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

NY SPARCS - Outpatient Output data dictionary

OUTPATIENT OUTPUT DATA DICTIONARY

PRIMARY RECORDS

SPARCS Outpatient Output Page 56

Common Portion of All Records

SPARCS Outpatient 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: NO 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

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 Outpatient 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 Outpatient 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 will be 0 02. 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 092).

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

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SPARCS Outpatient 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 001. For example, if a patient discharge has a Record Sequence Count equal to 005, this means that there are 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.

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SPARCS Outpatient Segment: Primary Records

Patient Sex................................................................................................................

Data Element Name: Patient Control Number Record Position: 24 - 43 Record Position for Encrypted* 3201 - 3244 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 for Encrypted only; otherwise, NO. Identifiable Data Set: YES Deniable Data Element: Yes

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

Description: A patient's unique Control Number is assigned by the hospital to facilitate retrieval of individual financial and clinical records and posting of the payment.

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 Outpatient Segment: Primary Records

Patient Race...............................................................................................................

(^) Data Element Name: Medical Record Number Record Position: 44 - 60 Record Position for Encrypted* 3245 – 3288 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 for Encrypted only; otherwise, NO. Identifiable Data Set: YES Deniable Data Element: Yes *Medical Record Number is only 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 Outpatient Segment: Primary Records

Patient Ethnicity.........................................................................................................

Data Element Name: Unique Personal Identifier Record Position: 61 - 70 Record Position for Encrypted* 3289 - 3310 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 only 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 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 were 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 Outpatient Segment: Primary Records

Patient City...............................................................................................................

Data Element Name: Enhanced Unique Personal Identifier Record Position: 71 - 89 Record Position for Encrypted* 3311 - 3354 Format – Length: Character - 19 Format Length for Encrypted* Character - 44 Effective Date: Implemented June 2012 and added to years 1995 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 only 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 sex 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

Enhanced Unique Personal Identifier cont’d.

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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 were 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 sex, 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.

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SPARCS Outpatient Segment: Primary Records

Patient State...............................................................................................................

Data Element Name: Patient Birth Date Record Position: 90 - 97 Record Position for Encrypted* 3355 - 3376 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 only available with as the year and month.

Description: Date of 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.
Age, calculated as the difference between Patient Birth Date and Admission Date/Start of Care, must be than 125 years.

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 Outpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Age Record Position: 98 - 100 Format – Length: Number - 3 Effective Date: January 1, 1982 Contained In: (^) De-Identified Data Set: YES -  90, then equals 90 O Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No Description: Patient's age calculated as the difference in Admission Date/Start of Care and the Patient Birth Data. Codes and Values:

Right justified, zero filled.
For a patient under one year, age = 000.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records PATIENT SEGMENT

(^)

Age in Days (for Newborn).............................................................................................

Record Position: 101 - 103 Format – Length: Number - 3 Effective Date: Implemented May 1, 2005 and added to all years’

DISCHARGE DATE..................................................................................................

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

Description: Calculated age in days for all records with an age equal to 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 data element.

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SPARCS Outpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Sex Record Position: 104 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 Admission Date/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 Outpatient Segment: Primary Records PATIENT SEGMENT Data Element Name: Patient Race Record Position: 105 - 106 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 patient’s race.

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 Outpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Ethnicity Record Position: 107 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 patient’s ethnicity. 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 Outpatient Segment: Primary Records PATIENT SEGMENT

(^) Data Element Name: Patient Address Line 1 Record Position: 108 - 125 Record Position for Encrypted* 3377 - 3420 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 an Encrypted Data Element. Description: The mailing address of the patient's principal residence at the time of Admission Date/Start of Care>. 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).

SPARCS Outpatient Output Page 73

SPARCS Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient Address Line 2 Record Position: 126 - 143 Record Position for Encrypted* 3421 - 3464 Format – Length: Character - 18 Format – Length for Encrypted* Character - 44 Effective Date: January 1, 1 994 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 an Encrypted Data Element.

Description: Continuation of the mailing address of the patient's principal residence at the time of

ADMISSION/START OF CARE DATE..........................................................................

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 Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient City Record Position: 144 - 158 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 at the time of Admission Date/Start of Care

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.

SPARCS Outpatient Output Page 75

SPARCS Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient State Record Position: 159 - 160 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 at the time of Admission Date/Start of Care, 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.

SPARCS Outpatient Output Page 76

SPARCS Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient Postal Service Zip Code and Extension Code Record Position: 161 - 169 Record Position for Encrypted* 3465 - 3486 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 Limited Data Set: YES; Extension - NO Identifiable Data Set: YES; Extension - YES Deniable Data Element: No: 5-digit zip code

Patient ZIP CODE EXTENSION...................................................................................

Patient Postal Service Zip Code Extension Code (four digits) is only available on the Limited Data Set as 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 Date/Start of Care.

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 containing no embedded blanks. In cases where only a five-digit code was entered, the remaining four positions must be 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 Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: Patient County Code Record Position: 170 - 171 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 at the time of Admission Date/Start of Care.

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 Outpatient Segment: Primary Records PATIENT SEGMENT

Data Element Name: SPARCS Region Code Record Position: 172 - 173 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: Based upon county of the facility, this is a geographical subdivision of the State of New York as assigned by SPARCS. 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, unless otherwise noted.

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

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SPARCS Outpatient Segment: Primary Records NEWBORN SEGMENT

Data Element Name: Newborn Flag Record Position: 174 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 characters of the Principal/Primary Diagnosis Code.

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.

“V30” = Single liveborn Specifically: ‘V300’, ‘V301’, ‘V3000’, or ‘V3001’
“V31” = 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 “V39” = 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

SPARCS Outpatient Output Page 80

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 Outpatient Segment: Primary Records

Facility Name............................................................................................................

Facility Identifier (previously SPARCS Identification Number).................................................. FACILITY SEGMENT - Primary Records

Record Position: 175 - 180 Format – Length: Character - 6 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 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 stipulate 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, unless otherwise noted.

INPUT Edits on Element:

Must have been a valid entry.

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Facility Identifier Check Digit Record Position: 181 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 based on its’ 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.

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Facility Name Record Position: 182 - 251 Format – Length: Character - 70 Effective Date: Implemented May, 2005 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: 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 current Facility Name as of the update date of this record. It is not specific to discharge year.

Codes and Values:

Valid Facility Name.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Health Service Area Record Position: 252

Payer ID Number 1 –

Effective Date: Implemented May 2005 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: Based upon county of the facility, this is a geographical subdivision of the State of New York as assigned by SPARCS.. For the list of Health Service Areas (HSA) by county see NYS County/Region/HSA Table in Appendix U.

Codes and Values:

A one digit number between 1 and 8. See Appendix U.

OUTPUT Edits on Element:

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

INPUT Edits on Element: Not applicable.

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

Facility County (previously Hospital County)

Record Position: 253 - 254 Format – Length: Number - 2 Effective Date: Implemented in May 2005 and added to all years’

Discharge Weekday.....................................................................................................

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

Description: The county in which 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, unless otherwise noted.

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

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

Data Element Name: Operating Certificate Number Record Position: 255 - 261 Format – Length: Number - 7 Effective Date: Implemented May 2005 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: The number assigned by the Department of Health Division of Health Facility Planning.

Department regulations stipulate 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 discharge year.

Codes and Values:

Maintained by the Health Facility Information Systems (HFIS), in 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, unless otherwise noted.

INPUT Edits on Element:

Not applicable. This is an assigned data element.

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SPARCS Outpatient Segment: Primary Records FACILITY SEGMENT

National Provider ID (previously Provider Identification Number)..............................................

Record Position: 262 - 271 Format – Length: Number - 10 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: Released if reported.

The unique identification number assigned to the provider submitting the bill. Required for billing providers in the United States and its territories on/after the mandated HIPAA National Provider Identifier (NPI) implementation date (2004). Required when reporting to Centers for Medicare and Medicaid Services.

Codes and Values:

Equals facility’s National Provider ID (NPI)
Prior to HIPAA implementation, payers assigned identification numbers to providers.

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.

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SPARCS Outpatient Segment: Primary Records PHYSICIAN SEGMENT

Data Element Name: Attending Provider State License Number Record Position: 272 - 279 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the NYS Department of Education, is 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.

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 eighth positions are the six digit NYS 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:

Must have been valid numerically for category range of entry. Example: Physician must have first 2 digits “00”, and the valid range is between 000000 01 - 00300000 and 00900000- 00999999.
For physicians, license number is validated against the NYS Education Department license file.

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SPARCS Outpatient Segment: Primary Records PHYSICIAN SEGMENT

Operating Physician State License Number..........................................................................

Record Position: 280 - 287 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the NYS 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 giver.

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 eighth positions are the six digit NYS 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:

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 Outpatient Output Page 90

SPARCS Outpatient Segment: Primary Records PHYSICIAN SEGMENT

Data Element Name: Other Operating Physician State License Number Record Position: 288 - 295 Format – Length: Character - 8 Effective Date: January 1, 19 82 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: Yes Restricted for selected records (See Appendix Z and TT)

Description: The professional license number, issued by the NYS 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, nurse/midwife, etc.).

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 eighth positions are the six digit NYS 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.

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

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

Record Position: 296 - 300 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 are directed to report the expected payer using the greatest level of detail without sacrificing accuracy.

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

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: X12 Source of Payment (aka Claim Filing Indicator) is Reported as:

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

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

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

Record Position: 301 - 305 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. Facilities are directed to report the expected payer using the greatest level of detail without sacrificing accuracy. Facilities with Managed Care Plans (MCPs) are directed to concentrate on the variety of Managed Care Plans (HMO and PPO), as well as the funding for these MCPs (Medicare, Medicaid, etc.).

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.

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Source of Payment Typology III Record Position: 306 - 310 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. Facilities are directed to report the expected payer using the greatest level of detail without sacrificing accuracy. Facilities with Managed Care Plans (MCPs) are directed to concentrate on the variety of Managed Care Plans (HMO and PPO), as well as the funding for these MCPs (Medicare, Medicaid, etc.).

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.

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SPARCS Outpatient 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 1 311 Source of Payment 4 383 Source of Payment 2 335 Source of Payment 5 407 Source of Payment 3^359 Source of Payment^6 431 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 type of payment for this visit.

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 Claim Filing Indicator and how they are grouped in the Source of Payment on the Output File:

Output- Source of Payment Input - 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

SPARCS Outpatient Output Page 95

INPUT Edits on Element:

For all payers, Source of Payment Code, Covered Days and Non-Covered Days are required.
The table below indicates the additional data items that are required, depending on the value in the Claim Filing Indicator. 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: Claim Filing Indicator is Reported as: SoP I must be: 16, MA, MB 1xxx MC 2xxx

Source of Payment 1- 6 cont’d

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SPARCS Outpatient 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 1 312 - 313 Claim Filing Indicator 4 384 - 385 Claim Filing Indicator 2 336 - 337 Claim Filing Indicator 5 408 - 409 Claim Filing Indicator^3 360 -^361 Claim Filing Indicator^6 432 -^433 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 Outpatient Output Page 97

INPUT Edits on Element:

For all payers, Source of Payment Code, Covered Days and Non-Covered Days are required.
The table below indicates the additional data items that are required, depending on the value in the Claim Filing Indicator Code/Source of Payment.

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 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

Claim Filing Indicator Code 1 - 6 cont’d.

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SPARCS Outpatient 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 1 314 - 321 Payer ID 4 386 - 393 Payer ID 2 338 - 345 Payer ID 5 410 - 417 Payer ID^3 362 -^369 Payer ID^6 434 -^441 Format – Length: Character - 8 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 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 sequences 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.

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

Billing National Provider Identification Number 1 –

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

Data Element Record Position Billing NPI 1 322 - 334 Billing NPI 4 394 - 406 Billing NPI 2 346 - 358 Billing NPI 5 418 - 430 Billing NPI^3 370 -^382 Billing NPI^6 442 -^454 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 and its territories on/after the mandated HIPAA National Provider Identifier (NPI) implementation date (2004). Required when reporting to Centers for Medicare and Medicaid Services.

Codes and Values:

Equals facility’s National Provider ID (NPI) after the HIPAA implementation.
Prior to HIPAA implementation (before 2004) the payer associated with the provider submitting the bill assigned the ID number..
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.

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Expected Principal Reimbursement Record Position: 455 - 456 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 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:

After October 1, 1995, based on the NYS 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 annual updates are effective on October 1st of each year.

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SPARCS Outpatient Segment: Primary Records PAYER SEGMENT

Data Element Name: Medicaid Rate Code Record Position: 457 - 460 Format – Length: Character - 4 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 Medicaid Rate Code which identifies the service being paid. These are used only for claims paid for by Medicaid (fee-for-service and managed care). This code is only collected for outpatient services (i.e. not collected for emergency department or ambulatory surgery).

Note: This data element is only available on Outpatient Services File.

Codes and Values:

Values for the Medicaid Rate Code are found in Appendix OO.
If this field was not applicable, it must contain blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid entry.

SPARCS Outpatient Output Page 102

SPARCS Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Log Number Record Position: 461 - 466 Format – Length: Number - 6 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 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 Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Transaction Code Record Position: 467 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: 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". 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.

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SPARCS Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Date Processed Record Position: 468 - 475 Format – Length: Character - 8 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 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.

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SPARCS Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: SPARCS Collector Code Record Position: 476 - 478 Format – Length: Number – 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 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 correspond with the approved Facility Identifier.

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SPARCS Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Claim Type Record Position: 479 Format – Length: Character - 1 Effective Date: January 1, 2011 and added to all years’

Discharge Hour..........................................................................................................

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.

Codes and Values:

“A” = “Ambulatory Surgery Services” “E” = “Emergency Department Services” “O” = “Outpatient Services”

OUTPUT Edits on Element:

These values are based on the following groupings of revenue codes: “A” = Revenue Codes: 0360 Operating Room Services 0362 Operating Room Services 0369 Operating Room Services 0481 Cardiology 0490 Ambulatory Surgery 0499 Ambulatory Surgery 0750 Gastro-Intestinal Services 0790 Lithotripsy

“E”= Revenue Codes: 0450 General Classification of ER 0451 EMTALA Emergency Medical Screening 0452 ER Beyond EMTALA 0456 Urgent Care ER/Urgent 0459 Other Emergency Room

“O”= None of the above Revenue Codes

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

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SPARCS Outpatient Segment: Primary Records DATA COLLECTION SEGMENT

Data Element Name: Source File Type (Complete/Incomplete) Record Position: 480 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 contained patient DDAs matched to the patient's corresponding final bills (UBF). The Incomplete File was comprised of 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 (1994 – current year) "I" = Incomplete file record (used before 1994)

OUTPUT Edits on Element:

This is a derived field.

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

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SPARCS Outpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Residence Indicator Record Position: 481 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: Code indicates the residence status of a patient as either: HOMELESS at the time of discharge, or 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”.

INPUT Edits on Element:

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

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SPARCS Outpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Procedure Time Record Position: 482 - 484 Format – Length: Character - 3 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 total time in hours and minutes that the patient was in the operating room, exclusive of pre-op (preparation) and post-op (recovery) time. This time should have been calculated from actual entry into the ambulatory surgery procedure room and should have ended at actual departure from the ambulatory surgery procedure room.

Codes and Values:

Equals Procedure Time.
Hours must be “0” - “9” and minutes must be “00” - “59”.
If not applicable this field contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must equal Procedure Time.
The value is entered in the NTE fixed width segment requiring specific spacing.

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SPARCS Outpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Accident Hour Record Position: 485 - 486 Format – Length: Character - 2 Effective Date: January 1, 19 94 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: The hour when the accident occurred that necessitated medical treatment.

Codes and Values:

The Value Amount (Accident Hour) must be entered as a two-digit or four-digit number in accordance with Appendix B.
If not applicable this field contains blanks.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

This is a derived data element from the “Value Code” and “Value Amount” data elements collected. This element was created when the corresponding Value Code w as equal to: “ 45 ” = Accident Hour.
If submitted, the record must have contained the appropriate time in accordance with Appendix B.

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SPARCS Outpatient Segment: Primary Records MISCELLANEOUS SEGMENT

Data Element Name: Emergency Department Indicator Record Position: 487 Format – Length: Character - 1 Effective Date: January 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 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.

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 collecting all Emergency Department data on the Outpatient file. The information about the ED visit is not contained in the Inpatient Record.

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STATEMENT THRU DATE (previously Statement Covers Period Through Date)

Period From Date) Record Position: 488 - 495 Record Position for Encrypted* 3487 - 3508 Format – Length: Number - 8 Format - Length 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 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 beginning date of the billing period. The “From” date should not be confused with the Admission Date. The “From” Date is the earliest date of service on the bill. It is not required that the Admission Date fall between the “From” Date and the Statement “Through” Date. The Statement Covers Period identifies the span of service dates included in a particular bill.

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:

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 dates as century, year, month, and day (CCYYMMDD). For example: November 3, 2010 must be entered as: 20101103.

Notes:

The Admission Date is purely the date the patient was admitted 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.

(^) Statement Covers Period From Date cont’d.

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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- 9 - 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.

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Data Element Name: Statement Thru Date (Previously Statement Covers Period Through Date) Record Position: 496 - 503 Record Position for Encrypted* 3509 - 3530 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 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 ending 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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SPARCS Outpatient Segment: Primary Records TREATMENT SEGMENT

Data Element Name: Admission/Start of Care Date Record Position: 504 - 511 Record Position for Encrypted* 3531 - 3552 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 identifiable 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:

1.^ CCYYMMDD = Century Year Month Day^ 2. 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^ years.^

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’.
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.

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Data Element Name: Admit Weekday Record Position: 512 - 514 Format – Length: Character - 3 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 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: 515 - 516 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: Discharge Date Record Position: 517 - 524 Record Position for Encrypted* 3553 - 3574 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 identifiable 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: 525 - 527 Format – Length: Character - 3 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 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: 528 - 529 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: Same Day Discharge Indicator Record Position: 530 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 Thru Date’.

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

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Patient Discharge Status (previously NYS Patient Status or Discharge Disposition)

or Discharge Disposition) Record Position: 531 - 532 Format – Length: Character - 2 Effective Date: January 1, 1982 – January 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: 533 - 535 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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Data Element Name: Service Category Group Record Position: 536 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................................................................................................

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.

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Data Element Name: Admitting Diagnosis Code Record Position: 537 - 543 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- 9 - CM code excluding the decimal point. To be valid, ICD- 9 - CM codes must have been entered at the most specific level to which they are classified in the ICD- 9 - 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- 9 - CM coding reference, excluding the decimal point, and space filled.
E-codes are not valid as Admitting Diagnosis Codes. E-codes are 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- 9 - 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.

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Data Element Name: Principal Diagnosis Code Record Position: 544 – 550 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- 9 - CM code excluding decimal points. To have been valid, ICD- 9 - CM codes must have been entered at the most specific level to which they are classified in the ICD- 9 - 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- 9 - 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- 9 - 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- 9 - CM reference file indicates an "unacceptable principal/primary diagnosis without a secondary diagnosis" an ‘Other Diagnosis Code 1 ’ must have been reported.

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Diagnosis codes reported in the ICD- 9 - CM range of 800.00-999.99 require the reporting of a valid ‘External Cause-of-Injury Code’ unless listed as an exception in Appendix N.
E-codes are 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.

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

Record Position

Data Element

Record Position

Data Element

Record Position ODC 1 551 - 557 ODC 9 607 - 613 ODC 17 663 - 669 ODC 2 558 - 564 ODC 1 0 614 - 620 ODC 18 670 - 676 ODC 3 565 - 571 ODC 1 1 621 - 627 ODC 19 677 - 683 ODC 4 572 - 578 ODC 12 628 - 634 ODC 20 684 - 690 ODC 5 579 - 585 ODC 13 635 - 641 ODC 21 691 - 697 ODC 6 586 - 592 ODC 14 642 - 648 ODC 22 698 - 704 ODC 7 593 - 599 ODC 15 649 - 655 ODC 23 705 - 711 ODC^8 600 -^606 ODC 16^656 -^662 ODC 24^712 -^718

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- 9 - CM code excluding the decimal point. To have been valid, ICD- 9 - CM codes must have been entered at the most specific level to which they are classified in the ICD- 9 - 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 cause the record to be rejected.
Must have been left justified and entered exactly as shown in the ICD- 9 - CM coding reference, excluding the decimal point, and space filled.
Only E-codes in the ICD- 9 - CM range of E930.0 through 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 contain blanks.

SPARCS Outpatient Output Page 129

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to ICD- 9 - 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- 9 - 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 require 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.

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SPARCS Outpatient Segment: Primary Records DIAGNOSIS SEGMENT

Clinical Classification Software (CCS) Diagnosis Category......................................................

Record Position: 719 - 721 Format – Length: Character - 3 Effective Date: January 1, 2011 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 into 285 mutually exclusive categories.

As part of the Healthcare Cost and Utilization Project (HCUP), a federal, state and industry partnership, the CCS software and documentation is maintained on the HCUP website at: http://www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp.

(Note: CCS was formerly called the Clinical Classification for Healthcare Policy Research – CCHPR).

Example: ICD- 9 - CM Diagnosis Reference for Diagnosis Group - Acute bronchitis (Single Level) ICD- 9 - CM Code Description CCS Category 4660 ACUTE BRONCHITIS 125 – Acute Bronchitis 46 61, 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

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Data Element Name: Accident Related Code Record Position: 722 - 723 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: None.

INPUT Edits on Element:

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

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SPARCS Outpatient Segment: Primary Records DIAGNOSIS SEGMENT

Data Element Name: Accident Related Date Record Position: 724 - 731 Record Position for Encrypted* 3575 - 3596 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 only 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 identifiable 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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Data Element Name: External Cause of Injury Record Position: 732 - 738 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. Facilities 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- 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 entered exactly as shown in the ICD- 9 - CM coding reference excluding the decimal point, and space filled.
If this field was not applicable, it must contain 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.

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Data Element Name: Place of Injury Code Record Position: 739 - 745 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 must contain 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. 2.^ 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.

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Procedure Time..........................................................................................................

Data Element Name: Principal Procedure Code Record Position: 746 - 749 Format – Length: Character - 4 Effective Date: January 1 , 1982 – December 31, 2007 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 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 must contain 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.

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Data Element Name: Principal Procedure Date Record Position: 750 - 757 Record Position for Encrypted* 3597 - 3618 Format – Length: Number - 8 Format – Length for Encrypted* Number - 22 Effective Date: January 1, 1983 – December 31, 2007 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month only 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.

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.

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

Admit Weekday.........................................................................................................

Record Position: Data Element^ Record Position

Data Element Record Position Pre-Admit Proc. Ind 1 758 Pre-Admit Proc. Ind 9 862 Pre-Admit Proc. Ind 2 771 Pre-Admit Proc. Ind 10 875 Pre-Admit Proc. Ind 3 784 Pre-Admit Proc. Ind 11 888 Pre-Admit Proc. Ind 4 797 Pre-Admit Proc. Ind 12 901 Pre-Admit Proc. Ind 5 810 Pre-Admit Proc. Ind 13 914 Pre-Admit Proc. Ind 6 823 Pre-Admit Proc. Ind 14 927 Pre-Admit Proc. Ind 7 836 Pre-Admit Proc. Ind 15 940 Pre-Admit Proc. Ind^8 849 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 ICD- 9 - CM procedure was done before or on/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: Other Procedure Code 1 - 14 Record Position:

Format – Length:

Data Element Record Position

Data Element Record Position Other Procedure 1 759 - 762 Other Procedure 8 850 - 853 Other Procedure 2 772 - 775 Other Procedure 9 863 - 866 Other Procedure 3 785 - 788 Other Procedure 10 876 - 879 Other Procedure 4 798 – 801 Other Procedure 11 889 – 892 Other Procedure 5 811 – 814 Other Procedure 12 902 - 905 Other Procedure 6 824 - 827 Other Procedure 13 915 - 918 Other Procedure 7 837 - 840 Other Procedure 14 928 - 931

Character – 4

Effective Date: Effective Date^ Reporting^ End Date^ January 1, 1982 Other Procedure Code 1- 4 December 31, 2007 January 1, 1992 Other Procedure Code 5 December 3 1, 2007 January^ 1,^1994 Other Procedure Code 6-^14 December^3 1, 2007^ 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 must contain blanks. 3..

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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Data Element Name: Other Procedure Date 1 - 14

Record Position: Data Element^ Record Position

Data Element Record Position Other Proc Date 1 763 - 770 Other Proc Date 8 854 – 861 Other Proc Date 2 776 - 783 Other Proc Date 9 867 – 874 Other Proc Date 3 789 – 796 Other Proc Date 10 880 – 887 Other Proc Date 4 802 – 809 Other Proc Date 11 893 – 900 Other Proc Date 5 815 – 822 Other Proc Date 12 906 – 913 Other Proc Date 6 828 – 835 Other Proc Date 13 919 – 926 Other^ Proc Date^7 841 -^848 Other^ Proc Date^14 932 -^939

Record Position for Encrypted*

Data Element Record Position

Data Element Record Position Other Proc Date 1 3597 -^3618 Other Proc Date 8 3773 –^3794 Other Proc Date 2 3619 –^3640 Other Proc Date 9 3795 –^3816 Other Proc Date 3 3641 –^3662 Other Proc Date 10 3817 –^3838 Other Proc Date 4 3663 – 3706 Other Proc Date 11 3839 - 3860 Other Proc Date 5 3707 –^3728 Other Proc Date 12 3861 -^3882 Other Proc Date 6 3729 –^3750 Other Proc Date 13 3883 -^3904 Other^ Proc Date 7^3751 –^3772 Other^ Proc Date 14^3905 -^3926

Format – Length: Number - 8 Format – Length for Encrypted*

Number - 22

Effective Date: January 1, 1983 - December 31, 2007 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month only 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 identifiable 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 must contain blanks.

SPARCS Outpatient Output Page 140

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.

Other Procedure Date 1- 14 cont’d.

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Clinical Classification Software (CCS) Procedure Category......................................................

Record Position: 941 - 943 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: No

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.

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.

(Note: CCS was formerly called the Clinical Classification for Healthcare Policy research – CCHPR).

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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SPARCS Outpatient Segment: Primary Records PROCEDURE SEGMENT

Data Element Name: Method of Anesthesia Used Record Position: 944 - 945 Format – Length: Number - 2 Effective Date: January 1, 1983 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniab le 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. (^) INPUT Edits on Element:

Must have been a valid entry.

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SPARCS Outpatient Segment: Primary Records PROCEDURE SEGMENT

Data Element Name: Age Warning Flag Record Position: 946 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- 9 - 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- 9 - CM reference file.

" " = NO conflict between reported data and ICD- 9 - 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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SPARCS Outpatient Segment: Primary Records PROCEDURE SEGMENT

Data Element Name: Procedure Date Warning Flag Record Position: 947 Format – Length: Character - 1 Effective Date: January 1, 2000 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 Used Record Position: 948 Format – Length: Character - 1 Effective Date: January 1, 1994 - January 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 outpatient visit.

Note: This data element is available from January 1, 1994 - January 1, 2003.

Codes and Values:

External Place-of-Injury Codes in the range of E849.0 – E849.9 were the only valid entries.
“3” = CPT-3 (for Worker’s Compensation and No-Fault Claims)
“4” = CPT- 4
“5” - HCPCS
"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 Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Grouping Claim Processed Flag Record Position: 949 - 950 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: Grouping Claim Processed Flag. For internal DOH use only.

Codes and Values:

“ 00 ” - Claim processed without errors or warnings/messages. “ 01 ” - Claim processed with warnings/messages (see Claim Processed Warning/Messages on page 147). “ 02 ” - Claim could not be processed. Invalid claim from or through date, or outside supported period. “ 03 ” - Claim could not be processed. Single visit Claim Action Flag option not selected and line date not within from/through dates or invalid. “ 04 ” - Claim could not be processed (claim has no valid visits). “ 05 ” - Claim could not be processed (blank Pdx). “ 99 ” - Fatal error; APG cannot run - the environment cannot be set up as needed; exit immediately.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Processed Warning/Messages Record Position: 951 – 960 Format – Length: Character - 10 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: Claim Processed Warning/Messages. For internal DOH use only.

Codes and Values:

The ten (10) character length allows this data element to represent up to five values, each with a 2-byte value: “ 00 ” - Claim processed without warnings/messages “ 01 ” - Claim processed with some visits unassigned “ 02 ” - Claim processed with all visits unassigned “ 03 ” - Claim processed,From Date and Through Date span code versions “ 04 ” - Claim processed under user defined configuration/non-standard Example: “0402000000” can be a valid value, representing two codes above, “04” and “02”.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Number of Visits Record Position: 961 - 963 Format – Length: Character - 3 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: Number of visits. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: APG Version Used Record Position: 964 - 975 Format – Length: Character - 12 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: 3M® Enhanced APG Software 2011 version 4.0. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: APG List Return Code Record Position: 976 - 977 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: Identifies which list contains the first offending element that failed loading. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: APG List Error Location Record Position: 978 - 980 Format – Length: Character - 3 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: Identifies error location in the list that triggered the failure. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Item ID Number Record Position: 981 - 983 Format – Length: Character - 3 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: Item ID Number. For internal DOH use only.

Codes and Values:

Values are generated by the software. (“001” common value generated by software)

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Error Return Code Record Position: 984 - 986 Format – Length: Character - 3 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: Error Return Code. For internal DOH use only.

Codes and Values:

“000” = Base rate 904 for NY

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim APG Payment Record Position: 987 - 994 Format – Length: Character - 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: Standard APG-based payment for claim.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Claim Transition Visit APG Payment.................................................................................

Record Position: 995 - 1002 Format – Length: Character - 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:

Claim APG Payment....................................................................................................

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Existing Payment Record Position: 1003 - 1010 Format – Length: Character - 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:

Claim Existing Payment................................................................................................

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Blended Payment Record Position: 1011 - 1018 Format – Length: Character - 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: Claim Blended Payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Add-on Payment Record Position: 1019 - 1026 Format – Length: Character - 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: Claim Add-on Payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Total Claim Payment Record Position: 1027 - 1034 Format – Length: Character - 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: Claim payment including cost outlier payment, if applicable.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Non-Transition Payment Record Position: 1035 - 1042 Format – Length: Character - 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: Claim Non-Transition Payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Adjusted APG Weight Record Position: 1043 - 1051 Format – Length: Character - 9 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: Sum of line item adjusted APG weights. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Total Claim Full APG Weight.........................................................................................

Record Position: 1052 - 1060 Format – Length: Character - 9 Effective Date: January 1, 20 11 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Description: Total Claim Full APG Weight. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records DRG SEGMENT

Data Element Name: Claim Payment Record Position: 1061 – 1068 Format – Length: Character – 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: Calculated Claim Payment using the APG software.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records AMI SEGMENT

Data Element Name: AMI Warning Flag Record Position: 1069

Line Item Number 1 –

Effective Date: July 1, 2007 – December 31, 2007 [six months] Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: A flag set when the ‘Principal/Primary Diagnosis’ code equals Acute Myocardial Infarction (AMI) 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.

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SPARCS Outpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Heart Rate on Arrival Record Position: 1070 - 1072 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’s heart rate in beats per minute (bpm) taken at first patient contact after arrival at the hospital for patients with a ‘Principal/Primary Diagnosis’ of Acute Myocardial Infarction (AMI) 410.0x-410.9x. The data is collected and reported on Inpatient and Emergency Department records.

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 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’ is between 410.0x - 410.9x.
NTE segment is a fixed width. Required spacing must be maintained if element is not applicable.

Note = Reported on Inpatient and Emergency Department records.

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SPARCS Outpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Systolic BP on Arrival Record Position: 1073 - 1075 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:

Description: The patient’s systolic blood pressure in mg/dl taken at first patient contact after arrival at the 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 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’ is between 410.0x - 410.9x.
NTE segment is a fixed width. Required spacing must be maintained if element is applicable.

= Reported on Inpatient and Emergency Department records.

SPARCS Outpatient Output Page 167

SPARCS Outpatient Segment: Primary Records AMI SEGMENT

Data Element Name: Diastolic BP on Arrival Record Position: 1076 - 1078 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:

Description: The patient’s diastolic blood pressure in mg/dl taken at first patient contact after arrival at the 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 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 a fixed width. Required spacing must be maintained if element is applicable.

= Reported on Inpatient and Emergency Department records.

SPARCS Outpatient Output Page 168

SPARCS Outpatient Segment: Primary Records HIPAA SEGMENT Data Element Name: AIDS / HIV Flag Record Position: 1079 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:

Derived data element based on the definition in Appendix T.

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

SPARCS Outpatient Output Page 169

SPARCS Outpatient Segment: Primary Records HIPAA SEGMENT

Data Element Name: Abortion Flag Record Position: 1080 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 based on the definition in Appendix TT.

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

SPARCS Outpatient Output Page 170

SPARCS Outpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Charges Record Position: 1081 - 1092 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 all ancillary charges incurred by the patient during the billing period.

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 all individual occurrences of the (outpatient) ancillary charges.

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

SPARCS Outpatient Output Page 171

SPARCS Outpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Ancillary Total Charges Record Position: 1093 - 1102 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 (outpatient) ancillary total charges.
If Ancillary Revenue Codes of “ 001 ” through “ 099 ” were reported, any associated charges were NOT included in ‘Total Ancillary Charges’.

SPARCS Outpatient Output Page 172

SPARCS Outpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Non-Covered Charges Record Position: 1103 - 1114 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 all non-covered charges during the billing period.

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 all individual occurrences of the Ancillary Non-Covered Charges.

INPUT Edits on Element: Not applicable.

SPARCS Outpatient Output Page 173

SPARCS Outpatient Segment: Primary Records CHARGES SEGMENT

Data Element Name: Total Non-Covered Ancillary Charges Record Position: 1115 - 1124 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 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 ‘Ancillary Total Non-Covered Charges’.

INPUT Edits on Element:

If ‘Outpatient Ancillary Revenue Codes’ of “ 001 ” through “ 099 ” were reported, any associated charges were NOT included in ‘Total Ancillary Non-Covered Charges’.

SPARCS Outpatient Output Page 174

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Revenue Code 1- 7 (previously called Outpatient Ancillary Revenue Code) Record Position: Data Element^ Record Position

Data Element Record Position Rev Code 1 1125 - 1128 Rev Code 5 2197 - 2200 Rev Code 2 1393 - 1396 Rev Code 6 2465 - 2468 Rev Code 3 1661 - 1664 Rev Code 7 2733 - 2736 Rev Code 4^1929 -^1932

Format – Length: Character - 4 Effective Date: January 1, 1994 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: Codes that identify specific accommodations, ancillary services 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 outpatient services providers should report the corresponding HCPCS code for the service along with the date of service as well as the revenue code.
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 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.

For a submitted outpatient record to be identified in the SPARCS system as an Emergency Department or Ambulatory Surgery discharge, the appropriate Revenue Codes must be reported as indicated below.

Codes and Values:

Must be a valid code in accordance with the Revenue Codes in Appendix I.
Emergency Department Services must have: Emergency Room 045x
Ambulatory Surgery must have one of the following codes: Operating Room Services 0360, 0362, 0369 Cardiology 0481 Ambulatory Surgery 049 x Gastro-Intestinal Services 0750 Lithotripsy 0790

SPARCS Outpatient Output Page 175

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If ‘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 Total Charges and/or Total Non-Covered Charges.
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 Outpatient Output Page 176

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Revenue Type 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Revenue Type 1 1129 Revenue Type 5 2201 Revenue Type 2 1397 Revenue Type 6 2469 Revenue Type 3 1665 Revenue Type 7 2737 Revenue Type^4 1933

Format – Length: Character - 1 Effective Date: January 1, 2011 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 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 Outpatient Output Page 177

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: HCPCS/CPT Procedure Code 1 - 7

Record Position: Data Element Record Position

Data Element Record Position HCPCS/CPT Proc. 1 1130 - 1134 HCPCS/CPT Proc. 5 2202 - 2206 HCPCS/CPT Proc. 2 1398 - 1402 HCPCS/CPT Proc. 6 2470 - 2474 HCPCS/CPT Proc. 3 1666 - 1670 HCPCS/CPT Proc. 7 2738 - 2742 HCPCS/CPT Proc. 4 1934 - 1938

Format – Length: Character - 5 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 American Medical Association's Current Procedural Terminology 4th Edition (CPT-4) code or the Healthcare Common Procedure Coding System (HCPCS) code and modifiers, which apply to the outpatient procedure performed and associated with each line of service.

Codes and Values:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:.

A valid American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code must be entered.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes.

SPARCS Outpatient Output Page 178

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Procedure Modifier Code #^1 -^8 –

Record Position: Data Element Record Position

Data Element Record Position Proc. Modifier #1- 1 1135 - 1136 Proc. Modifier #1- 5 2207 - 2208 Proc. Modifier #1- 2 1403 - 1404 Proc. Modifier #1- 6 2475 - 2476 Proc. Modifier #1- 3 1671 - 1672 Proc. Modifier #1- 7 2743 - 2744 Proc. Modifier #1- 4 1939 - 1940

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 modifier clarifies or improves the reporting accuracy of the associated procedure code. These codes are from the American Medical Association's Current Procedural Terminology 4th Edition (CPT-4) code or the Healthcare Common Procedure Coding System (HCPCS) code and modifiers, and applicable to the outpatient procedure performed and associated with each line of service.

Codes and Values:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures performed.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to CPT-4 and HCPCS codes are validated on the basis of the Statement-Thru Date.
If CPT-4/HCPCS & Modifier 1 is entered, the associated Outpatient Revenue Code, Charges and Non-Covered Charges must also be reported.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes.

SPARCS Outpatient Output Page 179

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Procedure Modifier Code 2 -^1 -

Record Position: Data Element Record Position Data Element Record Position Proc. Modifier #2- 1 1137 - 1138 Proc. Modifier #2- 5 2209 - 2210 Proc. Modifier #2- 2 1405 - 1406 Proc. Modifier #2- 6 2477 - 2478 Proc. Modifier #2- 3 1673 - 1674 Proc. Modifier #2- 7 2745 - 2746 Proc. Modifier #2- 4 1941 - 1942

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 modifier clarifies or improves the reporting accuracy of the associated procedure code. These codes are from the American Medical Association's Current Procedural Terminology 4th Edition (CPT-4) Code or the Healthcare Common Procedure Coding System (HCPCS) code and modifiers, and applicable to the outpatient procedure performed and associated with each line of service.

Codes and Values:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures performed.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to CPT-4 and HCPCS codes are validated on the basis of the Statement-Thru Date.
If CPT-4/HCPCS & Modifier 2 is entered, the associated Outpatient Revenue Code, Charges and Non-Covered Charges must also be reported.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes

SPARCS Outpatient Output Page 180

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Service Charge 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Svc Chrg 1 1139 - 1148 Svc Chrg 5 2211 - 2220 Svc Chrg 2 1407 - 1416 Svc Chrg 6 2479 - 2488 Svc Chrg 3 1675 - 1684 Svc Chrg 7 2747 - 2756 Svc Chrg^4 1943 -^1952

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 amount of submitted charges on the service line segment for this claim. This will be the charges (accommodations charges and ancillary charges) incurred by the patient during the billing period that will be submitted to the primary 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.

OUTPUT Edits on Element: None.

INPUT Edits on Element: Not applicable.

SPARCS Outpatient Output Page 181

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Unit Type 1- 7

Record Position:- Data Element^ Record Position

Data Element

Record Position Unit Type 1 1149 - 1150 Unit Type 5 2221 - 2222 Unit Type 2 1417 - 1418 Unit Type 6 2489 - 2490 Unit Type 3 1685 - 1686 Unit Type 7 2757 - 2758 Unit Type 4^1953 -^1954

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 Outpatient Output Page 182

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Unit Quantity 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Unit Quantity 1 1151 - 1158 Unit Quantity 5 2223 - 2230 Unit Quantity 2 1419 - 1426 Unit Quantity 6 2491 - 2498 Unit Quantity 3 1687 - 1694 Unit Quantity 7 2759 - 2766 Unit Quantity 4^1955 -^1962

Format – Length:

Revenue Type 8 -

Effective Date: January 1, 2011 Prior to Jan 1, 2011 this was “Total Days” 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 Thru 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 can be reported as 1 or more based on the provider’s practice, health plan requirements or regulations.
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 regulations.
A zero or negative value is not allowed.
SPARCS allows for a maximum of 999 service lines to be reported.

SPARCS Outpatient Output Page 183

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Non-Covered Charge 1- 7 (previously Accommodation Total Charges and Inpatient Ancillary Total Non- covered Charges)

Record Position: Data Element Record Position

Data Element Record Position Non-Cov Charge 1 1159 - 1168 Non-Cov Charge 5 2231 - 2240 Non-Cov Charge 2 1427 - 1436 Non-Cov Charge 6 2499 - 2508 Non-Cov Charge 3 1695 - 1704 Non-Cov Charge 7 2767 - 2776 Non-Cov Charge 4 1963 - 1972

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 Outpatient Output Page 184

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Service Date 1 - 7 Record Position: Data Element Record Position

Data Element Record Position Service Date 1 1169 - 1176 Service Date 5 2241 - 2248 Service Date 2 1437 - 1444 Service Date 6 2509 - 2516 Service Date 3 1705 - 1712 Service Date 7 2777 - 2784 Service Date 4 1973 - 1980

Record Position for Encrypted* Data Element Record Position

Data Element Record Position Service Date 1 3927 - 3948 Service Date 5 4103 - 4124 Service Date 2 3971 - 3992 Service Date 6 4147 - 4168 Service Date 3 4015 - 4036 Service Date 7 4191 - 4212 Service Date 4 4059 - 4080

Format – Length: Character - 8 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES – Year Only Limited Data Set: YES – Month and Year only 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 identifiable Master file. See Appendix Z for release restrictions.

Description: The date the outpatient service was provided. When more than one service was provided on different dates, report each date of service.

Note: This data element is only available on Outpatient services file.

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 must contain blanks. 4..

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid date.

SPARCS Outpatient Output Page 185

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Pre-Visit Procedure Indicator 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Pre-Visit Proc. Indicator 1 1177 Pre-Visit Proc. Indicator 5 2249 Pre-Visit Proc. Indicator 2 1445 Pre-Visit Proc. Indicator^6 2517 Pre-Visit Proc. Indicator 3 1713 Pre-Visit Proc. Indicator 7 2785 Pre-Visit Proc. Indicator^4 1981

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: Indicates if a Healthcare Common Procedure Code System (HCPCS) procedure occurred before, on, or after the Date of Service.

Note: This data element is only available on Outpatient services file.

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:

Comparison of the Admission Date and Procedure Date.

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

SPARCS Outpatient Output Page 186

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Line Item Number 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Number 1 1178 - 1180 Line Item Number 5 2250 - 2252 Line Item Number 2 1446 - 1448 Line Item Number^6 2518 - 2520 Line Item Number 3 1714 - 1716 Line Item Number 7 2786 - 2788 Line Item Number^4 1982 -^1984

Format – Length: Character - 3 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: Number assigned for differentiation or to reference a line number within a transaction set. This is also referred to as the “Service Line Number” (located in the electronic version of the claim segment). The line number must begin with one and is incremented by one for each additional service line of a claim.

Codes and Values:

Values from “ 1 ” to “ 999 ”.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must be between “ 1 ” to “ 999 ” (entered sequentially).

SPARCS Outpatient Output Page 187

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit ID 1 - 7

Record Position: Data Element

Record Position

Data Element

Record Position Visit ID 1 1181 - 1183 Visit ID 5 2253 - 2255 Visit ID 2 1449 - 1451 Visit ID 6 2521 - 2523 Visit ID 3 1717 - 1719 Visit ID 7 2789 - 2791 Visit ID^4 1985 -^1987

Format – Length: Character - 3 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: Identifies the visit in which line items can be associated with. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 188

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Lines in Visit 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Lines in Visit 1 1184 - 1186 Lines in Visit 5 2256 - 2258 Lines in Visit 2 1452 - 1454 Lines in Visit 6 2524 - 2526 Lines in Visit 3 1720 - 1722 Lines in Visit 7 2792 - 2794 Lines in Visit^4 1988 -^1990

Format – Length: Character - 3 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: Number of lines in APG return buffer with this visit ID. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 189

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Date 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Date 1 1187 - 1194 Visit Date 5 2259 - 2266 Visit Date 2 1455 - 1462 Visit Date 6 2527 - 2534 Visit Date 3 1723 - 1730 Visit Date 7 2795 - 2802 Visit Date 4^1991 -^1998

Record Position for Encrypted* Data Element^ Record Position

Data Element Record Position Visit Date 1 3949 - 3970 Visit Date 5 4125 - 4146 Visit Date 2 3993 - 4014 Visit Date 6 4169 - 4190 Visit Date 3 4037 - 4058 Visit Date 7 4213 - 4234 Visit Date 4^4081 -^4102

Format – Length: Character - 8 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES; Year only Limited Data Set: YES – Year and Month only Identifiable Data Set: YES Deniable Data Element: No

Description: The Visit Date is filled with the earliest date on the claim using the single day visit option associated with the 3M software. The Visit Date is the same as the collected Service Date.

Codes and Values:

CCYYMMDD

OUTPUT Edits on Element:

The software does not edit the date values. The lowest date is selected.

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

SPARCS Outpatient Output Page 190

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Processed Flag 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Processed Flag 1 1195 Visit Processed Flag 5 2267 Visit Processed Flag 2 1463 Visit Processed Flag^6 2535 Visit Processed Flag 3 1731 Visit Processed Flag 7 2803 Visit Processed Flag^4 1999

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 Visit Processed Flag indicates if there were errors during processing.

Codes and Values:

Values are generated by the software “ 0 ” = Visit processed without errors or warnings/messages “ 1 ” = Visit processed with some warnings/messages

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 191

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Processed Warning/Messages 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Proc. Warn/Msg 1 1196 - 1205 Visit Proc. Warn/Msg 5 2268 - 2277 Visit Proc. Warn/Msg 2 1464 - 1473 Visit Proc. Warn/Msg^6 2536 - 2545 Visit Proc. Warn/Msg 3 1732 - 1741 Visit Proc. Warn/Msg 7 2804 - 2813 Visit Proc. Warn/Msg^4 2000 -^2009

Format – Length: Character - 10 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: Visit Processed Warning/Messages. For internal DOH use only.

Codes and Values:

The ten (10) character length allows this data element to represent up to five values, each with a 2-byte value:

“ 00 ” = Visit processed without warnings/messages “ 01 ” = Visit processed with some lines unassigned “ 02 ” = Visit processed with all lines unassigned “ 03 ” = Visit processed with multiple per diems assigned

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 192

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Overall Visit Type 1 - 7

Record Position: Data Element Record Position

Data Element Record Position Overall Visit Type 1 1206 - 1207 Overall Visit Type 5 2278 - 2279 Overall Visit Type 2 1474 - 1475 Overall Visit Type 6 2546 - 2547 Overall Visit Type 3 1742 - 1743 Overall Visit Type 7 2814 - 2815 Overall Visit Type 4 2010 - 2011

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: The Overall Visit type based on services provided.

Codes and Values:

Values are generated by the software. “ 00 ” = Undetermined “ 01 ” = Per Diem and Significant Procedure Visit “ 11 ” = Per Diem and Physical Therapy & Rehabilitation Visit “ 12 ” = Per Diem and Mental Health & Counseling Visit “ 13 ” = Per Diem and Dental Visit “ 14 ” = Per Diem and Radiologic Visit “ 15 ” = Per Diem and Other Diagnostic Visit “ 02 ”= Per Diem Visit “ 03 ” = Significant Procedure/Medical Visit “ 04 ” = Significant Procedure Visit “ 31 ” = Physical Therapy & Rehabilitation/Medical Visit “ 41 ” = Physical Therapy & Rehabilitation Visit “ 32 ” = Mental Health & Counseling/Medical Visit “ 42 ” = Mental Health & Counseling Visit “ 33 ” = Dental/Medical Visit “ 43 ” = Dental Procedure Visit “ 34 ” = Radiologic/Medical Visit “ 44 ” = Radiologic Procedure Visit “ 35 ” = Other Diagnostic/Medical Visit “ 45 ” = Other Diagnostic Procedure Visit “ 05 ” = Medical Visit. “ 06 ” = Ancillary Visit “ 07 ” = DME, Drug, Incidental only “ 08 ” = Unassigned APG assigned only

Note: The overall visit type assignment is in hierarchical order.

SPARCS Outpatient Output Page 193

OUTPUT Edits on Element:

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

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

Overall Visit Type 1- 7 Cont’d.

SPARCS Outpatient Output Page 194

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Medical Visit Diagnosis 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Medical Visit Diagnosis 1 1208 - 1214 Medical Visit Diagnosis 5 2280 - 2286 Medical Visit Diagnosis 2 1476 - 1482 Medical Visit Diagnosis 6 2548 - 2554 Medical Visit Diagnosis 3 1744 - 1750 Medical Visit Diagnosis 7 2816 - 2822 Medical Visit Diagnosis^4 2012 -^2018

Format – Length: Character - 7 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: Medical Visit Diagnosis reported by facility. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Final APG Assignment 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Final APG Assig. 1 1215 - 1219 Final APG Assig. 5 2287 - 2291 Final APG Assig. 2 1483 - 1487 Final APG Assig. 6 2555 - 2559 Final APG Assig. 3 1751 - 1755 Final APG Assig. 7 2823 - 2827 Final APG Assig.^4 2019 -^2023

Format – Length: Character - 5 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: Final APG Assignment.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Final APG Type 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Final APG Type 1 1220 - 1221 Final APG Type 5 2292 - 2293 Final APG Type 2 1488 - 1489 Final APG Type 6 2560 - 2561 Final APG Type 3 1756 - 1757 Final APG Type 7 2828 - 2829 Final APG Type^4 2024 -^2025

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: Ambulatory Patient Group (APG) Type Code is a classification of the procedures which may be performed on an ambulatory basis.

Codes and Values:

“ 01 ” - Per Diem “ 02 ” - Significant Procedure “ 21 ” - Physical Therapy & Rehabilitation Procedure “ 22 ” - Mental Health & Counseling Procedure “ 23 ” - Dental Procedure “ 24 ” - Radiologic Procedure “ 25 ” - Other Diagnostic Procedure “ 03 ” - Medical Visit “ 04 ” - Ancillary “ 05 ” - Incidental “ 06 ” - Drug “ 07 ” - DME “ 08 ” - Unassigned (gets APG 999, 994, 993)

Note: The final APG Type is in hierarchical order.

OUTPUT Edits on Element:

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

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

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Data Element Name: Final APG Category 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position

Final APG Category 1 (^1222) - 1223 Final APG Category 5 (^2294) - 2295 Final APG Category 2 (^1490) - 1491 Final APG Category 6 (^2562) - 2563 Final APG Category 3 (^1758) - 1759 Final APG Category 7 (^2830) - 2831 Final APG Category 4^2026 -^2027 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:

Final APG Category 1 –

Codes and Values: “ 01 ” - Skin and integumentary system procedures “ 02 ” - Breast procedures “ 03 ” - Musculoskeletal system procedures “ 04 ” - Respiratory procedures “ 05 ” - Cardiovascular procedures “ 06 ” - Hematologic, lymphatic, and endocrine procedures “ 07 ” - Gastrointestinal system procedures “ 08 ” - Genitourinary system procedures “ 09 ” - Male Reproductive system procedures “ 10 ” - Female Reproductive system procedures “ 11 ” - Neurologic system procedures “ 12 ” - Ophthalmologic system procedures “ 13 ” - Otolaryngologic system procedures “ 14 ” - Rehabilitation “ 15 ” - Radiologic procedures “ 16 ” - Mental illness and substance abuse therapies “ 17 ” - Nuclear Medicine “ 18 ” - Radiation Oncology “ 19 ” - Dental procedures “ 20 ” - Anesthesia “ 21 ” - Pathology “ 22 ” - Laboratory “ 23 ” - Other ancillary tests and procedures “ 24 ” - Chemotherapy and other drugs “ 25 ” - Radiology “ 30 ” - Incidental procedures and services “ 50 ” - Observation “ 51 ” - Major signs, symptoms and findings “ 52 ” - Diseases and disorders of the nervous system “ 53 ” - Diseases and disorders of the eye

SPARCS Outpatient Output Page 198

“ 54 ” - Ear, nose, mouth, throat and craniofacial diseases and disorders “ 55 ” - Diseases and disorders of the respiratory system “ 56 ” - Diseases and disorders of the circulatory system “ 57 ” - Diseases and disorders of the digestive system “ 58 ” - Diseases and disorders of the hepatobiliary system and pancreas “ 59 ” - Diseases and disorders of the musculoskeletal system and connective tissue “ 60 ” - Diseases and disorders of the skin, subcutaneous tissue and breast “ 61 ” - Endocrine, nutritional and metabolic diseases and disorders “ 62 ” - Diabetes Mellitus “ 63 ” - Diseases and disorders of the kidney and urinary tract “ 64 ” - Diseases and disorders of the male reproductive system “ 65 ” - Diseases and disorders of the female reproductive system “ 66 ” - Pregnancy, childbirth and the puerperium “ 67 ” - Neonates “ 68 ” - Diseases and disorders of blood, blood forming organs and immunologic disorders “ 69 ” - Lymphatic, hematopoietic, other malignancies, chemotherapy and radiotherapy “ 70 ” - Infectious and parasitic diseases, systemic or unspecified sites “ 71 ” - Mental diseases and disorders “ 72 ” - Alcohol/drug use and alcohol/drug induced organic mental disorders “ 73 ” - Poisonings, toxic effects, other injuries and other complications of treatment “ 74 ” - Burns “ 75 ” - Rehabilitation, aftercare, other factors influencing health status and other health services “ 76 ” - Human immunodeficiency virus infections “ 99 ” - No APG assigned

OUTPUT Edits on Element:

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

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

Final APG Category 1- 7 , cont’d.

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Multiple Significant Procedure (MSP) Discounting Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position MSP Disc. Flag 1 1224 MSP Disc. Flag 5 2296 MSP Disc. Flag 2 1492 MSP Disc. Flag^6 2564 MSP Disc. Flag 3 1760 MSP Disc. Flag 7 2832 MSP Disc. Flag^4 2028

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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. Multiple significant procedures on the same day are flagged for same day multiple procedure discounting.

Codes and Values:

Values are generated by the software. “0” = None

Multiple Significant Procedure (MSP) Discounting Flag 8 –

OUTPUT Edits on Element:

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

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

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Repeat Ancillary Discounting Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position

RAD Flag 1 1225 RAD Flag 5 (^2297) RAD Flag 2 1493 RAD Flag 6 (^2565) RAD Flag 3 1761 RAD Flag 7 (^2833) RAD^ Flag 4^2029 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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. Multiple ancillary charges performed on the same visit are flagged with the repeat ancillary discount flag. This discounting only applies to ancillary drug and DME EAPGs. Codes and Values:

“ 0 ” - None “ 1 ” - Repeat Ancillary Discounting applies

OUTPUT Edits on Element:

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

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

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Data Element Name: Bilateral Discounting Flag 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position

Bil. Disc. Flag 1 1226 Bil. Disc. Flag 5 (^2298) Bil. Disc. Flag 2 1494 Bil. Disc. Flag 6 (^2566) Bil. Disc. Flag 3 1762 Bil. Disc. Flag 7 (^2834) Bil. Disc.^ Flag^4 2030 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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. The bilateral discounting flag indicates that an identical service is performed on the opposite side of the body at the same session or visit. This discounting applies to bilateral codes that are applied to significant procedures, physical therapy & rehabilitation procedures, dental procedures, radiologic procedures and other diagnostic procedures and ancillary services. Codes and Values:

“ 0 ” - None “ 1 ” - Bilateral discounting applies “ 2 ” - Surgical bilateral discounting applies “ 3 ” - Non-surgical bilateral discounting applies

OUTPUT Edits on Element:

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

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

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Terminated Procedure Discounting Flag 1 –

Record Position: Data Element

Record Position

Data Element

Record Position

TPD Flag 1 1227 TPD Flag (^5 2299) TPD Flag 2 1495 TPD Flag (^6 2567) TPD Flag 3 1763 TPD Flag (^7 2835) TPD^ Flag^4 2031 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 terminated procedure flag is applied when a procedure is terminated due to medical complications which would increase the risk to the patient. This discount is for terminated procedures that are significant procedures, physical therapy & rehabilitation procedures, dental procedures, radiologic procedures and other diagnostic procedures and ancillary services. Codes and Values:

Values are generated by the software. “0” = None “1” = Procedure terminated

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Line Item Unassigned Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position

LI Unassig. Flag 1 (^1228) - 1229 LI Unassig. Flag 5 (^2300) - 2301 LI Unassig. Flag 2 (^1496) - 1497 LI Unassig. Flag 6 (^2568) - 2569 LI Unassig. Flag 3 (^1764) - 1765 LI Unassig. Flag 7 (^2836) - 2837 LI^ Unassig.^ Flag 4^2032 -^2033 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: When a claim is not assigned to an APG code, a value of Unassigned APG (999) is given to line items with a corresponding Line Item Unassigned Flag. The Line Item Unassigned Flag in conjunction with the Unassigned APG value explains why the individual’s record was not assigned an APG code. Codes and Values:

"00" = Line item assigned "01" = User Ignored (Line Action flag) "02" = Inpatient Procedure "03" = Invalid Procedure Code "04" = Not used by APGs "05" = Invalid Dx for Medical visit "06" = E-code Dx for medical visit "07" = Non-covered care or settings "08" = Invalid Date cannot be used (invalid or out of range) "09" = Invalid procedure, cannot be blank "10" = Direct Per Diem code without qualifying Pdx "11" = Observation Condition error "12" = DAO Condition error "13" = Gender unknown or invalid for medical gender specific APG assignment "14" = Home Management "15 "= User option for Direct PD assignment off "16" = EAPG assignment condition not met

OUTPUT Edits on Element:

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

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

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Data Element Name: Packaging Per Diem Flag 1 - 7

Record Position: Data Element

Record Position

Data Element

Record Position

PPD Flag 1 1230 PPD Flag (^5 2302) PPD Flag 2 1498 PPD Flag (^6 2570) PPD Flag 3 1766 PPD Flag (^7 2838) PPD^ Flag^4 2034 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: Packaged Per Diem Flag indicates line item packaged as part of partial hospitalization per diem or daily mental health service per diem. Codes and Values:

“ 0 ” = Not Packaged into Per Diem APG “1” = Packaged into Per Diem APG

OUTPUT Edits on Element:

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

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

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Data Element Name: Packaging Flag 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position

Packaging Flag 1 1231 Packaging Flag 5 (^2303) Packaging Flag 2 1499 Packaging Flag 6 (^2571) Packaging Flag 3 1767 Packaging Flag 7 (^2839) Packaging Flag 4^2035 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: Packaging Flag indicates line items that are bundled together, such as anesthesia, supplies, certain drugs, and the use of recovery and observation rooms. Codes and Values:

“ 0 ” = Not Packaged into Per Diem APG “ 1 ” = Packaged into Per Diem APG

OUTPUT Edits on Element: This is a derived data element using software to generate the value.

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

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Same Significant Procedure (SSP) Consolidation Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position

SSPC Flag 1 1232 SSPC Flag (^5 2304) SSPC Flag 2 1500 SSPC Flag (^6 2572) SSPC Flag 3 1768 SSPC Flag (^7 2840) SSPC^ Flag^4 2036 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:

Same Significant Procedure (SSP) Consolidation Flag 8 –

the same significant procedures are performed at the same visit. The Same Significant Procedure (SSP) Consolidation Flag indicates they are consolidated into one for reimbursement.

Codes and Values:

“ 0 ” = None “ 1 ” = SSP Consolidation applies

OUTPUT Edits on Element:

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

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

(^)

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Clinical Significant Procedure (CSP) Consolidation Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position

CSPC Flag 1 1233 CSPC Flag (^5 2305) CSPC Flag 2 1501 CSPC Flag (^6 2573) CSPC Flag 3 1769 CSPC Flag (^7 2841) CSPC^ Flag^4 2037 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:

Clinical Significant Procedure (CSP) Consolidation Flag 8 –

instances of the same clinical significant procedure is performed at the same visit. The Clinical Significant Procedure (CSP) Consolidation Flag indicates they are consolidated into one for reimbursement.

Codes and Values:

“ 0 ” = None “ 1 ” = CSP Consolidation applies

OUTPUT Edits on Element:

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

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

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Line Item Acuity Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Acuity Flag 1 1234 - 1235 Line Item Acuity Flag 5 2306 - 2307 Line Item Acuity Flag 2 1502 - 1503 Line Item Acuity Flag 6 2574 - 2575 Line Item Acuity Flag 3 1770 - 1771 Line Item Acuity Flag 7 2842 - 2843 Line Item Acuity^ Flag 4^2038 -^2039

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: Indicates if the line item contains a complex or chronic secondary diagnosis code. This field is being flagged due to the presence of Acuity Medical AEPG (Enhanced Ambulatory Patient Group) or Secondary Medical Diagnosis list. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Service Item ID Number 1 –

Record Position: Data Element^ Record Position

Data Element Record Position

Service Item ID Number 1 (^1236) - 1238 Service Item ID Number 5 (^2308) - 2310 Service Item ID Number 2 (^1504) - 1506 Service Item ID Number 6 (^2576) - 2578 Service Item ID Number 3 (^1772) - 1774 Service Item ID Number 7 (^2844) - 2846 Service Item ID Number 4^2040 -^2042 Format – Length: Character - 3 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: Service Item ID Number. For internal DOH use only. Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Line Item APG Payment 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item APG Pay. 1 1239 - 1246 Line Item APG Pay. 5 2311 - 2318 Line Item APG Pay. 2 1507 - 1514 Line Item APG Pay. 6 2579 - 2586 Line Item APG Pay. 3 1775 - 1782 Line Item APG Pay. 7 2847 - 2854 Line Item APG Pay.^4 2043 -^2050

Format – Length: Numeric - 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: The Line Item APG Payment (Ambulatory Patient Group [APG] Final APG Amount) is calculated by multiplying the APG Paid Amount by a percentage based on the APG Blend Type code.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Line Item Existing Payment 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Exis. Pay. 1 1247 - 1254 Line Item Exis. Pay. 5 2319 - 2326 Line Item Exis. Pay. 2 1515 - 1522 Line Item Exis. Pay. 6 2587 - 2594 Line Item Exis. Pay. 3 1783 - 1790 Line Item Exis. Pay.t 7 2855 - 2862 Line Item Exis. Pay. 4^2051 -^2058

Format – Length: Numeric - 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: Line Item Existing Payment (Ambulatory Patient Group [APG] Existing Paid Amount) is the calculated dollar amount to be paid to the provider based on a blended rate determined by the State Rate Setting Agencies.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Line Item Blended Payment 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Blend. Pay. 1 1255 - 1262 Line Item Blend. Pay. 5 2327 - 2334 Line Item Blend. Pay. 2 1523 - 1530 Line Item Blend. Pay. 6 2595 - 2602 Line Item Blend. Pay. 3 1791 - 1798 Line Item Blend. Pay. 7 2863 - 2870 Line Item Blend. Pay.^4 2059 -^2066

Format – Length: Numeric - 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: Line Item Blended Payment (Ambulatory Patient Group [APG] Blend type Code) identifies the percentage of the blended rate amount used in calculating the final APG payment amount. It is derived from the Line Item Blended Percent from the 3M Grouper.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Line Item Add-On Payment 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Add-on Pay. 1 1263 - 1270 Line Item Add-on Pay. 5 2335 - 2342 Line Item Add-on Pay. 2 1531 - 1538 Line Item Add-on Pay. 6 2603 - 2610 Line Item Add-on Pay. 3 1799 - 1806 Line Item Add-on Pay. 7 2871 - 2878 Line Item Add-on^ Pay.^4 2067 -^2074

Format – Length: Numeric - 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: Line Item Add-on Payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Line Item Total Payment 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Tot. Pay. 1 1271 - 1278 Line Item Tot. Pay. 5 2343 - 2350 Line Item Tot. Pay. 2 1539 - 1546 Line Item Tot. Pay. 6 2611 - 2618 Line Item Tot. Pay. 3 1807 - 1814 Line Item Tot. Pay. 7 2879 - 2886 Line Item Tot. Pay.^4 2075 -^2082

Format – Length: Numeric - 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: Line item payment including possible cost outlier payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Line Item Blend Percent 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Blend Percent 1 1279 - 1283 Line Item Blend Percent 5 2351 - 2355 Line Item Blend Percent 2 1547 - 1551 Line Item Blend Percent 6 2619 - 2623 Line Item Blend Percent 3 1815 - 1819 Line Item Blend Percent 7 2887 - 2891 Line Item Blend Percent^4 2083 -^2087

Format – Length: Numeric - 5 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 percentage used to calculate the blended amount for calculating payment. This is typically in increments of 25%. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Line Item Adjusted APG Weight 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Ln. It. Adj. APG Wgt. 1 1284 - 1292 Ln. It. Adj. APG Wgt. 5 2356 - 2364 Ln. It. Adj. APG Wgt. 2 1552 - 1560 Ln. It. Adj. APG Wgt. 6 2624 - 2632 Ln. It. Adj. APG Wgt. 3 1820 - 1828 Ln. It. Adj. APG Wgt. 7 2892 - 2900 Ln. It.^ Adj. APG Wgt.^4 2088 -^2096

Format – Length: Numeric - 9 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: Line Item Adjusted APG Weight is the APG weight after discounting and consolidation of the line item. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Line Item Full APG Weight 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Ln. Item Full APG Wgt. 1 1293 - 1301 Ln. Item Full APG Wgt. 5 2365 - 2373 Ln. Item Full APG Wgt. 2 1561 - 1569 Ln. Item Full APG Wgt. 6 2633 - 2641 Ln. Item Full APG Wgt. 3 1829 - 1837 Ln. Item Full APG Wgt. 7 2901 - 2909 Ln.^ Item Full APG Wgt.^4 2097 -^2105

Format – Length: Numeric - 9 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: Line Item Full APG Weight. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Line Item Payment Percent 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Ln. Item Pymt. Perc. 1 1302 - 1307 Ln. Item Pymt. Perc. 5 2374 - 2379 Ln. Item Pymt. Perc. 2 1570 - 1575 Ln. Item Pymt. Perc. 6 2642 - 2647 Ln. Item Pymt. Perc. 3 1838 - 1843 Ln. Item Pymt. Perc. 7 2910 - 2915 Ln.^ Item Pymt. Perc.^4 2106 -^2111

Format – Length: Numeric - 6 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: Line Item Payment Percent is the APG percentage after discounting and consolidation. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Line Item Payment Action 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Ln. Item Pymt. Act. 1 1308 - 1309 Ln. Item Pymt. Act. 5 2380 - 2381 Ln. Item Pymt. Act. 2 1576 - 1577 Ln. Item Pymt. Act. 6 2648 - 2649 Ln. Item Pymt. Act. 3 1844 - 1845 Ln. Item Pymt. Act. 7 2916 - 2917 Ln.^ Item Pymt. Act.^4 2112 -^2113

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: Line Item Payment Action describes how the line is paid depending upon the remainder of the claim. It could be paid fully, consolidated, discounted, or packaged.

Codes and Values:

Values are generated by the software. "00" = Not processed "01" = Full Payment "02" = Consolidated "03" = Discounted "04" = Packaged "05" = No Payment "06" = Bilateral "07" = Discounted Bilateral "08" = Stand Alone "09" = Excluded "10" = Per Diem "11" = Low Cost Outlier "12" = High Cost Outlier "13" = Alternate Payment "14" = Manually Priced "19" = Never pay

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 220

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Line Item Paid Units 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Paid Units 1 1310 - 1316 Line Item Paid Units 5 2382 - 2388 Line Item Paid Units 2 1578 - 1584 Line Item Paid Units 6 2650 - 2656 Line Item Paid Units 3 1846 - 1852 Line Item Paid Units 7 2918 - 2924 Line Item Paid Units^4 2114 -^2120

Format – Length: Character - 7 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: Line Item Paid Units are the number of units paid. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 221

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Line Item Payment Adjustment Flag 1 –

Record Position: Data Element^ Record Position

Data Element Record Position Ln. Item Pymt. Adj. Flag 1 1317 - 1318 Ln. Item Pymt. Adj. Flag 1 2389 - 2390 Ln. Item Pymt. Adj. Flag 12 1585 - 1586 Ln. Item Pymt. Adj. Flag 16 2657 - 2658 Ln. Item Pymt. Adj. Flag 13 1853 - 1854 Ln. Item Pymt. Adj. Flag 17 2925 - 2926 Ln.^ Item Pymt. Adj. Flag^14 2121 -^2122

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: The description is maintained within the software package.

Codes and Values:

"00"= Standard APG weight, non-units based "01"= Standard APG weight, units based "02"= Alternate weight, non-units based "03"= Alternate weight, units based

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 222

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit APG Payment 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit APG Payment 1 1319 - 1326 Visit APG Payment 5 2391 - 2398 Visit APG Payment 2 1587 - 1594 Visit APG Payment 6 2659 - 2666 Visit APG Payment 3 1855 - 1862 Visit APG Payment 7 2927 - 2934 Visit APG Payment^4 2123 -^2130

Format – Length: Numeric - 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: Visit APG Payment (Ambulatory Patient Group [APG] Paid Amount) is the calculated dollar value that will be paid to a provider.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 223

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Transition APG Payment 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Trans. APG Pymt. 1 1327 - 1334 Visit Trans. APG Pymt. 5 2399 - 2406 Visit Trans. APG Pymt. 2 1595 - 1602 Visit Trans. APG Pymt. 6 2667 - 2674 Visit Trans. APG Pymt. 1863 - 1870 Visit Trans. APG Pymt. 7 2935 - 2942 Visit Trans. APG Pymt.^4 2131 -^2138

Format – Length: Numeric - 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: Visit Transition APG Payment is the amount paid based on the calculated values of both the existing payment and the blended payment combined to create the total APG payment specified phase. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 224

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Existing Payment 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Ex. Pymt 1 1335 - 1342 Visit Ex. Pymt 5 2407 - 2414 Visit Ex. Pymt 2 1603 - 1610 Visit Ex. Pymt 6 2675 - 2682 Visit Ex. Pymt 3 1871 - 1878 Visit Ex. Pymt 7 2943 - 2950 Visit Ex. Pymt^4 2139 -^2146

Format – Length: Numeric - 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: Visit Existing Payment is used for blending purposed and is based upon a provider’s average per visit reimbursement for services moving to APGS for calendar year 2007. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 225

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Blended Payment 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Blend. Pymt. 1 1343 - 1350 Visit Blend. Pymt. 5 2415 - 2422 Visit Blend. Pymt. 2 1611 - 1618 Visit Blend. Pymt. 6 2683 - 2690 Visit Blend. Pymt. 3 1879 - 1886 Visit Blend. Pymt. 7 2951 - 2958 Visit Blend. Pymt.^4 2147 -^2154

Format – Length: Numeric - 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: Visit Blended Payment is the amount that the APG methodology would calculate for the visit based upon the coded procedures and diagnosis. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 226

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Add-On Payment 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Add-on Pymt. 1 1351 - 1358 Visit Add-on Pymt. 5 2423 - 2430 Visit Add-on Pymt. 2 1619 - 1626 Visit Add-on Pymt. 6 2691 - 2698 Visit Add-on Pymt. 3 1887 - 1894 Visit Add-on Pymt. 7 2959 - 2966 Visit Add-on Pymt.^4 2155 -^2162

Format – Length: Numeric - 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: Visit Add-On Payment is the fixed add-on payment for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 227

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Payment 1 - 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Payment 1 1359 - 1366 Visit Payment 5 2431 - 2438 Visit Payment 2 1627 - 1634 Visit Payment 6 2699 - 2706 Visit Payment 3 1895 - 1902 Visit Payment 7 2967 - 2974 Visit Payment^4 2163 -^2170

Format – Length: Numeric - 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: Visit Payment is the payment for the visit not including outlier payment and revenue code add-on.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 228

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Non-Transition Payment1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Non-Trans. Pymt. 1 1367 - 1374 Visit Non-Trans. Pymt. 1 2439 - 2446 Visit Non-Trans. Pymt. 2 1635 - 1642 Visit Non-Trans. Pymt. 6 2707 - 2714 Visit Non-Trans. Pymt. 3 1903 - 1910 Visit Non-Trans. Pymt. 7 2975 - 2982 Visit Non-Trans. Pymt.^4 2171 -^2178

Format – Length: Numeric - 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: Visit Non-Transition Payment is the amount paid based solely on the fully blended payment (100%) to create the total APG payment during the specified phase. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 229

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Adjusted APG Weight 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Adj. APG Wgt. 1 1375 - 1383 Visit Adj. APG Wgt. 5 2447 - 2455 Visit Adj. APG Wgt. 2 1643 - 1651 Visit Adj. APG Wgt. 6 2715 - 2723 Visit Adj. APG Wgt. 3 1911 - 1919 Visit Adj. APG Wgt. 7 2983 - 2991 Visit Adj. APG Wgt.^4 2179 -^2187

Format – Length: Numeric - 9 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: Visit Adjusted APG Weight is the sum of adjusted APG weights for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 230

SPARCS Outpatient Segment: Primary Records SERVICE SEGMENT

Data Element Name: Visit Full APG Weight 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Full APG Wgt. 1 1384 - 1392 Visit Full APG Wgt. 5 2456 - 2464 Visit Full APG Wgt. 2 1652 - 1660 Visit Full APG Wgt. 6 2724 - 2732 Visit Full APG Wgt. 3 1920 - 1928 Visit Full APG Wgt. 7 2992 - 3000 Visit Full APG Wgt.^4 2188 -^2196

Format – Length: Numeric - 9 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: Visit Full APG Weight is the sum of APG weights for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 231

Page Intentionally Blank

SPARCS Outpatient Output Page 232

IV CONTINUATION RECORDS

SPARCS Outpatient Output Page 233

V. Continuation Records

Common Portion of All Records

SPARCS Outpatient 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

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.

SPARCS Outpatient Output Page 234

SPARCS Outpatient 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 visit. 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 Outpatient Output Page 235

SPARCS Outpatient Segment: Common Detail Data Element Name: Record Sequence Number Record Position: 16 - 18 Format – Length: Numeric- 3 Effective Date: January 1, 19 94 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 visit.

This number is sequential (001, 002, etc.). For example, the Record Sequence Number for the second record in a set of 3 records for a particular patient stay/discharge is set equal to

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 092).

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

SPARCS Outpatient Output Page 236

SPARCS Outpatient 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 001. If a patient discharge has a Record Sequence Count equal to 005, this means 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 0 92 ).

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

SPARCS Outpatient Output Page 237

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Revenue Code 8 - 18 (previously called Outpatient Ancillary Revenue Code) Record Position: Data Element

Record Position

Data Element

Record Position Rev Code 8 53 - 56 Rev Code 14 1661 - 1664 Rev Code 9 321 - 324 Rev Code 15 1929 - 1932 Rev Code 1 0 589 - 592 Rev Code 16 2197 - 2200 Rev Code 1 1 857 - 860 Rev Code 17 2465 - 2468 Rev Code 1 2 1125 - 1128 Rev Code 18 2733 - 2736 Rev Code^13 1393 -^1396 Format – Length: Character - 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 Revenue Codes identify specific accommodations, ancillary service or unique billing calculations or arrangements. The code set is maintained by the National Uniform Bill Committee (NUBC). The record positions above reflect the first continuation record; there can be up to 92 continuation records.

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 outpatient services providers should report the corresponding HCPCS code for the service along with the date of service as well as the revenue code.
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.

For a submitted outpatient record to be identified in the SPARCS system as an Emergency Department or Ambulatory Surgery discharge, the appropriate Revenue Codes must be reported as indicated below.

Codes and Values:

Must be a valid code in accordance with the Revenue Codes in Appendix I.
Emergency Department Services must have: Emergency Room '045x'
Ambulatory Surgery must have one of the following codes: Operating Room Services 03 60, 0362, 0369 Cardiology 0481 Ambulatory Surgery 049x Gastro-Intestinal Services 0750 Lithotripsy 0790

SPARCS Outpatient Output Page 238

OUTPUT Edits on Element: None.

INPUT Edits on Element:

If a 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.
For outpatient claims, there must be at least one total and one 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 8 - 18 cont’d.

SPARCS Outpatient Output Page 239

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Revenue Type 8 - 18 Record Position: Data Element^ Record Position

Data Element Record Position Revenue Type 8 57 Revenue Type 14 1665 Revenue Type 9 325 Revenue Type 15 1933 Revenue Type 10 593 Revenue Type 16 2201 Revenue Type 11 861 Revenue Type 17 2469 Revenue Type 12 1129 Revenue Type 18 2737 Revenue Type^13 1397 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 Outpatient Output Page 240

SPARCS Outpatient Segment: Continuation Records

Data Element Name: HCPCS/CPT Procedure Code 8- 18

Record Position: Data Element Record Position

Data Element Record Position HCPCS/CPT Proc. 8 58 - 62 HCPCS/CPT Proc. 14 1666 - 1670 HCPCS/CPT Proc. 9 326 - 330 HCPCS/CPT Proc. 15 1934 - 1938 HCPCS/CPT Proc. 10 594 - 598 HCPCS/CPT Proc. 16 2202 - 2206 HCPCS/CPT Proc. 11 862 - 866 HCPCS/CPT Proc. 17 2470 - 2474 HCPCS/CPT Proc. 12 1130 - 1134 HCPCS/CPT Proc. 18 2738 - 2742 HCPCS/CPT Proc. 13 1398 - 1402

Format – Length: Character - 5 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:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures.
If this field was not applicable, it contains zeroes.

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

A valid CPT-4 or HCPCS code must be entered.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes.

SPARCS Outpatient Output Page 241

SPARCS Outpatient Segment: Continuation Records

Procedure Modifier Code #^2 -^8 –

Record Position: Data Element Record Position

Data Element Record Position Proc. Modifier #1 8 63 - 64 Proc. Modifier #1 14 1671 - 1672 Proc. Modifier #1 9 331 - 332 Proc. Modifier #1 15 1939 - 1940 Proc. Modifier #1 10 599 - 600 Proc. Modifier #1 16 2207 - 2208 Proc. Modifier #1 11 867 - 868 Proc. Modifier #1 17 2475 - 2476 Proc. Modifier #1- 12 1135 - 1136 Proc. Modifier #1 18 2743 - 2744 Proc. Modifier #1 13 1403 - 1404

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 modifier clarifies or improves the reporting accuracy of the associated procedure code. These codes are from the American Medical Association's Current Procedural Terminology 4th Edition (CPT-4) or the Healthcare Common Procedure Coding System (HCPCS), and applicable to the outpatient procedure performed and associated with each line of service.

Codes and Values:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to CPT-4 and HCPCS codes are validated on the basis of the Statement-Thru Date.
If CPT-4/HCPCS & Modifier 1 is entered; the associated Outpatient Revenue Code, Charges and Non-Covered Charges must also be reported.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes.

SPARCS Outpatient Output Page 242

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Procedure Modifier Code #2 - 8 - 18 Record Position: Data Element Record Position

Data Element Record Position Proc. Modifier #2- 8 65 - 66 Proc. Modifier #2- 14 1673 - 1674 Proc. Modifier #2- 9 333 - 334 Proc. Modifier #2- 15 1941 - 1942 Proc. Modifier #2- 10 601 - 602 Proc. Modifier #2- 16 2209 - 2210 Proc. Modifier #2- 11 869 - 870 Proc. Modifier #2- 17 2477 - 2478 Proc. Modifier #2- 12 1137 - 1138 Proc. Modifier #2- 18 2745 - 2746 Proc. Modifier #2- 13 1405 - 1406

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:

Must have been right justified and zero filled.
Entered exactly as shown in the American Medical Association's Current Procedural Terminology - 4th Edition (CPT-4) or the Centers for Medicare and Medicaid Services HCPCS code for ambulatory surgery and emergency department procedures performed.
If this field was not applicable, it contains zeroes.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Edits pertaining to CPT-4 and HCPCS codes are validated on the basis of the Statement-Thru Date.
If CPT-4/HCPCS & Modifier 2 is entered, the associated Outpatient Revenue Code, Charges and Non-Covered Charges must also be reported.
SPARCS allows a maximum of 999 CPT-4 and HCPCS codes

SPARCS Outpatient Output Page 243

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Service Charge 8 - 18 (previously Accommodation Total Charges and Outpatient Ancillary Total Charges) Record Position: Data Element^ Record Position

Data Element Record Position Svc. Chrg. 8 67 - 76 Svc. Chrg. 14 1675 - 1684 Svc. Chrg. 9 335 - 344 Svc. Chrg. 15 1943 - 1952 Svc. Chrg. 10 603 - 612 Svc. Chrg. 16 2211 - 2220 Svc. Chrg. 11 871 - 880 Svc. Chrg. 17 2479 - 2488 Svc. Chrg. 12 1139 - 1148 Svc. Chrg. 18 2747 - 2756 Svc. Chrg.^13 1407 -^1416 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:

Description: The amount of submitted charges on the service line segment for this visit. This will be the charges (accommodations charges and ancillary charges) incurred by the patient during the billing period that will be submitted to the primary payer.

Codes and Values:

Must have been right justified and zero filled.
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: Not applicable.

SPARCS Outpatient Output Page 244

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Unit Type 8 - 18 Record Position: Data Element^ Record Position

Data Element Record Position Unit Type 8 77 - 78 Unit Type 14 1685 - 1686 Unit Type 9 345 - 346 Unit Type 15 1953 - 1954 Unit Type 10 613 - 614 Unit Type 16 2221 - 2222 Unit Type 11 881 - 882 Unit Type 17 2489 - 2490 Unit Type 12 1149 - 1150 Unit Type 18 2757 - 2758 Unit Type^13 1417 -^1418 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:

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 Outpatient Output Page 245

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Unit Quantity 8 - 18 Record Position: Data Element^ Record Position

Data Element Record Position Unit Quantity 8 79 - 86 Unit Quantity 14 1687 - 1694 Unit Quantity 9 347 - 354 Unit Quantity 15 1955 - 1962 Unit Quantity 10 615 - 622 Unit Quantity 16 2223 - 2230 Unit Quantity 11 883 - 890 Unit Quantity 17 2491 - 2498 Unit Quantity 12 1151 - 1158 Unit Quantity 18 2759 - 2766 Unit Quantity^13 1419 -^1426

Line Item 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:

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 Thru 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 can be reported as 1 or more based on the provider’s practice, health plan requirements or regulations.
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 regulations.
A zero or negative value is not allowed.

Note: SPARCS allows for a maximum of 999 service lines to be reported.

SPARCS Outpatient Output Page 246

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Non-Covered Charge 8 - 18 (previously Accommodation Total Charges and Inpatient Ancillary Total Non- covered Charges) Record Position: Data Element Record Position

Data Element Record Position Non-Cov Chrg 8 87 - 96 Non-Cov Chrg 14 1695 - 1704 Non-Cov Chrg 9 355 - 364 Non-Cov Chrg 15 1963 - 1972 Non-Cov Chrg 10 623 - 632 Non-Cov Chrg 16 2231 - 2240 Non-Cov Chrg 11 891 - 900 Non-Cov Chrg 17 2499 - 2508 Non-Cov Chrg 12 1159 - 1168 Non-Cov Chrg 18 2767 - 2776 Non-Cov Chrg 13 1427 - 1436 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 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.

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.

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Service Date 8 - 18

Record Position: Data Element Record Position

Data Element Record Position Service Date 8 97 - 104 Service Date 14 1705 - 1712 Service Date 9 365 - 372 Service Date 15 1973 - 1980 Service Date 10 633 - 640 Service Date 16 2241 - 2248 Service Date 11 901 - 908 Service Date 17 2509 - 2516 Service Date 12 1169 - 1176 Service Date 18 2777 - 2784 Service Date 13 1437 - 1444

Record Position for Encrypted* Data Element Record Position

Data Element Record Position Service Date 8 3201 - 3222 Service Date 14 3465 - 3486 Service Date 9 3245 - 3266 Service Date 15 3509 - 3530 Service Date 10 3289 - 3310 Service Date 16 3553 - 3574 Service Date 11 3333 - 3354 Service Date 17 3597 - 3618 Service Date 12 3377 - 3398 Service Date 18 3641 - 3662 Service Date 13 3421 - 3442

Format – Length: Character - 8 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 2011 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.

Description: The date the outpatient service was provided. When more than one service was provided on different dates, report each date of service.

Note: This data element is only available on Outpatient services file.

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 must contain blanks. 4..

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must have been a valid date.

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Pre-Visit Procedure Indicator 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Pre-Visit Proc. Ind. 8 105 Pre-Visit Proc. Ind. 14 1713 Pre-Visit Proc. Ind. 9 373 Pre-Visit Proc. Ind. 15 1981 Pre-Visit Proc. Ind. 10 641 Pre-Visit Proc. Ind. 16 2249 Pre-Visit Proc. Ind. 11 909 Pre-Visit Proc. Ind. 17 2517 Pre-Visit Proc. Ind. 12 1177 Pre-Visit Proc. Ind. 18 2785 Pre-Visit Proc. Ind.^13 1445

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: Indicates if a Healthcare Common Procedure Code System (HCPCS) procedure occurred before, on, or after the Date of Service.

Note: This data element is only available on Outpatient services file.

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:

Comparison of the Admission Date and Procedure Date.

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

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Number 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Number 8 106 - 108 Line Item Number 14 1714 - 1716 Line Item Number 9 374 - 376 Line Item Number 15 1982 - 1984 Line Item Number 10 642 - 644 Line Item Number 16 2250 - 2252 Line Item Number 11 910 - 912 Line Item Number 1 7 2518 - 2520 Line Item Number 1 2 1178 - 1180 Line Item Number 1 8 2786 - 2788 Line Item Number 1^3 1446 -^1448

Format – Length: Character - 3 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element: No

Codes and Values:

Equals a numeric value from 1 to 999.

OUTPUT Edits on Element: None.

INPUT Edits on Element:

Must enter a numeric value from 1 to 999 (entered sequentially).

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit ID 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit ID 8 109 - 111 Visit ID 14 1717 - 1719 Visit ID 9 377 - 379 Visit ID 16 1985 - 1987 Visit ID 10 645 - 647 Visit ID 16 2253 - 2255 Visit ID 11 913 - 915 Visit ID 17 2521 - 2523 Visit ID 12 1181 - 1183 Visit ID 18 2789 - 2791 Visit ID 13^1449 -^1451

Format – Length: Character - 3 Effective Date: January 1, 2 011 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month only Identifiable Data Set: YES Deniable Data Element: No

Description: Identifies the visit in which line items can be associated with. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Lines in Visit 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Lines in Visit 8 112 - 114 Lines in Visit 14 1720 - 1722 Lines in Visit 9 380 - 382 Lines in Visit 15 1988 - 1990 Lines in Visit 10 648 - 650 Lines in Visit 16 2256 - 2258 Lines in Visit 11 916 - 918 Lines in Visit 17 2524 - 2526 Lines in Visit 12 1184 - 1186 Lines in Visit 18 2792 - 2794 Lines in Visit^13 1452 -^1454

Format – Length: Character - 3 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: Number of lines in APG return buffer with this visit ID. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Visit Date 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Date 8 115 - 122 Visit Date 14 1723 - 1730 Visit Date 9 383 - 390 Visit Date 15 1991 - 1998 Visit Date 10 651 - 658 Visit Date 16 2259 - 2266 Visit Date 11 919 - 926 Visit Date 17 2527 - 2534 Visit Date 12 1187 - 1194 Visit Date 18 2795 - 2802 Visit Date 13^1455 -^1462

Record Position for Encrypted* Data Element

Record Position

Data Element

Record Position Visit Date 8 3223 - 3244 Visit Date 14 3487 - 3508 Visit Date 9 3267 - 3288 Visit Date 15 3531 - 3552 Visit Date 10 3311 - 3332 Visit Date 16 3575 - 3596 Visit Date 11 3355 - 3376 Visit Date 17 3619 - 3640 Visit Date 12 3399 - 3420 Visit Date 18 3663 - 3684 Visit Date 13^3443 -^3464

Format – Length: Character - 8 Format – Length for Encrypted* Character - 22 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES – Year only Limited Data Set: YES – Year and Month only Identifiable Data Set: YES Deniable Data Element: No

Description: The Visit Date is filled with the lowest date on the claim using the single day visit option associated with the 3M software. The Visit Date is the same as the collected Service Date.

Codes and Values:

CCYYMMDD

OUTPUT Edits on Element:

The software does not edit the date values. The lowest date is selected.

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

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Data Element Name: Visit Processed Flag 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Processed Flag 8 123 Visit Processed Flag 14 1731 Visit Processed Flag 9 391 Visit Processed Flag^15 1999 Visit Processed Flag 10 659 Visit Processed Flag 16 2267 Visit Processed Flag 11 927 Visit Processed Flag 17 2535 Visit Processed Flag 12 1195 Visit Processed Flag 18 2803 Visit Processed Flag^13 1463

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 Visit Processed Flag indicates if there were errors during processing.

Codes and Values:

Values are generated by the software “ 0 ” = Visit processed without errors or warnings/messages “ 1 ” = Visit processed with some warnings/messages

OUTPUT Edits on Element:

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

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

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Data Element Name: Visit Processed Warning/Messages 1- 7

Record Position: Data Element^ Record Position

Data Element Record Position Visit Proc. Warn./Msgs. 8 124 - 133 Visit Proc. Warn./Msgs. 14 1732 - 1741 Visit Proc. Warn./Msgs. 9 392 - 401 Visit Proc. Warn./Msgs. 15 2000 - 2009 Visit Proc. Warn./Msgs. 10 660 - 669 Visit Proc. Warn./Msgs. 16 2268 - 2277 Visit Proc. Warn./Msgs. 11 928 - 937 Visit Proc. Warn./Msgs. 17 2536 - 2545 Visit Proc. Warn./Msgs. 12 1196 - 1205 Visit Proc. Warn./Msgs. 18 2804 - 2813 Visit Proc. Warn./Msgs.^13 1464 -^1473

Format – Length: Character - 10 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: Visit Processed Warning /Messages. For internal DOH use only.

Codes and Values:

The ten (10) character length allows this data element to represent up to five values, each with a 2-byte value:

OUTPUT Edits on Element:

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

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

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Data Element Name: Overall Visit Type 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Overall Visit Type 8 134 - 135 Overall Visit Type 14 1742 - 1743 Overall Visit Type 9 402 - 403 Overall Visit Type 15 2010 - 2011 Overall Visit Type 10 670 - 671 Overall Visit Type 16 2278 - 2279 Overall Visit Type 11 938 - 939 Overall Visit Type 17 2546 - 2547 Overall Visit Type 12 1206 - 1207 Overall Visit Type 18 2814 - 2815 Overall Visit Type^13 1474 -^1475

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: The Overall Visit type based on services provided.

Codes and Values:

Values are generated by the software. “ 00 ” = Undetermined “ 01 ” = Per Diem and Significant Procedure Visit “ 11 ” = Per Diem and Physical Therapy & Rehabilitation Visit “ 12 ” = Per Diem and Mental Health & Counseling Visit “ 13 ” = Per Diem and Dental Visit “ 14 ” = Per Diem and Radiologic Visit “ 15 ” = Per Diem and Other Diagnostic Visit “ 02 ”= Per Diem Visit “ 03 ” = Significant Procedure/Medical Visit “ 04 ” = Significant Procedure Visit “ 31 ” = Physical Therapy & Rehabilitation/Medical Visit “ 41 ” = Physical Therapy & Rehabilitation Visit “ 32 ” = Mental Health & Counseling/Medical Visit “ 42 ” = Mental Health & Counseling Visit “ 33 ” = Dental/Medical Visit “ 43 ” = Dental Procedure Visit “ 34 ” = Radiologic/Medical Visit “ 44 ” = Radiologic Procedure Visit “ 35 ” = Other Diagnostic/Medical Visit “ 45 ” = Other Diagnostic Procedure Visit “ 05 ” = Medical Visit. “ 06 ” = Ancillary Visit “ 07 ” = DME, Drug, Incidental only “ 08 ” = Unassigned APG assigned only

Note: The overall visit type assignment is in hierarchical order.

SPARCS Outpatient Output Page 256

OUTPUT Edits on Element:

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

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

Overall Visit Type 8- 18 Cont’d.

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SPARCS Outpatient Segment: Continuation Records

Data Element Name: Medical Visit Diagnosis 8 - 18

Record Position: Data Element^ Record Position

Data Element Record Position Med. Visit Diag. 8 136 - 142 Med. Visit Diag. 14 1744 - 1750 Med. Visit Diag. 9 404 - 410 Med. Visit Diag. 15 2012 - 2018 Med. Visit Diag. 10 672 - 678 Med. Visit Diag. 16 2280 - 2286 Med. Visit Diag. 11 940 - 946 Med. Visit Diag. 17 2548 - 2554 Med. Visit Diag. 12 1208 - 1214 Med. Visit Diag. 18 2816 - 2822 Med. Visit Diag.^13 1476 -^1482

Format – Length: Character - 7 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: Medical Visit Diagnosis reported by the facility. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Final APG Assignment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Final APG Assig. 8 143 - 147 Final APG Assig. 14 1751 - 1755 Final APG Assig. 9 411 - 415 Final APG Assig. 15 2019 - 2023 Final APG Assig. 10 679 - 683 Final APG Assig. 16 2287 - 2291 Final APG Assig. 11 947 - 951 Final APG Assig. 17 2555 - 2559 Final APG Assig. 12 1215 - 1219 Final APG Assig. 18 2823 - 2827 Final APG Assig.^13 1483 -^1487

Format – Length: Character - 5 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: Final APG Code Assignment.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

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Data Element Name: Final APG Type 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Final APG Type 8 148 - 149 Final APG Type 14 1756 - 1757 Final APG Type 9 416 - 417 Final APG Type 15 2024 - 2025 Final APG Type 10 684 - 685 Final APG Type 16 2292 - 2293 Final APG Type 11 952 - 953 Final APG Type 1 7 2560 - 2561 Final APG Type 1 2 1220 - 1221 Final APG Type 1 8 2828 - 2829 Final APG Type 1^3 1488 -^1489

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: Ambulatory Patient Group (APG) Type Code is a classification of the procedures which may be performed on an ambulatory basis.

Codes and Values:

“01” - Per Diem “02” - Significant Procedure “21” - Physical Therapy & Rehabilitation Procedure “22” - Mental Health & Counseling Procedure “23” - Dental Procedure “24” - Radiologic Procedure “25” - Other Diagnostic Procedure “03” - Medical Visit “04” - Ancillary “05” - Incidental “06” - Drug “07” - DME “08” - Unassigned (gets APG 999, 994, 993)

Note: The final APG Type is in hierarchical order.

OUTPUT Edits on Element:

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

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

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Data Element Name: Final APG Category 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Final APG Category 8 (^150) - 151 Final APG Category 14 (^1758) - 1759 Final APG Category 9 (^418) - 419 Final APG Category 15 (^2026) - 2027 Final APG Category 10 (^686) - 687 Final APG Category 16 (^2294) - 2295 Final APG Category (^11 954) - 955 Final APG Category 1 (^7 2562) - 2563 Final APG Category 1 (^2 1222) - 1223 Final APG Category 1 (^8 2830) - 2831 Final APG Category 1^3 1490 -^1491 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:

Final APG Category 8 –

Codes and Values: “01” - Skin and integumentary system procedures “02” - Breast procedures “03” - Musculoskeletal system procedures “04” - Respiratory procedures “05” - Cardiovascular procedures “06” - Hematologic, lymphatic, and endocrine procedures “07” - Gastrointestinal system procedures “08” - Genitourinary system procedures “09” - Male Reproductive system procedures “10” - Female Reproductive system procedures “11” - Neurologic system procedures “12” - Ophthalmologic system procedures “13” - Otolaryngologic system procedures “14” - Rehabilitation “15” - Radiologic procedures “16” - Mental illness and substance abuse therapies “17” - Nuclear Medicine “18” - Radiation Oncology “19” - Dental procedures “20” - Anesthesia “21” - Pathology “22” - Laboratory “23” - Other ancillary tests and procedures “24” - Chemotherapy and other drugs “25” - Radiology “30” - Incidental procedures and services “50” - Observation “51” - Major signs, symptoms and findings “52” - Diseases and disorders of the nervous system “53” - Diseases and disorders of the eye

SPARCS Outpatient Output Page 261

“54” - Ear, nose, mouth, throat and craniofacial diseases and disorders “55” - Diseases and disorders of the respiratory system “56” - Diseases and disorders of the circulatory system “57” - Diseases and disorders of the digestive system “58” - Diseases and disorders of the hepatobiliary system and pancreas “59” - Diseases and disorders of the musculoskeletal system and connective tissue “60” - Diseases and disorders of the skin, subcutaneous tissue and breast “61” - Endocrine, nutritional and metabolic diseases and disorders “62” - Diabetes Mellitus “63” - Diseases and disorders of the kidney and urinary tract “64” - Diseases and disorders of the male reproductive system “65” - Diseases and disorders of the female reproductive system “66” - Pregnancy, childbirth and the puerperium “67” - Neonates “68” - Diseases and disorders of blood, blood forming organs and immunologic disorders “69” - Lymphatic, hematopoietic, other malignancies, chemotherapy and radiotherapy “70” - Infectious and parasitic diseases, systemic or unspecified sites “71” - Mental diseases and disorders “72” - Alcohol/drug use and alcohol/drug induced organic mental disorders “73” - Poisonings, toxic effects, other injuries and other complications of treatment “74” - Burns “75” - Rehabilitation, aftercare, other factors influencing health status and other health services “76” - Human immunodeficiency virus infections “99” - No APG assigned

OUTPUT Edits on Element:

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

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

Final APG Category 8- 18, cont’d.

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Data Element Name: Multiple Significant Procedure (MSP) Discounting Flag 8-^18

Record Position: Data Element^ Record Position

Data Element Record Position

MSP Disc. Flag 8 (^152) MSP Disc. Flag 14 1760 MSP Disc. Flag 9 420 MSP Disc. Flag^15 2028 MSP Disc. Flag 10 688 MSP Disc. Flag 16 2296 MSP Disc. Flag 11 956 MSP Disc. Flag^17 2564 MSP Disc. Flag 12 1224 MSP Disc. Flag 1 (^8 2832) MSP Disc. Flag^13 1492 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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. Multiple significant procedures on the same day are flagged for same day multiple procedure discounting. Codes and Values:

Values are generated by the software. “0” = None “1” = Multiple Significant Procedure Discounting Candidate

OUTPUT Edits on Element:

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

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

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Data Element Name: Repeat Ancillary Discounting Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

RAD Flag 8 153 RAD Flag (^14 1761) RAD Flag 9 421 RAD Flag (^15 2029) RAD Flag 10 689 RAD Flag (^16 2297) RAD Flag 11 957 RAD Flag (^17 2565) RAD Flag 12 1225 RAD Flag (^18 2833) RAD Flag^13 1493 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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. Multiple ancillary charges performed on the same visit are flagged with the repeat ancillary discount flag. This discounting only applies to ancillary drug and DME EAPGs. Codes and Values:

“0” - None

Repeat Ancillary Discounting Flag 8 –

OUTPUT Edits on Element:

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

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

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Data Element Name: Bilateral Discounting Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Bil. Disc. Flag 8 154 Bil. Disc. Flag 14 (^1762) Bil. Disc. Flag 9 422 Bil. Disc. Flag 15 (^2030) Bil. Disc. Flag 10 690 Bil. Disc. Flag 16 (^2298) Bil. Disc. Flag 11 958 Bil. Disc. Flag 1 (^7 2566) Bil. Disc. Flag 1 2 1226 Bil. Disc. Flag 18 (^2834) Bil. Disc. Flag 13^1494 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: Discounting provides a way of accounting for duplicate costs accrued when multiple significant procedures, ancillary lab services and/or ancillary non-lab services are performed during the same visit. The bilateral discounting flag indicates that an identical service is performed on the opposite side of the body at the same session or visit. This discounting applies to bilateral codes that are applied to significant procedures, physical therapy & rehabilitation procedures, dental procedures, radiologic procedures and other diagnostic procedures and ancillary services. Codes and Values:

“0” - None “1” - Bilateral discounting applies “2” - Surgical bilateral discounting applies “3” - Non-surgical bilateral discounting applies

OUTPUT Edits on Element:

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

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

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Data Element Name: Terminated Procedure Discounting Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

TPD Flag 8 155 TPD Flag (^14 1763) TPD Flag 9 423 TPD Flag (^15 2031) TPD Flag 10 691 TPD Flag (^16 2299) TPD Flag 11 959 TPD Flag (^17 2567) TPD Flag 12 1227 TPD Flag (^18 2835) TPD^ Flag^13 1495 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 terminated procedure flag is applied when a procedure is terminated due to medical complications which would increase the risk to the patient. This discount is for terminated procedures that are significant procedures, physical therapy & rehabilitation procedures, dental procedures, radiologic procedures and other diagnostic procedures and ancillary services. Codes and Values:

Values are generated by the software. “0” = None “1” = Procedure terminated

OUTPUT Edits on Element:

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

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

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Data Element Name: Line Item Unassigned Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Line Item Unassig. Flag 1 (^156) - 157 Line Item Unassig. Flag 5 (^1764) - 1765 Line Item Unassig.Flag 2 (^424) - 425 Line Item Unassig. Flag 6 (^2032) - 2033 Line Item Unassig. Flag 3 (^692) - 693 Line Item Unassig. Flag 7 (^2300) - 2301 Line Item Unassig. Flag 4 (^960) - 961 Line Item Unassig. Flag 1 (^2568) - 2569 Line Item Unassig. Flag 1 (^1228) - 1229 Line Item Unassig. Flag 2 (^2836) - 2837 Line Item Unassig.^ Flag 2^1496 -^1497 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: Description: When a claim is not assigned to an APG code, a value of Unassigned APG (999) is given to line items with a corresponding Line Item Unassigned Flag. The Line Item Unassigned Flag in conjunction with the Unassigned APG value explains why the individual’s record was not assigned an APG code. Codes and Values:

"00" = Line item assigned "01" = User Ignored (Line Action flag) "02" = Inpatient Procedure "03" = Invalid Procedure Code "04" = Not used by APGs "05" = Invalid Dx for Medical visit "06" = E-code Dx for medical visit "07" = Non-covered care or settings "08" = Invalid Date cannot be used (invalid or out of range) "09" = Invalid procedure, cannot be blank "10" = Direct Per Diem code without qualifying Pdx "11" = Observation Condition error "12" = DAO Condition error "13" = Gender unknown or invalid for medical gender specific APG assignment "14" = Home Management "15 "= User option for Direct PD assignment off "16" = EAPG assignment condition not met

OUTPUT Edits on Element:

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

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

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Data Element Name: Packaging Per Diem Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Pack. Per Diem Flag 1 158 Pack. Per Diem Flag (^5 1766) Pack. Per Diem Flag 2 426 Pack. Per Diem Flag (^6 2034) Pack. Per Diem Flag 3 694 Pack. Per Diem Flag (^7 2302) Pack. Per Diem Flag 4 962 Pack. Per Diem Flag (^1 2570) Pack. Per Diem Flag 1 1230 Pack. Per Diem Flag (^2 2838) Pack.^ Per Diem Flag^2 1498 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: Packaging Flag indicates line items that are bundled together, such as anesthesia, supplies, certain drugs, and the use of recovery and observation rooms. Codes and Values:

“0” = Not Packaged into Per Diem APG “1” = Packaged into Per Diem APG

OUTPUT Edits on Element: This is a derived data element using software to generate the value.

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

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Data Element Name: Packaging Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Packaging Flag 8 159 Packaging Flag 14 (^1767) Packaging Flag 9 427 Packaging Flag 15 (^2035) Packaging Flag 10 695 Packaging Flag 16 (^2303) Packaging Flag 11 963 Packaging Flag 1 (^7 2571) Packaging Flag 1 2 1231 Packaging Flag 18 (^2839) Packaging Flag 13^1499 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: Packaging Flag indicates line items that are bundled together, such as anesthesia, supplies, certain drugs, and the use of recovery and observation rooms. Codes and Values:

“0” = Not Packaged into Per Diem APG “1” = Packaged into Per Diem APG

OUTPUT Edits on Element: This is a derived data element using software to generate the value.

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

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Data Element Name: Same Significant Procedure (SSP) Consolidation Flag 8- 18

Record Position: Data Element

Record Position

Data Element

Record Position

SSPC Flag 8 160 SSPC Flag (^14 1768) SSPC Flag 9 428 SSPC Flag (^15 2036) SSPC Flag 10 696 SSPC Flag (^16 2304) SSPC Flag 11 964 SSPC Flag (^17 2572) SSPC Flag 12 1232 SSPC Flag (^18 2840) SSPC^ Flag^13 1500 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: Same Significant Procedure (SSP) Consolidation Flag is applied when multiple instances of the same significant procedures are performed at the same visit. The Same Significant Procedure (SSP) Consolidation Flag indicates they are consolidated into one for reimbursement. Codes and Values:

“0” = None “1” = SSP Consolidation applies

OUTPUT Edits on Element:

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

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

(^)

SPARCS Outpatient Output Page 270

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Clinical Significant Procedure (CSP) Consolidation Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

CSPC Flag 8 161 CSPC Flag (^14 1769) CSPC Flag 9 429 CSPC Flag (^15 2037) CSPC Flag 10 697 CSPC Flag (^16 2305) CSPC Flag 11 965 CSPC Flag (^17 2573) CSPC Flag 12 1233 CSPC Flag (^18 2841) CSPC^ Flag^13 1501 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 Clinical Significant Procedure (CSP) Consolidation Flag is applied when multiple instances of the same clinical significant procedure is performed at the same visit. The Clinical Significant Procedure (CSP) Consolidation Flag indicates they are consolidated into one for reimbursement. Codes and Values:

“0” = None “1” = CSP Consolidation applies

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 271

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Acuity Flag 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Acuity Flag 8 162 - 163 Line Item Acuity Flag 14 1770 - 1771 Line Item Acuity Flag 9 430 - 431 Line Item Acuity Flag 15 2038 - 2039 Line Item Acuity Flag 10 698 - 699 Line Item Acuity Flag 16 2306 - 2307 Line Item Acuity Flag 11 966 - 967 Line Item Acuity Flag 17 2574 - 2575 Line Item Acuity Flag 12 1234 - 1235 Line Item Acuity Flag 18 2842 - 2843 Line Item Acuity^ Flag 13^1502 -^1503

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

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 272

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Service Item ID Number 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position

Service Item ID Number 8 (^164) - 166 Service Item ID Number 14 (^1772) - 1774 Service Item ID Number 9 (^432) - 434 Service Item ID Number 15 (^2040) - 2042 Service Item ID Number 10 (^700) - 702 Service Item ID Number 16 (^2308) - 2310 Service Item ID Number 11 (^968) - 970 Service Item ID Number 1 (^7 2576) - 2578 Service Item ID Number 1 (^2 1236) - 1238 Service Item ID Number 18 (^2844) - 2846 Service Item ID Number 13^1504 -^1506 Format – Length: Character - 3 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: Service Item ID Number. For internal DOH use only. Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 273

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item APG Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item APG Pymt. 8 167 - 174 Line Item APG Pymt. 14 1775 - 1782 Line Item APG Pymt. 9 435 - 442 Line Item APG Pymt. 15 2043 - 2050 Line Item APG Pymt. 10 703 - 710 Line Item APG Pymt. 16 2311 - 2318 Line Item APG Pymt. 11 971 - 978 Line Item APG Pymt. 17 2579 - 2586 Line Item APG Pymt. 12 1239 - 1246 Line Item APG Pymt. 18 2847 - 2854 Line Item APG Pymt.^13 1507 -^1514

Format – Length: Numeric - 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: The Line Item APG Payment (Ambulatory Patient Group (APG) Final APG Amount) is calculated by multiplying the APG Paid Amount by a percentage based on the APG Blend Type code.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 274

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Existing Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Exis. Pymt. 8 175 - 182 Line Item Exis. Pymt. 14 1783 - 1790 Line Item Exis. Pymt. 9 443 - 450 Line Item Exis. Pymt. 15 2051 - 2058 Line Item Exis. Pymt. 10 711 - 718 Line Item Exis. Pymt. 16 2319 - 2326 Line Item Exis. Pymt. 11 979 - 986 Line Item Exis. Pymt. 17 2587 - 2594 Line Item Exis. Pymt. 12 1247 - 1254 Line Item Exis. Pymt. 18 2855 - 2862 Line Item Exis. Pymt.^13 1515 -^1522

Format – Length: Numeric - 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: Line Item Existing Payment (Ambulatory Patient Group (APG) Existing Paid Amount) is the calculated dollar amount to be paid to the provider based on a blended rate determined by the State Rate Setting Agencies.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 275

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Blended Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Blend. Pymt. 8 183 - 190 Line Item Blend. Pymt. 14 1791 - 1798 Line Item Blend. Pymt. 9 451 - 458 Line Item Blend. Pymt. 15 2059 - 2066 Line Item Blend. Pymt. 10 719 - 726 Line Item Blend. Pymt. 16 2327 - 2334 Line Item Blend. Pymt. 11 987 - 994 Line Item Blend. Pymt. 17 2595 - 2602 Line Item Blend. Pymt. 12 1255 - 1262 Line Item Blend. Pymt. 18 2863 - 2870 Line Item Blend. Pymt.^13 1523 -^1530

Format – Length: Numeric - 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: Line Item Blended Payment (Ambulatory Patient Group (APG Blend type Code) identifies the percentage of the blended rate amount used in calculating the final APG payment amount. It is derived from the Line Item Blended Percent from the 3M Grouper.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 276

SPARCS Outpatient Segment: Continuation Records

Line Item Add-on Payment 8 –

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Add-on Pymt. 8 191 - 198 Line Item Add-on Pymt. 14 1799 - 1806 Line Item Add-on Pymt. 9 459 - 466 Line Item Add-on Pymt. 15 2067 - 2074 Line Item Add-on Pymt. 10 727 - 734 Line Item Add-on Pymt. 16 2335 - 2342 Line Item Add-on Pymt. 11 995 - 1002 Line Item Add-on Pymt. 17 2603 - 2610 Line Item Add-on Pymt. 12 1263 - 1270 Line Item Add-on Pymt. 18 2871 - 2878 Line Item Add-on Pymt.^13 1531 -^1538

Format – Length: Numeric - 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: Line Item Add-on Payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 277

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Total Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Tot. Pymt. 8 199 - 206 Line Item Tot. Pymt. 1807 - 1814 Line Item Tot. Pymt. 9 467 - 474 Line Item Tot. Pymt. 15 2075 - 2082 Line Item Tot. Pymt. 10 735 - 742 Line Item Tot. Pymt. 16 2343 - 2350 Line Item Tot. Pymt. 1003 - 1010 Line Item Tot. Pymt. 17 2611 - 2618 Line Item Tot. Pymt. 12 1271 - 1278 Line Item Tot. Pymt. 18 2879 - 2886 Line Item Tot. Pymt.^13 1539 -^1546

Format – Length: Numeric - 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: Line item payment including possible cost outlier payment. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 278

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Blend Percent 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Blend Percent 8 207 - 211 Line Item Blend Percent 14 1815 - 1819 Line Item Blend Percent 9 475 - 479 Line Item Blend Percent 15 2083 - 2087 Line Item Blend Percent 10 743 - 747 Line Item Blend Percent 16 2351 - 2355 Line Item Blend Percent 11 1011 - 1015 Line Item Blend Percent 17 2619 - 2623 Line Item Blend Percent 12 1279 - 1283 Line Item Blend Percent 1 8 2887 - 2891 Line Item Blend Percent 13^1547 -^1551

Format – Length: Numeric - 5 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 percentage used to calculate the blended amount for calculating payment. This is typically in increments of 25%. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 279

SPARCS Outpatient Segment: Continuation Records

Line Item Adjusted APG Weight 8 –

Record Position: Data Element^ Record Position

Data Element Record Position Ln. Item Adj. APG Wgt. 8 212 - 220 Ln. Item Adj. APG Wgt. 14 1820 - 1828 Ln. Item Adj. APG Wgt. 9 480 - 488 Ln. Item Adj. APG Wgt. 15 2088 - 2096 Ln. Item Adj. APG Wgt. 10 748 - 756 Ln. Item Adj. APG Wgt. 16 2356 - 2364 Ln. Item Adj. APG Wgt. 11 1016 - 1024 Ln. Item Adj. APG Wgt. 17 2624 - 2632 Ln. Item Adj. APG Wgt. 12 1284 - 1292 Ln. Item Adj. APG Wgt. 18 2892 - 2900 Ln.^ Item Adj. APG Wgt.^13 1552 -^1560

Format – Length: Numeric - 9 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: Line Item Adjusted APG Weight is the APG weight after discounting and consolidation of the line item. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 280

SPARCS Outpatient Segment: Continuation Records

Line Item Full APG Weight 8 –

Record Position: Data Element^ Record^ Position

Data Element Record Position Ln. Item Full APG Wgt. 8 221 - 229 Ln. Item Full APG Wgt. 14 1829 - 1837 Ln. Item Full APG Wgt. 9 489 - 497 Ln. Item Full APG Wgt. 15 2097 - 2105 Ln. Item Full APG Wgt. 10 757 - 765 Ln. Item Full APG Wgt. 16 2365 - 2373 Ln. Item Full APG Wgt. 11 1025 - 1033 Ln. Item Full APG Wgt. 17 2633 - 2641 Ln. Item Full APG Wgt. 12 1293 - 1301 Ln. Item Full APG Wgt. 18 2901 - 2909 Ln.^ Item Full APG Wgt.^13 1561 -^1569

Format – Length: Numeric - 9 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: Line Item Full APG Weight. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 281

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Payment Percent 8- 18

Record Position: Data Element^ Record^ Position

Data Element Record Position Line Item Pymt Pct 8 230 - 235 Line Item Pymt Pct 14 1838 - 1843 Line Item Pymt Pct 9 498 - 503 Line Item Pymt Pct 15 2106 - 2111 Line Item Pymt Pct 10 766 - 771 Line Item Pymt Pct 16 2374 - 2379 Line Item Pymt Pct 11 1034 - 1039 Line Item Pymt Pct 17 2642 - 2647 Line Item Pymt Pct 12 1302 - 1307 Line Item Pymt Pct 18 2910 - 2915 Line Item Pymt Pct^13 1570 -^1575

Format – Length: Numeric - 6 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: Line Item Payment Percent is the APG percentage after discounting and consolidation. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 282

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Payment Action 8- 18

Record Position: Data Element^ Record^ Position

Data Element Record Position Line Item Pymt Act 8 236 - 237 Line Item Pymt Act 14 1844 - 1845 Line Item Pymt Act 9 504 - 505 Line Item Pymt Act 15 2112 - 2113 Line Item Pymt Act 10 772 - 773 Line Item Pymt Act 16 2380 - 2381 Line Item Pymt Act 11 1040 - 1041 Line Item Pymt Act 17 2648 - 2649 Line Item Pymt Act 12 1308 - 1309 Line Item Pymt Act 18 2916 - 2917 Line Item Pymt Act^13 1576 -^1577

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: Line Item Payment Action describes how the line is paid depending upon the remainder of the claim. It could be paid fully, consolidated, discounted, or packaged.

Codes and Values:

Values are generated by the software. "00" = Not processed "01" = Full Payment "02" = Consolidated "03" = Discounted "04" = Packaged "05" = No Payment "06" = Bilateral "07" = Discounted Bilateral "08" = Stand Alone "09" = Excluded "10" = Per Diem "11" = Low Cost Outlier "12" = High Cost Outlier "13" = Alternate Payment "14" = Manually priced "19" = Never pay

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 283

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Line Item Paid Units 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Line Item Paid Units 8 238 - 244 Line Item Paid Units 14 1846 - 1852 Line Item Paid Units 9 506 - 512 Line Item Paid Units 15 2114 - 2120 Line Item Paid Units 10 774 - 780 Line Item Paid Units 16 2382 - 2388 Line Item Paid Units 11 1042 - 1048 Line Item Paid Units 17 2650 - 2656 Line Item Paid Units 12 1310 - 1316 Line Item Paid Units 18 2918 - 2924 Line Item Paid Units 13^1578 -^1584

Format – Length: Character - 7 Effective Date: January 1, 2011 Contained In: De-Identified Data Set: YES Limited Data Set: YES Identifiable Data Set: YES Deniable Data Element:

Description: Line Item Paid Units are the number of units paid. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 284

SPARCS Outpatient Segment: Continuation Records

Line Item Payment Adjustment Flag 8 –

Record Position: Data Element^ Record Position

Data Element Record Position Ln Item Pymt Adj Flag 8 245 - 246 Ln Item Pymt Adj Flag 14 1853 - 1854 Ln Item Pymt Adj Flag 9 513 - 514 Ln Item Pymt Adj Flag 15 2121 - 2122 Ln Item Pymt Adj Flag 10 781 - 782 Ln Item Pymt Adj Flag 16 2389 - 2390 Ln Item Pymt Adj Flag 11 1049 - 1050 Ln Item Pymt Adj Flag 17 2657 - 2658 Ln Item Pymt Adj Flag 12 1317 - 1318 Ln Item Pymt Adj Flag 18 2925 - 2926 Ln^ Item Pymt Adj Flag 13^1585 -^1586

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: The description is maintained within the software package.

Codes and Values:

"00"= Standard APG weight, non-units based "01"= Standard APG weight, units based "02"= Alternate weight, non-units based "03"= Alternate weight, units based

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 285

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit APG Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit APG Payment 8 247 - 254 Visit APG Payment 14 1855 - 1862 Visit APG Payment 9 515 - 522 Visit APG Payment 15 2123 - 2130 Visit APG Payment 10 783 - 790 Visit APG Payment 16 2391 - 2398 Visit APG Payment 11 1051 - 1058 Visit APG Payment 17 2659 - 2666 Visit APG Payment 12 1319 - 1326 Visit APG Payment 18 2927 - 2934 Visit APG Payment 13^1587 -^1594

Format – Length: Numeric - 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: Visit APG Payment (Ambulatory Patient Group (APG) Paid Amount) is the calculated dollar value that will be paid to a provider.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 286

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Transition APG Payment 8- 18

Record Position: Data Element^ Record^ Position

Data Element Record Position Visit Trans APG Pymt 8 255 - 262 Visit Trans APG Pymt 14 1863 - 1870 Visit Trans APG Pymt 523 - 530 Visit Trans APG Pymt 15 2131 - 2138 Visit Trans APG Pymt 10 791 - 798 Visit Trans APG Pymt 16 2399 - 2406 Visit Trans APG Pymt 11 1059 - 1066 Visit Trans APG Pymt 17 2667 - 2674 Visit Trans APG Pymt 12 1327 - 1334 Visit Trans APG Pymt 18 2935 - 2942 Visit Trans APG Pymt^13 1595 -^1602

Format – Length: Numeric - 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

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 287

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Existing Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Exist Pymt 8 263 - 270 Visit Exist Pymt 14 1871 - 1878 Visit Exist Pymt 9 531 - 538 Visit Exist Pymt 15 2139 - 2146 Visit Exist Pymt 10 799 - 806 Visit Exist Pymt 16 2407 - 2414 Visit Exist Pymt 11 1067 - 1074 Visit Exist Pymt 17 2675 - 2682 Visit Exist Pymt 12 1335 - 1342 Visit Exist Pymt 18 2943 - 2950 Visit Exist Pymt^13 1603 -^1610

Format – Length: Numeric - 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

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 288

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Blended Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Blend Pymt 8 271 - 278 Visit Blend Pymt 14 1879 - 1886 Visit Blend Pymt 9 539 - 546 Visit Blend Pymt 15 2147 - 2154 Visit Blend Pymt 10 807 - 814 Visit Blend Pymt 16 2415 - 2422 Visit Blend Pymt 11 1075 - 1082 Visit Blend Pymt 17 2683 - 2690 Visit Blend Pymt 12 1343 - 1350 Visit Blend Pymt 18 2951 - 2958 Visit Blend Pymt^13 1611 -^1618

Format – Length: Numeric - 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: Visit Blended Payment is the amount that the APG methodology would calculate for the visit based upon the coded procedures and diagnosis. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 289

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Add-On Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Add-on Pymt 8 279 - 286 Visit Add-on Pymt 14 1887 - 1894 Visit Add-on Pymt 9 547 - 554 Visit Add-on Pymt 15 2155 - 2162 Visit Add-on Pymt 10 815 - 822 Visit Add-on Pymt 16 2423 - 2430 Visit Add-on Pymt 11 1083 - 1090 Visit Add-on Pymt 17 2691 - 2698 Visit Add-on Pymt 12 1351 - 1358 Visit Add-on Pymt 18 2959 - 2966 Visit Add-on Pymt^13 1619 -^1626

Format – Length: Numeric - 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: Visit Add-On Payment is the fixed add-on payment for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 290

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Payment 8- 10

Record Position: Data Element^ Record Position

Data Element Record Position Visit Payment 8 287 - 294 Visit Payment 14 1895 - 1902 Visit Payment 9 555 - 562 Visit Payment 15 2163 - 2170 Visit Payment 10 823 - 830 Visit Payment 16 2431 - 2438 Visit Payment 11 1091 - 1098 Visit Payment 17 2699 - 2706 Visit Payment 12 1359 - 1366 Visit Payment 18 2967 - 2974 Visit Payment 13^1627 -^1634

Format – Length: Numeric - 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: Visit Payment is the payment for the visit not including outlier payment and revenue code add-on.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 291

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Non-Transition Payment 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Non-Trans Pymt 8 295 - 302 Visit Non-Trans Pymt 14 1903 - 1910 Visit Non-Trans Pymt 9 563 - 570 Visit Non-Trans Pymt 15 2171 - 2178 Visit Non-Trans Pymt 10 831 - 838 Visit Non-Trans Pymt 16 2439 - 2446 Visit Non-Trans Pymt 11 1099 - 1106 Visit Non-Trans Pymt 17 2707 - 2714 Visit Non-Trans Pymt 12 1367 - 1374 Visit Non-Trans Pymt 18 2975 - 2982 Visit Non-Trans Pymt^13 1635 -^1642

Format – Length: Numeric - 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

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 292

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Adjusted APG Weight 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Adj APG Wgt 8 303 - 311 Visit Adj APG Wgt 14 1911 - 1919 Visit Adj APG Wgt 9 571 - 579 Visit Adj APG Wgt 15 2179 - 2187 Visit Adj APG Wgt 10 839 - 847 Visit Adj APG Wgt 16 2447 - 2455 Visit Adj APG Wgt 11 1107 - 1115 Visit Adj APG Wgt 17 2715 - 2723 Visit Adj APG Wgt 12 1375 - 1383 Visit Adj APG Wgt 18 2983 - 2991 Visit Adj APG Wgt^13 1643 -^1651

Format – Length: Numeric - 9 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: Visit Adjusted APG Weight is the sum of adjusted APG weights for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 293

SPARCS Outpatient Segment: Continuation Records

Data Element Name: Visit Full APG Weight 8- 18

Record Position: Data Element^ Record Position

Data Element Record Position Visit Full APG Wgt 8 312 - 320 Visit Full APG Wgt 14 1920 - 1928 Visit Full APG Wgt 9 580 - 588 Visit Full APG Weight 15 2188 - 2196 Visit Full APG Wgt 10 848 - 856 Visit Full APG Weight 16 2456 - 2464 Visit Full APG Wgt 11 1116 - 1124 Visit Full APG Weight 17 2724 - 2732 Visit Full APG Wgt 12 1384 - 1392 Visit Full APG Weight 18 2992 - 3000 Visit Full APG Wgt 13^1652 -^1660

Format – Length: Numeric - 9 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: Visit Full APG Weight is the sum of APG weights for the visit. For internal DOH use only.

Codes and Values:

Values are generated by the software.

OUTPUT Edits on Element:

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

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

SPARCS Outpatient Output Page 294

V. 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

NY SPARCS - Outpatient Output data dictionary