been CCYYMMDD = Century Year Month Day (Example: 19591103).
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.
The age, calculated as the difference between the Patient Birth Date and the Admission Date/Start of Care, must have been less than 125.

INPUT Edits on Element:

Cannot have been after Admission Date/Start of Care.
Must have equaled the patient’s date of birth.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Age Record Position: 102 - 104 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: (^) De-Identified Data Set: YES -  90 , then equals O 90 Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: The patient's age in years calculated as of the date of admission calculated by the difference in the date of admission and the date of birth. Codes and Values:

Right justified, zero filled.
For a patient under one year of age or a newborn, age = "000".
For a patient over the age of 90, the age is will be = “O90” on the de-identified file.

OUTPUT Edits on Element:

Derived by SPARCS based on Patient Birth Date and Admission Date/Start of Care.
When a patient is over the age of 90, the age is will be = “O90” on the de-identified file.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Age in Days (for Newborn) Record Position: 105 - 107 Format – Length: Number - 3 Effective Date: Implemented May 1, 2005 and added to all years’ discharge records. Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: Calculated age in days for all records with an age equal 0, based on the Patient Birth Date and Admission Date/Start of Care. Codes and Values:

Numeric value for patient under one year of age.

OUTPUT Edits on Element:

This is a derived field that is only for children less than one year old.

INPUT Edits on Element:

Not applicable. This is a derived field that is only for children less than one year old.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Sex Record Position: 108 Format – Length: Character - 1 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: The sex of the patient as recorded on the date of the admission or start of care. Codes and Values:

"M" = Male "F" = Female "U" = Unknown

OUTPUT Edits on Element: None.

INPUT Edits on Element: Not applicable.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT Data Element Name: Patient Race Record Position: 109 - 110 Format – Length: Character - 2 Effective Date: January 1, 198 2 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which best describes the race of the patient.

Codes and Values:

For Discharges Prior to January 1, 2014 "01" = White "02" = Black or African American "03" = Native American or Alaskan Native "04" = Asian "05" = Native Hawaiian or Other Pacific Islander "88" = Other Race "99" = Unknown
For Discharges On or after January 1, 2014 “01” = White “02” = African American (Black) “03” = Native American (American Indian/Eskimo/Aleut) “41” = Asian Indian “42” = Chinese “43” = Filipino “44” = Japanese “45” = Korean “46” = Vietnamese “49” = Other Asian “51” = Native Hawaiian “52” = Samoan “53” = Guamanian or Chamorro “59” = Other Pacific Islander “88” = Other Race “MR” = Multi-racial

OUTPUT Edits on Element:

These are derived data elements.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Ethnicity Record Position: 111 Format – Length: Character - 1 Effective Date: January 1, 1986 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: The code which best describes the ethnic origin of the patient. Codes and Values:

For Discharges Prior to January 1, 2014 "1" = Spanish/Hispanic Origin "2" = Not of Spanish/Hispanic Origin "9" = Unknown
For Discharges On or after January 1, 2014 “ 2 ” = Not of Spanish/Hispanic Origin “ 3 ” = Mexican, Mexican American, Chicano/a “ 4 ” = PuertoRican “ 5 ” = Cuban Origin “ 6 ” = Other Spanish/Hispanic Origin “9” = Unknown “M” = Multi-ethnic

OUTPUT Edits on Element:

Depending upon which segment is used to report this data element, it may be translated to the above values for consistency.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Address Line 1 Record Position: 112 - 129 Record Position for Encrypted* 2877 - 2920 Format – Length: Character - 18 Format – Length for Encrypted* Character - 44 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: NO Limited Data Set: YES for Encrypted only; otherwise, NO. Identifiable Data Set: YES Deniable Data Element: Yes *Patient Address Line 1 is only available on the Limited Data Set as solely an Encrypted Data Element. Description: The mailing address of the patient's principal residence at the time of admission/visit, and can be reflected as a street number, post office box number or RFD. Codes and Values:

Standard abbreviations as listed in Address Abbreviations in the Official United States Postal Service (USPS) Abbreviations Web site: http://www.usps.com/ncsc/lookups/usps_abbreviations.html.

For reference there are also standard abbreviations listed in Appendix E - Address
Abbreviations.

Homeless patients may be coded as "HOMELESS".
Left justified and space filled.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must be entered.
Facilities were instructed to use standard abbreviations from the United States Postal Services (as listed above).

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient Address Line 2 Record Position: 130 - 147 Record Position for Encrypted* 2921 - 2964 Format – Length: Character - 18 Format – Length for Encrypted* Character - 44 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: NO Limited Data Set: YES for Encrypted only; otherwise, NO. Identifiable Data Set: YES Deniable Data Element: Yes

*Patient Address Line 2 is only available on the Limited Data Set as solely an Encrypted Data Element.

Description: The continuation of the mailing address of the patient's principal residence at the time of admission/visit.

Codes and Values:

Standard abbreviations as listed in Address Abbreviations in the Official United States Postal Service (USPS) Abbreviations Web site: http://www.usps.com/ncsc/lookups/usps_abbreviations.html.

For reference there are also standard abbreviations listed in Appendix E - Address
Abbreviations.

If this data element was not applicable, it contains blanks.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must be a valid entry.
If this field was not applicable, it must be blank.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient City Record Position: 148 - 162 Format – Length: Character - 15 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The name of the city, town or village in which the patient's principal residence is located on the day of admission/visit.

Codes and Values:

Facilities are instructed to use the standard city, town or village names approved by the U.S. Postal Service for mailing purposes.
Homeless patients are coded as "HOMELESS".

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted, unless otherwise noted.

INPUT Edits on Element:

Must be entered.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient State Record Position: 163 - 164 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The capitalized two-letter abbreviation for the state in which the patient's principal residence is located on the day of admission/visit, including US Territories, Commonwealths and Canadian Provinces.

Codes and Values:

Must have been valid in accordance with the State Edit Validation Table in Appendix G. For a complete listing of "State Abbreviations" go to the Official United States Postal Service (USPS) Abbreviations Web site: http://www.usps.com/ncsc/lookups/usps_abbreviations.html
“99” = Homeless or Unknown

"XX" = Other than United States or Canada.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be entered.

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SPARCS Inpatient Segment: Primary PATIENT SEGMENT

Data Element Name: Patient Postal Service Zip Code and Extension Code Record Position: 165 - 173 Record Position for Encrypted* 2965 - 2986 Format – Length: Character - 9 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: Only the first three digits of the zip code if the population is greater than 20,000, otherwise blank; Extension - NO Limited Data Set: YES; Extension - NO Identifiable Data Set: YES; Extension - YES Deniable Data Element: No: 5-digit zip code Yes: Extension Zip Code

Patient Postal Service Zip Code Extension Code (four digits) is only available on the Limited Data Set as solely an Encrypted Data Element.

Description: The Zip Code (five digits) and Extension Code (four digits) assigned by the U.S. Postal Service to the patient's principal residence at the time of admission or date of visit.

Codes and Values:

For United States residences, this Data Element is divided into a five-digit Zip Code and a four-digit Extension Code. For Canadian residences, this Data Element is defined as a six character Zip Code and 3 character filler.
Must have been left-justified and contained no embedded blanks. In cases where only a five-digit code was entered, the remaining four positions must have been space filled.
"XXXXX" = Unknown "YYYYY" = Foreign Country (Other Than Canada)
See Appendix F for Zip/County Code Edit Validation Table

OUTPUT Edits on Element:

When the Abortion Indicator or HIV Flag is equal to ‘Y’ only the first three digits of the zip code are released if the population is greater than 20,000, else redacted.
When the Abortion Indicator or HIV Flag is equal to ‘Y’, the Zip Code Extension is redacted, unless otherwise noted.

INPUT Edits on Element:

A minimum of a five-digit zip code is required for United States residences.
Must have been a valid code for the Patient County Code assigned to the patient's principal residence in accordance with the Zip/County Code Edit Validation Table in Appendix F.
If Patient Postal Service Zip Code was "10000"-"14999" or "06390", Patient State must have equaled "NY", and Patient County Code must have been "01"-"62" or "99".
Must be entered.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient County Code Record Position: 174 - 175 Format – Length: Number - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code assigned to the county where the patient's principal residence is located on the day of admission.

Codes and Values:

A valid two-digit code in accordance with the Zip/County Code Edit Validation Table in Appendix F.
“99” = Homeless “88” = Patient lives outside of New York State

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted, unless otherwise noted.

INPUT Edits on Element:

Must have been a valid county code for the Patient Postal Service Zip Code assigned to the patient's principal residence. If not the record would have been rejected.
Must have been compatible with Patient State. If the Patient County Code is in New York State (01-62), then Patient State must equal “NY”.
A valid two-digit code in accordance with the Zip/County Code Edit Validation Table in Appendix F.
If a Patient County Code was outside New York State (88), Patient State must NOT have equaled "NY”.

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SPARCS Inpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: SPARCS Region Code Record Position: 176 - 177 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: This is a geographical subdivision of the State of New York within which the health care facility is located, and is assigned by SPARCS based upon the county of the facility. Currently there are eleven regions. For the list of regions by county see NYS County/Region/HSA Table in Appendix U.

Codes and Values:

A two digit number between 01 and 11.

OUTPUT Edits on Element:

If Abortion Flag equals “Y”, this data element is redacted.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records

Newborn

**Data Element Name:** Newborn Flag
Record Position: 178
Format – Length: Character - 1
Effective Date: Implemented May 2005 and added to all years’ discharge.
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
A flag to indicate the patient's newborn status as determined by the first 5 characters of the
Principal/Primary Diagnosis Code content having any of the listed codes.

**Codes and Values:**

“ 0 ” = not a newborn “ 1 ” = newborn “ 2 ” = one of multiple newborns

**OUTPUT Edits on Element:**
These categories are intended for the coding of liveborn infants who are utilizing health
care (e.g. crib or bassinet occupancy).

“V30” = Single liveborn Specifically: ‘V300’, ‘V301’, ‘V3000’, or ‘V3001’
“V 31 ” = Twin, mate liveborn “V32” = Twin, mate stillborn “V33” = Twin, unspecified “V34” = Other multiple, mates all liveborn “V35” = Other multiple, mates all stillborn “V36” = Other multiple, mates live and stillborn “V37” = Other multiple, unspecified “V3 9 ” = Unspecified Specifically: ‘V310’, ‘V311’, ‘V320’, ‘V321’, ‘V330’, ‘V331’, ‘V340’, ‘V341’, ‘V350’, ‘V351’, ‘V360’, ‘V361’, ‘V370’, ‘V371’, ‘V3100’, ‘V3101’, ‘V3200’, ‘V3201’, ‘V3300’, ‘V3301’, ‘V3400’, ‘V3401’, ‘V3500,’ ‘V3501’, ‘V3600’, ‘V3601’, ‘V3700’, V3701’ Note: The following four-digit sub-divisions are for use with categories V30-V39: “ 0 ” – Born in hospital “ 1 ” – Born before admission to hospital “ 2 ” – Born outside hospital and not hospitalized Example: V30.x

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The following two fifth-digits are for use with the forth-digit .0, Born in hospital: “ 0 ” – delivered without mention of cesarean section “ 1 ” – delivered by cesarean delivery Example: V30.xx

OUTPUT Edits on Element: None.

INPUT Edits on Element: Not applicable. This is a derived data element.

Newborn Flag cont’d.

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SPARCS Inpatient Segment: Primary Records NEWBORN SEGMENT

Data Element Name: Mother’s Medical Record Number (for Newborn) Record Position: 179 - 195 Record Position for Encrypted* 2987 - 3030 Format – Length: Character - 17 Format – Length for Encrypted* Character - 44 Effective Date: January 1, 1990 Contained In: De-Identified Data Set: NO Limited Data Set: YES; Encrypted Identifiable Data Set: YES Deniable Data Element: Yes

Mother’s Medical Record Number (MRN ) is available on the Limited Data Set as an Encrypted Data Element.

Description: The medical record number of the newborn child's mother which links the newborn's hospital stay and the mother's stay.

Codes and Values:

Present when a valid newborn diagnosis code was entered in the Principal/Primary Diagnosis Code.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted, unless otherwise noted.

INPUT Edits on Element:

Must have been left justified with no embedded blanks and space filled.
Must not have equaled zero.
Must have been numeric (0-9) and/or alphabetic (A-Z). Special characters are invalid.
For Medicare discharges before 10/01/89 and non-Medicare discharges before 01/01/90, valid newborn codes are: V300 V3 01 V310 V311 V320 V321 V330 V331 V340 V341 V350 V351 V360 V361 V370 V371
For Medicare discharges after 9/30/89 and non-Medicare discharges after 12/31/89, valid newborn codes are: V3000 V3001 V301 V3100 V3101 V311 V3200 V3201 V321 V3300 V3301 V331 V 3400 V3401 V341 V3500 V3501 V351 V3600 V3601 V361 V3700 V3701 V371

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When a valid newborn diagnosis code was reported in the Principal/Primary Diagnosis Code and the mother was not admitted to the hospital, then all 9's were reported in the Mother's Medical Record Number for Newborn Child.
If this field was not applicable it contains blanks.

Mother’s Medical Record Number cont’d.

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SPARCS Inpatient Segment: Primary Records NEWBORN SEGMENT

Data Element Name: Newborn Birth Weight (Previously Neonate Birth Weight) Record Position: 196 - 199 Format – Length: Number - 4 Effective Date: January 1, 1987 Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: Yes

Description: Actual birth weight (in grams) or weight at time of admission for an extramural birth. Required on all claims with Type of Admission of 4 and on other claims as required by state law.

Codes and Values:

A valid number between "0100" and "9000".
The amount must have been entered as a positive whole number.
Right justified and zero filled.
Birth Weights less than "0099" grams were reported as "0100" grams. 5. If this field was not applicable it contains zeros or remains blank.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is rounded to the nearest hundred grams (e.g. 2583g = 2600g).

INPUT Edits on Element:

If the Admission Date was within 28 days of the Patient Birth Date, the Newborn Birth Weight must have been reported.
If the Newborn Birth Weight was reported as less than 1500 grams, and the New York State Patient Discharge Status was reported as code "01" home, then the Length of Stay must have been greater than 10 days.
Must have been a valid number between "0100" and less than "900 1 ".

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SPARCS Inpatient Segment: Primary Records

Facility

**Data Element Name:** Facility Identifier
Previously SPARCS Identification Number
Record Position: 200 - 205
Format – Length: Character - 6
Effective Date: January 1, 1982
Contained In: De-Identified Data Set: YES – Redacted for abortion records
Limited Data Set: YES – Redacted for abortion records
Identifiable Data Set: YES – Redacted for abortion records
Deniable Data Element: No

**Description:**
The number is assigned by the Department of Health upon certification. It is a six-digit
Facility Identifier used for a specific physical building location. This was previously
referred to as the Permanent Facility Identifier (PFI) or SPARCS Identification Number.
Department regulations state that services must be reported under the physical location
where they are provided. Common ownership of different facilities does not change this
requirement.

**Codes and Values:**

A six-digit number.
A valid number as maintained by the NYSDOH Division of Health Facility Planning.

**OUTPUT Edits on Element:**

If Abortion Flag equals ‘Y’, this data element is redacted.

**INPUT Edits on Element:**

Must have been a valid entry.

SPARCS Inpatient Output Page 69

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Facility Identifier Check Digit Record Position: 206 Format – Length: Character - 1 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Upon submission, the Facility Identifier Check digit follows the Facility Identifier number and is used to facilitate editing during the SPARCS input process. The facility identifier check digit is used for internal control purposes.

Codes and Values:

A numeric value from 0-9.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The edit on the Facility Identifier Check Digit is in relationship to the submitted Facility Identifier. If the check digit is incorrect, the submission will fail.

Note: The Facility Identifier Check Digit is assigned by the SPARCS Administrative Unit.

SPARCS Inpatient Output Page 70

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Facility Name Record Position: 207 - 276 Format – Length: Character - 70 Effective Date: Implemented May, 2005 and added to all years’ discharge records. Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES Deniable Data Element: No

Description: The name of the facility where services were performed based on the Facility Identifier, previously referred to as the Permanent Facility Identifier (PFI). This name is maintained by the NYSDOH Division of Health Facility Planning.

Note: This data element contains the Facility Name current to the update date of this record. It is not specific to its discharge year.

Codes and Values:

Valid Facility Name.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element: Not applicable. This is an assigned data element.

SPARCS Inpatient Output Page 71

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Health Service Area Record Position: 277 Format – Length: Number - 1 Effective Date: Implemented May 2005 and added to all years’ discharge records. Contained In: De-Identified Data Set: YES– Redacted for abortion records Limited Data Set: YES– Redacted for abortion records Identifiable Data Set: YES Deniable Data Element: No

Codes and Values:

A one digit number between 1 and 8.

OUTPUT Edits on Element:

This is a derived data element.
If Abortion Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element: Not applicable.

SPARCS Inpatient Output Page 72

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Facility County Record Position: 278 - 279 Format – Length: Number - 2 Effective Date: Implemented in May 2005 and added to all years’ discharge records. Contained In: De-Identified Data Set: YES– Redacted for abortion records Limited Data Set: YES– Redacted for abortion records Identifiable Data Set: YES Deniable Data Element: No

Description: The county where the health care facility is located. For the list of county codes see NYS County/Region/HSA Table in Appendix U.

Codes and Values:

Values are located in Appendix U – NYS County/Region/HSA Table.
A valid two-digit numeric code.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element: Not applicable. This is an assigned data element.

SPARCS Inpatient Output Page 73

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Operating Certificate Number Record Position: 280 - 286 Format – Length: Number - 7 Effective Date: Implemented May 2005 and added to all years’ discharge records. Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES Deniable Data Element: No

Description: The number assigned by the Department of Health Division of Health Facility Planning.

Department regulations state that services must be reported under the physical location where they are provided. Common ownership of different facilities does not change this requirement.

Note: This data element contains the Operating Certificate Number current to the update date of this record. It is not specific to its discharge year.

Codes and Values:

Maintained by the Health Facility Information Systems (HFIS), by the Division of Health Facility Planning. The Operating Certificate Numbers are available on the Health Commerce System, under the HFIS application.
A valid number as maintained by the NYSDOH Division of Health Facility Planning.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element:

Not applicable. This is an assigned data element.

SPARCS Inpatient Output Page 74

SPARCS Inpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: National Provider ID

Record Position: 287 - 296 Format – Length: Number - 10 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES Deniable Data Element: No

Description: Released if reported.

The unique identification number assigned to the provider submitting the bill, and is released when reported. Required for billing providers in the United States or its territories on or after the mandated HIPAA National Provider Identifier (NPI) implementation date when the provider is eligible to receive an NPI. Required when reporting for Centers for Medicare and Medicaid Services.

Codes and Values:

Equals facility’s National Provider ID (NPI)
Prior to HIPAA implementation, the number was assigned by the payer associated with this provider submitting the bill.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element: Not collected at this time.

Note: The NPI is ten numeric characters in length.

SPARCS Inpatient Output Page 75

SPARCS Inpatient Segment: Primary Records PHYSICIAN SEGMENT

Data Element Name: Attending Provider State License Number Record Position: 297 - 304 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES – Redacted for abortion records Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the New York State Department of Education, used to identify the physician or other health care professional primarily responsible for the care of the patient.

In some instances the health facility’s policy may dictate that an Attending Provider or chief of service may be assigned to any number of patients who may not have a primary care physician.

Codes and Values:

The first two positions of this field indicate the category of license held by the health care professional (see License Code Description in Appendix J.).
The third through eight positions are the six digit New York State Education Department license number.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element:

Must have been valid numerically for category range of entry. Example: Physician must have first 2 digits “00”, and the valid range is between 000 00001 - 00300000 and 00900000- 00999999.
For physicians, the actual license number is validated against the NYS Education Department license file.

SPARCS Inpatient Output Page 76

SPARCS Inpatient Segment: Primary Records PHYSICIAN SEGMENT

Data Element Name: Operating Physician State License Number Record Position: 305 - 312 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES – Redacted for abortion records Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the New York State Department of Education, used to identify the physician or other health care professional who performed the principal procedure.

Note: Hospital policy may dictate which physician license number will be used for this data element. In some instances hospital policy may dictate that an Attending Provider or chief of surgery may be assigned to any number of patients who may not have a primary care

Physician

Codes and Values:

The first two positions of this field indicate the category of license held by the health care professional (see License Code Description in Appendix J).
The third through eight positions are the six digit New York State Education Department license number.

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted

INPUT Edits on Element:

Must have been valid numerically for category range of entry. Example: Physician must have first 2 digits “00”, and the valid range is between 00000001 - 00300000 or 00900000 - 00999999.
If the Operating Physician State License Number was entered, the Principal Procedure Code and the Principal Procedure Date must have also been reported.

SPARCS Inpatient Output Page 77

SPARCS Inpatient Segment: Primary Records PHYSICIAN SEGMENT

Data Element Name: Other Operating Physician State License Number Record Position: 313 - 320 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES – Redacted for abortion records Limited Data Set: YES – Redacted for abortion records Identifiable Data Set: YES – Redacted for abortion records Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the New York State Department of Education, used to identify the physician or other health care professional (other than the Attending Provider or Operating Physician) who was involved in the patient's care or treatment (i.e., consulting physician, second operating physician, and nurse/midwife).

Codes and Values:

The first two positions of this field indicate the category of license held by the health care professional (see License Code Description in Appendix J)).
The third through eight positions are the six digit New York State Education Department license number

OUTPUT Edits on Element:

If Abortion Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

If reported, must have been valid numerically for category range of entry. Example: Physician must have first 2 digits “00”, and the valid range is between 0000000 1 - 00300000 and 00900000- 00999999.

SPARCS Inpatient Output Page 78

SPARCS Inpatient Segment: Primary Records
PAYER SEGMENT

Source of Payment Typology 2...................................................................

Record Position: 321 - 325
Format – Length: Number - 5
Effective Date: July 1, 2 009
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
Source of Payment Typology I (SoP I) is a hierarchical code list used to identify the payer
expected to pay the MAJOR portion of the patient's bill. It provides a range of codes from
broad categories to related sub-categories that are more specific. Facilities were directed to
report the expected payer using the greatest level of detail without sacrificing accuracy of
the information.

Facilities with Managed Care Plans (MCPs) were directed to concentrate on the variety of
Managed Care Plans (HMO and PPO), as well as the funding for these MCPs (Medicare or
Medicaid).

The code set is maintained by the Public Health Care Data Consortium (www.phdsc.org)

**Codes and Values:**

A valid code in accordance with the Source of Payment Typology Codes in Appendix P.

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

Source of Payment Typology I must have been entered.
Must have been left justified and space-filled right.
Medicaid and Medicare payers must be reported with a minimum of two digits from the typology. That is when:

Claim Filing Indicator is
Reported as:

SoP I must be:
16, MA, MB 1xxx
MC 2xxx

SPARCS Inpatient Output Page 79

SPARCS Inpatient Segment: Primary Records
PAYER SEGMENT

Source of Payment Typology 3...................................................................

Record Position: 326 - 330
Format – Length: Number - 5
Effective Date: July 1, 2009
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
Source of Payment Typology II (SoP II) is used to identify the secondary payer expected to
pay a portion of the patient’s bill if applicable.

Source of Payment Typology II is a hierarchical code list. It provides a range of codes from
broad categories to related sub-categories that are more specific. Report the expected payer
using the greatest level of detail without sacrificing accuracy of the information.
Facilities with Managed Care Plans (MCPs) were directed to concentrate on the variety of
Managed Care Plans (HMO and PPO), as well as the funding for these MCPs (Medicare or
Medicaid).

The code set is maintained by the Public Health Care Data Consortium (www.phdsc.org).

**Codes and Values:**

A valid code in accordance with the Source of Payment Typology Codes in Appendix P.

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

If entered, Source of Payment Typology II must have been a valid code.
Must have been left justified and space-filled right.

SPARCS Inpatient Output Page 80

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Source of Payment Typology 3 Record Position: 331 - 335 Format – Length: Number - 5 Effective Date: July 1, 2009 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Source of Payment Typology III (SoP III) is used to identify the third payer expected to pay a portion of the patient’s bill if applicable.

Source of Payment Typology III is a hierarchical code list. It provides a range of codes from broad categories to related sub-categories that are more specific. Report the expected payer using the greatest level of detail without sacrificing accuracy of the information. Facilities with Managed Care Plans (MCPs) were directed to concentrate on the variety of Managed Care Plans (HMO and PPO), as well as the funding for these MCPs (Medicare or Medicaid). The code set is maintained by the Public Health Care Data Consortium (www.phdsc.org).

Codes and Values:

A valid code in accordance with the Source of Payment Typology Codes in Appendix P.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If entered, Source of Payment Typology III must have been a valid code.
Must have been left justified and space-filled right.

SPARCS Inpatient Output Page 81

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Source of Payment 1- 6 Record Position: Data Element^ Record Position

Data Element Record Position Source of Payment 1 336 Source of Payment 4 513 Source of Payment 2 395 Source of Payment 5 572 Source of Payment 3^454 Source of Payment^6 631 Format – Length: Character - 1 Effective Date: January 1, 1 994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates the type of payment for this occurrence.

Codes and Values:

"A"=Self-Pay "B"=Workers' Compensation "C"=Medicare "D"=Medicaid "E"=Other Federal Program "F"=Insurance Company "G"=Blue Cross "H"=CHAMPUS "I"=Other Non-Federal Program "J"= Disability "K"= Title V "L"= Unknown

OUTPUT Edits on Element:

The following table details reported values for the Claim Filing Indicator and how they are grouped in the Source of Payment on the Output File:

SPARCS Inpatient Output Page 82

Output- Source of Payment Claim Filing Indicator

A – Self Pay 09 – Self Pay B – Workers’ Compensation WC – Workers’ Compensation Health Claim

C - Medicare

16 – Health Maintenance Organization (HMO) Medicare Risk MA – Medicare Part A MB – Medicare Part B D - Medicaid MC - Medicaid

E – Other Federal Program

FI – Federal Employees Program
OF – Other Federal Program
VA – Veterans’ Affairs Plan

F –Insurance Company

12 – Preferred Provider Organization (PPO) 13 – Point of Service 14 – Exclusive Provider Organization (EPO) 15 – Indemnity Insurance 17 – Dental Maintenance Organization AM – Automobile Medical CI – Commercial Insurance Co. HM – Health Maintenance Organization LM – Liability Medical G – Blue Cross BL – Blue Cross H- CHAMPUS CH – CHAMPUS I – Other Non-Federal Program 11 – Other Non-Federal Programs J – Disability DS – Disability K – Title V TV – Title V L - Unknown ZZ – Mutually Defined/Type of Insurance Unknown

**INPUT Edits on Element:**

For all payers Source of Payment Code, Covered Days, and Non-Covered Days were required.
The table below indicate the additional data items that are required, depending on the value in the Claim Filing Indicator. The Payer ID, Insured’s Policy Number and Billing NPI are required when the Claim Filing Indicator and Source of Payment Typology are reported with a Medicaid or Medicare payer type.

Claim Filing Indicator Code Payer ID Insured’s Policy
Number

Billing NPI
(Previously
Provider ID)
09, 11, 13, 14, 15, 17, AM, CH, DS,
FI, LM, OF, TV, VA, WC, ZZ

--------- ----------- --------

12, CI, HM, Required Required-IP only --------
16, BL, MA, MB, MC Required Required-IP only Required

For the first Claim Filing Indicator Code reported this edit applies:

Medicaid and Medicare payers must be reported with a minimum of two digits from
the typology. That is when:

Source of Payment 1- 6 cont’d

Source of Payment 1- 6 cont’d

SPARCS Inpatient Output Page 83

Claim Filing Indicator is Reported as: SoP* I must be:
16, MA, MB 1xxx
MC 2xxx

* = SoP for Medicare and Medicaid must be reported with a minimum of two digits
from the typology.

SPARCS Inpatient Output Page 84

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Claim Filing Indicator Code 1 - 6 Record Position:

Data Element Record
Position

Data Element Record Position Claim Filing Indicator 1 337 - 338 Claim Filing Indicator 4 514 - 515 Claim Filing Indicator 2 396 - 397 Claim Filing Indicator 5 573 - 574 Claim Filing Indicator^3 455 -^456 Claim Filing Indicator^6 632 -^633 Format – Length: Character - 2 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates the type of payment for this occurrence.

Codes and Values:

Codes and Values: (Bolded codes added 7/1/11). “09” = Self-pay “11” = Other Non-Federal Programs “12” = Preferred Provider Organization (PPO) “13” = Point of Service (POS) “14” = Exclusive Provider Organization (EPO) “15” = Indemnity Insurance “16” = Health Maintenance Organization (HMO) Medicare Risk “17” = Dental Maintenance Organization “AM” =^ Automobile Medical^ “BL” = Blue Cross/Blue Shield “CH” = CHAMPUS “CI” = Commercial Insurance Co. “DS” =^ Disability^ “FI” = Federal Employees Program “HM” = Health Maintenance Organization “LM” =^ Liability Medical^ “MA” = Medicare Part A “MB” = Medicare Part B “MC” = Medicaid “OF” = Other Federal Program ( Use “OF” when submitting Medicare Part D Claims .) “TV” =^ Title V^ “VA” = Veterans Affairs Plan “WC” = Workers’ Compensation Health Claim “ZZ” =^ Type of Insurance is not known.^

OUTPUT Edits on Element: None.

SPARCS Inpatient Output Page 85

INPUT Edits on Element:

For all payers Source of Payment Code, Covered Days, and Non-Covered Days were required.
The table below indicate the additional data items that are required, depending on the value in the Claim Filing Indicator Code: The Payer ID, Insured’s Policy Number and Billing NPI are required when the Claim Filing Indicator (and Source of Payment Typology) are reported with a Medicaid or Medicare payer type.

Claim Filing Indicator Code for
Other Subscriber

Payer ID Insured’s Policy
Number

Billing NPI
(Previously
Provider ID)
09, 11, 13, 14, 15, 17, AM, CH, DS, FI,
LM, OF, TV, VA, WC, ZZ

--------- ----------- --------

12, CI, HM, Required Required
IP only

--------

16, BL, MA, MB, MC Required Required
IP only

Required

For the first Claim Filing Indicator reported this edit applies:

Medicaid and Medicare payers must be reported with a minimum of two digits from
the typology. That is when:

Claim Filing Indicator is Reported as: SoP* I must be:
16, MA, MB 1xxx
MC 2xxx

* = SoP for Medicare and Medicaid must be reported with a minimum of two digits
from the typology.

Claim Filing Indicator Code 1 - 6 cont’d.

SPARCS Inpatient Output Page 86

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Insured’s Policy Number 1- 6 Record Position: Data Element^ Record Position

Data Element Record
Position
Insured’s Policy # 1 339 - 357 Insured’s Policy # 4 516 - 534
Insured’s Policy # 2 398 - 416 Insured’s Policy # 5 575 - 593
Insured’s Policy # 3 457 - 475 Insured’s Policy # 6 634 - 652

Record Position for Encrypted* Data Element^ Record Position

Data Element Record Position Insured’s Policy # 1 3031 - 3074 Insured’s Policy # 4 3163 - 3206 Insured’s Policy # 2 3075 - 3118 Insured’s Policy # 5 3207 - 3250 Insured’s Policy #^3 3119 -^3162 Insured’s Policy #^6 3251 -^3294 Format – Length: Character - 19 Format – Length for Encrypted* Character - 44 Effective Date: 1/1/199 2 Contained In: De-Identified Data Set: NO Limited Data Set: NO Identifiable Data Set: YES Deniable Data Element: Yes - See Appendix Z for release restrictions.

Policy Number 1- 6 is only available on the Limited Data Set as solely an Encrypted Data Element.

Description: The unique identification number assigned by the payer to identify the patient.

Codes and Values:

Facilities were directed to enter the following values: Payer Type of Number Blue Cross Enter the information depending on specific Blue Cross Plan needs and contract requirement.

CHAMPUS Enter information depending on CHAMPUS
regulations.

Medicaid Enter Medicaid Client Identification Number (CIN) of
the insured or case head Medicaid number shown on
the Medicaid Identification Card.

Medicare Enter the patient’s Medicare HIC number as shown on
the Health Insurance Card, Certificate of Award,
Utilization Notice, Temporary Eligibility Notice, Hospital
Transfer Form or as reported by the Social Security Office.

For all other payer types, Commercial Insurers, etc. enter the insured’s unique number assigned by the payer.

SPARCS Inpatient Output Page 87

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Inpatient only. Required if the first reported Claim Filing Indicator Code was 12, BL, CI, HM, Medicare (MA, MB or 16) or Medicaid (MC).
Required if Source of Payment Typology I was Medicare (1xxxx) or Medicaid (2xxxx).
If SoP II and/or SoP III were reported with the Medicare or Medicaid values, then the Insured’s Policy Number for the Secondary or other subscriber should have been reported.

Insured’s Policy Number 1- 6 cont’d.

SPARCS Inpatient Output Page 88

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Payer ID Number 1 - 6 Record Position: Data Element

Record
Position

Data
Element

Record Position Payer ID 1 358 - 365 Payer ID 4 535 - 542 Payer ID 2 417 - 424 Payer ID 5 594 - 601 Payer ID^3 476 -^483 Payer ID^6 653 -^660 Format – Length: Character - 8 Effective Date: 1/1/19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number identifying the payer organization associated with this sequence for which the provider might expect some payment of the bill.

Typically the Primary payer is in the first sequence, and subsequent payers are in contained in the Payer ID Number data elements 2 - 6.

Codes and Values:

Facilities were directed to enter values using the following: Payer Type of Number Blue Cross = Plan Number Refer to Appendix L Commercial Insurers

= NAIC or DOI Number
Refer to Appendix K
Commercial Insurance and HMO companies are regulated by the
Department of Insurance (DOI) and issued either a NAIC or internal DOI
numbers. In lieu of DOI numbers, DOH numbers are issued. Some billing
situations require NEIC numbers to be reported. For additional information
on these numbers, and specific HMO codes, refer to Appendix K.
Medicaid = State Agency Assigned number to be determined.
Refer to Appendix O for Medicaid Managed Care Plan IDs.
Medicare = Blue Cross Number or Commercial Insurer NAIC Number depending on
intermediary
CHAMPUS = NAIC Number

If this field was not applicable it must have been blank.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If Source of Payment Code was 12, 16, CI, BL, HM, MA, MB, MC, then Other Payer Identification should have been reported.
If Source of Payment Typology (SoP) was 21xxx (Medicaid Managed Care), then Payer Identification Number should have equaled a value from Appendix O.

SPARCS Inpatient Output Page 89

SPARCS Inpatient Segment: Primary Records
PAYER SEGMENT

**Data Element Name:** Covered Days 1- 6
Record Position: Data Element^ Record
Position

Data Element Record
Position
Covered-Days 1 366 - 369 Covered-Days 4 543 - 546
Covered-Days 2 425 - 428 Covered-Days 5 602 - 605
Covered-Days^3 484 -^487 Covered-Days^6 661 -^664
Format – Length: Number - 4
Effective Date: 1/1/19 82 – 8/1/2011
1/1/1982 – 12/31/2007

Data Collection

1/1/2008 – 8/2/2011

Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
The number of days covered by the payer for this occurrence as qualified by the payer
organization.

Typically days covered by the primary payer are in the first sequence, and subsequent days
are in contained in the Covered Days data elements 2-6.

**Codes and Values:**

Right justified and zero filled.

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

The sum of Covered Days and Non-Covered must not exceed Total Length of Stay (Statement Through Date minus Admission Date/Start of Care) for any payer sequence.

Note:
Prior to December, 2007: Reporting of covered and non-covered days was reported in
various input formats (UBF/DDA and UDS) that allowed the reporting of specific payers to
be associated with the reporting of days.

January 1, 2008: With the collection of the X 12 - 837 format there was no provision to
associate the specific payer with days. Do not use covered/non-covered days in association
with specific payers during this timeframe.

Due to this issue that the X 12 - 837 does not associate the days to a specific payer, the data
element (covered/non-covered) was stopped in 2011. Please refer to the Insured Days/Non-
Insured Days data element.

SPARCS Inpatient Output Page 90

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Non-Covered-Days 1- 6 Record Position: Data Element^ Record Position

Data Element Record Position Non-Covered-Days 1 370 - 373 Non-Covered-Days 4 547 - 550 Non-Covered-Days 2 429 - 432 Non-Covered-Days 5 606 - 609 Non-Covered-Days^3 488 -^491 Non-Covered-Days^6 665 -^668 Format – Length: Number - 4 Effective Date: 1/1/1994 – 12/31/2007 Collection Changes: 1/1/2008 – 8/2/2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Days of care not covered by the payer for this occurrence.

Typically the days not covered by the primary payer are in the first sequence, and the days not covered by subsequent payers are in sequence 2-6.

Codes and Values:

Right justified and zero filled.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The sum of Non-Covered Days and Covered Days must not have exceeded Total Length of Stay (“Statement Covers Through Date minus Admission Date/Start of Care) for any payer sequence.

Note: Prior to December, 2007: Reporting of covered and non-covered days was reported in various input formats (UBF/DDA and UDS) that allowed the reporting of specific payers to be associated with the reporting of days.

January 1, 2008: With the collection of the X 12 - 837 format there was no provision to associate the specific payer with days. Do not use covered/non-covered days in association with specific payers during this timeframe.

Due to this issue that the X 12 - 837 does not associate the days to a specific payer, the data element (covered/non-covered) was stopped in 2011. Please refer to the Insured Days/Non- Insured Days data element.

SPARCS Inpatient Output Page 91

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Billing National Provider Identification Number (NPI) 1 - 6 (previously Provider ID) Record Position: Data Element^ Record Position

Data Element Record Position Billing NPI 1 374 - 386 Billing NPI 4 551 - 563 Billing NPI 2 433 - 435 Billing NPI 5 610 - 622 Billing NPI^3 492 -^504 Billing NPI^6 669 -^681 Format – Length: Character - 13 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The unique identification number assigned to the provider submitting the bill. Required for billing providers in the United States or its territories on or after the mandated HIPAA National Provider Identifier (NPI) implementation date (2004) when the provider is eligible to receive an NPI. Required when reporting for Centers for Medicare and Medicaid services.

Codes and Values:

Equals facility’s National Provider ID (NPI) after the HIPAA implementation.
Prior to HIPAA implementation (prior to 2004) the number assigned was by the payer associated with this provider submitting the bill.
Must have been left justified with no embedded blanks and space filled.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry if Source of Payment Code was Medicare, Medicaid, or Blue Cross.

SPARCS Inpatient Output Page 92

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Alternate Level of Care (ALC) Days 1- 6 Record Position: Data Element^ Record Position

Data Element Record Position ALC Days 1 387 - 390 ALC Days 4 564 - 567 ALC Days 2 446 - 449 ALC Days 5 623 - 626 ALC^ Days^3 505 -^508 ALC^ Days^6 682 -^685 Format – Length: Number - 4 Effective Date: 1/1/1982 – 1/1/1999 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of patient days associated with this sequence at a level of care other than acute.

Codes and Values:

Must have been right justified and zero filled.
If this field was not applicable it must have contained zeros.

OUTPUT Edits on Element:

This is a derived data element from 1982 – 1999.
Must have been less than the Length of Stay.

INPUT Edits on Element:

The number of days must have been less than or equal to the number of days from the Date Alternate Care Required to the Discharge Date.
Total Alternate Level of Care Days for multiple payer submissions must not exceed Length of Stay.
If Alternate Level of Care Days was entered, Type of Alternate Care Required and Date Alternate Care Required were also reported. If Type and Date of Alternate Care Required were reported, at least one Alternate Level of Care Day for one of the record sequences must have been reported.

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SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Leave of Absence (LOA) Days 1- 6 Record Position: Data Element

Record
Position

Data
Element

Record Position LOA-Days 1 391 - 394 LOA-Days 4 568 - 571 LOA-Days 2 450 - 453 LOA-Days 5 627 - 630 LOA-Days^3 509 -^512 LOA-Days^6 686 -^689 Format – Length: Number - 4 Effective Date: 1/1/19 87 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of days, associated with this sequence, which the patient was in leave of absence status.

Codes and Values:

Must have been right justified and zero filled.
If this field was not applicable it must have contained zeros.

OUTPUT Edits on Element:

Calculated using the date range for Leave of Absence Days.
Must have been less than the Length of Stay.

INPUT Edits on Element:

Not applicable. This is a calculated data edit using the Occurrence Span for Leave of Absence Dates.

SPARCS Inpatient Output Page 94

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Expected Principal Reimbursement Record Position: 690 - 691 Format – Length: Character - 2 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identifies the payer expected to pay the major portion of the patient's bill. The Medicare and Medicaid HMO payer codes were used when the HMO responsible for payment received the reimbursement from one of the respective payers for the patient. If this information was not available from the patient's insurance card or from the admittance interview, the Other HMO payer code was used.

Codes and Values:

Must have been a valid code in accordance with the Expected Reimbursement Codes in Appendix D.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Inpatient Only: Prior to October 1, 1995 edits pertaining to ICD- 9 - CM codes were validated on the basis of the Discharge Date and the Expected Principal Reimbursement. The edit application reflects the yearly updating of the ICD- 9 - CM codes. ICD- 9 - CM updates become effective on October 1 for Medicare, CHAMPUS, and Medicare HMO discharges and on January 1 of the following year for all other payer discharges.

NOTE: After October 1, 1995, based on the Department of Health Memorandum
(Health Facilities Series: H4 95-7) issued on May 1, 1995, all edits pertaining to ICD-
9 - CM codes were validated on the basis of the Statement Covers Period – Through
Date (Discharge Date). The edit application reflects the yearly updating of the ICD- 9 -
CM codes. The ICD- 9 - CM updates became effective on October 1 for all payers.

SPARCS Inpatient Output Page 95

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Expected Reimbursement Other 1 Record Position: 692 - 693 Format – Length: Character - 2 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identifies secondary source of payment which is expected to pay some part of the hospital bill.

The Medicare and Medicaid HMO payer codes were used when the HMO responsible for payment received the reimbursement from one of the respective payers for the patient. If this information was not available from the patient's insurance card or from the admittance interview, the Other HMO payer code was used.

Codes and Values:

Must have been a valid code in accordance with the Expected Reimbursement Codes in Appendix D.
If this field was not applicable it must have contained blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.

SPARCS Inpatient Output Page 96

SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Expected Reimbursement Other 2 Record Position: 694 - 695 Format – Length: Character - 2 Effective Date: 1/1/ 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identified the tertiary source of payment which was expected to pay some part of the hospital bill.

Codes and Values:

Must have been a valid code in accordance with the Expected Reimbursement Codes in Appendix D.
If this field was not applicable it must have contained blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.

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SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Worker’s Compensation/No Fault Indicator Record Position: 696 - 697 Format – Length: Character - 2 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates whether the bill was covered by Workers' Compensation or No- Fault Insurance. Workers' Compensation is a form of liability insurance which provides health care coverage for employment-related causes and is the primary payer over all third- party payer sources. No-Fault is a form of vehicular insurance which provides health care coverage for vehicle-related accidents in New York State.

Codes and Values:

"NF" = No-Fault, Including Auto/Other "WC" = Workers' Compensation
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Value Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Value Code” data element collected. This element was created when the corresponding value codes were equal to: “ 14 ” = No Fault, including Auto/Other “ 15 ” = Worker’s Compensation
If submitted, the record must have contained the appropriate value code.

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SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Worker’s Compensation/No Fault Amount Record Position: 698 - 706 Format – Length: Number - 9 Effective Date: 1/1/1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The dollar amount of the bill that is covered by Workers' Compensation or No-Fault Insurance.

Codes and Values:

Right justified and zero filled.
The amount was entered in dollars and cents. This amount was defined with TWO implied decimal places and must have been entered as a positive amount.
If not applicable this field contains zeroes.

OUTPUT Edits on Element:

Derived data element based on “Value Amount” collected.

INPUT Edits on Element:

This is a derived data element from the “Value Amount” data element collected. The corresponding amount was collected for the derived field when the “Value Code” was equal to: “ 14 ” = No Fault, including Auto/Other “ 15 ” = Worker’s Compensation
If submitted, the record must have contained the appropriate “Value Code” and corresponding value amount.

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SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Surplus, Catastrophic or Recurring Monthly Income Code Record Position: 707 Format – Length: Character - 1 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: The code which indicates that a monthly payment was required of this Medicaid patient towards the cost of their hospitalization.

Codes and Values:

"1" = Surplus "2" = Catastrophic. "3" = Recurring Monthly Income
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Value Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Value Code” data element collected. This data element was collected when value codes were equal to: “21” = Catastrophic “22” = Surplus “23” = Recurring Monthly Income.
If submitted, the record must have contained the appropriate “Value Code”.

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SPARCS Inpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Surplus, Catastrophic or Recurring Monthly Income Amount Record Position: 708 - 716 Format – Length: Number - 9 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The monthly payment required of Medicaid patients towards the cost of their hospitalization.

Codes and Values:

Right justified and zero filled.
The amount must have been entered in dollars and cents. This amount was defined with TWO implied decimal places and must have been entered as a positive amount.

OUTPUT Edits on Element:

Derived data element based on “Value Amount” collected.

INPUT Edits on Element:

This is a derived data element from the “Value Amount” data element collected. This data element was when “Value Code” was equal to: ”21” = Catastrophic “22” = Surplus ”23” = Recurring Monthly Income
If submitted, the record must have contained the appropriate Value Code and corresponding “Value Amount”.

SPARCS Inpatient Output Page 101

SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Log Number Record Position: 717 - 722 Format – Length: Number - 6 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The sequential number assigned by SPARCS that identifies the submission to which the record belonged.

Codes and Values:

Must be an assigned number between 000001 and 999999.

OUTPUT Edits on Element: Not Applicable.

INPUT Edits on Element:

No edit applied. Number assigned sequentially at the time of successful file submission.

Note: Facilities may submit multiple files within a submission month for varying discharge months.

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SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Transaction Code Record Position: 723 Format – Length: Character - 1 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: This code is used for processing records into the SPARCS Master File. The Transaction Code comes from the third digit of the three digit numeric data element called 'Type of Bill' by the National Uniform Billing Committee (NUBC). This data element is referenced in the ASC X12N reporting guide as the "Claim Frequency Code". This code identifies the type of transaction for the electronic institutional claims: informational, new, replacement and void/cancel.

Codes and Values:

Code Value Type of Bill "1" Delete Third position code "8" "2" Add Third position code "1" "3" Correction Third position code "7"

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The following values are collected at intake: Claim Transaction Type

Value
Description

1 Admit thru Discharge Claim
(New Claim )

Use this code when billing for a confined treatment or inpatient
period. This will include bills representing a total confinement
or course of treatment and bills that represent an entire benefit
period of the primary third party payer.
7 Replacement of Prior Claim This code is used when a specific bill has been issued for a
specific provider, patient, payer, insured and "Statement Covers
Period" and it needs to be restated in its entirety, except for the
same identity information.
8 Void/Cancel of Prior Claim This code reflects the elimination in its entirety of a previously
submitted bill for a specific provider, patient, payer, insured and
"Statement Covers Period".

Must have been entered. If not, the record would have been rejected.
Must have been a valid value. If not, the record would have been rejected.

SPARCS Inpatient Output Page 103

SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Date Processed Record Position: 724 - 731 Format – Length: Character - 8 Effective Date: 1/1/ 1982 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year, Month, Day Identifiable Data Set: YES Deniable Data Element: No

Description: The date the facility created the file to submit to SPARCS.

Codes and Values:

Equals the actual date of the Transaction Set Creation.
Should be in the format CCYYMMDD.
Should be date in accordance with the Date Edit Validation Table in Appendix A.

OUTPUT Edits on Element: None.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 104

SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: SPARCS Collector Code Record Position: 732 - 734 Format – Length: Number – 3 Effective Date: 1/1/19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The three-digit identification number used to identify the hospital or vendor (data collector) submitting the data. Not to be confused with the Facility Identification Number. This code is used to identify the data submitter. If the data submitter is a vendor, an approved vendor agreement form has been signed and registered by SPARCS. The agreement form is an annual agreement between the vendor and facility that allows the vendor to submit SPARCS data on behalf of the facility.

Codes and Values:

Equals SPARCS Collector Code.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

A valid SPARCS collector code in accordance with the SPARCS Facility Profile Reference file maintained by the SPARCS Administrative Unit.
Must have corresponded with the approved Facility Identifier.

SPARCS Inpatient Output Page 105

SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Claim Type Record Position: 735 Format – Length: Character - 1 Effective Date: Implemented August 2012 and added to all years’ discharge records. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Claim Type is used to help define the data sets collected. SPARCS collects two data files from facilities: Inpatient and Outpatient. When processing the two different files collected, several data elements (type of bill and Revenue Code) are used to distinguish data types, particularly on the Outpatient file collection. The Inpatient file submission only results in one Claim Type – Inpatient.

Codes and Values:

“I” = “Inpatient Services”

OUTPUT Edits on Element:

All successful Inpatient records are coded as “I”.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 106

SPARCS Inpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Source File Type (Complete/Incomplete) Record Position: 736 Format – Length: Number - 1 Effective Date: Implemented May 1, 2005 , and added to all year’s files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The type of source file from which this record originated. Pre-1994 SPARCS inpatient data was created by matching a patient's hospital information from two separate files: the Discharge Data Abstract File (DDA) and the Uniform Billing File (UBF). The Complete File contains patient DDAs matched to the patient's corresponding final bills (UBF). The Incomplete File comprises those records from the DDA file and UBF not contained in the Complete File. Starting in 1994, inpatient data was reported in single record (UDS format). As of January 1, 1994, all records are coded to a value of "C".

The Incomplete File contains: i. DDAs without any billing information ii. DDAs with an interim bill but not a final bill iii. Final bills with no DDA iv. Interim bills with no DDA

Codes and Values:

"C" = Complete file record "I" = Incomplete file record

OUTPUT Edits on Element: This is a derived field.

INPUT Edits on Element: Not applicable. This is a derived field.

SPARCS Inpatient Output Page 107

SPARCS Inpatient Segment: Primary Records

Miscellaneous

**Data Element Name:** Residence Indicator
Record Position: 737
Format – Length: Character - 1
Effective Date: January 1, 1997
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
A code which indicates the residence status of a patient as either: HOMELESS at the time of
discharge or that the patient was a Non-United States Resident.

Note: Patients discharged to a shelter are also categorized as HOMELESS.

**Codes and Values:**

"H" = HOMELESS Patient "F" = Non-United States Resident (Foreign Born)
If not applicable this field contains blanks.

**OUTPUT Edits on Element:**
Derived data element based on “Condition Code” collected.

**INPUT Edits on Element:**

This is a derived data element from the “Condition Code” data element collected. This element was created when the corresponding Condition Code were equal to: “ 17 ” = Patient is Homeless “ 25 ” = Patient is Non-United States (US) Resident
If submitted, the record must have contained the appropriate “Condition Code”.

SPARCS Inpatient Output Page 108

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Special Program; Disability (DIS) Record Position: 738 Format – Length: Character - 1 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates if the patient was entitled to Medicaid benefits due to a specified physical impairment or treatment for a condition of a disabling nature.

A disabling condition means the inability to engage in any substantial or gainful activity by reason of any medically determinable physical or mental impairment which can be expected to result in death, or has lasted (or can be expected to last) for a continuous period of not less than 12 months.

Codes and Values:

"Y" = Disability
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Condition Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Condition Code” data element collected. This element was created when the corresponding Condition Code were equal to: “A5” = Disability
If submitted, the record must have contained the appropriate “Condition Code”.

SPARCS Inpatient Output Page 109

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Special Program; Family Planning (FP) Record Position: 739 Format – Length: Character - 1 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates if the patient was entitled to Medicaid benefits due to a specified physical impairment or treatment for family planning procedures by state law.

Codes and Values:

"Y" = Family Planning
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Condition Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Condition Code” data element collected. This element was created when the corresponding Condition Code were equal to: “A4” = Family Planning.
If submitted, the record must have contained the appropriate “Condition Code”.

SPARCS Inpatient Output Page 110

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Special Program; Physical Handicapped Children’s Program (PHC) Record Position: 740 Format – Length: Character - 1 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicated if the patient was entitled to Medicaid benefits due to a specified physical impairment or treatment under the Physically Handicapped Children's (PHP) Program. Services provided under this program receive special funding through Title VII of the Social Security Act or the TRICARE program for the Handicapped.

Codes and Values:

"Y" = Physically Handicapped Children's Program.
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Condition Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Condition Code” data element collected. This element was created when the corresponding Condition Code were equal to: “A 2 ” = Physically Handicapped Children’s Program (PHP).
If submitted, the record must have contained the appropriate “Condition Code”.

SPARCS Inpatient Output Page 111

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Special Program; Special Federal Funding (SFP) Record Position: 741 Format – Length: Character - 1 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates if the patient was entitled to Medicaid benefits due to a specified physical impairment or treatment under the Special Funding Project (SFP).

Codes and Values:

"Y" = Special Federal Funding
If not applicable this field contains blanks.

OUTPUT Edits on Element:

Derived data element based on “Condition Code” collected.

INPUT Edits on Element:

This is a derived data element from the “Condition Code” data element collected. This element was created when the corresponding Condition Code were equal to: “A 3 ” = Special Federal Funding (SFP)
If submitted, the record must have contained the appropriate “Condition Code”.

SPARCS Inpatient Output Page 112

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Old SPARCS Accommodation Codes 1- 5 (Previously SPARCS Accommodation Codes) Record Position: Data Element^ Record Position

Data Element Record Position Old SPARCS Accomm 1 742 Old SPARCS Accomm 4 745 Old SPARCS Accomm 2 743 Old SPARCS Accomm 5 746 Old SPARCS Accomm^3 744 Format – Length: Character - 4 Effective Date: 1/1/ 1980 - 12 / 31 /1999 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: From 1980 until 1999 the SPARCS system collected accommodation codes that were created by New York State. A crosswalk of these codes to the NUBC Revenue Codes was created. The old accommodation codes were replaced with the NUBC Revenue Codes for this data element.

Note: This data element was available for a limited time period.

Codes and Values:

See Appendix I – Revenue Codes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.

SPARCS Inpatient Output Page 113

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Placement of Bed Indicator Record Position: 762 - 764 Format – Length: Character - 3 Effective Date: 1/1/1994 - 5/1/1996 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The bed placement indicator was used shortly from 1994 to 1996. This indicator was used to detail the patient accommodation within a hospital that had exempt status for billing purposes.

Codes and Values:

"UB" = Unit Bed - Patient accommodation was bed within an organized hospital unit for which costs and statistics are separately maintained and an exempt payment (per diem or enhanced DRG rate) was expected for the patients in this unit.

"SB" = Scatter Bed - Patient accommodation was bed within an organized hospital unit which was not limited to exempt status patients but to which patients qualifying for exempt payment were admitted.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.
Must have been left justified with no embedded blanks and space filled.
If this field was not applicable, it contains blanks.

SPARCS Inpatient Output Page 114

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Do Not Resuscitate Indicator Record Position: 765 Format – Length: Character - 1 Effective Date: 1/1/1996 - 12/31/1997. Collection of this data element discontinued January 1998. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A code which indicates whether a DO NOT RESUSCITATE (DNR) Order written by a physician and placed in the patient's medical record to withhold cardiopulmonary resuscitation in the event of cardiopulmonary arrest existed for the patient's hospital stay at the time of discharge.

Note: Collection of this data element discontinued in January of 1998.

Codes and Values:

"Y" = A DNR Order Does exist for the patient's hospital stay

"N" = A DNR Order Does Not exist for the patient's hospital stay

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be a valid entry.

SPARCS Inpatient Output Page 115

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Emergency Department Indicator Record Position: 766 Format – Length: Character - 1 Effective Date: 1/1/2003 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Emergency Department Indicator is set based on the submitted revenue codes. If the record contained an Emergency Department revenue code of 045X, the indicator is set to "E", otherwise it will be blank.

This data element reflects a visit that had services in the Emergency Department that resulted in Inpatient stay.

Codes and Values:

"E" = Emergency Department Services indicated on record. Blank (no value) = when not applicable.

OUTPUT Edits on Element:

Derived data element based on the value of the Revenue Code.

INPUT Edits on Element:

Must be a valid Revenue Code.

Note: Please see the Claim Type data element in relation to the Emergency Department Indicator data element.

In 2003 SPARCS started the collection of all Emergency Department data on the Outpatient file. The information about the ED visit itself (in the Emergency Department) is not contained in the Inpatient Record.

SPARCS Inpatient Output Page 116

SPARCS Inpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Exempt Unit Indicator Record Position: 767 - 769 Format – Length: Character - 3 Effective Date: January 1, 199 0 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identifies a discharge from a unit within the facility that is exempt from Diagnosis Related Group (DRG) reimbursement.

Codes and Values:

“ALR” = Alcohol Rehabilitation “ALC” = Alternate Level of Care “CEP” = Comprehensive Psychiatric Emergency Program Observation “DGR” = Drug Rehabilitation “NDB” = Non-DRG Billable Claim “EPI” = Epilepsy “EXH” = All Services at Hospital are Exempt “MRH” = Medical Rehabilitation “PSY” = Psychiatric “XYZ” = HIV-AIDS “TBI” = Traumatic Brain Injury “VTD” = Ventilator Dependent
If this field was not applicable, it contains blanks.

OUTPUT Edits on Element:

This is a derived data element from the calculated Diagnostic Related Group (DRG).
Must have maintained a fixed width, and required spacing must have been maintained if element was not applicable.

INPUT Edits on Element: Not applicable.

SPARCS Inpatient Output Page 117

SPARCS Inpatient Segment: Primary Records

Treatment

**Data Element Name:** Statement From Date (previously Statement Covers
Period From Date)
Record Position: 770 - 777
Record Position for Encrypted* 3295 - 3316
Format – Length: Number - 8
Format - Length Number - 22
Effective Date: 1/1/19 82
Contained In: De-Identified Data Set: YES – Year only
Limited Data Set: YES – Year and Month
Identifiable Data Set: YES
Deniable Data Element: This field is composed of both non-deniable and
deniable components. **The 2-digit day is
identifiable and is ONLY present on the identifiable
file. See Appendix Z for release restrictions.

* Statement From Date is available on the Limited Data Set as an Encrypted Data Element;
otherwise it is available only with the Year and Month.

**Description:**
The start date of the billing period. The “From” date should not be confused with the
Admission Date. The Statement From Date is distinctly different than the Admission Date.
The dates may coincide in some circumstances, but should not be confused. It is also not a
requirement that the Admission Date fall in between the “From” Date and the Statement
“Through” Date. The Statement Covers Period identifies the span of service dates included
in a particular bill. The “From” Date is the earliest date of service on the bill.

**Codes and Values:**

CCYYMMDD = Century Year Month Day
Must have been valid date in accordance with the Date Edit Validation Table in Appendix A.

**OUTPUT Edits on Element:**

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

**INPUT Edits on Element:**

Must have been on or before the Statement Thru Date.
Enter both dates as month, day, and year (CCYYMMDD). For example: November 3, 2010 must be entered as: 20101103.

SPARCS Inpatient Output Page 118

Notes:

The Admission Date is purely the date the patient was admitted as an inpatient to the facility (or indicates the start of care date for home health and hospice). It is reported on all inpatient claims regardless of whether it is an initial, interim, or final bill.

NUBC Examples of Correct Usage:

When Medicare patients receive outpatient services 72 hours prior to an inpatient admission, the outpatient charges are included on the inpatient bill. In this situation, the Statement Covers Period reflects the entire range of dates associated with the services on the billing statement. Therefore, the Admission Date and the “From” Date will differ. On an initial bill the “From” Date would be prior to the Admission Date.
A patient is treated in the Emergency Department and is subsequently admitted after midnight (the next day). The “From” Date and the ED (ICD-CM) Procedure Date would be the same, but the Admission Date would be the following day.
In a longer term stay situation, it is necessary for the provider to issue an initial bill, one or more interim bills, and a final bill. The Admission Date is reported on each bill and will be the same on all of these bills. The Statement Covers Period will vary and reflects only the dates of services performed during the respective billing period.

Statement Covers Period From Date cont’d.

SPARCS Inpatient Output Page 119

SPARCS Inpatient Segment: Primary Records TREATMENT SEGMENT

Data Element Name: Statement Through Date (previously Statement Covers Period Through Date) Record Position: 778 - 785 Record Position for Encrypted* 3317 - 3338 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: 1/1/19 82 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and identifiable components. **The 2-digit day is deniable and is ONLY present on the identifiable file. See Appendix Z for release restrictions.

Statement Thru Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The end date of the billing period. The date when the patient was discharged from the hospital or death occurred.

Codes and Values:

CCYYMMDD = Century Year Month Day
Must have been valid date in accordance with the Date Edit Validation Table in Appendix A.

OUTPUT Edits on Element:

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must have been on or before the ‘Statement From Date’.
Multiple edits exist with this data element. When using the ‘Statement Thru Date’ to calculate ‘Length of Stay’, if the Neonate Birth Weight was reported as less than 1500 grams, and the ‘Patient Discharge Status’ was reported as code "01" home, then the ‘Length of Stay’ must have been greater than 10 days.

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Data Element Name: Admission/Start of Care Date Record Position: 786 - 793 Record Position for Encrypted* 3339 - 3360 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. See Appendix Z for release restrictions.

Admission/Start of Care Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: This is the date of the patient's admission to the hospital.

Codes and Values:

CCYYMMDD = Century Year Month Day
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.

OUTPUT Edits on Element:

Multiple edits exist with this data element in the Output file. The age, calculated as the difference between the ‘Patient Birth Date’ and the ‘Admission /Start of Care Date’ must have been less than 125.
When using the ‘Admission/Start of Care Date’ to calculate ‘Length of Stay’, if the ‘Newborn Birth Weight’ was reported as less than 1500 grams, and the ‘Patient Discharge Status’ was reported as code "01" home, then the ‘Length of Stay’ must have been greater than 10 days.
If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted

INPUT Edits on Element:

Must have been on or before ‘Statement Thru Date’.
Must have been on or before the ‘Date Processed’.

SPARCS Inpatient Output Page 121

Must have been on or after the opening date, and on or before the closing date, of an Article 28 facility as specified in the SPARCS Facility Reference File maintained by the SPARCS Administrative Unit.

Admission/Start of Care Date cont’d.

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Data Element Name: Admit Weekday Record Position: 794 - 796 Format – Length: Character - 3 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The day of the week that the patient was admitted to the hospital.

Codes and Values:

“MON” = Monday “TUE” = Tuesday “WED” = Wednesday “THU” = Thursday “FRI” = Friday “SAT” = Saturday “SUN” = Sunday

OUTPUT Edits on Element:

This is a derived data element.

INPUT Edits on Element: None.

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Data Element Name: Admission Hour Record Position: 797 - 798 Format – Length: Number - 2 Effective Date: January 1, 198 0 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The hour during which the patient was admitted for inpatient care.

Codes and Values:

Must have been right justified and zero filled.
HHMM = Hour Minutes. The hour must have been recorded in whole numbers, disregarding minutes, in accordance with the Admission/Discharge Hour Code Table in Appendix B.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.
SPARCS currently only edits and collects the first 2 numbers. Please refer to the Admission/Discharge Code Table in Appendix B.

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Data Element Name: Unscheduled/Scheduled Admission Record Position: 799 Format – Length: Character - 1 Effective Date: 1/1/1982 - 12/31/2000 Populated: 1/1/2001 – 9/30/2007 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which best describes the urgency of the patient's admission to the hospital.

Note: This data element was available for a limited time period. Effective January 1, 2001 (for all discharges) this data element is no longer collected by SPARCS from provider information systems. For the period January 1, 2001 through September 30, 2007 it was derived and populated from the ‘Type of Admission’ and ‘Source of Admission’. Effective October 1, 2007 (when ‘Source of Admission’ was replaced with the ‘Point of Origin’) this data element was no longer populated by SPARCS.

See Appendix X for details on the Unscheduled/Scheduled Admission Conversion Algorithm.

Codes and Values:

"1" = Unscheduled - An admission which was not arranged with the hospital at least 24 hours before the admission.

"2" = Scheduled - An admission arranged through the hospital at least 24 hours before the admission.

"9" = Information not available.

OUTPUT Edits on Element:

This was a derived data element from January 1, 2001 to September 30, 2007.

INPUT Edits on Element:

Must have been a valid entry for the period 1/1/1982 - 12/31/2000.

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Data Element Name: Discharge Date Record Position: 800 - 807 Record Position for Encrypted* 3361 - 3382 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 198 0 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. See Appendix Z for release restrictions.

Discharge Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The date when the patient was discharged or death occurred.

Note: Effective 1/1/1998 this field was populated from the ‘Statement Covers Through Date’.

Codes and Values:

CCYYMMDD = Century Year Month Day
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.

OUTPUT Edits on Element:

When using the ‘Discharge Date’ aka ‘Statement Covers Through Date’, if the ‘Neonate Birth Weight’ was reported as less than 1500 grams, and the ‘New York State Patient Discharge Status’ was reported as code "01" home, then the ‘Length of Stay’ must have been greater than 10 days.
If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Must have been on or after the ‘Admission/Start of Care Date’.
Must have been on or before the ‘Date Processed’.
Must have been on or after the opening date, or on or before the closing date, of an Article 28 facility as specified in the SPARCS Facility Reference File maintained by the SPARCS Administrative Unit.

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Data Element Name: Discharge Weekday Record Position: 808 - 810 Format – Length: Character - 3 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: NO Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The weekday the patient was discharged from the hospital.

Codes and Values:

“MON” = Monday “TUE” = Tuesday “WED” = Wednesday “THU” = Thursday “FRI” = Friday “SAT” = Saturday “SUN” = Sunday

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Discharge Hour Record Position: 811 - 812 Format – Length: Number - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The hour when the patient was discharged or death occurred.

Codes and Values:

Must have been right justified and zero filled.
The hour must have been recorded in whole numbers, disregarding minutes, in accordance with the ‘Admission/Discharge Hour’ Code Table in Appendix B.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.
Please refer to the ‘Admission/Discharge Hour’ Code Table in Appendix B.

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Data Element Name: Length of Stay Record Position: 813 - 816 Format – Length: Number - 4 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of patient days at an acute level and/or other than acute care level (excluding leave of absence days).

Codes and Values:

Numeric value greater than zero.

OUTPUT Edits on Element:

‘Length of Stay’ (LOS) equals ‘Discharge Date’ minus ‘Admission Date/Start of Care’ minus ‘Leave of Absence Days’.
If the ‘Date of Discharge’ equals the ‘Date of Admission’, then ‘Length of Stay’ (LOS) equals “ 1 ”.
When the ‘Neonate Birth Weight’ is reported as less than 1500 grams, and the ‘Patient Discharge Status Code’ is reported as “01” (Home), then the ‘Length of Stay’ must be greater than 10 days.

INPUT Edits on Element: Not applicable. This is a derived data element

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Data Element Name: Insured Days Record Position: 817 - 820 Format – Length: Number - 4 Effective Date: January 1, 2008 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of days covered by the primary payer as qualified by the payer. The days are reported by the facility based on the beneficiary’s policy.

Codes and Values:

Numeric values greater than zero.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The sum of ‘Insured Days’ and ‘Non-Insured Days’ must not exceed ‘Total Length of Stay’ (‘Statement Through Date’ minus ‘Admission/Start of Care Date’).

Note: Facilities were required to switch to the X 12 - 837 by 12/31/2007. Due to the collection change in 2008, the data elements ‘Covered Days’, ‘Non-Covered Days’ were not available by payer in the new format. These data elements were stopped, and the ‘Insured Days’ and ‘Non-Insured Days’ should be used in their place starting in 2008.

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Data Element Name: Non-Insured Days Record Position: 821 - 824 Format – Length: Number - 4 Effective Date: January 1, 2008 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of days not covered by the primary payer, and reported by the facility.

Codes and Values:

Numeric values greater than zero.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The sum of ‘Non-Insured Days’ and ‘Insured Days’ must not exceed ‘Total Length of Stay’ (‘Statement Thru Date’ minus ‘Admission Date/Start of Care’).

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Data Element Name: Total Leave of Absence Days Record Position: 825 - 828 Format – Length: Number - 4 Effective Date: January 1, 1987 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The sum of ‘Leave of Absence Days’ reported in all the payer sequences for the corresponding inpatient stay.

Codes and Values:

Numeric values greater than zero.
If this field was not applicable, it will contain zeros.

OUTPUT Edits on Element:

This is a derived data element.
Field must be less than the ‘Length of Stay’.

INPUT Edits on Element:

This is a derived data field from the ‘Occurrence Span Code’ information. The reported ‘Occurrence Span Code’ must have a value of “74” for ‘Leave of Absence’.
The ‘Occurrence Span Code From Date’ must be on or before the ‘Occurrence Span Through Date’ for each ‘Occurrence Span’ that is reported.
The corresponding ‘Occurrence Span From Date’ and ‘Thru Date’ must be within the stay as defined by the ‘Admission Date’ and the ‘Statement Thru Date’.

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Data Element Name: Total Alternate Care Days Record Position: 829 - 832 Format – Length: Number - 4 Effective Date: 1 /1/1994 – 1/1/1999 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of patient days associated with this sequence at a level of care other than acute.

Note: This data element was available for a limited time period.

Codes and Values:

Must have been right justified and zero filled.
If this field was not applicable it must have contained zeros.

OUTPUT Edits on Element:

‘Unit Quantity’ and ‘Unit Type’ must have been less than the ‘Length of Stay’.
The number of days must have been less than or equal to the number of days from the ‘Date Alternate Care Required’ to the ‘Discharge Date’.
Total ‘Alternate Level of Care Days’ for multiple payer submissions must not exceed ‘Length of Stay’.
If ‘Alternate Level of Care Days’ was entered, ‘Type of Alternate Care Required’ and ‘Date Alternate Care Required’ were also reported. If ‘Type and Date of Alternate Care Required’ were reported, at least one ‘Alternate Level of Care Day’ for one of the record sequences must have been reported.

INPUT Edits on Element:

This is a derived data element using the reported ‘Occurrence SPAN Date’ range.

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Data Element Name: Type of Alternate Care Required Record Position: 833 Format – Length: Character - 1 Effective Date: 1/1/1994 - 1/1/199 9 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which specifies the type of alternate care required for a patient determined to need a level of care other than acute during their hospitalization.

If a determination was made as to the type of care required but the patient's condition changed necessitating a different type of alternate care, the first determined type of alternate care required is entered.

Note: This data element was available for a limited period of time.

Codes and Values:

"1" = Residential Health Care Facility "2" = Medically Related Home Care Services "3" = Domiciliary Care "4" = Other Institution "5" = Home Health Service
If this field was not coded it contains blanks.

OUTPUT Edits on Element:

Calculated data element based a reported ‘Occurrence Code’: Reported occurrence Code Description Narrative

Reported Value
Occurrence Code

Reported Value/
ALC Code
Residential Health Care Facility 75 1
Medically Related Home Care
Services

81 2

Domiciliary Care 82 3
Other Institution 82 4
Home Health Services 81 5

INPUT Edits on Element:

Not applicable. This data element is derived from the reported ‘Occurrence Code’.

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Data Element Name: Date Alternate Care Required Record Position: 834 - 841 Record Position for Encrypted* 3383 - 3404 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: 1/1/1994 - 1/1/1999 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. The 4-digit year and the 2-digit month are non-deniable and are present on all files. Yes - See Appendix Z for release restrictions.

Alternate Care Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The first date that acute care was no longer needed as determined by the UR/PRO Representative. A patient's status can change several times during a hospital stay. If it changed more than once and consequently required a change back from alternate level of care to acute care, the FIRST date that acute care was no longer needed was entered. This date is not necessarily the date the determination was made or the date the level of care was changed; it is the date that acute care was no longer needed.

Note: This data element was available for a limited time period.

Codes and Values:

CCYYMMDD = Century Year Month Day.
If this field was not applicable, it will contain zeros.

OUTPUT Edits on Element:

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

This data element is derived from the ‘Occurrence Span Date’. The date must have been on or after the ‘Admission Date’ and prior to or the same as the ‘Discharge Date’.
If ‘Date Alternate Care Required’ was entered, then ‘Type of Alternate Care Required’ and ‘Total Alternate Level of Care Days’ were also reported.
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.

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Data Element Name: Total Acute Certified Days Record Position: 842 - 845 Format – Length: Number - 4 Effective Date: 1/1/1982 - 12/31/1997 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of patient days certified as medically necessary at an acute level of care.

Note: This data element was available for a limited time period.

Codes and Values:

Must have been less than or equal to "9999".
"0000" was a valid entry only if the entire stay was denied by the Utilization Review/PRO Representative.
Must have been right justified and zero filled.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The number of days entered must have been less than or equal to the ‘Length of Stay’.

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Data Element Name: Non-Acute Care Type (NACT) 1 - 30

Record Position Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record
Position
NACT 1 846 - 847 NACT 11 1026 - 1027 NACT 21 1206 - 1207
NACT 2 864 - 865 NACT 12 1044 - 1045 NACT 22 1224 - 1225
NACT 3 882 - 883 NACT 13 1062 - 1063 NACT 23 1242 - 1243
NACT 4 900 - 901 NACT 14 1080 - 1081 NACT 24 1260 - 1261
NACT 5 918 - 919 NACT 15 1098 - 1099 NACT 25 1278 - 1279
NACT 6 936 - 937 NACT 16 1116 - 1117 NACT 26 1296 - 1297
NACT 7 954 - 955 NACT 17 1134 - 1135 NACT 27 1314 - 1315
NACT 8 972 - 973 NACT 18 1152 - 1153 NACT 28 1332 - 1333
NACT 9 990 - 991 NACT 19 1170 - 1171 NACT 29 1350 - 1351
NACT 10^1008 -^1009 NACT 20^1188 -^1189 NACT 30^1368 -^1369

Format – Length: Character - 2 Effective Date: January 1, 1999 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: A code which indicates the type of non-acute care that was reported.

Codes and Values:

"74" = Leave of Absence. "75" = SNF Level of Care or Residential Care Facility. "81" = Home Health Level of Care – Code removed in November of 2010. "82" = Other Level of Care – Code removed in November of 2010.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be a valid entry for ‘Occurrence SPAN Code’. Valid codes are “ 74 ”, “ 75 ”, “ 81 ” or “ 82 ”.
Codes “81” and “82” are valid only for discharge dates prior to November 2010, and were eliminated after November 2010.

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Data Element Name: Non-Acute From (NACF) Date 1- 30 Record Position: Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record
Position
NACF 1 848 - 855 NACF 11 1028 - 1035 NACF 21 1208 - 1215
NACF 2 866 - 873 NACF 12 1046 - 1053 NACF 22 1226 - 1233
NACF 3 884 - 891 NACF 13 1064 - 1071 NACF 23 1244 - 1251
NACF 4 902 - 909 NACF 14 1082 - 1089 NACF 24 1262 - 1269
NACF 5 920 - 927 NACF 15 1100 - 1107 NACF 25 1280 - 1287
NACF 6 938 - 945 NACF 16 1118 - 1125 NACF 26 1298 - 1305
NACF 7 956 - 963 NACF 17 1136 - 1143 NACF 27 1316 - 1323
NACF 8 974 - 981 NACF 18 1154 - 1161 NACF 28 1334 - 1341
NACF 9 992 - 999 NACF 19 1172 - 1179 NACF 29 1352 - 1359
NACF 10^1010 -^1017 NACF 20^1190 -^1197 NACF 30^1370 -^1377

Record Position for Encrypted* Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record Position NACF 1 3405 - 3426 NACF 11 3845 - 3866 NACF 21 4285 - 4306 NACF 2 3449 - 3470 NACF 12 3889 - 3910 NACF 22 4329 - 4350 NACF 3 3493 - 3514 NACF 13 3933 - 3954 NACF 23 4373 - 4394 NACF 4 3537 - 3558 NACF 14 3977 - 3998 NACF 24 4417 - 4438 NACF 5 3581 - 3602 NACF 15 4021 - 4042 NACF 25 4461 - 4482 NACF 6 3625 - 3646 NACF 16 4065 - 4086 NACF 26 4505 - 4526 NACF 7 3669 - 3690 NACF 17 4109 - 4130 NACF 27 4549 - 4570 NACF 8 3713 - 3734 NACF 18 4153 - 4174 NACF 28 4593 - 4614 NACF 9 3757 - 3778 NACF 19 4197 - 4218 NACF 29 4637 - 4658 NACF 10^3801 -^3822 NACF 20^4241 -^4262 NACF 30^4681 -^4702 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 1999 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. The 4-digit year and the 2-digit month are non-deniable and are present on the De-identified file. See Appendix Z for release restrictions.

Non-Acute From Date 1 - 30 is available on the Limited Data Set as an Encrypted Data Element. otherwise it is available only with the Year and Month.

Description: The date this occurrence of non-acute care began.

Codes and Values:

CC YY MM DD = Century Year Month Day
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.
If this field was not applicable it contains blanks.

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OUTPUT Edits on Element:

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

The reported ‘Occurrence SPAN Date’ must have been on or after the ‘Admission Date/Start of Care’ and prior to or the same as ‘Discharge Date’.

Non-Acute From Date 1- 30 cont’d.

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Data Element Name: Non-Acute Thru Date (NATD) 1 - 30

Record Position: Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record
Position
NATD 1 856 - 863 NATD 11 1036 - 1043 NATD 21 1216 - 1223
NATD 2 874 - 881 NATD 12 1054 - 1061 NATD 22 1234 - 1241
NATD 3 892 - 899 NATD 13 1072 - 1079 NATD 23 1252 - 1259
NATD 4 910 - 917 NATD 14 1090 - 1097 NATD 24 1270 - 1277
NATD 5 928 - 935 NATD 15 1108 - 1115 NATD 25 1288 - 1295
NATD 6 946 - 953 NATD 16 1126 - 1133 NATD 26 1306 - 1313
NATD 7 964 - 971 NATD 17 1144 - 1151 NATD 27 1324 - 1331
NATD 8 982 - 989 NATD 18 1162 - 1169 NATD 28 1342 - 1349
NATD 9 1000 - 1007 NATD 19 1180 - 1187 NATD 29 1360 - 1367
NATD 10^1018 -^1025 NATD 20^1198 -^1205 NATD 30^1378 -^1385

Record Position for Encrypted* Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record Position NATD 1 3427 - 3448 NATD 11 3867 - 3888 NATD 21 4307 - 4328 NATD 2 3471 - 3492 NATD 12 3911 - 3932 NATD 22 4351 - 4372 NATD 3 3515 - 3536 NATD 13 3955 - 3976 NATD 23 4395 - 4416 NATD 4 3559 - 3580 NATD 14 3999 - 4020 NATD 24 4439 - 4460 NATD 5 3603 - 3624 NATD 15 4043 - 4064 NATD 25 4483 - 4504 NATD 6 3647 - 3668 NATD 16 4087 - 4108 NATD 26 4527 - 4548 NATD 7 3691 - 3712 NATD 17 4131 - 4152 NATD 27 4571 - 4592 NATD 8 3735 - 3756 NATD 18 4175 - 4196 NATD 28 4615 - 4636 NATD 9 3779 - 3800 NATD 19 4219 - 4240 NATD 29 4659 - 4680 NATD 10^3823 -^3844 NATD 20^4263 -^4284 NATD 30^4703 -^4724 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 1999 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. The 4-digit year and the 2-digit month are non-deniable and are present on the De-identified file. See Appendix Z for release restrictions.

Non-Acute Thru Date 1 - 30 is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The date this occurrence of non-acute care ended.

Codes and Values:

CCYYMMDD = Century Year Month Day.
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.
If this field was not applicable it contains blanks.

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OUTPUT Edits on Element:

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

The reported ‘Occurrence Span Date’ must have been on or after the ‘Admission Date/Start of Care’ and prior to or the same as ‘Discharge Date’.

Non-Acute Thru Date 1- 30 cont’d.

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Data Element Name: Same Day Discharge Indicator Record Position: 1386 Format – Length: Character - 1 Effective Date: Implemented May 1, 2005, and added to all year’s files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A flag indicating if the patient was admitted and discharged on the same day.

Codes and Values:

“ 0 ” = Not Same Day “ 1 ” = Same Day

OUTPUT Edits on Element:

A derived data element using the ‘Statement From Date’ and ‘Statement Through Date’.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Patient Discharge Status (previously NYS Patient Status or Discharge Disposition) Record Position: 1387 - 1388 Format – Length: Character - 2 Effective Date: 1/1/19 82 – 1/1/1993 reported as UDS codes that were translated to UB codes. Reported as Uniform Bill codes after 1993. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which best identifies the patient's destination or status upon discharge.

Codes and Values:

Must have been a valid code in accordance with codes listed in Appendix C (Patient Discharge Status Codes).
Must have been right justified and zero filled.

OUTPUT Edits on Element:

If Patient Discharge Status code "10" was reported, computed ‘Age’ must have equaled "000" [calculated from the ‘Patient Birth Date’ at the time of admission].
If the ‘Neonate Birth Weight’ was reported as less than 1500 grams, and the ‘Patient Status’ was reported as code "01" home, then the ‘Length of Stay’ must have been greater than 10 days.

INPUT Edits on Element:

Must have been a valid entry in accordance with values in Appendix C.

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Data Element Name: Type of Bill Record Position: 1389 - 1391 Format – Length: Character - 3 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A three-digit numeric code which identified the specific type of bill (inpatient, adjustments, voids, etc.). The first digit represents Type of Facility, the second digit the Bill Classification, and the third digit the Frequency.

Codes and Values:

First Digit: "1" = Hospital "8" = Special Facility (Rural Primary Care Facility Only)

Second Digit: "1" = Inpatient (including Medicare Part A) "2" = Inpatient (Medicare Part B) "5" = Rural Primary Care Hospital

Third Digit: "1" = Admit thru discharge claim (new) "7" = Replacement of prior claim (change) "8" = Void/cancel of prior claim (delete)

All positions must have been fully coded.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry as assigned by the National Uniform Bill Committee (NUBC).

Note: This data element is derived from two data field from the X 12 - 837 forward. They are: ‘Facility Type Code’ and ‘Claim Transaction Type’.

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SPARCS Inpatient Segment: Primary Records TREATMENT SEGMENT

Data Element Name: Service Category Group Record Position: 1392 Format – Length: Character - 1 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Categorization of the discharge record by NYS Department of Health defined Service Category Group as described in the SPARCS Annual Report Series Tables. See Appendix S - Service Category Group Definitions.

Codes and Values:

“ 1 ” = Medical “ 2 ” = Surgical “ 3 ” = Pediatric “ 4 ” = Obstetrical “ 5 ” = Nursery/Newborn “ 6 “= Psychiatric

OUTPUT Edits on Element:

See Appendix S for grouping definitions using the ICD- 9 - CM Principal Diagnosis.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 145

SPARCS Inpatient Segment: Primary Records TREATMENT SEGMENT

Data Element Name: Type of Admission Record Position: 1393 Format – Length: Character - 1 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates the manner in which the patient was admitted to the health care facility.

Codes and Values:

"1" = Emergency - The patient requires immediate medical intervention as a result of severe, life threatening, or potentially disabling conditions.

"2" = Urgent - The patient requires immediate attention for the care and treatment of a physical or mental disorder. Generally the patient is admitted to the first available and suitable accommodation.

"3" = Elective - The patient's condition permits adequate time to schedule the admission based on the availability of a suitable accommodation.

"4" = Newborn - Use of this code necessitates the use of special codes in the Source of Admission.

"5" = Trauma - Visit to a trauma center/hospital as licensed or designated by the state or local government authority authorized to do so, or as verified by the American College of Surgeons and involving a trauma activation.

"9" = Information not available. The provider cannot classify the type of admission.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.

SPARCS Inpatient Output Page 146

SPARCS Inpatient Segment: Primary Records
TREATMENT SEGMENT

**Data Element Name:** Point of Origin (previously Source of Admission)
Record Position: 1394
Format – Length: Character - 1
Effective Date: January 1, 1986
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
The code indicating the point of patient origin for admission to the hospital. See Conversion
Appendix for historical information.

**Codes and Values:**

“ 1 ” = Non-Health Facility Point of Origin Inpatient: The patient was admitted to this facility upon an order of a physician.

“ 2 ” = Clinic Inpatient: The patient was referred to this facility as a transfer from a freestanding or non-freestanding clinic.

“ 3 ” = Reserved for assignment by the NUBC.

“ 4 ” = Transfer From a Hospital (Different Facility) Inpatient: The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient or outpatient.

“ 5 ” = Transfer From a Skilled Nursing Facility (SNF) or Intermediate Care Facility (ICF) Inpatient: The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident.

“ 6 ” = Transfer From Another Health Care Facility Inpatient: The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list.

“ 7 ” = Emergency Room (Discontinued Effective 7/1/2010) Inpatient: The patient was admitted to this facility after receiving services in this facility's emergency department.

Excludes: Patients who came to the emergency room from another health care
facility.

SPARCS Inpatient Output Page 147

“ 8 ” = Court/Law Enforcement Inpatient: The patient was admitted to this facility upon the direction of a court of law, or upon the request of a law enforcement agency representative.

“ 9 ” = Information Not Available The means by which the patient was admitted to this hospital was not known.

“A” = Transfer from a Rural Primary Care Hospital (Only valid for discharges prior to 10/1/2007) The patient was admitted to this facility as a transfer from a Rural Primary Care Hospital (RPCH) where he or she was an inpatient.

“D” = Transfer from One Distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in a Separate Claim to the Payer (only valid for discharges prior to 10/1/2007). Inpatient: The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer.

“E” = Transfer from Ambulatory Surgery Center (Effective 10/1/2007) Inpatient: The patient was admitted to this facility as a transfer from an ambulatory surgery center.

“F” = Transfer from Hospice and is Under a Hospice Plan of Care or Enrolled in a Hospice Program (Effective 10/1/2007)

Inpatient: The patient was admitted to this facility as a transfer from a hospice.

If the Type of Admission is a Newborn, "4", the following coding scheme must be used for Source of Admission:

“ 1 ” = Normal Delivery (Only valid for discharges prior to 10/1/2007)

“ 2 ” = Premature Delivery (Only valid for discharges prior to 10/1/2007)

“ 3 ” = Sick Baby (Only valid for discharges prior to 10/1/2007)

“ 4 ” = Extra Mural Birth (Only valid for discharges prior to 10/1/2007)

“ 5 ” = Born Inside Hospital (Effective 10/1/2007) A baby born inside this Hospital.

“ 6 ” = Born Outside Hospital (Effective 10/1/2007) A baby born outside of this Hospital.

**OUTPUT Edits on Element:**
None.
**INPUT Edits on Element:**

Must have been a valid entry for ‘Point of Origin’.
Prior to 1994 the data element collected was ‘Source of Admission/Admission Source”. Note: The National Uniform Bill Committee (NUBC) name of this data element changed from ‘Source of Admission’ to ‘Point of Origin’.

Point of Origin cont’d.

SPARCS Inpatient Output Page 148

SPARCS Inpatient Segment: Primary Records

Diagnosis

**Data Element Name:** Admitting Diagnosis Code
Record Position: 1395 - 1401
Format – Length: Character - 7
Effective Date: January 1, 1982
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
The diagnosis provided by the practitioner at the time of admission which describes the
patient's condition upon admission to the hospital. Since the Admitting Diagnosis is
formulated before all tests and examinations are complete, it may have been stated in the
form of a problem or symptom and it may differ from any of the final diagnoses recorded in
the medical record.

**Codes and Values:**

Must have been a valid ICD-CM code excluding the decimal point. To be valid, ICD- CM codes must have been entered at the most specific level to which they are classified in the ICD-CM Tabular List. Failure to enter all required digits in the diagnosis codes would have caused the record to be rejected.
Must have been left justified and entered exactly as shown in the ICD-CM coding reference, excluding the decimal point, and space filled.
E-codes were not valid as Admitting Diagnosis Codes. E-codes were reported in External Cause-of-Injury Code and Place-of-Injury Code.

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

Edits pertaining to ICD-CM codes were validated on the basis of the ‘Discharge Date’ and ‘Expected Principal Reimbursement’ depending on conditions described in Appendix N, which included age-specific and sex-specific diagnosis code conditions.

SPARCS Inpatient Output Page 149

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Principal Diagnosis Code Record Position: 1402 - 1408 Format – Length: Character - 7 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The ‘Principal/Primary Diagnosis’ is the condition established after study to have been chiefly responsible for occasioning the admission of the patient to the hospital for care. Since the ‘Principal/Primary Diagnosis’ represents the reason for the patient's stay, it may not necessarily have been the diagnosis which represented the greatest length of stay, the greatest consumption of hospital resources, or the most life-threatening condition. Since the ‘Principal/Primary Diagnosis’ reflects clinical findings discovered during the patient's stay, it may differ from ‘Admitting Diagnosis’.

Codes and Values:

Must have been a valid ICD-CM code excluding decimal points. To have been valid, ICD-CM codes must have been entered at the most specific level to which they are classified in the ICD-CM Tabular List. Three-digit codes further divided at the four- digit level must have been entered using all four digits. Four-digit codes further subclassified at the five-digit level must have been entered using all five digits. Failure to enter all required digits in the diagnosis codes would have caused the record to be rejected.
Must have been left justified and entered exactly as shown in the ICD-CM coding reference, excluding the decimal point, and space filled.

OUTPUT Edits on Element:

If the ‘Neonate Birth Weight’ was reported as less than 1500 grams, and the ‘New York State Patient Discharge Status’ was reported as code "01" home, then the calculated ‘Length of Stay’ must be greater than 10 days.

INPUT Edits on Element:

Edits pertaining to ICD-CM codes are validated on the basis of the ‘Discharge Date’ and ‘Expected Principal Reimbursement’ depending on conditions described in Appendix N, which includes age-specific and sex-specific diagnosis code conditions.
When the edit flag on the ICD-CM reference file indicates an "unacceptable principal/primary diagnosis without a secondary diagnosis" an ‘Other Diagnosis Code 1 ’ must have been reported.

SPARCS Inpatient Output Page 150

Diagnosis codes reported in the ICD- 9 - CM range of 800.00-999.99 required the reporting of a valid ‘External Cause-of-Injury Code’ unless as an exception in Appendix N.
E-codes were not valid as ‘Principal/Primary Diagnosis Codes’. E-codes are reported in ‘External Cause-of-Injury Code’ and ‘Place-of-Injury Code’.

Principal Diagnosis Code cont’d.

SPARCS Inpatient Output Page 151

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Other Diagnosis Code 1- 24 Record Position: Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record
Position
ODC 1 1410 - 1416 ODC 9 1474 - 1480 ODC 17 1538 - 1544
ODC 2 1418 - 1424 ODC 1 0 1482 - 1488 ODC 18 1546 - 1552
ODC 3 1426 - 1432 ODC 1 1 1490 - 1496 ODC 19 1554 - 1560
ODC 4 1434 - 1440 ODC 12 1498 - 1504 ODC 20 1562 - 1568
ODC 5 1442 - 1448 ODC 13 1506 - 1512 ODC 21 1570 - 1576
ODC 6 1450 - 1456 ODC 14 1514 - 1520 ODC 22 1578 - 1584
ODC 7 1458 - 1464 ODC 15 1522 - 1528 ODC 23 1586 - 1592
ODC^8 1466 -^1472 ODC 16^1530 -^1536 ODC 24^1594 -^1600

Format – Length: Character - 7 Effective Date: Effective Date Reporting January 1982 Other Diagnosis Code 1- 4 January 1992 Other Diagnosis Code 5- 8 January 1994 Other Diagnosis Code 9- 14 August 2011 Other Diagnosis Code 15- 24

Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Other Diagnoses include all conditions that coexisted at the time of admission, or developed subsequently, which affected the treatment received and/or length of stay. Diagnoses that relate to an earlier episode which had no bearing on the current hospital stay were excluded.

Conditions should have been coded that affected patient care in terms of requiring: clinical evaluation, therapeutic treatment, diagnostic procedures, extended length of hospital stay, or increased nursing care and/or monitoring.

Codes and Values:

Must have been a valid ICD-CM code excluding the decimal point. To have been valid, ICD-CM codes must have been entered at the most specific level to which they are classified in the ICD-CM Tabular List. Three-digit codes further divided at the four-digit level must have been entered using all four digits. Four-digit codes further sub-classified at the five-digit level must have been entered using all five digits. Failure to enter all required digits in the diagnosis codes would have caused the record to be rejected.
Must have been left justified and entered exactly as shown in the ICD-CM coding reference, excluding the decimal point, and space filled.
Only E-codes in the ICD- 9 - CM range of E930.0 thru E949.9 are valid as ‘Other Diagnosis Codes’ (other E-codes are to be reported in ‘External Cause-of-Injury Code’ and ‘Place-of-Injury Code’. Prior to 1990 and after December 1, 1998, additional E-codes could have been reported as valid ‘Other Diagnosis Codes’).
If this field was not applicable, it must have contained blanks.

SPARCS Inpatient Output Page 152

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to ICD-CM codes are validated on the basis of the ‘Discharge Date’ and ‘Expected Principal Reimbursement’ depending on conditions described in Appendix N, which includes age-specific and sex-specific diagnosis code conditions.
When the edit flag on the ICD-CM reference file for an "unacceptable principal/primary diagnosis without and secondary diagnosis" was applicable for the ‘Principal/Primary Diagnosis Code’, an ‘Other Diagnosis Code 1 ’ must have also been reported.
Diagnosis codes reported in the ICD- 9 - CM range of 800.00-999.99 required the reporting of a valid ‘External Cause-of-Injury Code’ unless listed as an exception in Appendix N.
If an ‘Other Diagnosis Code’ was reported, the corresponding ‘Present on Admission Indicator’ must have also been reported.

Other Diagnosis Code 1- 24 cont’d.

SPARCS Inpatient Output Page 153

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Present on Admission (POA) Indicator 1 - 24

Record Position: Data Element

Record
Position

Data
Element

Record
Position

Data
Element

Record
Position
POA 1 1417 POA 9 1481 POA 17 1545
POA 2 1425 POA 10 1489 POA 18 1553
POA 3 1433 POA 11 1497 POA 19 1561
POA 4 1441 POA 12 1505 POA 20 1569
POA 5 1449 POA 13 1513 POA 21 1577
POA 6 1457 POA 14 1521 POA 22 1585
POA 7 1465 POA 15 1529 POA 23 1593
POA 8^1473 POA 16^1537 POA 24^1601

Format – Length: Character - 1 Effective Date: Effective Date^ Reporting^ January 1990 POA 1- 4 January 1992 POA 5- 8 January 1994 POA 9- 14 August 2011^ POA 15-^24 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The ‘Present on Admission Indicator Code’ is used to identify the diagnosis onset as it relates to the diagnosis reported in the ‘Other Diagnosis Code’. The ‘Present on Admission Indicator’ on ‘Other Diagnoses’ indicates whether the onset of the diagnosis preceded or followed admission to the hospital.

Effective January 1, 2011 all claims involving inpatient admissions to general acute care hospital or other facilities that are subject to a law or regulation (e.g. Deficit Reduction Act of 2005) are mandated to collect present on admission information, or as mutually agreed to under contract with an insurance company.

Codes and Values:

“ 1 ” = Yes - Present at the time of inpatient admission.

“ 2 ” = No - Not present at the time of inpatient admission.

“ 3 ” = Clinically Undetermined - Provider is unable to clinically determine whether
condition was present on admission or not

“ 9 ” = Unknown - Documentation is insufficient to determine if condition is present
on admission

“X” = Exempt from POA reporting for selected ICD- 9 - CM codes

If this field was not applicable it contains blanks.

SPARCS Inpatient Output Page 154

OUTPUT Edits on Element:

In 2007 this became a data element based upon current values as approved by NUBC; the values collected were converted into the above values for consistency.

INPUT Edits on Element:

Must have equaled appropriate values at the time of submission (i.e., 2007 and forward values are: “Y” = Yes; “N” = No; “U” = Unknown; “W” = Clinically Undetermined “1” or blank = Exempt from Reporting
If an ‘Other Diagnosis Code’ was reported, then there must have been a corresponding Present on Admission Indicator, coded appropriately.
If ‘Present on Admission Indicator’, was reported, ‘Other Diagnosis Code’ must have also been reported.

Present on Admission (POA) Indicator 1- 24 cont’d.

SPARCS Inpatient Output Page 155

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Clinical Classification Software (CCS) Diagnosis Category Record Position: 1602 - 1604 Format – Length: Character - 3 Effective Date: Implemented August 2012 and added to all years’ discharge records Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: The Clinical Classification Software (CCS) was developed by the Agency for Healthcare Research and Quality (AHRQ) as a tool to cluster patient diagnoses and procedures without having to sort through thousands of codes.

The CCS Diagnosis Category data element uses the reported ICD- 9 - CM code (when appropriate, future years will use the corresponding ICD- 10 - CM code). The “clinical grouper” makes it easier for researchers to explore the types of conditions. The “CCS Diagnosis Category” is the single level classification system that aggregates illness and conditions in to (currently) 285 mutually exclusive categories.

As part of the Healthcare Cost and Utilization Project (HCUP), a federal-state industry partnership, the CCS software and documentation is maintained on the HCUP website at: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp. (CCS was formerly called the Clinical Classification for Healthcare Policy research – CCHPR).

Example: ICD Diagnosis Reference for Diagnosis Group - Acute bronchitis (Single Level) ICD Code Description CCS Category 4660 ACUTE BRONCHITIS 125 – Acute Bronchitis 4661, 46611 AC BRONCHIOLITIS D/T RSV 125 – Acute Bronchitis 46619 AC BRONCHIOLITIS-ORG NEC 125 – Acute Bronchitis

Codes and Values:

See the above website for CCS Diagnosis Category Values

OUTPUT Edits on Element:

Calculated using the CCS software.

INPUT Edits on Element: Not applicable. This is a derived data element

SPARCS Inpatient Output Page 156

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: After Anesthesia Indicator 1 - 14

Record Position: Data Element^ Record Position

Data Element Record Position After Anesth Ind 1 1605 After Anesth Ind 8 1612 After Anesth Ind 2 1606 After Anesth Ind 9 1613 After Anesth Ind 3 1607 After Anesth Ind 10 1614 After Anesth Ind 4 1608 After Anesth Ind 11 1615 After Anesth Ind 5 1609 After Anesth Ind 12 1616 After Anesth Ind 6 1610 After Anesth Ind 13 1617 After Anesth Ind^7 1611 After Anesth Ind^14 1618 Format – Length: Character - 1 Effective Date: 1/1/1994 – 4/9/1997 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which indicates whether the corresponding Other Diagnosis Code was judged to have occurred after the administration of anesthesia to the patient.

Note: This data element is available for a limited timeframe.

Codes and Values:

"1" = Yes, the diagnosis occurred after the administration of anesthesia.

"2" = No, the diagnosis did not occur after the administration of anesthesia or NO
anesthesia was administered.

"9" = Unknown, if diagnosis occurred before or after the administration of
anesthesia.

If this field was not applicable it contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If an ‘Other Diagnosis Code’ was reported, then there must have been a corresponding After Anesthesia Indicator coded appropriately.
If ‘After Anesthesia Indicator’ was reported then, ‘Other Diagnosis Code’ and ‘Other Diagnosis Present on Admission’ must have also been reported.

SPARCS Inpatient Output Page 157

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Accident Related Code Record Position: 1619 - 1620 Format – Length: Character - 2 Effective Date: January 1, 1982 – December 31, 1993 Converted in 1994 to the Uniform Bill Codes, and modified on all records. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identifies the specific event relating to the bill that may affect payer processing.

Codes and Values: 1. Value Name Description 01 Accident /Medical Coverage

Code indicating accident-related injury for which there is
medical payment coverage. Provide the date of accident/injury.
02 No Fault Insurance
Involved/ Including
Auto Accident/Other

Code indicating the date of an accident including auto or other
where state has applicable no fault liability laws (i.e., legal basis
for settlement without admission of proof of guilt).
03 Accident /Tort Liability Code indicating the date of an accident resulting from a third
party’s action that may involve a civil court process in an
attempt to require payment by the third party, other than no fault
liability.
04 Accident /Employment
Related

Code indicating the date of an accident allegedly relating to the
patient’s employment.
05 Accident /No Medical
or Liability Coverage

Code indicating accident related injury for which there is no
medical payment or third-party liability coverage. Provide the
date of accident/injury.
06 Crime Victim Code indicating the date on which a medical condition resulted
from alleged criminal action committed by one or more parties.

If not applicable this field contains blanks.

OUTPUT Edits on Element:

If Abortion or HIV Flags equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

If ‘Occurrence Information Code’ was reported, then a valid ‘Occurrence Information Date’ must also have been reported.

SPARCS Inpatient Output Page 158

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Accident Related Date Record Position: 1621 - 1628 Record Position for Encrypted* 4725 - 4746 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. The 4-digit year and the 2-digit month are non-deniable and are also present on the De- Identified file. Yes - See Appendix Z for release restrictions.

Accident Related Date is available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The date corresponding to the significant event relating to the bill that may affect payer processing.

Codes and Values:

CCYYMMDD =Century Year Month Day
The Date must have been valid in accordance with the Date Edit Validation Table in Appendix A.
If not applicable this field contains blanks.

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted.

INPUT Edits on Element: None.

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SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: External Cause of Injury Record Position: 1629 - 1635 Format – Length: Character - 7 Effective Date: January 1, 1990 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The ICD- 9 - CM code for the external cause of an injury, poisoning, or adverse effect. Hospitals complete this item whenever there is a diagnosis of an injury, poisoning, or adverse effect. The priorities for recording an External Code (E-Code) are: (1) principal diagnosis of an injury or poisoning, (2) other diagnosis of an injury, poisoning, or adverse effect directly related to the principal diagnosis, and (3) other diagnosis with an external cause.

Only the first E-Code is recorded in this item. Additional E-Codes were not entered.

Codes and Values:

Must have been a valid ICD- 9 - CM "E" code excluding the decimal point. To have been valid, the code must have been entered at the most specific level classified in the ICD-CM Tabular List. Three-digit codes further divided to the four-digit level must have been entered using all four digits plus the prefix letter "E". Failure to enter the prefix "E" and all required digits would have caused the record to reject.
Must have been left justified including the prefix letter "E" and all digits exactly as shown in the ICD-CM coding reference excluding the decimal point, and space filled.
If this field was not applicable, it contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

A valid entry was required in this field when either the ‘Principal/Primary Diagnosis Code’ or an ‘Other Diagnosis Code 1- 14 ’* reported were in the range 800.00-999.99.
When an ‘External Cause-of-Injury Code’ in the range of E850.0 to E869.9 or E880.0 to E928.9 was reported, then a ‘Place-of-Injury Code’ must also have been reported.
Prior to 1990, E-codes were reported in the ‘Other Diagnosis Code 1- 14 ’ field.
After December 1, 1998, additional E-codes may have been reported in the ‘Other Diagnosis Code 1- 14 ’ field.

*Starting in 2011, there are also ‘ Other Diagnosis Codes 15- 24 ’ collected, that should be examined for additional information.

SPARCS Inpatient Output Page 160

SPARCS Inpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Place of Injury Code Record Position: 1636 - 1642 Format – Length: Character - 7 Effective Date: January 1, 1990 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The code which identifies the place where the corresponding injury was reported in ‘External Cause-of-Injury Code’.

Codes and Values: 1. Value Description E849.0 Home accidents E849.1 Farm accidents E849.2 Mine and quarry accidents E849.3 Accidents occurring in industrial places and premises E849.4 Accidents occurring in place for recreation and sport E849.5 Street and highway accidents E849.6 Accidents occurring in public building E849.7 Accidents occurring in residential institution E849.8 Accidents occurring in other specified places E849.9 Accidents occurring in unspecified place

Must have been a valid ICD- 9 - CM "E" code excluding the decimal point. To have been valid, the code must have been entered at the most specific level classified in the ICD- 9 - CM Tabular List. Three-digit codes further divided to the four-digit level must have been entered using all four digits plus the prefix letter "E". Failure to enter the

prefix "E" and all required digits would have caused the record to reject.^

Must have been left justified including the prefix letter "E" and all digits exactly as shown in the ICD- 9 - CM coding reference excluding the decimal point, and space

filled.^

If this field was not applicable, it contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been reported when ‘External Cause-of-Injury Code’ was in the range of E850.0 - E869.9 or E880.0 - E928.9.
Prior to 1990, E-codes were reported in the ‘Other Diagnosis Code 1- 14 ’ field*.
After December 1, 1998, additional E-codes may have been reported in the ‘Other Diagnosis Code 1- 14 ’ field*.

*Starting in 2011, there are also ‘ Other Diagnosis Codes 15- 24 ’ collected, that should be examined for additional information.

SPARCS Inpatient Output Page 161

SPARCS Inpatient Segment: Primary Records

Procedure

**Data Element Name:** Principal Procedure Code
Record Position: 1643 - 1649
Format – Length: Character - 7
Effective Date: January 1 , 1982
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
The ICD code that identifies the inpatient principal procedure performed at the claim level
during the period covered by this event.

The principal procedure was one that was performed for definitive treatment rather than one
performed for diagnostic or exploratory purposes, or was necessary to take care of a
complication. A significant procedure was surgical in nature, carried a procedural risk,
carried an anesthetic risk, or required specialized training. Surgery included incision,
excision, amputation, introduction, endoscopy, repair, destruction, suture, and manipulation.

If there appeared to be two procedures that were principal, then the one most related to the
principal diagnosis should have been selected as the principal procedure.

**Codes and Values:**

Must have been left justified and entered exactly as shown in the ICD coding reference, excluding the decimal point, and space filled.
If this field was not applicable, it contains blanks.

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

Edits pertaining to ICD codes are validated on the basis of the ‘Discharge Date’ and ‘Expected Principal Reimbursement’ depending on conditions described in Appendix N, which includes sex-specific diagnosis code conditions.
If the ‘Principal Procedure Code’ was entered, the ‘Operating Physician State License Number’ and ‘Principal Procedure Date’ must have also been reported.

SPARCS Inpatient Output Page 162

SPARCS Inpatient Segment: Primary Records PROCEDURE SEGMENT

Data Element Name: Principal Procedure Date Record Position: 1650 - 1657 Record Position for Encrypted* 4747 - 4768 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: 1/1/1983 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month Identifiable Data Set: YES Deniable Data Element: This field is composed of both non-deniable and deniable components. **The 2-digit day is deniable and is ONLY present on the Master file. The 4-digit year and the 2-digit month are non-deniable and are also present on the De-Identified file. See Appendix Z for release restrictions.

The entire Principal Procedure Date is only available on the Limited Data Set as an Encrypted Data Element; otherwise it is available only with the Year and Month.

Description: The date the Principal Procedure was performed.

Codes and Values:

CCYYMMDD = Century Year Month Day
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.
If this field was not applicable it contains blanks.

OUTPUT Edits on Element:

If Abortion or HIV Flag equal ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Date must have been no more than 3 days prior to ‘Admission Date/Start of Care’ and before or the same as ‘Discharge Date’.
If ‘Principal Procedure Date’ was entered, the ‘Operating Physician ID’ and ‘Principal Procedure Code’ must also have been reported.

SPARCS Inpatient Output Page 163

SPARCS Inpatient Segment: Primary Records PROCEDURE SEGMENT

Data Element Name: Pre-Admit Procedure Indicator 1 - 15 (previously Pre- Admit Indicator)

Record Position: Data Element^ Record Position

Data Element Record Position Pre-Admit Ind 1 1658 Pre-Admit Ind 9 1850 Pre-Admit Ind 2 1682 Pre-Admit Ind 10 1874 Pre-Admit Ind 3 1706 Pre-Admit Ind 11 1898 Pre-Admit Ind 4 1730 Pre-Admit Ind 12 1922 Pre-Admit Ind 5 1754 Pre-Admit Ind 13 1946 Pre-Admit Ind 6 1778 Pre-Admit Ind 14 1970 Pre-Admit Ind 7 1802 Pre-Admit Ind 15 1994 Pre-Admit Ind^8 1826 Format – Length: Character - 1 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: A flag to indicate if the procedure was done before, on, or after the ‘Admission Date’.

Codes and Values:

"-" If the procedure was done before the admit date

"+" If the procedure was done on or after the admit date

" " If no procedure was done (field is blank)

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived element.

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Data Element Name: Pre-Op Days 1- 15 Record Position: Data Element^ Record Position

Data Element Record Position Pre-Op Days 1 1659 - 1662 Pre-Op Days 9 1851 - 1854 Pre-Op Days 2 1683 - 1686 Pre-Op Days 10 1875 - 1878 Pre-Op Days 3 1707 - 1710 Pre-Op Days 11 1899 - 1902 Pre-Op Days 4 1731 - 1734 Pre-Op Days 12 1923 - 1926 Pre-Op Days 5 1755 - 1758 Pre-Op Days 13 1947 - 1950 Pre-Op Days 6 1779 - 1782 Pre-Op Days 14 1971 - 1974 Pre-Op Days 7 1803 - 1806 Pre-Op Days 15 1995 - 1998 Pre-Op^ Days 8^1827 -^1830 Format – Length: Character - 4 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of days between a procedure and the ‘Admission Date’. See the corresponding ‘Pre-Admit Indicator’ to determine if the procedure was before, after, or on the ‘Admission Date’.

Codes and Values:

Equals Number of Days.

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Post-Op Days 1- 15

Record Position: Data Element^ Record Position

Data Element Record Position Post-Op Days 1 1663 - 1666 Post-Op Days 9 1855 - 1858 Post-Op Days 2 1687 - 1690 Post-Op Days 10 1879 - 1889 Post-Op Days 3 1711 - 1714 Post-Op Days 11 1903 - 1906 Post-Op Days 4 1735 - 1738 Post-Op Days 12 1927 - 1930 Post-Op Days 5 1759 - 1762 Post-Op Days 13 1951 - 1954 Post-Op Days 6 1783 - 1786 Post-Op Days 14 1975 - 1978 Post-Op Days 7 1807 - 1810 Post-Op Days 15 1999 - 2002 Post-Op Days 8^1831 -^1834 Format – Length: Character - 4 Effective Date: Implemented May 1, 2005 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of days between a procedure and the discharge date. See the corresponding ‘Pre- Admit Indicator’ to determine if the procedure was before, after or on the admit date, which could result in values being greater than the total length of stay for this discharge.

Codes and Values:

Equals Number of Days.

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Other Procedure Code 1 - 14 Record Position:

Format – Length:

Data Element Record
Position

Data Element Record
Position
Other Procedure 1 1667 - 1673 Other Procedure 8 1835 - 1841
Other Procedure 2 1691 - 1697 Other Procedure 9 1859 - 1865
Other Procedure 3 1715 - 1721 Other Procedure 10 1883 - 1889
Other Procedure 4 1739 - 1745 Other Procedure 11 1907 - 1913
Other Procedure 5 1763 - 1769 Other Procedure 12 1931 - 1937
Other Procedure 6 1787 - 1793 Other Procedure 13 1955 - 1961
Other Procedure 7 1811 - 1817 Other Procedure 14 1979 - 1985

Character – 7

Effective Date: Effective Date^ Reporting^ January 1, 1982 Other Procedure Code 1- 4 January 1, 1992 Other Procedure Code 5 January^ 1,^1994 Other Procedure Code 6-^14 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The ICD codes identifying all significant procedures, other than the ‘Principal Procedure’, that were performed. The facilities are asked to report those procedures that are most important for the episode of care, and specifically any therapeutic procedures closely related to the principal diagnosis.

A significant procedure was one that was surgical in nature, carried a procedural risk, carried an anesthetic risk, or required specialized training. Surgery included incision, excision, amputation, introduction, endoscopy, repair, destruction, suture, and manipulation.

Codes and Values:

Must have been left justified and entered exactly as shown in the ICD coding reference, excluding the decimal point, and space filled.
If this field was not applicable, it contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to ICD codes are validated on the basis of the ‘Discharge Date’ and ‘Expected Principal Reimbursement’ depending on conditions described in Appendix N, which includes sex-specific diagnosis code conditions.
If ‘Other Procedure Code 1- 14 ’ was entered, the corresponding ‘Other Procedure Date 1- 14 ’ must have also been reported.

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PROCEDURE SEGMENT

OTHER PROCEDURE DATE 1-

Record Position: Data Element^ Record
Position

Data Element Record
Position
Oth Proc Date 1 1674 - 1681 Oth Proc Date 8 1842 - 1849
Oth Proc Date 2 1698 - 1705 Oth Proc Date 9 1866 - 1873
Oth Proc Date 3 1722 - 1729 Oth Proc Date 10 1890 - 1897
Oth Proc Date 4 1746 - 1753 Oth Proc Date 11 1914 - 1921
Oth Proc Date 5 1770 - 1777 Oth Proc Date 12 1938 - 1945
Oth Proc Date 6 1794 - 1801 Oth Proc Date 13 1962 - 1969
Oth Proc Date^7 1818 -^1825 Oth Proc Date^14 1986 -^1993

Record Position for Encrypted* Data Element^ Record
Position

Data Element Record
Position
Oth Proc Date 1 4769 - 4790 Oth Proc Date 8 4923 - 4944
Oth Proc Date 2 4791 - 4812 Oth Proc Date 9 4945 - 4966
Oth Proc Date 3 4813 - 4834 Oth Proc Date 10 4967 - 4988
Oth Proc Date 4 4835 - 4856 Oth Proc Date 11 4989 - 5010
Oth Proc Date 5 4857 - 4878 Oth Proc Date 12 5011 - 5032
Oth Proc Date 6 4879 - 4900 Oth Proc Date 13 5033 - 5054
Oth Proc Date 7^4901 -^4922 Oth Proc Date 14^5055 -^5076
Format – Length: Number - 8
Format – Length for Encrypted* Number - 22
Effective Date: 1/1/19 83
Contained In: De-Identified Data Set: YES – Year only
Limited Data Set: YES – Year and Month
Identifiable Data Set: YES
Deniable Data Element: This field is composed of both non-deniable and
deniable components. **The 2-digit day is deniable
and is ONLY present on the Master file. The 4-digit
year and the 2-digit month are non-deniable and are
also present on the De-Identified file. See Appendix
Z for release restrictions.

*The entire Other Procedure Date 1- 14 is only available on the Limited Data Set as an
Encrypted Data Element; otherwise year and month; otherwise it is available only with the
Year and Month.

**Description:**
The date the ‘Principal Procedure’ was performed.

**Codes and Values:**

CCYYMMDD = Century Year Month Day
Must have been a valid date in accordance with the Date Edit Validation Table in Appendix A.
If this field was not applicable it contains blanks.

SPARCS Inpatient Output Page 168

OUTPUT Edits on Element:

If Abortion or HIV Flag equals ‘Y’, this data element is redacted unless otherwise noted.

INPUT Edits on Element:

Date must have been no more than 3 days prior to ‘Admission Date/Start of Care’ and before or the same as ‘Discharge Date’.
If ‘Principal Procedure Date’ was entered, the ‘Operating Physician ID’ and ‘Principal Procedure Code’ must also have been reported.

Other Procedure Date 1- 14 cont’d.

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Data Element Name: Clinical Classification Software (CCS) Procedure Category Record Position: 2003 - 2005 Format – Length: Character - 3 Effective Date: Implemented July 2012 and added to all years’ files. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

The “CCS Procedure Category” data element uses the reported procedure codes to group into procedure categories that will make it easier for researchers to explore the types of procedures being formed. The CCS single level classification system is used for this data element; there are currently 231 procedure categories.

Example: ICD Procedure Reference for Procedure Group - Cardiac stress tests (Single Level) ICD Code Description CCS Procedure Category 8941 TREADMILL STRESS TEST 201 – CARDIA STRESS TEST 8942 MASTERS' 2-STEP TEST 201 – CARDIA STRESS TEST 8943 BICYCLE ERGOMETER TEST 201 – CARDIA STRESS TEST 8944 CV STRESS TEST NEC 201 – CARDIA STRESS TEST

Codes and Values:

See the above website for CCS Procedure Category values.

OUTPUT Edits on Element:

Data values calculated using the CCS software.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Method of Anesthesia Used Record Position: 2006 - 2007 Format – Length: Number - 2 Effective Date: January 1, 1983 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Type of anesthesia administered on the patient during the stay. If during the stay, anesthesia is administered more than once, the level of anesthesia is reported in the following hierarchical order: General, Regional, Other, and Local.

Codes and Values:

"00" = No Anesthesia

(^) "10" = Local Anesthesia Administered by the infiltration of a local anesthetic agent at the body site where pain might originate during the procedure. Local anesthesia is typically administered by the surgeon or other health care provider performing the procedure. Anesthesia care providers sometimes monitor the patient during the administration of local anesthesia by the surgeon or other provider, in which case the anesthetic procedure is sometimes referred to as "local/MAC". In this term, MAC stands for "Monitored Anesthesia Care". "20" = General Anesthesia Administered by the intravenous injection of anesthetic agents, the inhalation of anesthetic agents, or (more often) a combination of the two. Anesthetic agents are sometimes (but infrequently) administered by other routes, such as via the nasal or rectal mucosa. General anesthesia involves loss of consciousness and loss of protective reflexes. (^) "30" = Regional Anesthesia Administered by injecting a local anesthetic agent to interrupt nerve impulses on large nerves or nerve roots serving relatively large segments of the body. Included under the term regional anesthesia are the following: spinal anesthesia, epidural anesthesia, caudal anesthesia, brachial plexus anesthesia (including axillary block, interscalene block, supraclavicular block), sacral nerve block, femoral nerve block, and ankle block. (This list is not exhaustive.) "40" = Other Any anesthetic that does not fit one of the above categories should be classified "other". Analgesia or sedation that is administered to make a patient more comfortable during a procedure but does not involve loss of consciousness or loss of protective reflexes would come under this category. OUTPUT Edits on Element: None. 7 INPUT Edits on Element:

Must have been a valid entry.

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Data Element Name: Blood Furnished Amount Record Position: 2008 - 2016 Format – Length: Number - 9 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of pints of whole blood or units of packed red cells furnished to the patient, whether or not replaced.

Codes and Values:

Right justified and zero filled.
The amount was entered in decimal format. This amount is defined with TWO implied decimal places and must have been entered as a positive amount. For example, 8 pints of blood furnished would have been entered as: “ 000000800 ”.
If not applicable this field contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

The ‘Value Code’ must have been entered as “37” for ‘Units of Blood Furnished’. The corresponding ‘Value Amount’ (actual pints of blood) must have been entered.
If entered, the amount must be greater than zero.

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Data Element Name: Age Warning Flag Record Position: 2017 Format – Length: Character - 1 Effective Date: January 1, 1996 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A flag set when a diagnosis from a list of exceptions agreed to by the Department of Health and the New York Health Information Management Association is in conflict with normal age-specific edits as defined in the ICD-CM coding reference file.

These claims have been accepted by the SPARCS system, but a warning message was returned to the health care facility to flag potential reporting problems at time of submission. A list of current exception diagnosis codes is available from SPARCS.

Codes and Values:

"1" = Age-specific conflict between reported data and ICD-CM reference file.

" " = NO conflict between reported data and ICD-CM reference file (blank).

OUTPUT Edits on Element:

Derived data element based on the list of exceptions.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Procedure Date Warning Flag Record Position: 2018 Format – Length: Character - 1 Effective Date: January 1, 20 00 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A flag set when a procedure date for this discharge is reported no more than three (3) days prior to the ‘Admission Date/Start of Care’. These claims have been accepted by the SPARCS system, but a warning message was returned to the health care facility to flag potential reporting problems at time of submission.

Codes and Values:

"1" = ‘Procedure Date’ reported no more than three (3) days prior to the ‘Admission Date/Start of Care’

" " = NO conflict between reported data and reported procedure dates (blank).

OUTPUT Edits on Element:

This is a derived data element using the submitted fields as described above.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Procedure Coding Method Record Position: 2019 Format – Length: Character - 1 Effective Date: 1/1/1994 - 1/1/2003 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A code which identifies the coding structure used for reporting procedures performed during the patient stay.

All procedure and diagnosis codes reported for inpatient stays are ICD- 9 - CM.

Note: This data element is available for a limited time frame.

Codes and Values:

"9" = ICD- 9 - CM

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Federal Diagnostic Risk Grouper (DRG) Record Position: 2020 - 2022 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Federal Diagnosis Related Group (DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes for the calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Federal Major Diagnostic Category (MDC) Record Position: 2023 - 2024 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Federal Major Diagnostic Category (MDC) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes for the calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Past Federal Diagnosis Related Group (DRG) (previously called DRG Prior Federal) Record Position: 2025 - 2027 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past Federal Diagnosis Related Group (DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes. This DRG is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: Past Federal Major Diagnostic Category (MDC) (previously called MDC Prior Federal) Record Position: 2028 - 2029 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past Federal Major Diagnostic Category (MDC) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes. This MDC is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: New Federal Diagnostic Related Group (DRG) Record Position: 2030 - 2032 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The New Federal Diagnosis Related Group (DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes. This DRG is specific to the following (new) calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: New Federal Major Diagnostic Category (MDC) Record Position: 2033 - 2034 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The New Federal Major Diagnostic Category (MDC) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), to categorize patient records for reimbursement and research purposes. This MDC is specific to the following (new) calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: All Patient Diagnosis Related Group (AP DRG) Record Position: 2035 - 2037 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The All Patient Diagnosis Related Group (AP DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), and in conjunction with 3M Corporation, to categorize patient records for reimbursement and research purposes for all patients (this evaluation and development of the AP DRG was in part due to the original DRGs being developed for only Medicare reimbursement). This DRG is specific to the calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate AP DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: All Patient Major Diagnostic Category (AP MDC) Record Position: 2038 - 2039 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The All Patient Major Diagnostic Category (AP MDC) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), and in conjunction with 3M Health Information Systems, to categorize patient records for reimbursement and research purposes for all patients (this evaluation and development of the AP DRG was in part due to the original DRGs being developed for only Medicare reimbursement). This MDC is specific to the calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate AP MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Diagnostic Related Group (AP DRG) Record Position: 2040 - 2042 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past All Patient Diagnosis Related Group (AP DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), and in conjunction with 3M Health Information Systems, to categorize patient records for reimbursement and research purposes for all patients (this evaluation and development of the AP DRG was in part due to the original DRGs being developed for only Medicare reimbursement). This DRG is specific to the prior calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate AP DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Major Diagnostic Category (AP MDC) Record Position: 2043 - 2044 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past All Patient Major Diagnostic Category (AP MDC) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), and in conjunction with 3M Health Information Systems, to categorize patient records for reimbursement and research purposes for all patients (this evaluation and development of the AP DRG was in part due to the original DRGs being developed for only Medicare reimbursement). This MDC is specific to the past/prior calendar year of the date of service.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate AP MDC value.

INPUT Edits on Element: Not applicable. This is a derive data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Diagnosis Related Group (AP DRG) Record Position: 2045 - 2047 Format – Length: Character - 3 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Diagnosis Related Group (DRG) is developed by the former Healthcare Financing Administration (HCFA), now called the Centers for Medicare and Medicaid Services (CMS), and in conjunction with 3M Health Information Systems, to categorize patient records for reimbursement and research purposes for all patients (this evaluation and development of the AP DRG was in part due to the original DRGs being developed for only Medicare reimbursement). This DRG is specific to the following calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate AP DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Major Diagnostic Category (AP MDC) Record Position: 2048 - 2049 Format – Length: Character - 2 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate new AP MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: All Patient Refined Diagnosis Related Group (APR DRG) Record Position: 2050 - 2052 Format – Length: Character - 3 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The All Patient Refined Diagnosis Related Group (APR DRG) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This APR DRG is specific to the calendar year of the date of discharge.

The All Patient Refined (APR) incorporate Severity of Illness subclasses into the AP DRGs (the APR DRGs were an expansion of the basic DRG to be more representative of the non- Medicare populations such as pediatric patients).

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate new APR DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: All Patient Refined Major Diagnostic Category (APR MDC) Record Position: 2053 - 2054 Format – Length: Character - 2 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: N/A

Description: The All Patient Refined Major Diagnostic Category (MDC) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This APR MDC is specific to the calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate new AP MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: All Patient Refined Risk of Mortality (APR ROM) Record Position: 2055 Format – Length: Character - 1 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: N/A

Description: The All Patient Refined Risk of Mortality (APR ROM) flag is assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This APR ROM is specific to the calendar year of the date of discharge.

The All Patient Refined (APR) process incorporates Severity of Illness into the calculations. Each secondary diagnosis is assigned to one of the four Severity of Illness and one of the four Risk of Mortality levels. These flags are then just one factor in assigning the patient’s subclass level.

Codes and Values:

“ 1 ” = Minor Mortality Level “ 2 ” = Moderate Mortality Level “ 3 ” = Major Mortality Level “ 4 ” = Extreme Mortality Level
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate new APR ROM value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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Data Element Name: All Patient Refined Severity of Illness (APR SOI) Record Position: 2056 Format – Length: Character - 1 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: N/A

Description: The All Patient Refined Severity of Illness (SOI) flag assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This SOI is specific to the calendar year of the date of discharge.

Codes and Values:

“ 1 ” = Minor Severity of Illness “ 2 ” = Moderate Severity of Illness “ 3 ” = Major Severity of Illness “ 4 ” = Extreme Severity of Illness
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate new APR SOI value.

INPUT Edits on Element: Not applicable. This is a derived data element.

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SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Refined Diagnosis Related Group (APR DRG) Record Position: 2057 - 2059 Format – Length: Character - 3 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: N/A

Description: The Past All Patient Refined Diagnosis Related Group (APR DRG) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This DRG is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR DRG value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 192

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Refined Major Diagnostic Category (APR MDC) Record Position: 2060 - 2061 Format – Length: Character - 2 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past All Patient Refined Major Diagnostic Category (APR MDC) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This MDC is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR MDC value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 193

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Refined Risk of Mortality (APR ROM) Record Position: 2062 Format – Length: Character - 1 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past All Patient Risk of Mortality (APR ROM) flag assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This ROM is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

“ 1 ” = Minor Mortality Level “ 2 ” = Moderate Mortality Level “ 3 ” = Major Mortality Level “ 4 ” = Extreme Mortality Level
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR ROM value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 194

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Past All Patient Refined Severity of Illness (APR SOI) Record Position: 2063 Format – Length: Character - 1 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Past All Patient Refined Severity of Illness (APR SOI) flag assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This SOI is specific to the past/prior calendar year of the date of discharge.

Codes and Values:

“ 1 ” = Minor Severity of Illness “ 2 ” = Moderate Severity of Illness “ 3 ” = Major Severity of Illness “ 4 ” = Extreme Severity of Illness
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR SOI value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 195

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Refined Diagnosis Related Group (APR DRG) Record Position: 2064 - 2066 Format – Length: Character - 3 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: N/A

Description: The New All Patient Refined Diagnosis Related Group (APR DRG) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This DRG is specific to the following calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR SOI value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 196

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Refined Major Diagnostic Category (APR MDC) Record Position: 2067 - 2068 Format – Length: Character - 2 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The New All Patient Refined Major Diagnostic Category (APR MDC) assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This MDC is specific to the following calendar year of the date of discharge.

Codes and Values:

See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR SOI value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 197

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Refined Risk of Mortality (APR ROM) Record Position: 2069 Format – Length: Character - 1 Effective Date: 2/2010 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The New All patient Refined Risk of Mortality (ROM) flag assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This ROM is specific to the following calendar year of the date of discharge.

Codes and Values:

“ 1 ” = Minor Mortality Level “ 2 ” = Moderate Mortality Level “ 3 ” = Major Mortality Level “ 4 ” = Extreme Mortality Level
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR ROM value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 198

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: New All Patient Refined Severity of Illness (APR SOI) Record Position: 2070 Format – Length: Character - 1 Effective Date: Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The New All Patient Refined Severity of Illness (SOI) flag assigned to the claim using the All Patient Refined Diagnostic Related Grouper software, which was developed by 3M Health Information Systems. This information is used to categorize patient records for reimbursement and research purposes. This SOI is specific to the following calendar year of the date of discharge.

Codes and Values:

“ 1 ” = Minor Severity of Illness “ 2 ” = Moderate Severity of Illness “ 3 ” = Major Severity of Illness “ 4 ” = Extreme Severity of Illness
See Appendix Y - Grouper Versions Used by Year Reference File Table.

OUTPUT Edits on Element:

This is a derived data element using software to generate the appropriate APR SOI value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 199

SPARCS Inpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Diagnosis Related Group (DRG) Billed Record Position: 2071 - 2074 Format – Length: Character - 4 Effective Date: 1/1/1994 – 12/ 3 1/1997 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number of the Diagnosis Related Group (DRG) obtained from grouping the diagnoses and procedures and billed to the principal payer, or as used in the calculation of the charge payer cap for billings to charge payers.

Note: This data element was collected for a limited timeframe.

Codes and Values:

Must have been right justified and zero filled.
If this field was not applicable, it contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry when Exempt Unit Indicator was blank.

SPARCS Inpatient Output Page 200

SPARCS Inpatient Segment: Primary Records

AMI

**Data Element Name:** AMI Warning Flag
Record Position: 2075
Format – Length: Number - 1
Effective Date: July 1, 2007 – December 31, 2 007
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element:

**Description:**
A flag set when a diagnosis the principal/primary diagnosis code equals 410.0x - 410.9x.

**Codes and Values:**

"1" = AMI code reported. " 0 " = No AMI code reported.

**OUTPUT Edits on Element:**

A derived data element based on ICD codes.

**INPUT Edits on Element:**
Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 201

SPARCS Inpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Heart Rate on Arrival Record Position: 2076 - 2078 Format – Length: Number - 3 Effective Date: October, 2007 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description:

The patient heart rate in beats per minute (bpm) taken at first patient contact after arrival at this hospital for patients with a ‘Principal/Primary Diagnosis’ of Acute Myocardial Infarction (AMI) 410.0x-410.9x.

Codes and Values:

Equals ‘Patient Heart Rate on Arrival’.
“888” = Undocumented in Medical Chart
“999” = Unknown (To be used only in circumstances where patient cannot have reading taken at time of arrival.)
“ “ [Blank] = Not applicable, (i.e. ‘Principal/Primary Diagnosis’ is not in the range of 410.0x – 410.9x).

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be greater than or equal to zero.
Must be reported when ‘Principal/Primary Diagnosis Code’ equals 410.0x - 410.9x.
NTE segment is fixed width. Required spacing must be maintained if element is not applicable.

SPARCS Inpatient Output Page 202

SPARCS Inpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Systolic BP on Arrival Record Position: 2079 - 2081 Format – Length: Number - 3 Effective Date: Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: The patient systolic blood pressure in mg/dl taken at first patient contact after arrival at this hospital for patients with a ‘Principal/Primary Diagnosis’ of Acute Myocardial Infarction (AMI) 410.0x – 410.9x.

Codes and Values:

Equals ‘Systolic Blood Pressure Upon Arrival’.
“888” = Undocumented in Medical Chart
“999” = Unknown (To be used only in circumstances where patient cannot have reading taken at time of arrival.)
” “ = Not applicable, (i.e. the ‘Principal/Primary Diagnosis’ is not in the range of 410.0x – 410.9x).

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be greater than or equal to zero.
Must be reported when ‘Principal/Primary Diagnosis Code’ equals 410.0x - 410.9x.
NTE segment is fixed width. Required spacing must be maintained if element is applicable.

SPARCS Inpatient Output Page 203

SPARCS Inpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Diastolic BP on Arrival Record Position: 2082 - 2084 Format – Length: Number - 3 Effective Date: Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: The patient diastolic blood pressure in mg/dl taken at first patient contact after arrival at this hospital for patients with a ‘Principal/Primary Diagnosis’ of Acute Myocardial Infarction (AMI) 410.0x – 410.9x.

Codes and Values:

Equals ‘Diastolic Blood Pressure Upon Arrival’.
“888” = Undocumented in Medical Chart
“999” = Unknown (To be used only in circumstances where patient cannot have reading taken at time of arrival.)
” “ = Not applicable, (i.e. the ‘Principal/Primary Diagnosis’ is not in the range of 410.0x – 410.9x).

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be greater than or equal to zero.
Must be reported when ‘Principal/Primary Diagnosis Code’ equals 410.0x - 410.9x.
NTE segment is fixed width. Required spacing must be maintained if element is applicable.

SPARCS Inpatient Output Page 204

SPARCS Inpatient Segment: Primary Records HIPAA SEGMENT Data Element Name: AIDS / HIV Flag Record Position: 2085 Format – Length: Character - 1 Effective Date: Implemented May 1, 2005 and added to all years’ records. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A flag to indicate if the discharge record contains any indication of AIDS/HIV. See Appendix T - AIDS/HIV Record Editing.

Codes and Values:

“Y” = AIDS/HIV is indicated “N” = AIDS/HIV is not indicated

OUTPUT Edits on Element: None.

INPUT Edits on Element: Note applicable. This is a derived field.

SPARCS Inpatient Output Page 205

SPARCS Inpatient Segment: Primary Records HIPAA SEGMENT

Data Element Name: Abortion Flag Record Position: 2086 Format – Length: Character - 1 Effective Date: Implemented May 1, 2005 and added to all years’ records. Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A flag to indicate if the discharge record contains any indication of abortion. See Appendix TT - Abortion Record Editing.

Codes and Values:

“Y” = Abortion is indicated “N” = Abortion is not indicated

OUTPUT Edits on Element: This is a derived data element.

INPUT Edits on Element: Not applicable. This is a derived field.

SPARCS Inpatient Output Page 206

SPARCS Inpatient Segment: Primary Records

Charges

**Data Element Name:** Total Charges
Record Position: 2087 - 2098
Format – Length: Number - 12
Effective Date: January 1, 1982
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
The sum of ‘Total Accommodations Charges’ and ‘Total Ancillary Charges’ for the patient's
stay.

**Codes and Values:**

Must have been right justified and zero filled.
This total amount entered in dollars and cents as a positive amount. There are TWO implied decimal places for the currency.

**OUTPUT Edits on Element:**

Calculated by SPARCS as the sum of ‘Total Accommodations Charges’ and ‘Total Ancillary Charges’.

**INPUT Edits on Element:**
Not applicable. This is derived data element.

SPARCS Inpatient Output Page 207

SPARCS Inpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Accommodation Charges Record Position: 2099 - 2108 Format – Length: Character - 10 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The sum of all Accommodation charges incurred during the patient’s stay.

Codes and Values:

Must have been right justified and zero filled.
The total amount entered in dollars and cents. There are TWO implied decimal places for the currency.
If this field was not applicable it contains zeros.

OUTPUT Edits on Element:

Calculated by SPARCS as the sum of all service line Accommodations Charges.

INPUT Edits on Element:

Sum of individual occurrences of ‘Accommodations Total Charges’ must have equaled ‘Total Accommodations Charges’.
‘Accommodations Total Charges’ must have equaled ‘Accommodations Rate’ times ‘Accommodations Days’.
If ‘Accommodations Total Charges’ was entered, the other related Data Elements listed in the Accommodations Information Group Definition must also have been reported.

SPARCS Inpatient Output Page 208

SPARCS Inpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Ancillary Total Charges Record Position: 2109 - 2118 Format – Length: Character - 10 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total of all Ancillary Charges incurred during the patient's stay.

Codes and Values:

Must have been right justified and zero filled.
The total amount entered in dollars and cents. There are TWO implied decimal places for the currency.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element:

Calculated by SPARCS as the sum of all service line Ancillary Charges.

INPUT Edits on Element:

Must have equaled the sum of the individual occurrences of the ‘Inpatient Ancillary Total Charges’.
If ‘Inpatient Ancillary Revenue Codes’ of “ 001 ” thru “ 099 ” were reported, any associated charges were NOT included in ‘Total Ancillary Charges’.

SPARCS Inpatient Output Page 209

SPARCS Inpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Non-Covered Charges Record Position: 2119 - 2130 Format – Length: Number - 12 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The sum of ‘Total Accommodations Non-Covered Charges’ and ‘Total Ancillary Non- Covered Charges’ for the patient's stay.

Codes and Values:

Must have been right justified and zero filled.
The total amount entered in dollars and cents. There are TWO implied decimal places for the currency.

OUTPUT Edits on Element:

Calculated by SPARCS as the sum of ‘Total Accommodations Non-Covered Charges’ and ‘Total Ancillary Non-Covered Charges’.

INPUT Edits on Element: Not applicable.

SPARCS Inpatient Output Page 210

SPARCS Inpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Non-Covered Accommodation Charges Record Position: 2131 - 2140 Format – Length: Character - 10 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The accommodation (room) charges which were not reimbursable by the payer.

Codes and Values:

Must have been right justified and zero filled.
The total amount entered in dollars and cents. There are TWO implied decimal places for the currency.
If this field was not applicable it contains zeros.

OUTPUT Edits on Element:

Calculated by SPARCS as the sum of all service line non-covered Accommodations Charges.

INPUT Edits on Element:.

If ‘Accommodations Non-Covered Charges’ was entered, the other related Data Elements listed in the Accommodations Charges must also have been reported.

SPARCS Inpatient Output Page 211

SPARCS Inpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Non-Covered Ancillary Charges Record Position: 2141 - 2150 Format – Length: Character - 10 Effective Date: 1/1/19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total of all ‘Ancillary Non-Covered Charges’ during the patient's stay.

Codes and Values:

Must have been right justified and zero filled.
The total amount entered in dollars and cents. There are TWO implied decimal places for the currency.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element:

Sum of the individual occurrences of the ‘Inpatient Ancillary Total Non-Covered Charges’.

INPUT Edits on Element:.

If ‘Inpatient Ancillary Revenue Codes’ of “ 001 ” thru “ 099 ” were reported, any associated charges were NOT included in ‘Total Ancillary Non-Covered Charges’.

SPARCS Inpatient Output Page 212

SPARCS Inpatient Segment: Primary Records

Service

**Data Element Name:** Revenue Code 1- 10 (previously UB-92 Accommodation Code
and Inpatient Ancillary Revenue Code)

Record Position: Data^ Element^ Record
Position

Data Element Record
Position
Rev Code 1 2151 - 2154 Rev Code 6 2326 - 2329
Rev Code 2 2186 - 2189 Rev Code 7 2361 - 2364
Rev Code 3 2221 - 2224 Rev Code 8 2396 - 2399
Rev Code 4 2256 - 2259 Rev Code 9 2431 - 2434
Rev Code 5^2291 -^2294 Rev Code^10 2466 -^2469

Format – Length:
Character - 4
Effective Date: Jan. 1, 1994
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

**Description:**
Codes that identify specific accommodations, ancillary service or unique billing calculations
or arrangements. The code set is maintained by the National Uniform Bill Committee
(NUBC).

This data element is called the ‘Service Line Revenue Code’ in the X12 guidelines. It is
commonly referred to as the ‘Revenue Code’. Each service should be assigned a revenue
code:

For inpatient services involving multiple services for the same item providers should aggregate the services under the assigned revenue code and then report the total number of units that represent those services.
If multiple services are provided on the same day for like services, that is, those with the same HCPCS, the provider should aggregate the like services for each day and report the date along with the number of units provided, as well as the revenue code. The exception is for the Evaluation and Management (E/M) HCPCS code. For E/M HCPCS, report each of these separately but also use Condition Code "G0" to indicate a Distinct Medical visit.
Services provided on different days should be listed separately along with the date of service, units and revenue code.

**Codes and Values:**

Must be a valid code in accordance with the Revenue Codes in Appendix I.

**OUTPUT Edits on Element:**
None.

SPARCS Inpatient Output Page 213

**INPUT Edits on Element:**

If the ‘Revenue Code’ is entered, then the appropriate ‘Service Line Rate’, ‘Service Units’, ‘Service Line Charge Amount’, and ‘Service Line Non-Covered Charge Amount’ must also be reported.
If a Revenue Code is entered, the associated Total Charges and Total Non-Covered Charges must also be reported.
If Revenue Codes 0001 through 0099 are reported, the associated charges must NOT be included in the totals calculated for the Total Charges or Total Non-Covered Charges.
On Inpatient submissions, it is necessary to report at least one Revenue Code between the values of 010x and 100x with each inpatient claim.
For Outpatient submissions, there must be at least one total and non-covered charge for all revenue codes reported except for the 036x, 045x, 048x, 049x, 051x, 052x, 075x, 076x or 079x categories. For these exceptions the total and non-covered charges may be rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each claim.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

Effective with discharges after 12/31/99, UB-92 Accommodation Codes are reported in place of SPARCS Accommodation Codes.

The UB-92 Accommodation Codes for all years prior to 2000 have been derived from the reported SPARCS Accommodation Codes based on the table in Appendix H.

Revenue Code 1- 10 cont’d.

SPARCS Inpatient Output Page 214

SPARCS Inpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Revenue Type 1- 10

Record Position: Data Element^ Record Position

Data Element Record
Position
Revenue Type 1 2155 Revenue Type 6 2330
Revenue Type 2 2190 Revenue Type 7 2365
Revenue Type 3 2225 Revenue Type 8 2400
Revenue Type 4 2260 Revenue Type 9 2435
Revenue Type^5 2295 Revenue Type^10 2470

Format – Length: Character - 1 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Revenue type identifies the type of revenue code utilized, and is grouped into two categories: accommodation codes and ancillary codes.

Codes and Values:

“A” = Accommodation “R” = Ancillary

OUTPUT Edits on Element: This is a derived data element based on revenue codes.

INPUT Edits on Element: None.

SPARCS Inpatient Output Page 215

SPARCS Inpatient Segment: Primary Records
SERVICE SEGMENT

Data Element Name: Service Charge 1- 10

Record Position: Data Element^ Record Position

Data Element Record
Position
Service Charge 1 2156 - 2165 Service Charge 6 2331 - 2340
Service Charge 2 2191 - 2200 Service Charge 7 2366 - 2375
Service Charge 3 2226 - 2235 Service Charge 8 2401 - 2410
Service Charge 4 2261 - 2270 Service Charge 9 2436 - 2445
Service^ Charge^5 2296 -^2305 Service^ Charge^10 2471 -^2480

Format – Length: Number - 10 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Service amount of all submitted charges on each service line segment for this claim. This will be the sum of revenue charges (accommodations charges and ancillary charges) for the patient's stay.

Codes and Values:

Must have been right justified and zero filled.
The Service amount entered in dollars and cents. There are TWO implied decimal places for the currency.

OUTPUT Edits on Element:

Calculated by SPARCS as the sum of all ‘Line Item Charge Amounts’ (all revenue codes, both accommodation and ancillary charges).

INPUT Edits on Element: Not applicable.

SPARCS Inpatient Output Page 216

SPARCS Inpatient Segment: Primary Records
SERVICE SEGMENT

Data Element Name: Unit Type 1- 10

Record Position:- Data Element^ Record Position

Data
Element

Record
Position
Unit Type 1 2166 - 2167 Unit Type 6 2341 - 2342
Unit Type 2 2201 - 2201 Unit Type 7 2376 - 2377
Unit Type 3 2236 - 2237 Unit Type 8 2411 - 2412
Unit Type 4 2271 - 2272 Unit Type 9 2446 - 2447
Unit Type 5^2306 -^2307 Unit Type 10^2481 -^2482

Format – Length: Character - 2 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Code specifying the measurement units in which a value is being expressed, or manner in which a measurement has been taken.

Codes and Values:

“DA” = Days “UN” = Unit

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must equal “DA” or “UN” when service line charges are reported.
SPARCS allows for a maximum of 999 service lines to be reported.

SPARCS Inpatient Output Page 217

SPARCS Inpatient Segment: Primary Records
SERVICE SEGMENT

Data Element Name: Unit Quantity 1- 10

Record Position: Data Element^ Record Position

Data Element Record
Position
Unit Quantity 1 2168 - 2175 Unit Quantity 6 2343 - 2350
Unit Quantity 2 2203 - 2210 Unit Quantity 7 2378 - 2385
Unit Quantity 3 2238 - 2245 Unit Quantity 8 2413 - 2420
Unit Quantity 4 2273 - 2280 Unit Quantity 9 2448 - 2455
Unit Quantity 5^2308 -^2315 Unit Quantity^10 2483 -^2490

Format – Length: Number - 8 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A quantitative measure of services rendered that occurred by revenue category to or for the patient. The number of service units that occurred during the bill period for the patient. This will include items such as number of accommodation days, miles, pints of blood, renal dialysis treatments, etc.

Codes and Values:

Equals Days or Units.
Must be greater than zero.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

When reporting days, the number must be less than or equal to the number of days in the billing period as documented in Admission Date/Start of Care and Statement Through Date. The total number of days reported must not exceed the calculated length of stay.
When reporting days, the appropriate revenue code, Service Rate (4050R only), Total Charges, and Total Non-Covered Charges must also be reported to reflect room and board accommodations.
When reporting units, the value of unit can be reported as “1” or more based on the provider’s practice, health plan requirements or regulation.
When HCPCS codes are reported, the unit is defined by the HCPCS definition. Where the unit is not defined by the HCPCS codes, units can be reported as “1” or more based on the provider’s practice, health plan requirements or regulation.

SPARCS Inpatient Output Page 218

A zero or negative value is not allowed.
SPARCS allows for a maximum of 999 service lines to be reported.

Unit Quantity 1- 10 cont’d.

SPARCS Inpatient Output Page 219

SPARCS Inpatient Segment: Primary Records
SERVICE SEGMENT

**Data Element Name:** Non-Covered Charge 1- 10

Record Position: Data Element^ Record
Position

Data Element Record
Position
Non-Cov Charge 1 2176 - 2185 Non-Cov Charge 6 2351 - 2360
Non-Cov Charge 2 2211 - 2220 Non-Cov Charge 7 2386 - 2395
Non-Cov Charge 3 2246 - 2255 Non-Cov Charge 8 2421 - 2430
Non-Cov Charge 4 2281 - 2290 Non-Cov Charge 9 2456 - 2465
Non-Cov Charge^5 2316 -^2325 Non-Cov Charge^10 2491 -^2500

Format – Length:
Number - 10
Effective Date: January 1, 1982
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

Description: Non-covered charge amount reflects the non-covered charges for the payer as it pertains to the associated revenue code.

**Codes and Values:**

Equals Non-Covered Charge Amount entered in dollars and cents. Example: $125.24 would be entered as: 125.24

**OUTPUT Edits on Element:**
None.

**INPUT Edits on Element:**

Must equal Non-Covered Charge Amount.
If Non-Covered Charges are entered, the associated Revenue Code and Line Item Charge Amount must also be reported.
Non-Covered Charge Amount must be less than or equal to the corresponding Line Item Charge Amount.
If Non-Covered Charge Amount is entered, then Revenue Code, Service Unit Count, Line Item Charge Amount and HCPCS Accommodations Rate must also be reported.
It is necessary to report at least one Revenue Code with each outpatient claim (AS, ED, OP). There must be at least one Line Item Charge Amount and Non-Covered Charge Amount for all Revenue outpatient codes reported except for the 036x, 045x, 048x, 049x, 051x, 052x, 075x, 076x or 079x categories. For these exceptions the Line Item Charge Amount and non-covered charge amount may be rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each outpatient claim.
SPARCS allows for a maximum of 999 service lines to be reported.

SPARCS Inpatient Output Page 220

CONTINUATION RECORDS

SPARCS Inpatient Output Page 221

V. Continuation Records

Common Portion of All Records

SPARCS Inpatient Segment: Common Detail Data Element Name: Discharge Sequential Number Record Position: 1 - 14 Format – Length: Numeric – 14 Effective Date: May 1, 2005 Contained in: De-Identified Data Set: YES

Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Codes and Values:

An assigned numeric value.

OUTPUT Edits on Element:

Must be a numeric value.
If Abortion Flag equals ‘Y’ then the Discharge Number is reconfigured.

INPUT Edits on Element: Not applicable. This is a derived field.

SPARCS Inpatient Output Page 222

SPARCS Inpatient Segment: Common Detail Data Element Name: Continuation Indicator Record Position: 15 Format – Length: Numeric – 1 Effective Date: May 1, 2005 Contained in: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A code which indicates if continuation records exist for this discharge. This is a derived data element.

Codes and Values:

“0” = no continuation records
A value of “1” or greater means this is a continuation record.

OUTPUT Edits on Element:

Must be a numeric value.

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 223

SPARCS Inpatient Segment: Common Detail Data Element Name: Record Sequence Number Record Position: 16 - 18 Format – Length: Character - 3 Effective Date: January 1, 1994 Contained in: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The number assigned by SPARCS to indicate the record's position within a set of records for a particular patient discharge.

Codes and Values:

Right justified and zero filled.
“001” = Primary Record
“002” to “ 092 ” = Continuation Records

OUTPUT Edits on Element:

Must be numeric (‘ 001 ’ to ‘092’).

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 224

SPARCS Inpatient Segment: Common Detail Data Element Name: Record Sequence Count Record Position: 19 - 21 Format – Length: Character - 3 Effective Date: January 1, 1994 Contained in: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The total number of records reported for a particular patient stay/discharge.

This data element is assigned in conjunction with Record Sequence Number.

A patient discharge will result in one primary record and possible continuation records. All primary records will have a Record Sequence Number equal to one. For example, if a patient discharge has a “Record Sequence Count” equal to ‘005’, this means that there is a total of five records containing information for that patient stay; the primary record and four continuation records.

Codes and Values:

Right justified and zero filled.

OUTPUT Edits on Element:

Must be numeric (‘ 001 ’ to ‘092’).

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 225

SPARCS Inpatient Segment: Continuation Records

Data Element Name: Revenue Code 11- 80 Record Position: Data Element^ Record Position

Data Element Record Position Rev Code 11 51 - 54 Rev Code 46 1275 - 1279 Rev Code 12 86 - 89 Rev Code 47 1311 - 1314 Rev Code 13 121 - 124 Rev Code 48 1346 - 1349 Rev Code 14 156 - 159 Rev Code 49 1381 - 1384 Rev Code 15 191 - 194 Rev Code 50 1416 - 1419 Rev Code 16 226 - 229 Rev Code 51 1451 - 1454 Rev Code 17 261 - 264 Rev Code 52 1486 - 1489 Rev Code 18 296 - 299 Rev Code 53 1521 - 1524 Rev Code 19 331 - 334 Rev Code 54 1556 - 1559 Rev Code 20 366 - 369 Rev Code 55 1591 - 1594 Rev Code 21 401 - 404 Rev Code 56 1626 - 1629 Rev Code 22 436 - 439 Rev Code 57 1661 - 1664 Rev Code 23 471 - 474 Rev Code 58 1696 - 1699 Rev Code 24 506 - 509 Rev Code 59 1731 - 1734 Rev Code 25 541 - 544 Rev Code 60 1766 - 1769 Rev Code 26 576 - 579 Rev Code 61 1801 - 1804 Rev Code 27 611 - 614 Rev Code 62 1836 - 1839 Rev Code 28 646 - 649 Rev Code 63 1871 - 1874 Rev Code 29 681 - 684 Rev Code 64 1906 - 1909 Rev Code 30 716 - 719 Rev Code 65 1941 - 1944 Rev Code 31 751 - 754 Rev Code 66 1976 - 1979 Rev Code 32 786 - 789 Rev Code 67 2011 - 2014 Rev Code 33 821 - 824 Rev Code 68 2046 - 2049 Rev Code 34 856 - 859 Rev Code 69 2081 - 2084 Rev Code 35 891 - 894 Rev Code 70 2116 - 2119 Rev Code 36 926 - 929 Rev Code 71 2151 - 2154 Rev Code 37 961 - 964 Rev Code 72 2186 - 2189 Rev Code 38 996 - 999 Rev Code 73 2221 - 2224 Rev Code 39 1031 - 1034 Rev Code 74 2256 - 2259 Rev Code 40 1066 - 1069 Rev Code 75 2291 - 2294 Rev Code 41 1101 - 1104 Rev Code 76 2326 - 2329 Rev Code 42 1136 - 1139 Rev Code 77 2361 - 2364 Rev Code 43 1171 - 1174 Rev Code 78 2396 - 2399 Rev Code 44 1206 - 1209 Rev Code 79 2431 - 2434 Rev Code^45 1241 -^1244 Rev Code^80 2466 -^2469 Format – Length: Character - 4 Effective Date: Jan. 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description Codes that identify specific accommodations, ancillary service or unique billing calculations or arrangements.

This data element is called the "Service Line Revenue Code" in the X12- 837 guidelines. It is commonly referred to as the "Revenue Code". Each service should be assigned a revenue code:

For inpatient services involving multiple services for the same item providers should aggregate the services under the assigned revenue code and then report the total number of units that represent those services.

SPARCS Inpatient Output Page 226

If multiple services are provided on the same day for like services, that is, those with the same HCPCS, the provider should aggregate the like services for each day and report the date along with the number of units provided, as well as the revenue code. The exception is for the Evaluation and Management (E/M) HCPCS code. For E/M HCPCS, report each of these separately but also use Condition Code "G0" to indicate a Distinct Medical visit.
Services provided on different days should be listed separately along with the date of service, units and revenue code.

Codes and Values:

Must be a valid code in accordance with the Revenue Codes in Appendix I.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If the Revenue Code is entered, then the appropriate Service Line Rate, Service Units, Service Line Charge Amount, and Service Line Non-Covered Charge Amount must also be reported.
If a Revenue Code is entered, the associated Total Charges and Total Non-Covered Charges must also be reported.
If Revenue Codes 0001 through 0099 are reported, the associated charges must NOT be included in the totals calculated for the Total Charges or Total Non-Covered Charges.
On Inpatient submissions, It is necessary to report at least one Revenue Code between the values of 010x and 100x with each inpatient claim.
For outpatient claims, there must be at least one total and non-covered charge for all revenue codes reported except for the 036x, 045x, 048x, 049x, 051x, 052x, 075x, 076x or 079x categories. For these exceptions the total and non-covered charges may be rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each claim.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

Revenue Code 11- 80 cont’d.

SPARCS Inpatient Output Page 227

SPARCS Inpatient Segment: Continuation Records

Data Element Name: Revenue Type 11- 80 Record Position: Data Element^ Record Position

Data Element Record Position Revenue Type 11 55 Revenue Type 46 1280 Revenue Type 12 90 Revenue Type 47 1315 Revenue Type 13 125 Revenue Type 48 1350 Revenue Type 14 160 Revenue Type 49 1385 Revenue Type 15 195 Revenue Type 50 1420 Revenue Type 16 230 Revenue Type 51 1455 Revenue Type 17 265 Revenue Type 52 1490 Revenue Type 18 300 Revenue Type 53 1525 Revenue Type 19 335 Revenue Type 54 1560 Revenue Type 20 370 Revenue Type 55 1595 Revenue Type 21 405 Revenue Type 56 1630 Revenue Type 22 440 Revenue Type 57 1665 Revenue Type 23 475 Revenue Type 58 1700 Revenue Type 24 510 Revenue Type 59 1735 Revenue Type 25 545 Revenue Type 60 1770 Revenue Type 26 580 Revenue Type 61 1805 Revenue Type 27 615 Revenue Type 62 1840 Revenue Type 28 650 Revenue Type 63 1875 Revenue Type 29 685 Revenue Type 64 1910 Revenue Type 30 720 Revenue Type 65 1945 Revenue Type 31 755 Revenue Type 66 1980 Revenue Type 32 790 Revenue Type 67 2015 Revenue Type 33 825 Revenue Type 68 2050 Revenue Type 34 860 Revenue Type 69 2085 Revenue Type 35 895 Revenue Type 70 2120 Revenue Type 36 930 Revenue Type 71 2155 Revenue Type 37 965 Revenue Type 72 2190 Revenue Type 38 1000 Revenue Type 73 2225 Revenue Type 39 1035 Revenue Type 74 2260 Revenue Type 40 1070 Revenue Type 75 2295 Revenue Type 41 1105 Revenue Type 76 2330 Revenue Type 42 1140 Revenue Type 77 2365 Revenue Type 43 1175 Revenue Type 78 2400 Revenue Type 44 1210 Revenue Type 79 2435 Revenue Type^45 1245 Revenue Type^80 2470 Format – Length: Character - 1 Effective Date: Implemented August 201 1 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The Revenue type identifies the type of revenue code utilized, and is grouped into two categories: accommodation codes and ancillary codes.

Codes and Values:

“A” = Accommodation “R” = Ancillary

INPUT Edits on Element: Not applicable. This is a derived data element.

SPARCS Inpatient Output Page 228

SPARCS Inpatient Segment: Continuation Records Data Element Name: Service Charge 11- 80 (previously Accommodation Total Charges and Inpatient Ancillary Total Charges) Record Position: Data Element^ Record Position

Data Element Record Position Total Charge 11 56 - 65 Total Charge 46 1281 - 1290 Total Charge 12 91 - 100 Total Charge 47 1316 - 1325 Total Charge 13 126 - 135 Total Charge 48 1351 - 1360 Total Charge 14 161 - 170 Total Charge 49 1386 - 1395 Total Charge 15 196 - 205 Total Charge 50 1421 - 1430 Total Charge 16 231 - 240 Total Charge 51 1456 - 1465 Total Charge 17 266 - 275 Total Charge 52 1491 - 1500 Total Charge 18 301 - 310 Total Charge 53 1526 - 1535 Total Charge 19 336 - 345 Total Charge 54 1561 - 1570 Total Charge 20 371 - 380 Total Charge 55 1596 - 1605 Total Charge 21 406 - 415 Total Charge 56 1631 - 1640 Total Charge 22 441 - 450 Total Charge 57 1666 - 1675 Total Charge 23 476 - 485 Total Charge 58 1701 - 1710 Total Charge 24 511 - 520 Total Charge 59 1736 - 1745 Total Charge 25 546 - 555 Total Charge 60 1771 - 1780 Total Charge 26 581 - 590 Total Charge 61 1806 - 1815 Total Charge 27 616 - 625 Total Charge 62 1841 - 1850 Total Charge 28 651 - 660 Total Charge 63 1876 - 1885 Total Charge 29 686 - 695 Total Charge 64 1911 - 1920 Total Charge 30 721 - 730 Total Charge 65 1946 - 1955 Total Charge 31 756 - 765 Total Charge 66 1981 - 1990 Total Charge 32 791 - 800 Total Charge 67 2016 - 2025 Total Charge 33 826 - 835 Total Charge 68 2051 - 2060 Total Charge 34 861 - 870 Total Charge 69 2086 - 2095 Total Charge 35 896 - 905 Total Charge 70 2121 - 2130 Total Charge 36 931 - 940 Total Charge 71 2156 - 2165 Total Charge 37 966 - 975 Total Charge 72 2191 - 2200 Total Charge 38 1001 - 1010 Total Charge 73 2226 - 2235 Total Charge 39 1036 - 1045 Total Charge 74 2261 - 2270 Total Charge 40 1071 - 1080 Total Charge 75 2296 - 2305 Total Charge 41 1106 - 1115 Total Charge 76 2331 - 2340 Total Charge 42 1141 - 1150 Total Charge 77 2366 - 2375 Total Charge 43 1176 - 1185 Total Charge 78 2401 - 2410 Total Charge 44 1211 - 1220 Total Charge 79 2436 - 2445 Total Charge^45 1246 -^1255 Total Charge^80 2471 -^2480 Format – Length: Character - 10 Effective Date: January 1, 1982 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: The sum of Total Accommodations Charges and Total Ancillary Charges for the patient's stay.

Codes and Values:

1.^ Must have been right justified and zero filled.^ 2. This amount was defined with TWO implied decimal places and must have been entered as a positive amount.

OUTPUT Edits on Element: None.

INPUT Edits on Element: Calculated by SPARCS as the sum of Total Accommodations Charges and Total Ancillary Charges.

SPARCS Inpatient Output Page 229

SPARCS Inpatient Segment: Continuation Records

Data Element Name: Unit Type 11- 80 Record Position: Data Element^ Record Position

Data Element Record Position Unit Type 11 66 - 67 Unit Type 46 1291 - 1292 Unit Type 12 101 - 102 Unit Type 47 1326 - 1327 Unit Type 13 136 - 137 Unit Type 48 1361 - 1362 Unit Type 14 171 - 172 Unit Type 49 1396 - 1397 Unit Type 15 206 - 207 Unit Type 50 1431 - 1432 Unit Type 16 241 - 242 Unit Type 51 1466 - 1467 Unit Type 17 276 - 277 Unit Type 52 1501 - 1502 Unit Type 18 311 - 312 Unit Type 53 1536 - 1537 Unit Type 19 346 - 347 Unit Type 54 1571 - 1572 Unit Type 20 381 - 382 Unit Type 55 1606 - 1607 Unit Type 21 416 - 417 Unit Type 56 1641 - 1642 Unit Type 22 451 - 452 Unit Type 57 1676 - 1677 Unit Type 23 486 - 487 Unit Type 58 1711 - 1712 Unit Type 24 521 - 522 Unit Type 59 1746 - 1747 Unit Type 25 556 - 557 Unit Type 60 1781 - 1782 Unit Type 26 591 - 592 Unit Type 61 1816 - 1817 Unit Type 27 626 - 627 Unit Type 62 1851 - 1852 Unit Type 28 661 - 662 Unit Type 63 1886 - 1887 Unit Type 29 696 - 697 Unit Type 64 1921 - 1922 Unit Type 30 731 - 732 Unit Type 65 1956 - 1957 Unit Type 31 766 - 767 Unit Type 66 1991 - 1992 Unit Type 32 801 - 802 Unit Type 67 2026 - 2027 Unit Type 33 836 - 837 Unit Type 68 2061 - 2062 Unit Type 34 871 - 872 Unit Type 69 2096 - 2097 Unit Type 35 906 - 907 Unit Type 70 2131 - 2132 Unit Type 36 941 - 942 Unit Type 71 2166 - 2167 Unit Type 37 976 - 977 Unit Type 72 2201 - 2202 Unit Type 38 1011 - 1012 Unit Type 73 2236 - 2237 Unit Type 39 1046 - 1047 Unit Type 74 2271 - 2272 Unit Type 40 1081 - 1082 Unit Type 75 2306 - 2307 Unit Type 41 116 - 1117 Unit Type 76 2341 - 2342 Unit Type 42 1151 - 1152 Unit Type 77 2376 - 2377 Unit Type 43 1186 - 1187 Unit Type 78 2411 - 2412 Unit Type 44 1221 - 1222 Unit Type 79 2446 - 2447 Unit Type^45 1256 -^1257 Unit Type^80 2481 -^2482 Format – Length: Character - 2 Effective Date: Implemented August 201 1 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Code specifying the measurement units in which a value is being expressed, or manner in which a measurement has been taken. Codes and Values:

“DA” = Days “UN” = Unit

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must equal “DA” or “UN” when service line charges are reported.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

SPARCS Inpatient Output Page 230

SPARCS Inpatient Segment: Continuation Records

Data Element Name: Unit Quantity 11- 80 Record Position: Data Element^ Record^ Position

Data Element Record Position Unit Quantity 11 68 - 75 Unit Quantity 46 1293 - 1300 Unit Quantity 12 103 - 110 Unit Quantity 47 1328 - 1335 Unit Quantity 13 138 - 145 Unit Quantity 48 1363 - 1370 Unit Quantity 14 173 - 180 Unit Quantity 49 1398 - 1405 Unit Quantity 15 208 - 215 Unit Quantity 50 1433 - 1440 Unit Quantity 16 243 - 250 Unit Quantity 51 1468 - 1475 Unit Quantity 17 278 - 285 Unit Quantity 52 1503 - 1510 Unit Quantity 18 313 - 320 Unit Quantity 53 1538 - 1545 Unit Quantity 19 348 - 355 Unit Quantity 54 1573 - 1580 Unit Quantity 20 383 - 390 Unit Quantity 55 1608 - 1615 Unit Quantity 21 418 - 425 Unit Quantity 56 1643 - 1650 Unit Quantity 22 453 - 460 Unit Quantity 57 1678 - 1685 Unit Quantity 23 488 - 495 Unit Quantity 58 1713 - 1720 Unit Quantity 24 523 - 530 Unit Quantity 59 1748 - 1755 Unit Quantity 25 558 - 565 Unit Quantity 60 1783 - 1790 Unit Quantity 26 593 - 600 Unit Quantity 61 1818 - 1825 Unit Quantity 27 628 - 635 Unit Quantity 62 1853 - 1860 Unit Quantity 28 663 - 670 Unit Quantity 63 1888 - 1895 Unit Quantity 29 698 - 705 Unit Quantity 64 1923 - 1930 Unit Quantity 30 733 - 740 Unit Quantity 65 1958 - 1965 Unit Quantity 31 768 - 775 Unit Quantity 66 1993 - 2000 Unit Quantity 32 803 - 810 Unit Quantity 67 2028 - 2035 Unit Quantity 33 838 - 845 Unit Quantity 68 2063 - 2070 Unit Quantity 34 873 - 880 Unit Quantity 69 2098 - 2105 Unit Quantity 35 908 - 915 Unit Quantity 70 2133 - 2140 Unit Quantity 36 943 - 950 Unit Quantity 71 2168 - 2175 Unit Quantity 37 978 - 985 Unit Quantity 72 2203 - 2210 Unit Quantity 38 1013 - 1020 Unit Quantity 73 2238 - 2245 Unit Quantity 39 1048 - 1055 Unit Quantity 74 2273 - 2280 Unit Quantity 40 1083 - 1090 Unit Quantity 75 2308 - 2315 Unit Quantity 41 1118 - 1125 Unit Quantity 76 2343 - 2350 Unit Quantity 42 1153 - 1160 Unit Quantity 77 2378 - 2385 Unit Quantity 43 1188 - 1195 Unit Quantity 78 2413 - 2420 Unit Quantity 44 1223 - 1230 Unit Quantity 79 2448 - 2455 Unit Quantity^45 1258 -^1265 Unit Quantity^80 2483 -^2490 Format – Length: Number - 8 Effective Date: Implemented August 201 1 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: A quantitative measure of services rendered that occurred by revenue category to or for the patient. The number of service units that occurred during the bill period for the patient This will include items such as number of accommodation days, miles, pints of blood, renal dialysis treatments, etc.

Codes and Values:

Equals Days or Units
Must be greater than zero.

SPARCS Inpatient Output Page 231

OUTPUT Edits on Element: None.

INPUT Edits on Element:

When reporting days, the number must be less than or equal to the number of days in the billing period as documented in Admission Date/Start of Care and Statement Through Date. The total number of days reported must not exceed the calculated length of stay.
When reporting days, the appropriate revenue code, Service Rate (4050R only), Total Charges, and Total Non-Covered Charges must also be reported to reflect room and board accommodations.
When reporting units, the value of unit can be reported as “1” or more based on the provider’s practice, health plan requirements or regulation.
When HCPCS codes are reported, the unit is defined by the HCPCS definition. Where the unit is not defined by the HCPCS codes, units can be reported as “1” or more based on the provider’s practice, health plan requirements or regulation.
A zero or negative value is not allowed.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

Unit Quantity 11- 80 cont’d.

SPARCS Inpatient Output Page 232

SPARCS Inpatient Segment: Continuation Records

**Data Element Name:** Non-Covered Charge 11- 80 (previously Accommodation
Total Charges and Inpatient Ancillary Total Non-
covered Charges)
Record Position: Data Element^ Record
Position

Data Element Record
Position
Non-Cov Chrg 11 76 - 85 Non-Cov Chrg 46 1301 - 1310
Non-Cov Chrg 12 111 - 120 Non-Cov Chrg 47 1336 - 1345
Non-Cov Chrg 13 146 - 155 Non-Cov Chrg 48 1371 - 1380
Non-Cov Chrg 14 181 - 190 Non-Cov Chrg 49 1406 - 1415
Non-Cov Chrg 15 216 - 225 Non-Cov Chrg 50 1441 - 1450
Non-Cov Chrg 16 251 - 260 Non-Cov Chrg 51 1476 - 1485
Non-Cov Chrg 17 286 - 295 Non-Cov Chrg 52 1511 - 1520
Non-Cov Chrg 18 321 - 330 Non-Cov Chrg 53 1546 - 1555
Non-Cov Chrg 19 356 - 365 Non-Cov Chrg 54 1581 - 1590
Non-Cov Chrg 20 391 - 400 Non-Cov Chrg 55 1616 - 1625
Non-Cov Chrg 21 426 - 435 Non-Cov Chrg 56 1651 - 1660
Non-Cov Chrg 22 461 - 470 Non-Cov Chrg 57 1686 - 1695
Non-Cov Chrg 23 496 - 505 Non-Cov Chrg 58 1721 - 1730
Non-Cov Chrg 24 531 - 540 Non-Cov Chrg 59 1756 - 1765
Non-Cov Chrg 25 566 - 575 Non-Cov Chrg 60 1791 - 1800
Non-Cov Chrg 26 601 - 610 Non-Cov Chrg 61 1826 - 1835
Non-Cov Chrg 27 636 - 645 Non-Cov Chrg 62 1861 - 1870
Non-Cov Chrg 28 671 - 680 Non-Cov Chrg 63 1896 - 1905
Non-Cov Chrg 29 706 - 715 Non-Cov Chrg 64 1931 - 1940
Non-Cov Chrg 30 741 - 750 Non-Cov Chrg 65 1966 - 1975
Non-Cov Chrg 31 776 - 785 Non-Cov Chrg 66 2001 - 2010
Non-Cov Chrg 32 811 - 820 Non-Cov Chrg 67 2036 - 2045
Non-Cov Chrg 33 846 - 855 Non-Cov Chrg 68 2071 - 2080
Non-Cov Chrg 34 881 - 890 Non-Cov Chrg 69 2106 - 2115
Non-Cov Chrg 35 916 - 925 Non-Cov Chrg 70 2141 - 2150
Non-Cov Chrg 36 951 - 960 Non-Cov Chrg 71 2176 - 2185
Non-Cov Chrg 37 986 - 995 Non-Cov Chrg 72 2211 - 2220
Non-Cov Chrg 38 1021 - 1030 Non-Cov Chrg 73 2246 - 2255
Non-Cov Chrg 39 1056 - 1065 Non-Cov Chrg 74 2281 - 2290
Non-Cov Chrg 40 1091 - 1100 Non-Cov Chrg 75 2316 - 2325
Non-Cov Chrg 41 1126 - 1135 Non-Cov Chrg 76 2351 - 2360
Non-Cov Chrg 42 1161 - 1170 Non-Cov Chrg 77 2386 - 2395
Non-Cov Chrg 43 1196 - 1205 Non-Cov Chrg 78 2421 - 2430
Non-Cov Chrg 44 1231 - 1240 Non-Cov Chrg 79 2456 - 2465
Non-Cov Chrg^45 1266 -^1275 Non-Cov Chrg^80 2491 -^2500
Format – Length: Number - 10
Effective Date: January 1, 19 82
Contained In: De-Identified Data Set: YES
Limited Data Set: YES
Identifiable Data Set: YES
Deniable Data Element: No

Description: Non-covered charge amount reflects the non-covered charges for the primary payer as it pertains to the associated revenue code.

**Codes and Values:**

Equals Non-Covered Charge Amount entered in dollars and cents. Example: $125.24 would be entered as: 125.24

**OUTPUT Edits on Element:**
None.

SPARCS Inpatient Output Page 233

INPUT Edits on Element:

Must equal Non-Covered Charge Amount.
If Non-Covered Charges are entered, the associated Revenue Code and Line Item Charge Amount must also be reported.
Non-Covered Charge Amount must be less than or equal to the corresponding Line Item Charge Amount.
If Non-Covered Charge Amount is entered, then Revenue Code, Service Unit Count, Line Item Charge Amount and HCPCS Accommodations Rate must also be reported.
It is necessary to report at least one Revenue Code with each outpatient claim (AS, ED, OP). There must be at least one Line Item Charge Amount and Non-Covered Charge Amount for all Revenue outpatient codes reported except for the 036x, 045x, 048x, 049x, 051x, 052x, 075x, 076x or 079x categories. For these exceptions the Line Item Charge Amount and non-covered charge amount may be rolled up to the first occurrence of the revenue code category with zero reported for subsequent occurrences on each outpatient claim.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

Non-Covered Charge 11- 80 cont’d.

SPARCS Inpatient Output Page 234

APPENDICES LISTING

APPENDIX	NAME	DESCRIPTION	USED BY
A	Date Edit Validation Table	Valid codes for Month; Day; Year	Both
B	Hour Reference Table	4 digit and 2 digit codes corresponding to each hour of the day	Both
C	New York State Patient Status or Disposition	Discharge Status of Patient from health care facility. Codes established by NUBC.	Both
D	Expected Reimbursement Codes	Code Definitions for pay source	Both
E	Address Abbreviations	Abbreviations for all address fields	Both
F	Zip/County Code Edit Validation Table	County Codes and first 3 digits of Zip Codes by county	Both
G	State Edit Validation Table	Abbreviations for States; Territories; and Canadian Provinces	Both
H	UB Accommodation Codes	Moved to Appendix I
I	Revenue Codes	Code Definitions for revenue codes	Both
J	License Code Descriptions	Valid codes for Health Care Professionals	Both
K	Payer IDs for Commercial Insurance and Other Payers	Provides resources to identify a variety of payers (commercial insurance companies; Medicaid FFS; Medicare FFS) for submitting "Payer ID" information. Lists codes for Medicaid Managed Care and Miscellaneous codes. Historical Codes for HMOs
L	Blue Cross and Blue Shield Plan Numbers	Plan Numbers By State and Canadian Province	Both
M	Input and Output Alphabetical Listing of Data Elements	List of all Data Elements with collection year; data element name; and number. Links to Data Dictionary for definitions; codes and values; and edit applications.	Both
N	Coding Conditions and Exceptions	Points out several important coding conditions as well as exceptions to common coding conditions	Submitters
NN	Programmers Guide for SPARCS requirements	Lists data elements and acceptable values. Indicates elements required by SPARCS.	Submitters
O	Medicaid Managed Care Payer ID Numbers	Lists payer ID; contract county; and plan type for Medicaid Managed Care Plans	Both
OO	Medicaid Rate Codes	Links to resources on Medicaid Rate Codes	Both
P	Source of Payment Typology	Codes and descriptions for Source of Payment	Both
Q	Inpatient Edit Program Error Codes	Lists and describes error codes for inpatient data. Links to data dictionary for additional information.	Submitters
R	Outpatient Edit Program Error Codes	Lists and describes error codes for outpatient data. Links to data dictionary for additional information.	Submitters
S	Service Category Group Definitions	Defines the six service category groups as listed on the SPARCS inpatient record and used in the Annual Report Series Tables	Users
T	T-AIDS/HIV Record Editing	Explains edits to those records subject to HIV/AIDS review	Users
TT	Abortion Record Editing	Explains guidelines that result in the setting of the abortion flag; restricting release of physician license number	Users
U	NYS County/Region/HSA Table	List of codes for NYS county; Region; and HSA	Both
V	Edited Inpatient Output File Description	Lists data element names and positions in the Edited Inpatient Output File. Links to data dictionary for additional information.	Users
VV	Edited UDS Outpatient Output File Description	Lists data element names and positions in the Edited Outpatient Output File. Links to data dictionary for additional information.	Users
VVV	Inpatient Master File Description	Lists data element names and positions in the Edited Inpatient Master File. Links to data dictionary for additional information.	Users
VVVV	Inpatient Non-Identified Abbreviated File Description	Lists data element names and positions in the Inpatient De-Identified Abbreviated File. Links to data dictionary for additional information.	Users
W	Edited UDS Outpatient Output Conversion Source	Edited UDS Outpatient Output Conversion Source	Users
WW	Conversion Notes	Conversion Notes	Both
X	Unscheduled/Scheduled Admission Conversion Algorithm	Table to be used for determining scheduled vs. unscheduled admission	Users
Y	Grouper Versions Used by Year Reference Table	The values in the CURRENT; PRIOR and NEW Federal; AP State and APR State DRG; MDC; ROM and SOI fields are dependent upon the discharge year of the patient. Listed are the version numbers of the groupers used.	Users
Z	Identifying and Restricted Data	Lists identifying fields requiring approval of the Data Protection Review Board prior to release.	Users
ZZ	Using Continuation Records	Explains how “continuation records" are created when multiple discharge records are created for a single patient stay. Explains continuation record handling for data users	Users