Texas Hospital Inpatient Discharge Data dictionary - onetomapanalytics/Meta_Data GitHub Wiki

Texas Hospital Inpatient Discharge

Public Use Data File

Data Dictionary

The following information is provided:

Field: Unique abbreviated name of the data element
Description: Brief explanation of the data element. Descriptions of data elements from the UB-92 are taken from specifications manuals.
**Data Source:**Provided by the hospital on the claim form (Claim); Assigned by DSHS (Assigned); Calculated by DSHS (Calculated). Note: For those data elements that have been temporarily suppressed, the quarter of data for which the data element will be released is noted following the Data Source.
Type: Alphanumeric or numeric
Coding Scheme: Valid codes for a data field. Values taken from specifications manuals.

Note a change: Any code provided by a hospital that has been determined to be invalid has been assigned the value '. Any data element that is blank should be interpreted as ‘missing’, no data provided, unless otherwise noted.

BASE DATA #1 FILE

Field 1: RECORD_ID Description: Record Identification Number. Unique number assigned to identify the record. First available 1 st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files (RDF’s). Beginning Position: 1 **Data Source:**Assigned Length: 12 Type: Alphanumeric
Field 2: DISCHARGE Description: Discharge Quarter. Year and quarter of discharge. yyyyQn. Beginning Position: 13 **Data Source:**Assigned Length: 6 Type: Alphanumeric
Field 3: THCIC_ID Description: Provider ID. Unique identifier assigned to the provider by DSHS. Suppression: Hospitals with fewer than 50 discharges have been aggregated into the Provider ID '999999'. If a hospital has fewer than 5 discharges of a particular gender, including ‘unknown’, Provider ID is '999998'. Beginning Position: 19 **Data Source:**Assigned Length: 6 Type: Alphanumeric
Field 4: PROVIDER_NAME Description: Hospital name provided by the hospital. Suppression: Hospitals with fewer than 50 discharges (Provider ID equals ‘999999’) are assigned the name ‘Low Discharge Volume Hospital’. If a hospital has fewer than 5 discharges of a particular gender, including ‘unknown’, Hospital Name is blank. Beginning Position: 13 **Data Source:**Provider Length: 55 Type: Alphanumeric
Field 5: TYPE_OF_ADMISSION Description: Code indicating the type of admission Coding Scheme: 1 Emergency; 2 Urgent; 3 Elective; 4 Newborn; 5 Trauma Center; 9 Information not available; ' Invalid Beginning Position: 80 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 6: SOURCE_OF_ADMISSION Description: Code indicating source of the admission. Coding Scheme: 1 Non-Healthcare Facility Point of Origin (Beginning July 1, 2010); 2 Clinic referral; 4 Transfer from a hospital; 5 Transfer from a skilled nursing facility, intermediate care facility or assisted living facility; 6 Transfer from another health care facility; 8 Court/Law Enforcement; 9 Information not available; 0 Transfer from psychiatric, substance abuse, rehab hospital; B Transfer from another home health agency; D Transfer from One distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in Separte Claim to the Payer; E Transfer from Amubulatory Surgery Center; F Transfer from a Hospice Facility; ' Invalid. If Type of Admission=4 (Newborn); 5 Born inside this hospital; 6 Born outside this hospital Beginning Position: 81 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 7: SPEC_UNIT_ Description: Specialty Units in which most days during stay occurred based on number of days by Type of Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through; SPEC_UNIT_5 are combined in one
Field in the Tab Delimited file and can be accessed individually in the fixed length file. Coding Scheme: C Coronary Care Unit P Pediatric Unit D Detoxification Unit Y Psychiatric Unit I Intensive Care Unit R Rehabilitation Unit H Hospice Unit U Sub-acute Care Unit N Nursery S Skilled Nursing Unit B Obstetric Unit Blank Acute Care O Oncology Unit Beginning Position: 82 **Data Source:**Calculated Length: 1 Type: Alphanumeric
Field 8: SPEC_UNIT_ Description: Specialty Units in which most days during stay occurred based on number of days by Type of Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through SPEC_UNIT_5 are combined in one
Field in the Tab Delimited file and can be accessed individually in the fixed length file. Coding Scheme: C^ Coronary Care Unit P Pediatric Unit D Detoxification Unit Y Psychiatric Unit I Intensive Care Unit R Rehabilitation Unit H Hospice Unit U Sub-acute Care Unit N Nursery S Skilled Nursing Unit B Obstetric Unit Blank Acute Care O Oncology Unit Beginning Position: 83 Data Source: Length: 1 Type: Alphanumeric
Field 9: SPEC_UNIT_ Description: Specialty Units in which most days during stay occurred based on number of days by Type of Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through SPEC_UNIT_5 are combined in one
Field in the Tab Delimited file and can be accessed individually in the fixed length file. Coding Scheme: C^ Coronary Care Unit P Pediatric Unit D Detoxification Unit Y Psychiatric Unit I Intensive Care Unit R Rehabilitation Unit H Hospice Unit U Sub-acute Care Unit N Nursery S Skilled Nursing Unit B Obstetric Unit Blank Acute Care O Oncology Unit Beginning Position: 84 Data Source: Length: 1 Type: Alphanumeric
Field 10: SPEC_UNIT_ Description: Specialty Units in which most days during stay occurred based on number of days by Type of Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through SPEC_UNIT_5 are combined in one
Field in the Tab Delimited file and can be accessed individually in the fixed length file. Coding Scheme: C^ Coronary Care Unit P Pediatric Unit D Detoxification Unit Y Psychiatric Unit I Intensive Care Unit R Rehabilitation Unit H Hospice Unit U Sub-acute Care Unit N Nursery S Skilled Nursing Unit B Obstetric Unit Blank Acute Care O Oncology Unit Beginning Position: 85 Data Source: Length: 1 Type: Alphanumeric
Field 11: SPEC_UNIT_ Description: Specialty Units in which most days during stay occurred based on number of days by Type of Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through SPEC_UNIT_5 are combined in one
Field in the Tab Delimited file and can be accessed individually in the fixed length file. Coding Scheme: C^ Coronary Care Unit P Pediatric Unit D Detoxification Unit Y Psychiatric Unit I Intensive Care Unit R Rehabilitation Unit H Hospice Unit U Sub-acute Care Unit N Nursery S Skilled Nursing Unit B Obstetric Unit Blank Acute Care O Oncology Unit Beginning Position: 86 Data Source: Length: 1 Type: Alphanumeric
Field 12: PAT_STATE Description: State of the patient’s mailing address in Texas and contiguous states. Standard 2-character Postal Service abbreviation. Coding Scheme: AR Arkansas LA Louisiana NM New Mexico OK Oklahoma TX Texas ZZ All other states and American Territories FC Foreign country XX Foreign country^ Beginning Position: 87 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 13: PAT_ZIP Description: Patient’s five-digit ZIP code. Suppression: Last two digits are blank if a ZIP code has fewer than 30 discharges. If state equals ‘ZZ’, ZIP code equals ‘88888’. If state equals ‘FC’ (foreign country) ZIP code is blank. If ICD-9-CM indicates alcohol or drug use or an HIV diagnosis the ZIP code is blank. If a hospital has fewer than fifty discharges the ZIP code is blank. If a hospital has fewer than 5 discharges of a particular gender, including ‘unknown’, the ZIP Code is blank. Beginning Position: 89 **Data Source:**Claim Length: 5 Type: Alphanumeric
Field 14: PAT_COUNTRY Description: Country of patient’s residential address. List maintained by the International Organization for Standardization (ISO). Suppression: Suppressed if fewer than 5 patients from one country. Coding Scheme: See [http: www.ISO.org](http: www.ISO.org) for complete list. Beginning Position: 94 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 15: PAT_COUNTY Description: FIPS code of patient’s county. Coding Scheme: | | | | | |---|---|---|---| | 1 Anderson | 129 Donley | 257 Kaufman | 385 Real | | 3 Andrews | 131 Duval | 259 Kendall | 387 Red River | | 5 Angelina | 133 Eastland | 261 Kenedy | 389 Reeves | | 7 Aransas | 135 Ector | 263 Kent | 391 Refugio | | 9 Archer | 137 Edwards | 265 Kerr | 393 Roberts | | 11 Armstrong | 139 Ellis | 267 Kimble | 395 Robertson | | 13 Atascosa | 141 El Paso | 269 King | 397 Rockwall | | 15 Austin | 143 Erath | 271 Kinney | 399 Runnels | | 17 Bailey | 145 Falls | 273 Kleberg | 401 Rusk | | 19 Bandera | 147 Fannin | 275 Knox | 403 Sabine | | 21 Bastrop | 149 Fayette | 283 La Salle | 405 San Augustine | | 23 Baylor | 151 Fisher | 277 Lamar | 407 San Jacinto | | 25 Bee | 153 Floyd | 279 Lamb | 409 San Patricio | | 27 Bell | 155 Foard | 281 Lampasas | 411 San Saba | | 29 Bexar | 157 Fort Bend | 285 Lavaca | 413 Schleicher | | 31 Blanco | 159 Franklin | 287 Lee | 415 Scurry | | 33 Borden | 161 Freestone | 289 Leon | 417 Shackelford | | 35 Bosque | 163 Frio | 291 Liberty | 419 Shelby | | 37 Bowie | 165 Gaines | 293 Limestone | 421 Sherman | | 39 Brazoria | 167 Galveston | 295 Lipscomb | 423 Smith | | 41 Brazos | 169 Garza | 297 Live Oak | 425 Somervell | | 43 Brewster | 171 Gillespie | 299 Llano | 427 Starr | | 45 Briscoe | 173 Glasscock | 301 Loving | 429 Stephens | | 47 Brooks | 175 Goliad | 303 Lubbock | 431 Sterling | | 49 Brown | 177 Gonzales | 305 Lynn | 433 Stonewall | | 51 Burleson | 179 Gray | 307 McCulloch | 435 Sutton | | 53 Burnet | 181 Grayson | 309 McLennan | 437 Swisher | | 55 Caldwell | 183 Gregg | 311 McMullen | 439 Tarrant | | 57 Calhoun | 185 Grimes | 313 Madison | 441 Taylor | | 59 Callahan | 187 Guadalupe | 315 Marion | 443 Terrell | | 61 Cameron | 189 Hale | 317 Martin | 445 Terry | | 63 Camp | 191 Hall | 319 Mason | 447 Throckmorton | | 65 Carson | 193 Hamilton | 321 Matagorda | 449 Titus | | 67 Cass | 195 Hansford | 323 Maverick | 451 Tom Green | | 69 Castro | 197 Hardeman | 325 Medina | 453 Travis | | 71 Chambers | 199 Hardin | 327 Menard | 455 Trinity | | 73 Cherokee | 201 Harris | 329 Midland | 457 Tyler | | 75 Childress | 203 Harrison | 331 Milam | 459 Upshur | | 77 Clay | 205 Hartley | 333 Mills | 461 Upton | | 79 Cochran | 207 Haskell | 335 Mitchell | 463 Uvalde | | 81 Coke | 209 Hays | 337 Montague | 465 Val Verde | | 83 Coleman | 211 Hemphill | 339 Montgomery | 467 Van Zandt | | 85 Collin | 213 Henderson | 341 Moore | 469 Victoria | | 87 Collingsworth | 215 Hidalgo | 343 Morris | 471 Walker | | 89 Colorado | 217 Hill | 345 Motley | 473 Waller | | 91 Comal | 219 Hockley | 347 Nacogdoches | 475 Ward | | 93 Comanche | 221 Hood | 349 Navarro | 477 Washington | | 95 Concho | 223 Hopkins | 351 Newton | 479 Webb | | 97 Cooke | 225 Houston | 353 Nolan | 481 Wharton | | 99 Coryell | 227 Howard | 355 Nueces | 483 Wheeler | | 101 Cottle | 229 Hudspeth | 357 Ochiltree | 485 Wichita | | 103 Crane | 231 Hunt | 359 Oldham | 487 Wilbarger | | 105 Crockett | 233 Hutchinson | 361 Orange | 489 Willacy | | 107 Crosby | 235 Irion | 363 Palo Pinto | 491 Williamson | | 109 Culberson | 237 Jack | 365 Panola | 493 Wilson | | 111 Dallam | 239 Jackson | 367 Parker | 495 Winkler | | 113 Dallas | 241 Jasper | 369 Parmer | 497 Wise | | 115 Dawson | 243 Jeff Davis | 371 Pecos | 499 Wood | | 117 Deaf Smith | 245 Jefferson | 373 Polk | 501 Yoakum | | 119 Delta | 247 Jim Hogg | 375 Potter | 503 Young | | 121 Denton | 249 Jim Wells | 377 Presidio | 505 Zapata | | 123 Dewitt | 251 Johnson | 379 Rains | 507 Zavala | | 125 Dickens | 253 Jones | 381 Randall | | | 127 Dimmit | 255 Karnes | 383 Reagan | ' Invalid | Beginning Position: 96 **Data Source:**Assigned; based on patient ZIP code Length: 3 Type: Alphanumeric
Field 16: PUBLIC_HEALTH_REGION Description: Public Health Region of patient’s address. 1 Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith, Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King, Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts, Sherman, Swisher, Terry, Wheeler, Yoakum counties 2 Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman, Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackleford, Stephens, Stonewall, Taylor, Throckmorton, Wichita, Wilbarger, Young counties 3 Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo Pinto, Parker, Rockwall, Somervell, Tarrant, Wise counties 4 Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar, Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood counties 5 Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine, San Jacinto, Shelby, Trinity, Tyler counties 6 Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery, Walker, Waller, Wharton counties 7 Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes, Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, McLennan, Madison, Milam, Mills, Robertson, San Saba, Travis, Washington, Williamson counties 8 Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales, Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val Verde, Victoria, Wilson, Zavala counties 9 Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble, Loving, McCulloch, Martin, Mason, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton, Terrell, Tom Green, Upton, Ward, Winkler counties 10 Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio counties 11 Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak, McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata counties ' Invalid Beginning Position: 99 **Data Source:**Assigned Length:^2 Type: Alphanumeric
Field 17: PAT_STATUS Description: Code indicating patient status as of the ending date of service for the period of care reported Coding Scheme:^1 Discharged to home or self-care (routine discharge) 2 Discharged to other short term general hospital 3 Discharged to skilled nursing facility 4 Discharged to intermediate care facility 5 Discharged/transferred to a Designated Cancer Center or Children's Hospital (effective 10-1-2007) 6 Discharged to care of home health service 7 Left against medical advice 8 Discharged to care of Home IV provider 9 Admitted as inpatient to this hospital 20 Expired 30 Still patient 40 Expired at home 41 Expired in a medical facility 42 Expired, place unknown 43 Discharged/transferred to federal health care facility 50 Discharged to hospice–home 51 Discharged to hospice–medical facility 61 Discharged/transferred within this institution to Medicare-approved swing bed^ 62 Discharged/transferred to inpatient rehabilitation facility 63 Discharged/transferred to Medicare-certified long term care hospital 64 Discharged/transferred to Medicaid-certified nursing facility 65 Discharged/transferred to psychiatric hospital or psychiatric distinct part of a hospital 66 Discharged/transferred to Critical Access Hospital (CAH) 71 Discharged/transferred to other outpatient service 72 Discharged/transferred to institution outpatient ' Invalid Beginning Position: 101 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 18: SEX_CODE Description: Gender of the patient as recorded at date of admission or start of care. Suppression: Code is suppressed if an ICD-9-CM code indicates drug or alcohol use or an HIV diagnosis. If a hospital has fewer than 5 patients of a particular gender, including unknown, Provider ID is ‘999998’ and Hospital Name and Patient ZIP Code are blank for those patients. Coding Scheme: M Male F Female U Unknown ' Invalid Beginning Position: 103 **Data Source:**Claim Length:^1 Type: Alphanumeric
Field 19: RACE Description: Code indicating the patient’s race. Suppression: If a hospital has fewer than ten patients of one race that race is changed to ‘Other’ (code equals 5).^ Coding Scheme: 1 American Indian/Eskimo/Aleut 2 Asian or Pacific Islander 3 Black 4 White 5 Other ' Invalid Beginning Position: 104 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 20: ETHNICITY Description: Code indicating the Hispanic origin of the patient. Suppression: If a hospital has fewer than ten patients of one race the ethnicity of patients of that race is suppressed (code is blank). Coding Scheme: 1 Hispanic Origin 2 Not of Hispanic Origin ' Invalid Beginning Position: 105 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 21: ADMIT_WEEKDAY Description: Code indicating day of week patient is admitted Coding Scheme: 1 Monday 5 Friday 2 Tuesday 6 Saturday 3 Wednesday 7 Sunday 4 Thursday ' Invalid Beginning Position: 106 **Data Source:**Assigned Length: 1 Type: Alphanumeric
Field 22: LENGTH_OF_STAY Description: Length of stay in days equals Statement covers period through date minus Admission/start of care date. The minimum length of stay is 1 day. The maximum is 9999 days. Beginning Position: 107 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 23: PAT_AGE Description: Code indicating age of patient in days or years on date of discharge. Coding Scheme: 00 1-28 days 10 35-39 20 85- 01 29-365 days 11 40-44 21 90+ 02 1-4 years 12 45-49 HIV and drug/alcohol use patients: 03 5-9 13 50-54 22 0- 04 10-14 14 55-59 23 18- 05 15-17 15 60-64 24 45- 06 18-19 16 65-69 25 65- 07 20-24 17 70-74 26 75+ 08 25-29 18 75-79 ' Invalid 09 30-34 19 80- Beginning Position: 111 **Data Source:**Assigned Length: 2 Type: Alphanumeric
Field 24: FIRST_PAYMENT_SRC Description: Code indicating the expected primary source of payment. Coding Scheme: 09 Self Pay Removed from 5010 format, use “ZZ”) 10 Central Certification 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 AM Automobile Medical BL Blue Cross/Blue Shield CH CHAMPUS ZZ Charity, Indigent or Unknown CI Commercial Insurance DS Disability Insurance HM Health Maintenance Organization LI Liability LM Liability Medical MA Medicare Part A MB Medicare Part B MC Medicaid TV Title V OF Other Federal Program VA Veteran Administration Plan WC Workers Compensation Health Claim ' ' Codes 09 and ZZ, combined for 2004 & 2005 ' Invalid Beginning Position: 113 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 25: SECONDARY_PAYMENT_SRC Description: Code indicating the expected secondary source of payment. Coding Scheme: Same as
Field 24, FIRST_PAYMENT_SRC Beginning Position: 115 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 26: TYPE_OF_BILL Description: Provides specific information about the claim data submitted. First digit = type of facility. Second digit = type of care. Third digit = sequence of the claim. Coding Scheme: | 1 st digit–Type of Facility | 2 nd digit–Type of Care | 3 rd digit–Sequence of claim | |---|---|---| | 1 Hospital | 1 Inpatient; including Medicare Part A | 0 Non-payment/Zero claim | | 2 Skilled nursing | 2 Inpatient; Medicare Part B only | 1 Admit through discharge claim | | 3 Home health | 3 Outpatient | 2 Interim–first claim | | 4 Religious non-medical health care–Hospital | 4 Outpatient Other; Medicare Part B only | 3 Interim–continuing claim | | 5 Religious non-medical health care–Extended care | 5 Intermediate Care–Level I | 4 Interim–last claim | | 6 Intermediate care | 6 Intermediate Care–Level II | 5 Late charge(s) only claim | | 7 Clinic | 7 Sub-acute inpatient – Level III | 6 Adjustment of prior claim (Not used by Medicare) | | 8 Special facility | 8 Swing bed | 7 Replacement of prior claim | | | | 8 Void/cancel of prior claim | Beginning Position: 117 **Data Source:**Claim Length: 3 Type: Alphanumeric
Field 27: TOTAL_CHARGES Sum of accommodation charges, non-covered accommodation charges, ancillary charges, non- covered ancillary charges. Replaces TOTAL_CHARGES_23. Beginning Position: 120 **Data Source:**Claim Length: 12 Type: Numeric
Field 28: TOTAL_NON_COV_CHARGES Sum of non-covered accommodation charges, non-covered ancillary charges. Beginning Position: 132 **Data Source:**Claim Length: 12 Type: Numeric
Field 29: TOTAL_CHARGES_ACCOMM Sum of covered and non-covered accommodation charges. Beginning Position: 144 **Data Source:**Claim Length: 12 Type: Numeric
Field 30: TOTAL_NON_COV_CHARGES_ACCOMM Sum of non-covered accommodations charges. Beginning Position: 156 **Data Source:**Claim Length: 12 Type: Numeric
Field 31: TOTAL_CHARGES_ANCIL Sum of covered and non-covered ancillary charges. Beginning Position: 168 **Data Source:**Claim Length: 12 Type: Numeric
Field 32: TOTAL_NON_COV_CHARGES_ANCIL Sum of non-covered ancillary charges. Beginning Position: 180 **Data Source:**Claim Length: 12 Type: Numeric
Field 33: POA_PROVIDER_INDICATOR Indicator identifying whether facility is required to submit Diagnosis Present on Admission (POA) codes. 25 TAC §421.9(e) identifies the following facility types as exempt from reporting POA to the department: Critical Access Hospitals, Inpatient Rehabilitation Hospitals , Inpatient Psychiatric Hospitals, Cancer Hospitals ,Children's or Pediatric Hospitals and Long Term Care Hospitals. Coding Scheme: M Mixed (Facility has sections that would be exempted from reporting POA for those patients) R Required X Exempt ' Invalid Beginning Position: 192 **Data Source:**Assigned Length: 1 Type: Alphanumeric
Field 34: ADMITTING_DIAGNOSIS ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 193 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 35: PRINC_DIAG_CODE ICD-9-CM diagnosis code for the principal diagnosis, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 199 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 36: POA_PRINC_DIAG_CODE Code identifying whether Principal Diagnonsis code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 205 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 37: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 206 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 38: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_1 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 212 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 39: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 213 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 40: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_2 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 219 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 41: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 220 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 42: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_3 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 226 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 43: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 227 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 44: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_4 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 233 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 45: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 234 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 46: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_5 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 240 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 47: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position:^241 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 48: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_6 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 247 **Data Source:**Claim Length:^1 Type: Alphanumeric
Field 49: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 248 **Data Source:**Claim Length:^6 Type: Alphanumeric
Field 50: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_7 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position:^254 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 51: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position:^255 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 52: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_8 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 261 **Data Source:**Claim Length:^1 Type: Alphanumeric
Field 53: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 262 **Data Source:**Claim Length:^6 Type: Alphanumeric
Field 54: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_9 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 268 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 55: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 269 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 56: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_10 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 275 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 57: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 276 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 58: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_11 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 282 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 59: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 283 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 60: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_12 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 289 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 61: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 290 **Data Source:**Claim

Length: 6 Type: Alphanumeric

Field 62: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_13 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 296 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 63: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 297 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 64: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_14 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 303 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 65: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 304 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 66: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_15 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 310 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 67: OTH_DIAG_CODE_ ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 311 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 68: POA_OTH_DIAG_CODE_ Code identifying whether Oth_Diag_Code_16 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 317 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 69: OTH_DIAG_CODE_17 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 318 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 70: POA_OTH_DIAG_CODE_17 Code identifying whether Oth_Diag_Code_17 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 324 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 71: OTH_DIAG_CODE_18 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 325 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 72: POA_OTH_DIAG_CODE_18 Code identifying whether Oth_Diag_Code_18 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 331 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 73: OTH_DIAG_CODE_19 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 332 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 74: POA_OTH_DIAG_CODE_19 Code identifying whether Oth_Diag_Code_19 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 338 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 75: OTH_DIAG_CODE_20 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 339 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 76: POA_OTH_DIAG_CODE_20 Code identifying whether Oth_Diag_Code_20 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 345 **Data Source:**Claim Length:^1 Type: Alphanumeric
Field 77: OTH_DIAG_CODE_21 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 346 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 78: POA_OTH_DIAG_CODE_21 Code identifying whether Oth_Diag_Code_21 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 352 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 79: OTH_DIAG_CODE_22 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 353 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 80: POA_OTH_DIAG_CODE_22 Code identifying whether Oth_Diag_Code_22 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 359 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 81: OTH_DIAG_CODE_23 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 360 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 82: POA_OTH_DIAG_CODE_23 Code identifying whether Oth_Diag_Code_23 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 366 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 83: OTH_DIAG_CODE_24 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 367 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 84: POA_OTH_DIAG_CODE_24 Code identifying whether Oth_Diag_Code_24 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 373 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 85: E_CODE_1 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of the primary external cause of injury. A decimal is implied following the third character. Beginning Position: 374 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 86: POA_E_CODE_1 Code identifying whether E_Code_1 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 380 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 87: E_CODE_2 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 381 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 88: POA_E_CODE_2 Code identifying whether E_Code_2 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 387 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 89: E_CODE_3 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 388 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 90: POA_E_CODE_3 Code identifying whether E_Code_3 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 394 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 91: E_CODE_4 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 395 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 92: POA_E_CODE_4 Code identifying whether E_Code_4 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 401 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 93: E_CODE_5 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 402 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 94: POA_E_CODE_5 Code identifying whether E_Code_5 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 408 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 95: E_CODE_6 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 409 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 96: POA_E_CODE_6 Code identifying whether E_Code_6 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 415 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 97: E_CODE_7 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 416 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 98: POA_E_CODE_7 Code identifying whether E_Code_7 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Clinically Undetermined Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 422 **Data Source:**Claim Length:^1 Type: Alphanumeric
Field 99: E_CODE_8 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 423 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 100: POA_E_CODE_8 Code identifying whether E_Code_8 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 429 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 101: E_CODE_9 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 430 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 102: POA_E_CODE_9 Code identifying whether E_Code_9 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 436 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 103: E_CODE_10 ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional external cause of injury. Decimal is implied following the third character. Beginning Position: 437 **Data Source:**Claim Length: 6 Type: Alphanumeric
Field 104: POA_E_CODE_10 Code identifying whether E_Code_10 code was present at the time the patient was admitted to the hospital Coding Scheme: Y Yes N No U Unknown W Clinically Undetermined 1 Space (1st & 2nd Qtr 2012 only) ' Invalid Beginning Position: 443 **Data Source:**Claim Length: 1 Type: Alphanumeric
Field 105: PRINC_SURG_PROC_CODE Code for the principal surgical or other procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 444 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 106: PRINC_SURG_PROC_DAY Day of principal surgical or other procedure equals Principal Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 451 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 107: PRINC_ICD9_CODE ICD-9-CM code for principal surgical or other procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 455 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 108: OTH_SURG_PROC_CODE_1 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 460 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 109: OTH_SURG_PROC_DAY_1 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 467 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 110: OTH_ICD9_CODE_1 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 471 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 111: OTH_SURG_PROC_CODE_2 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 476 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 112: OTH_SURG_PROC_DAY_2 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 483 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 113: OTH_ICD9_CODE_2 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 487 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 114: OTH_SURG_PROC_CODE_3 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 492 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 115: OTH_SURG_PROC_DAY_3 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 499 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 116: OTH_ICD9_CODE_3 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 503 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 117: OTH_SURG_PROC_CODE_4 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 508 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 118: OTH_SURG_PROC_DAY_4 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 515 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 119: OTH_ICD9_CODE_4 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 519 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 120: OTH_SURG_PROC_CODE_5 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 524 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 121: OTH_SURG_PROC_DAY_5 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 531 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 122: OTH_ICD9_CODE_5 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 535 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 123: OTH_SURG_PROC_CODE_6 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 540 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 124: OTH_SURG_PROC_DAY_6 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 547 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 125: OTH_ICD9_CODE_6 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 551 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 126: OTH_SURG_PROC_CODE_7 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 556 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 127: OTH_SURG_PROC_DAY_7 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 563 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 128: OTH_ICD9_CODE_7 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 567 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 129: OTH_SURG_PROC_CODE_8 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 572 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 130: OTH_SURG_PROC_DAY_8 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date Beginning Position: 579 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 131: OTH_ICD9_CODE_8 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 583 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 132: OTH_SURG_PROC_CODE_9 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 588 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 133: OTH_SURG_PROC_DAY_9 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 595 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 134: OTH_ICD9_CODE_9 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 599 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 135: OTH_SURG_PROC_CODE_10 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 604 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 136: OTH_SURG_PROC_DAY_10 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 611 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 137: OTH_ICD9_CODE_10 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 615 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 138: OTH_SURG_PROC_CODE_11 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 620 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 139: OTH_SURG_PROC_DAY_11 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 627 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 140: OTH_ICD9_CODE_11 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 631 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 141: OTH_SURG_PROC_CODE_12 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 636 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 142: OTH_SURG_PROC_DAY_12 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 643 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 143: OTH_ICD9_CODE_12 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 647 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 144: OTH_SURG_PROC_CODE_13 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 652 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 145: OTH_SURG_PROC_DAY_13 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 659 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 146: OTH_ICD9_CODE_13 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 663 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 147: OTH_SURG_PROC_CODE_14 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 668 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 148: OTH_SURG_PROC_DAY_14 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 675 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 149: OTH_ICD9_CODE_14 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 679 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 150: OTH_SURG_PROC_CODE_15 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 684 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 151: OTH_SURG_PROC_DAY_15 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 691 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 152: OTH_ICD9_CODE_15 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 695 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 153: OTH_SURG_PROC_CODE_16 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 700 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 154: OTH_SURG_PROC_DAY_16 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 707 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 155: OTH_ICD9_CODE_16 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 711 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 156: OTH_SURG_PROC_CODE_17 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 716 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 157: OTH_SURG_PROC_DAY_17 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 723 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 158: OTH_ICD9_CODE_17 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 727 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 159: OTH_SURG_PROC_CODE_18 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 732 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 160: OTH_SURG_PROC_DAY_18 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 739 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 161: OTH_ICD9_CODE_18 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 743 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 162: OTH_SURG_PROC_CODE_19 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 748 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 163: OTH_SURG_PROC_DAY_19 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 755 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 164: OTH_ICD9_CODE_19 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 759 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 165: OTH_SURG_PROC_CODE_20 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 764 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 166: OTH_SURG_PROC_DAY_20 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 771 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 167: OTH_ICD9_CODE_20 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 775 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 168: OTH_SURG_PROC_CODE_21 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 780 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 169: OTH_SURG_PROC_DAY_21 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 787 **Data Source:**Calculated Length:^4 Type: Alphanumeric
Field 170: OTH_ICD9_CODE_21 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 791 **Data Source:**Assigned Length:^5 Type: Alphanumeric
Field 171: OTH_SURG_PROC_CODE_22 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 796 **Data Source:**Claim Length:^7 Type: Alphanumeric
Field 172: OTH_SURG_PROC_DAY_22 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 803 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 173: OTH_ICD9_CODE_22 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 807 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 174: OTH_SURG_PROC_CODE_23 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 812 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 175: OTH_SURG_PROC_DAY_23 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 819 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 176: OTH_ICD9_CODE_23 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 823 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 177: OTH_SURG_PROC_CODE_24 Code for surgical or other procedure other than the principal procedure performed during the period covered by the bill. ICD-9, HCPCS, or CPT code. Beginning Position: 828 **Data Source:**Claim Length: 7 Type: Alphanumeric
Field 178: OTH_SURG_PROC_DAY_24 Day of other surgical or other procedure equals Other Surgical Procedure Date minus Admission/Start of Care Date. Beginning Position: 835 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 179: OTH_ICD9_CODE_24 ICD-9-CM code for surgical or other procedure other than the principal procedure, including the 4th and 5th digits if applicable. Decimal is implied following the third character. Beginning Position: 839 **Data Source:**Assigned Length: 5 Type: Alphanumeric
Field 180: MS-MDC Major Diagnostic Category (MDC) as assigned by Centers for Medicare and Medicaid Services (CMS) (formerly Health Care Financing Administration (HCFA)) for hospital payment for Medicare beneficiaries. First available 2004. Beginning Position: 844 **Data Source:**Assigned Length: 2 Type: Alphanumeric
Field 181: MS-DRG Centers for Medicare and Medicaid Services (CMS) Diagnosis Related Group (DRG), as assigned for hospital payment for Medicare beneficiaries. Beginning Position: 846 **Data Source:**Assigned Length: 3 Type: Alphanumeric
Field 182: MS_GROUPER_VERSION_NBR CMS Medicare Severity Diagnosis Related Grouper (formerly CMS DRG Grouper and previously reported as HCFA_GROUPER_VERSION_NBR) version used to assign MS DRG and, MS MDC codes

Beginning Position: 849 **Data Source:**Assigned Length: 5 Type: Alphanumeric

Field 183: MS_GROUPER_ERROR_CODE Error codes identify potential variations with MS DRG code assignment Coding Scheme:^00 No errors. DRG successfully assigned.

(^11) Invalid Principal Diagnosis (^01) Diagnosis code cannot be used as principal diagnosis (^19) DisableHac = 0 and at least one HAC POA is invalid or exempt (^02) Record does not meet criteria for any DRG (^20) DisableHac is invalid and at least one HAC POA is N or U (^03) Invalid Age 21 DisableHac is invalid and at least one HAC POA is invalid or exempt (^04) Invalid Sex 22 DisableHac = 0 and at least one HAC POA is exempt (^05) Invalid Discharge Status 23 DisableHac is invalid and at least one HAC POA is exempt (^10) Illogical Principal Diagnosis (CMS only) (^24) DisableHac = 0 and there are multiple HACs that have different HAC POA values that are not Y, W, N, U (^11) Invalid Principal Diagnosis 25 DisableHac is invalid and there are multiple HACs that have different HAC POA values that are not Y or W Clinically Undetermined (^10) Illogical Principal Diagnosis (CMS only) Beginning Position: 854 **Data Source:**Assigned Length: 2 Type: Alphanumeric

Field 184: APR-MDC Major Diagnostic Category (MDC) as assigned by 3M APR-DRG Grouper. Beginning Position: 856 **Data Source:**Assigned Length: 2 Type: Alphanumeric
Field 185: APR-DRG All Patient Refined (APR) Diagnosis Related Group (DRG) as assigned by 3M APR-DRG Grouper Beginning Position: 858 **Data Source:**Assigned Length: 4 Type: Alphanumeric
Field 186: RISK_MORTALITY Assignment of a risk of mortality score from the All Patient Refined (APR) Diagnosis Related Group (DRG) from the 3M APR-DRG Grouper. Indicates the likelihood of dying. Coding Scheme: 1 Minor 2 Moderate 3 Major 4 Extreme Beginning Position:^862 **Data Source:**Assigned Length: 1 Type: Alphanumeric
Field 187: ILLNESS_SEVERITY Assignment of a severity of illness score from the All Patient Refined (APR) Diagnosis Related Group (DRG) from the 3M APR-DRG Grouper. Indicates the extent of physiologic decompensation. Coding Scheme: 1 Minor 2 Moderate 3 Major 4 Extreme Beginning Position: 863 **Data Source:**Assigned Length: 1 Type: Alphanumeric
Field 188: APR_GROUPER_VERSION_NBR 3M™ All Patient Refined Diagnosis Related Grouper version used to assign APR DRG codes, APR MDC codes, Risk of Mortality rankings and,Severity of Illness rankings

Beginning Position: 864 **Data Source:**Assigned Length: 5 Type: Alphanumeric

Field 189: APR_GROUPER_ERROR_CODE Error codes identify potential variations with APR DRG code assignment Coding Scheme:^00 No errors. DRG successfully assigned.

(^12) Gestational age/birth weight conflict (APR only) (^01) Diagnosis code cannot be used as principal diagnosis (^19) DisableHac = 0 and at least one HAC POA is invalid or exempt (^02) Record does not meet criteria for any DRG (^20) DisableHac is invalid and at least one HAC POA is N or U (^03) Invalid Age 21 DisableHac is invalid and at least one HAC POA is invalid or exempt (^04) Invalid Sex 22 DisableHac = 0 and at least one HAC POA is exempt (^05) Invalid Discharge Status 23 DisableHac is invalid and at least one HAC POA is exempt (^06) Invalid birthweight (AP & APR only) (^24) DisableHac = 0 and there are multiple HACs that have different HAC POA values that are not Y, W, N, U (^09) Invalid discharge age in days (AP & APR only) (^25) DisableHac is invalid and there are multiple HACs that have different HAC POA values that are not Y or W Clinically Undetermined (^11) Invalid Principal Diagnosis Beginning Position: 869 **Data Source:**Assigned Length: 2 Type: Alphanumeric

Field 190: ATTENDING_PHYSICIAN_UNIF_ID Attending Physician Uniform Identifier. Unique identifier assigned to the licensed physician expected to certify medical necessity of services rendered, with primary responsibility for the patient’s medical care and treatment. Physician is an individual licensed to practice medicine under the Medical Practice Act. Can include an individual other than a physician who admits patients to hospitals or who provides diagnostic or therapeutic procedures to inpatients, including psychologists, chiropractors, dentists, nurse practitioners, nurse midwives, and podiatrists authorized by the hospital to admit or treat patients. Suppression: Suppressed when the number of physicians represented in a DRG for a hospital is less than the minimum cell size of five. Beginning Position: 871 **Data Source:**Assigned Length: 10 Type: Alphanumeric
Field 191: OPERATING_PHYSICIAN_UNIF_ID Operating or other Physician Uniform Identifier (if applicable). Unique identifier assigned to the operating physician or physician other than the attending physician. Physician is an individual licensed to practice medicine under the Medical Practice Act. Can include an individual other than a physician who admits patients to hospitals or who provides diagnostic or therapeutic procedures to inpatients, including psychologists, chiropractors, dentists, nurse practitioners, nurse midwives, and podiatrists authorized by the hospital to admit or treat patients. Suppression: Suppressed when the number of physicians represented in a DRG for a hospital is less than the minimum cell size of five. Coding Scheme:^9999999998 Cell size less than 5 9999999999 Temporary license or license number could not be matched Beginning Position: 881 **Data Source:**Assigned Length: 10 Type: Alphanumeric
Field 192: ENCOUNTER_INDICATOR Description: Indicates the number of claims used to create the encounter Beginning Position: 891 **Data Source:**Calculated Length:^2 Type: Alphanumeric
Field 193: CERT_STATUS Assignment of a code to indicate the certification of data and submission of comments by the hospital. First available 3rd quarter 1999. Coding Scheme:^1 Certified, without comment 2 Certified, with comment 3 Certified, with comment, comment not received by deadline 4 Hospital elected not to certify 5 Hospital closed, data not certified 6 Hospital out of compliance, did not certify data Beginning Position: 893 **Data Source:**Assigned Length: 1 Type: Alphanumeric
Field 194: FILLER_SPACE Description: Indicates the number of claims used to create the encounter Beginning Position: 894 **Data Source:**Calculated Length: 57 Type: Alphanumeric

BASE DATA #2 FILE

Field 1: RECORD_ID Description: Record Identification Number. Unique number assigned to identify the record. First available 1 st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files (RDF’s). Beginning Position:^1 **Data Source:**Assigned Length: 12 Type: Alphanumeric
Field 2: PRIVATE_AMOUNT Description: Accommodation Charge, Private Room Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 11X, 14X Beginning Position: 13 **Data Source:**Calculated Length: 12 Type: Numeric
Field 3: SEMI_PRIVATE_AMOUNT Accommodation Charge, Semi-private Room Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 10X, 12X- 14X, 16X-19X Beginning Position: 25 **Data Source:**Calculated Length: 12 Type: Numeric
Field 4: WARD_AMOUNT Accommodation Charge, Ward Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 15X. Beginning Position: 37 **Data Source:**Calculated Length: 12 Type: Numeric
Field 5: ICU_AMOUNT Accommodation Charge, Intensive Care Unit Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 20X. Beginning Position: 49 **Data Source:**Calculated Length: 12 Type: Numeric
Field 6: CCU_AMOUNT Accommodation Charge, Coronary Care Unit Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 21X. Beginning Position: 61 **Data Source:**Calculated Length: 12 Type: Numeric
Field 7: OTHER_AMOUNT Ancillary Service Charge, Other Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 002-099, 22X- 24X, 52X-53X, 55X-60X, 64X-70X, 76X-78X, 90X-95X, 99X. Beginning Position: 73 **Data Source:**Calculated Length: 12 Type: Numeric
Field 8: PHARM_AMOUNT Ancillary Service Charge, Pharmacy Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 25X, 26X, and 63X. Beginning Position: 85 **Data Source:**Calculated Length: 12 Type: Numeric
Field 9: MEDSURG_AMOUNT Ancillary Service Charge, Medical/Surgical Supply Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 27X, 62X. Beginning Position: 97 **Data Source:**Calculated Length: 12 Type: Numeric
Field 10: DME_AMOUNT Ancillary Service Charge, Durable Medical Equipment Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue centers 290-292, 294-299. Beginning Position: 109 **Data Source:**Calculated Length: 12 Type: Numeric
Field 11: USED_DME_AMOUNT Ancillary Service Charge, Used Durable Medical Equipment Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100- 0219, revenue center 293. Beginning Position: 121 **Data Source:**Calculated Length: 12 Type: Numeric
Field 12: PT_AMOUNT Ancillary Service Charge, Physical Therapy Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 42X. Beginning Position: 133 **Data Source:**Calculated Length:^12 Type: Numeric
Field 13: OT_AMOUNT Ancillary Service Charge, Occupational Therapy Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 42X. Beginning Position:^145 **Data Source:**Calculated Length: 12 Type: Numeric
Field 14: SPEECH_AMOUNT Ancillary Service Charge, Speech Pathology^ Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 44X, 47X. Beginning Position: 157 **Data Source:**Calculated Length:^12 Type: Numeric
Field 15: IT_AMOUNT Ancillary Service Charge, Inhalation Therapy Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 41X, 46X. Beginning Position:^169 **Data Source:**Calculated Length: 12 Type: Numeric
Field 16: BLOOD_AMOUNT Ancillary Service Charge. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 38X. Beginning Position: 181 **Data Source:**Calculated Length: 12 Type: Numeric
Field 17: BLOOD_ADMIN_AMOUNT Ancillary Service Charge. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 39X. Beginning Position: 193 **Data Source:**Calculated Length: 12 Type: Numeric
Field 18: OR_AMOUNT Ancillary Service Charge, Operating Room Charge amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 36X, 71X-72X. Beginning Position: 205 **Data Source:**Calculated Length: 12 Type: Numeric
Field 19: LITH_AMOUNT Ancillary Service Charge, Lithotripsy Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 79X. Beginning Position: 217 **Data Source:**Calculated Length: 12 Type: Numeric
Field 20: CARD_AMOUNT Ancillary Service Charge, Cardiology Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 48X, 73X. Beginning Position: 229 **Data Source:**Calculated Length: 12 Type: Numeric
Field 21: ANES_AMOUNT Ancillary Service Charge, Anesthesia Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 37X. Beginning Position: 241 **Data Source:**Calculated Length: 12 Type: Numeric
Field 22: LAB_AMOUNT Ancillary Service Charge, Laboratory Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 30X-31X, 74X-75X. Beginning Position: 253 **Data Source:**Calculated Length:^12 Type: Numeric
Field 23: RAD_AMOUNT Ancillary Service Charge, Radiology Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 28X, 32X- 35X, 40X. Beginning Position:^265 **Data Source:**Calculated Length: 12 Type: Numeric
Field 24: MRI_AMOUNT Ancillary Service Charge, MRI Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 61X. Beginning Position:^277 **Data Source:**Calculated Length: 12 Type: Numeric
Field 25: OP_AMOUNT Ancillary Service Charge, Outpatient Services Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 49X-50X. Beginning Position: 289 **Data Source:**Calculated Length:^12 Type: Numeric
Field 26: ER_AMOUNT Ancillary Service Charge, Emergency Room Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 45X. Beginning Position: 301 **Data Source:**Calculated Length: 12 Type: Numeric
Field 27: AMBULANCE_AMOUNT Ancillary Service Charge, Ambulance Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 54X. Beginning Position: 313 **Data Source:**Calculated Length: 12 Type: Numeric
Field 28: PRO_FEE_AMOUNT Ancillary Service Charge, Professional Fee Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 96X-98X. Beginning Position: 325 **Data Source:**Calculated Length: 12 Type: Numeric
Field 29: ORGAN_AMOUNT Ancillary Service Charge, Organ Acquisition Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 81X, 89X. Beginning Position: 337 **Data Source:**Calculated Length: 12 Type: Numeric
Field 30: ESRD_AMOUNT Ancillary Service Charge, End Stage Renal Dialysis Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 80X, 82X-88X. Beginning Position: 349 **Data Source:**Calculated Length: 12 Type: Numeric
Field 31: CLINIC_AMOUNT Ancillary Service Charge, Clinic Visit Charge Amount. Calculated using MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center 51X. Beginning Position: 361 **Data Source:**Calculated Length:^12 Type: Numeric
Field 186: OCCUR_CODE_1 Code describing a significant event relating to the claim. Coding Scheme:^1 Auto accident^40 Scheduled date of admission 2 No Fault Insurance Involved - Including Auto Accident/Othe 41 Date of first test of pre-admission testing 3 Accident/ Tort Liability 42 Date of discharge (hospice only) 4 Accident/ Employment Related 43 Scheduled date of canceled surgery 5 Other accident 44 Date treatment started - OT 6 Crime Victim 45 Date treatment started - ST 9 Start of Infertility Treatment Cycle 46 Date treatment started - Cardiac rehabiliation 10 Last Menstrual Period 47 Date cost outlier status begins 11 Onset of Symptoms/ Illness A1 Birthdate - Insured A 12 Date of Onset for a Chronically Dependent Individual A2 Effective Date - Insured A Policy 16 Date of Last Therapy A3 Payer A benefits exhausted 17 Date Outpatient OT Plan Established or Last Reviewed A4 Split Bill Date 18 Date of Retirement - Patient/Beneficiary B1 Birthdate - Insured B 19 Date of Retirement - Spouse B2 Effective date - Insured B Policy 20 Date Guarantee of Payment Began B3 Payer B benefits exhausted 21 Date UR Notice Received C1 Birthdate - Insured C 22 Date Active Care Ended C2 Effective date - Insured C Policy 24 Date Insurance Denied C3^ Payer C benefits exhausted 25 Date Benefits Terminated by Primary Payer DR Katrina disaster related 26 Date SNF Bed Became Available E1 Birthdate - Insured D 27 Date Home Health Plan Established or Last Reviewd E2 Effective date - Insured D Policy 28 Date Comprehensive Outpatient Rehabilitation Plan Established or Last Reviewed E3 Payer D benefits exhausted 29 Date Outpatient PT Plan established or last reviewed F1 Birthdate - Insured E 30 Date Outpatient ST Plan established or last reviewed F2 Effective date - Insured E Policy 31 Date beneficiary notified of intent to bill (accommodations) F3 Payer E benefits exhausted 32 Date beneficiary notified of intent to bill (procedures or treatments) G1 Birthdate - Insured F 37 Date of inpatient hospital discharge for non-covered transplant patients G2 Effective date - Insured F Policy 38 Date treatment started for home IV therapy G3 Payer F benefits exhausted 39 Date discharged on a continuous course if IV therapy Beginning Position: 373 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 33: OCCUR_DAY_1 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 375 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 34: OCCUR_CODE_2 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 379 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 35: OCCUR_DAY_2 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 381 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 36: OCCUR_CODE_3 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 385 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 37: OCCUR_DAY_3 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 387 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 38: OCCUR_CODE_4 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 391 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 39: OCCUR_DAY_4 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 393 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 40: OCCUR_CODE_5 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 397 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 41: OCCUR_DAY_5 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 399 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 42: OCCUR_CODE_6 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 403 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 43: OCCUR_DAY_6 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 405 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 44: OCCUR_CODE_7 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 409 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 45: OCCUR_DAY_7 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 411 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 46: OCCUR_CODE_8 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 415 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 47: OCCUR_DAY_8 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 417 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 48: OCCUR_CODE_9 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 421 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 49: OCCUR_DAY_9 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 423 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 50: OCCUR_CODE_10 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 427 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 51: OCCUR_DAY_10 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 429 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 52: OCCUR_CODE_11 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 433 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 53: OCCUR_DAY_11 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 435 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 54: OCCUR_CODE_12 Code describing a significant event relating to the claim. Coding Scheme: Same as
Field 186. Beginning Position: 439 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 55: OCCUR_DAY_12 Occurrence Day equals Occurrence Date minus Admission/Start of Care Date. Beginning Position: 441 **Data Source:**Calculated Length: 4 Type: Alphanumeric
Field 56: OCCUR_SPAN_CODE_1 Code describing a significant event relating to the claim that may affect payer processing. Coding Scheme:^70 Qualifying stay dates (for SNF use only)^78 SNF prior stay dates 71 Prior stay dates 79 Payer use codes 72 First/Last Visit DR Katrina disaster related 73 Benefit eligibility period M0 PRO/UR approved stay dates 74 Noncovered level of care/Leave of absence M1 Provider liability - no utilization 75 SNF level of care M2 Inpatient respite dates 76 Patient Liability Period M3 ICF level of care 77 Provider Liability - Utilization Charged M4 Residential level of care Beginning Position: 445 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 57: OCCUR_SPAN_FROM_1 Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date. Beginning Position: 447 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 58: OCCUR_SPAN_THRU_1 Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date. Beginning Position: 453 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 59: OCCUR_SPAN_CODE_2 Code describing a significant event relating to the claim that may affect payer processing. Coding Scheme: Same as
Field 210. Beginning Position: 459 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 60: OCCUR_SPAN_FROM_2 Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date. Beginning Position: 461 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 61: OCCUR_SPAN_THRU_2 Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date. Beginning Position: 467 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 62: OCCUR_SPAN_CODE_3 Code describing a significant event relating to the claim that may affect payer processing. Coding Scheme: Same as
Field 210. Beginning Position: 473 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 63: OCCUR_SPAN_FROM_3 Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date. Beginning Position: 475 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 64: OCCUR_SPAN_THRU_3 Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date. Beginning Position: 481 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 65: OCCUR_SPAN_CODE_4 Code describing a significant event relating to the claim that may affect payer processing.

Coding Scheme: Same as

Field 210. Beginning Position: 487 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 66: OCCUR_SPAN_FROM_4 Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date. Beginning Position: 489 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 67: OCCUR_SPAN_THRU_4 Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date. Beginning Position: 495 **Data Source:**Calculated Length: 6 Type: Alphanumeric
Field 68: CONDITION_CODE_1 Code describing a condition relating to the claim. Coding Scheme: 1 Military service related^76 Back-up in facility dialysis 2 Condition is employment related 77 Provider accepts or is obligated/required due to a contractual arrangement or law to accept payment by a primary payer as payment 3 Patient covered by insurance not reflected here 78 New coverage not implemented by HMO 4 Information only bill. 79 CORF services provided offsite 5 Lien has been filed 80 Home dialysis - nursing facility 6 ESRD patient in first 18 months of entitlement covered by EGHP A0 CHAMPUS external partnership program 7 Treatment of non-terminal condition for hospice patient A1 EPSDT/CHAP 8 Beneficiary would not provide information concerning other insurance coverage A2 Physically handicapped children's program 9 Neither patient or spouse is employed A3 Special Federal Funding 10 Patient and/or spouse is employed but no EGHP exists A4 Family planning 11 Disabled beneficiary but no LGHP coverage exists A5 Disability 17 Patient is homeless A6 Vaccines/Medicare 100% payment 18 Maiden name retained A7 Induced abortion - danger to life 19 Child retains mother's name A8 Induced abortion - victim rape/incest 20 Beneficiary requested billing A9 Second opinion surgery 21 Billing for denial notice AA Abortion performed due to rape 22 Patient on multiple drug regimen AB^ Abortion performed due to incest 23 Home care giver available AC Abortion performed due to serious fatal genetic defect, deformity, or abnormality 24 Home IV patient also receiving HHA services^ AD Abortion performed due to life endangering physical condition caused by, arising from or exacerbated by the pregnancy itself 25 Patient is non-US resident AE Abortion performed due to physical health of mother that is not life endangering 26 VA eligible patient chooses to receive services in a Medicare certified facility AF Abortion performed due to emotional/psychological health of mother 27 Patient referred to a sole community hospital for a diagnostic laboratory test AG Abortion performed due to social or economic reasons 28 Patient and/or spouse's EGHP is secondary to Medicare AH Elective abortion 29 Disabled beneficiary and/or family member's LGHP is secondary to Medicare AI Sterilization 30 Non-research services provided to patients enrolled in a qualified clinical trial AJ Payer responsible for co-payment 31 Patient is student (full time - day)^ AJ Payer responsible for co-payment 32 Patient is student (cooperative/work study program) AK Air ambulance required 33 Patient is student (full time - night) AL Specialized treatment/bed unavailable 34 Patient is student (part-time) AM Non-emergency medically necessary stretcher transport required 36 General care patient in a special unit AN Pre-admission screening not required 37 Ward accommodation at patient request B0 Medicare coordinated care demonstration claim 38 Semi-private room not available B1 Beneficiary is ineligible for demonstration program 39 Private room medically necessary B2 Critical access hospital ambulance attestation 40 Same day transfer B3 Pregnancy indicator 41 Partial hospitalization B4 Admission unrelated to discharge on same day 42 Continuing care not related to inpatient admission C1 Approved as billed 43 Continuing care not provided within prescribed postdischarge windoW Clinically Undetermined C2 Automatic approval as billed based on focused revieW Clinically Undetermined 44 Inpatient admission changed to outpatient C3 Partial approval 45 Reserved C4 Admission/services denied 46 Non-availability statement on file C5 Postpayment review applicable 47 Reserved for CHAMPUS C6 Admission Preauthorization 48 Psychiatric residential treatment centers for children and adolescents (RTCs) C7 Extended Authorization 49 Product replacement within product lifecycle D0 Changes to Service Dates 55 SNF bed not available D1 Changes to Charges 56 Medical appropriateness D2 Changes in Revenue Codes/HCPCS/HIPPS rate code 57 SNF readmission D3 Second or Subsequent Interim PPS Bill 58 Terminated Medicare+Choice organization enrollee D4 Change in ICD-9-CM diagnosis and/or procedure codes. 59 Non-primary ESRD facility D5 Cancel to correct HICN or Provider ID 60 Day outlier D6 Cancel Only to Repay a Duplicate or OIG Overpayment 61 Cost outlier D7 Change to Make Medicare the Secondary Payer 66 Provider does not wish cost outlier payment D8^ Change to Make Medicare the Primary Payer 67 Beneficiary elects not to use life time reserve (LTR) days D9 Any Other Change 68 Beneficiary elects to use life time reserve (LTR) days DR Katrina disaster related 69 IME/DGME/N&AH Payment Only E0 Changes in Patient Status 70 Self-administered anemia management drug G0 Distinct Medical Visit 71 Full care in unit H0 Delayed Filing, Statement of Intent Submitted 72 Self care in unit M0 All inclusive rate for outpatient services 73 Self care training M1 Roster billed influenza virus vaccine or pneumococcal pneumonia vaccine (PPV) 74 Home M2 HHA payment significantly exceeds total charges 75 Home - 100% reimbursement P1 Do not Resuscitate Order (DNR) WO United Mine Workers of America (UMWA) Demonstration Indicator Beginning Position: 501 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 69: CONDITION_CODE_2 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 503 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 70: CONDITION_CODE_3 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 505 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 71: CONDITION_CODE_4 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 507 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 72: CONDITION_CODE_5 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 509 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 73: CONDITION_CODE_6 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 511 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 74: CONDITION_CODE_7 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 513 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 75: CONDITION_CODE_8 Code describing a condition relating to the claim. Coding Scheme: Same as
Field 68. Beginning Position: 515 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 76: VALUE_CODE_1 Code describing information that may affect payer processing. Coding Scheme:^1 Most common semi-private rate^66 Medicaid spenddown amount 2 Hospital has no semi-private rooms 67 Peritoneal dialysis 4 Inpatient professional component charges which are combined billed

68 EPO-drug 5 Professional component included in charges and also billed separately to carrier 69 State charity care percentage 6 Medicare blood deductible 72 Flat rate surgery charge 8 Medicare life time reserve amount in the first calendar year 73 Drug deductible 9 Medicare coinsurance amount in the first calendar year 74 Drug coinsurance 10 Medicare lifetime reserve amount in the second calendar year 77 New technology add-on payment 11 Medicare coinsurance amount in the second calendar year A0 Special zip code reporting 12 Working aged beneficiary/spouse with employer group health plan A1 Deductible payer A 13 ESRD beneficiary in a Medicare coordination period with an employer group health plan A2 Coinsurance payer A 14 No fault, including auto/other^ A3 Estimated responsibility payer A 15 Worker's compensation A4 Covered self-administrable drugs - emergency 16 Public health service (PHS) or other federal agency

A5 Covered self-administrable drugs - administrable in form and situation furnished to patient 21 Catastrophic A6 Covered self-administrable drugs - diagnostic study and other 22 Surplus A7 Co-payment payer A 23 Recurring monthly income A8 Patient weight 24 Medicaid Rate Code A9 Patient height 25 Offset to the patient - payment amount - prescription drugs

AA Regulatory surcharges, assessments, allowances or health care related taxes - payer A 26 Offset to the patient - payment amount - hearing and ear services

AB Other assessments or allowances (e.g., medical eduction) - payer A 27 Offset to the patient - payment amount - vision and eye services

B1 Deductible payer B 28 Offset to the patient - payment amount - dental services

B2 Coinsurance payer B 29 Offset to the patient - payment amount - chiropractic services

B3 Estimated responsibility payer B 30 Preadmission testing B7 Co-payment payer B 31 Patient Liability Amount BA Regulatory surcharges, assessments, allowances or health care related taxes - payer B 32 Multiple patient ambulance transport BB Other assessments or allowances (e.g., medical eduction) - payer B 33 Offset to the patient - payment amount - podiatric services C1 Deductible payer C 34 Offset to the patient - payment amount - other medical services C2 Coinsurance payer C 35 Offset to the patient - payment amount - health insurance premiums

C3 Estimated responsibility payer C 37 Pints of blood furnished C7 Co-payment payer C 38 Blood deductible pints CA Regulatory surcharges, assessments, allowances or health care related taxes - payer C 39 Pints of blood replaced CB Other assessments or allowances (e.g., medical eduction) - payer C 40 New coverage not implemented by HMO D3 Patient estimated responsibility 41 Black lung DR Katrina disaster related 42 VA E1 Deductible Payer D 43 Disabled beneficiary under age 65 with LGHP E2 Coinsurance Payer D 44 Amount provider agreed to accept from primary payer when this amount is less than charges but higher than payment received

E3 Coinsurance Payer D 45 Accident hour E7 Co-payment payer D 46 Number of grace days EA Regulatory surcharges, assessments, allowances or health care related taxes - payer D 47 Any liability insurance EB Other assessments or allowances (e.g. medical education) - payer D 48 Hemoglobin reading F1 Deductible Payer E 49 Hematocrit reading F2^ Coinsurance Payer E 50 PT visits F3 Coinsurance Payer E 51 OT visits F7 Co-payment payer E 52 ST visits FA Regulatory surcharges, assessments, allowances or health care related taxes - payer E 53 Cardiac rehab visits FB Other assessments or allowances (e.g. medical education) - payer E 54 Newborn birth weight in grams G1 Deductible Payer F 55 Eligibility threshold for charity care G1 Deductible Payer F 56 Skilled nurse - home visit hours G2 Coinsurance Payer F 57 Home health aide - home visit hours G3 Coinsurance Payer F 58 Arterial blood gas G7 Co-payment payer F 59 Oxygen saturation GA Regulatory surcharges, assessments, allowances or health care related taxes - payer F 60 HHA branch MSA GB Other assessments or allowances (e.g. medical education) - payer F 61 Location where service is furnished (HHA and hospice)

P1 Do not resuscitate order (DNR) Y1 Part A Demonstration Payment Y2 Part B Demonstration Payment Y3 Part B Coinsurance Y4 Conventional Provider Payment Amount for Non-Demonstration Claims Beginning Position: 517 **Data Source:**Claim Length: 2 Type: Alphanumeric

Field 77: VALUE_AMOUNT_1 Dollar amount that may be affected. Beginning Position: 519 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 78: VALUE_CODE_2 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 222. Beginning Position: 528 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 79: VALUE_AMOUNT_2 Dollar amount that may be affected. Beginning Position: 530 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 80: VALUE_CODE_3 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 539 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 81: VALUE_AMOUNT_3 Dollar amount that may be affected. Beginning Position: 541 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 82: VALUE_CODE_4 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 550 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 83: VALUE_AMOUNT_4 Dollar amount that may be affected. Beginning Position: 552 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 84: VALUE_CODE_5 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 561 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 85: VALUE_AMOUNT_5 Dollar amount that may be affected. Beginning Position: 563 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 86: VALUE_CODE_6 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 572 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 87: VALUE_AMOUNT_6 Dollar amount that may be affected. Beginning Position: 574 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 88: VALUE_CODE_7 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 583 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 89: VALUE_AMOUNT_7 Dollar amount that may be affected. Beginning Position: 585 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 90: VALUE_CODE_8 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 594 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 91: VALUE_AMOUNT_8 Dollar amount that may be affected. Beginning Position: 596 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 92: VALUE_CODE_9 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 605 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 93: VALUE_AMOUNT_9 Dollar amount that may be affected. Beginning Position: 607 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 94: VALUE_CODE_10 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 616 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 95: VALUE_AMOUNT_10 Dollar amount that may be affected. Beginning Position: 618 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 96: VALUE_CODE_11 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 627 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 97: VALUE_AMOUNT_11 Dollar amount that may be affected. Beginning Position: 629 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 98: VALUE_CODE_12 Code describing information that may affect payer processing. Coding Scheme: Same as
Field 76. Beginning Position: 638 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 99: VALUE_AMOUNT_12 Dollar amount that may be affected. Beginning Position: 640 **Data Source:**Claim Length: 9 Type: Alphanumeric
Field 100: FILLER_SPACE

Beginning Position: 649 **Data Source:**Claim Length: 52 Type: Alphanumeric

CHARGES DATA FILE

Field 1: RECORD_ID Description: Record Identification Number. Unique number assigned to identify the record. First available 1 st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files (RDF’s). Beginning Position:^1 **Data Source:**Assigned Length: 12 Type: Alphanumeric
Field 2: REVENUE_CODE Description: Code corresponding to each specific accommodation, ancillary service or billing calculation related to the services being billed. Coding Scheme:^0100 All-inclusive room charges plus ancillary^0516 Clinic - urgent care 0101 All-inclusive room charges 0517 Clinic - family practice 0110 Room charges for private rooms - general 0519 Clinic - other 0111 Room charges for private rooms - medical/surgical/GYN

0520 Freestanding Clinic - general 0112 Room charges for private rooms - obstetrics 0521 Freestanding Clinic - Clinic Visit by Member to RHC/FQHC 0113 Room charges for private rooms - pediatric 0522 Freestanding Clinic - Home Visit by RHC/FQHC Practitioner 0114 Room charges for private rooms - psychiatric 0523 Freestanding Clinic - family practice 0115 Room charges for private rooms - hospice 0524 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a Covered Part A Stay at SNF 0116 Room charges for private rooms - detoxification 0525 Freestanding Clinic - Visit by RHC/FQHC Practitioner to a Member in a SNF (not Covered Part A Stay) or NF or ICF MR or Other Residential Facility 0117 Room charges for private rooms - oncology 0526 Freestanding Clinic - urgent care 0118 Room charges for private rooms - rehabilitation 0527 Freestanding Clinic - Visiting Nurse Services(s) to a Member's Home when in a Home Health Shortage Area 0119 Room charges for private rooms - other 0528 Freestanding Clinic – Visit by RHC/FQHC Practitioner to Other non RHC/FQHC Site (e.g. Scene of Accident) 0120 Room charges for semi-private rooms - general 0529 Freestanding Clinic - other 0121 Room charges for semi-private rooms - medical/surgical/GYN 0530 Osteopathic service - general 0122 Room charges for semi-private rooms - obstetrics 0531 Osteopathic service - therapy 0123 Room charges for semi-private rooms - pediatric

0539 Osteopathic service - other 0124 Room charges for semi-private rooms - psychiatric

0540 Ambulance service - general 0125 Room charges for semi-private rooms - hospice^0541 Ambulance service - supplies 0126 Room charges for semi-private rooms - detoxification

0542 Ambulance service - medical transport 0127 Room charges for semi-private rooms - oncology

0543 Ambulance service - heart mobile 0128 Room charges for semi-private rooms - rehabilitation

0544 Ambulance service - oxygen 0129 Room charges for semi-private rooms - other^0545 Ambulance service - air ambulance 0130 Room charges for semi-private - 3/4 beds - rooms - general

0546 Ambulance service - neonatal 0131 Room charges for semi-private - 3/4 beds - rooms - medical/surgical/GYN

0547 Ambulance service - pharmacy 0132 Room charges for semi-private - 3/4 beds - rooms - obstetrics

0548 Ambulance service - telephone transmission EKG 0133 Room charges for semi-private - 3/4 beds - rooms - pediatric

0549 Ambulance service - other 0134 Room charges for semi-private - 3/4 beds - rooms - psychiatric

0550 Skilled nursing - general 0135 Room charges for semi-private - 3/4 beds - rooms - hospice

0551 Skilled nursing - visit charge 0136 Room charges for semi-private - 3/4 beds - rooms - detoxification

0552 Skilled nursing - hourly charge 0137 Room charges for semi-private - 3/4 beds - rooms - oncology

0559 Skilled nursing - other 0138 Room charges for semi-private - 3/4 beds - rooms - rehabilitation

0560 Medical social services - general 0139 Room charges for semi-private - 3/4 beds - rooms - other

0561 Medical social services - visit charge 0140 Room charges for private (deluxe) rooms - general

0562 Medical social services - hourly charge 0141 Room charges for private (deluxe) rooms - medical/surgical/GYN

0569 Medical social services - other 0142 Room charges for private (deluxe) rooms - obstetrics

0570 Home health aide - general 0143 Room charges for private (deluxe) rooms - pediatric

0571 Home health aide - visit charge 0144 Room charges for private (deluxe) rooms - psychiatric

0572 Home health aide - hourly charge 0145 Room charges for private (deluxe) rooms - hospice

0579 Home health aide - other 0146 Room charges for private (deluxe) rooms - detoxification

0580 Other visits (home health) - general 0147 Room charges for private (deluxe) rooms - oncology

0581 Other visits (home health) - visit charge 0148 Room charges for private (deluxe) rooms - rehabilitation

0582 Other visits (home health) - hourly charge 0149 Room charges for private (deluxe) rooms - other

0583 Other visits (home health) - assessment 0150 Room charges for ward rooms - general^0589 Other visits (home health) - other 0151 Room charges for ward rooms - medical/surgical/GYN

0590 Units of service (home health) - general 0152 Room charges for ward rooms - obstetrics^0599 Units of service (home health) - other 0153 Room charges for ward rooms - pediatric^0600 Oxygen (home health) - general 0154 Room charges for ward rooms - psychiatric^0601 Oxygen (home health) - stat/equip/supply or contents 0155 Room charges for ward rooms - hospice^0602 Oxygen (home health) - stat/equip/supply under 1 liter per minute 0156 Room charges for ward rooms - detoxification^0603 Oxygen (home health) - stat/equip/supply over 4 liters per minute 0157 Room charges for ward rooms - oncology^0604 Oxygen (home health) - portable add-in 0158 Room charges for ward rooms - rehabilitation^0610 MRI - general 0159 Room charges for ward rooms - other^0611 MRI - brain (including brain stem) 0160 Room charges for other rooms - general^0612 MRI - spinal cord (including spine) 0161 Room charges for other rooms - medical/surgical/GYN

0619 MRI - other 0162 Room charges for other rooms - obstetrics^0621 Medical/surgical supplies - incident to radiology 0163 Room charges for other rooms - pediatric^0622 Medical/surgical supplies - incident to other diagnostic services 0164 Room charges for other rooms - psychiatric^0623 Medical/surgical supplies - surgical dressings 0165 Room charges for other rooms - hospice^0624 Medical/surgical supplies - FDA investigational devices 0166 Room charges for other rooms - detoxification^0630 Drugs requiring specific identification - general 0167 Room charges for other rooms - oncology^0631 Drugs requiring specific identification - single source 0168 Room charges for other rooms - rehabilitation^0632 Drugs requiring specific identification - multiple source 0169 Room charges for other rooms - other^0633 Drugs requiring specific identification - restrictive prescription 0170 Room charges for nursery - general^0634 Drugs requiring specific identification - EPO, less than 10,000 units 0171 Room charges for nursery - newborn level I^0635 Drugs requiring specific identification - EPO, 10,000 or more units 0172 Room charges for nursery - newborn level II^0636 Drugs requiring specific identification - requiring detailed coding 0173 Room charges for nursery - newborn level III^0637 Drugs requiring specific identification - self- adminstrable nto requiring detailed coding 0174 Room charges for nursery - newborn level IV^0640 Home IV therapy services - general 0179 Room charges for nursery - other^0641 Home IV therapy services - nonroutine nursing, central line 0180 Room charges for LOA - general^0642 Home IV therapy services - IV site care, central line 0182 Room charges for LOA - patient convenice- charges billable 0643 Home IV therapy services - IV start/change, peripheral line 0183 Room charges for LOA - therapeutic leave^0644 Home IV therapy services - nonroutine nursing, peripheral line 0184 Room charges for LOA - ICF mentally retarded - any reason 0645 Home IV therapy services - training patient/caregiver, central line 0185 Room charges for LOA - hospitalization^0646 Home IV therapy services - traning, disabled patient, central line 0189 Room charges for LOA - other^0647 Home IV therapy services - training, patient/caregiver, peripheral 0190 Room charges for subacute care - general^0648 Home IV therapy services - training, disabled patient, peripheral 0191 Room charges for subacute care - Level I (skilled care)

0649 Home IV therapy services - other 0192 Room charges for subacute care - Level II (comprehensive care)

0650 Hospice services - general 0193 Room charges for subacute care - Level III (complex care)

0651 Hospice services - routine home care 0194 Room charges for subacute care - Level IV (intensive care)

0652 Hospice services - continuous home care 0199 Room charges for subacute care - other^0655 Hospice services - inpatient respite care 0200 Room charges for intensive care - general^0656 Hospice services - general inpatient care (nonrespite) 0201 Room charges for intensive care - surgical^0657 Hospice services - physician services 0202 Room charges for intensive care - medical^0658 Hospice services - room and board - nursing facility 0203 Room charges for intensive care - pediatric^0659 Hospice services - other 0204 Room charges for intensive care - psychiatric^0660 Respite care - general 0206 Room charges for intensive care - intermediate intensive care unit (ICU)

0661 Respite care - hourly charge/skilled nursing 0207 Room charges for intensive care - burn care^0662 Respite care - hourly charge/aide/homemaker/companion 0208 Room charges for intensive care - trauma^0663 Respite care - daily charge 0209 Room charges for intensive care - other^0669 Respite care - other 0210 Room charges for coronary care - general^0670 Outpatient special residence - general 0211 Room charges for coronary care - myocardial infarction

0671 Outpatient special residence - hospital based 0212 Room charges for coronary care - pulmonary care

0672 Outpatient special residence - contracted 0213 Room charges for coronary care - heart transplant

0679 Outpatient special residence - other 0214 Room charges for coronary care - intermediate coronary care unit (CCU)

0681 Trauma response - level I 0219 Room charges for coronary care - other^0682 Trauma response - level II 0220 Special charges - general^0683 Trauma response - level III 0221 Special charges - admission charge^0684 Trauma response - level IV 0222 Special charges - technical support charge^0689 Trauma response - other 0223 Special charges - UR service charge^0700 Cast Room services - general 0224 Special charges - late discharge, medically necessary

0709 Cast Room services - other 0229 Special charges - other^0710 Recovery Room services - general 0230 Incremental nursing care - general^0719 Recovery Room services - other 0231 Incremental nursing care - nursery^0720 Labor/Delivery Room services - general 0232 Incremental nursing care - OB^0721 Labor/Delivery Room services - labor 0233 Incremental nursing care - ICU (includes transitional care)

0722 Labor/Delivery Room services - delivery 0234 Incremental nursing care - CCU (includes transitional care)

0723 Labor/Delivery Room services - circumcision 0235 Incremental nursing care - hospice^0724 Labor/Delivery Room services - birthing center 0239 Incremental nursing care - other^0729 Labor/Delivery Room services - other 0240 All-inclusive ancillary - general^0730 EKG/ECG services - general 0249 All-inclusive ancillary - other^0731 EKG/ECG services - holter monitor 0250 Pharmacy - general^0732 EKG/ECG services - telemetry 0251 Pharmacy - generic drugs^0739 EKG/ECG services - other 0252 Pharmacy - nongeneric drugs^0740 EEG services - general 0253 Pharmacy - take-home drugs^0749 EEG services - other 0254 Pharmacy - drugs incident to other diagnostic services

0750 Gastrointestinal services - general 0255 Pharmacy - drugs incident to radiology^0759 Gastrointestinal services - other 0256 Pharmacy - experimental drugs^0760 Treatment or observation room services - general 0257 Pharmacy - nonprescription^0761 Specialty Room - Treatment/ Observation Room

Treatment Room 0258 Pharmacy - IV solutions^0762 Specialty Room - Treatment/ Observation Room
Observation Room 0259 Pharmacy - other^ 0260 IV Therapy - general^0769 Treatment or observation room services - other 0261 IV Therapy - infusion pump^0770 Preventive care services - general 0262 IV Therapy - pharmacy services^0771 Preventive care services - vaccine administration 0263 IV Therapy - durg/supply delivery^0779 Preventive care services - other 0264 IV Therapy - supplies^0780 Telemedicine services - general 0269 IV Therapy - other^0789 Telemedicine services - other 0270 Medical surgical supplies and devices - general^0790 Extra-corporeal shockwave therapy - general 0271 Medical surgical supplies and devices - nonsterile

0799 Extra-corporeal shockwave therapy - other 0272 Medical surgical supplies and devices - sterile^ 0273 Medical surgical supplies and devices - take- home 0274 Medical surgical supplies and devices - prosthetic/orthotic

0800 Inpatient renal dialysis services - general 0275 Medical surgical supplies and devices - pacemaker

0801 Inpatient renal dialysis services - hemodialysis 0276 Medical surgical supplies and devices - intraocular lens (IOL)

0802 Inpatient renal dialysis services - peritoneal (non-CAPD) 0277 Medical surgical supplies and devices - oxygen

take-home

0803 Inpatient renal dialysis services - continuous ambulatory peritoneal dialysis (CAPD) 0278 Medical surgical supplies and devices - other implants

0804 Inpatient renal dialysis services - continuous cycling peritoneal dialysis (CAPD) 0279 Medical surgical supplies and devices - other^0809 Inpatient renal dialysis services - other 0280 Oncology - general^0810 Organ acquisition - general 0289 Oncology - other^0811 Organ acquisition - living donor 0290 DME - general^0812 Organ acquisition - cadaver donor 0291 DME - rental 0813 Organ acquisition - unknown donor 0292 DME - purchase of new^0814 Organ acquisition - unsuccessful organ search- donor bank charges 0293 DME - purchase of used^0819 Organ acquisition - other donor 0294 DME - supplies/drugs for DME effectiveness^0820 Hemodialysis - outpatient or home - general 0299 DME - other equipment^0821 Hemodialysis - outpatient or home - composite or other rate 0300 Laboratory - general^0825 Hemodialysis - outpatient or home - support services 0301 Laboratory - chemistry 0829 Hemodialysis - outpatient or home - other 0302 Laboratory - immunology^0830 Peritoneal dialysis - outpatient or home - general 0303 Laboratory - renal patient (home)^0831 Peritoneal dialysis - outpatient or home - composite or other rate 0304 Laboratory - nonroutine dialysis^0835 Peritoneal dialysis - outpatient or home - support services 0305 Laboratory - hemotology^0839 Peritoneal dialysis - outpatient or home - other 0306 Laboratory - bacteriology and microbiology^0840 CAPD - outpatient or home - general 0307 Laboratory - urology^0841 CAPD - outpatient or home - composite or other rate 0309 Laboratory - other^0845 CAPD - outpatient or home - support services 0310 Laboratory pathological - general^0849 CAPD - outpatient or home - other 0311 Laboratory pathological - cytology^0850 CCPD - outpatient or home - general 0312 Laboratory pathological - histology^0851 CCPD - outpatient or home - composite or other rate 0313 Laboratory pathological - biopsy^0855 CCPD - outpatient or home - support services 0319 Laboratory pathological - other^0859 CCPD - outpatient or home - other 0320 Radiology - diagnostic - general^0880 Miscellaneous dialysis - general 0321 Radiology - diagnostic - angiocardiography 0881 Miscellaneous dialysis - ultrafiltration 0322 Radiology - diagnostic - arthrography^0882 Miscellaneous dialysis - home aide visit 0323 Radiology - diagnostic - arteriography^0889 Miscellaneous dialysis - other 0324 Radiology - diagnostic - chest x-ray^0900 Behavior health reatments/services - general 0329 Radiology - diagnostic - other^0901 Behavior health treatments/services - electroshock 0330 Radiology - therapeutic and/or chemotherapy adminstration - general

0902 Behavior health treatments/services - milieu therapy 0331 Radiology - therapeutic and/or chemotherapy adminstration - chemotherapy - injected

0903 Behavioral health treatments/services - play therapy 0332 Radiology - therapeutic and/or chemotherapy adminstration - chemotherapy - oral

0904 Behavior health treatments/services - activity therapy 0333 Radiology - therapeutic and/or chemotherapy adminstration - radiation therapy

0905 Behavior health treatments/services - intensive outpatient services - psychiatric 0335 Radiology - therapeutic and/or chemotherapy adminstration - chemotherapy - IV

0906 Behavior health treatments/services - intensive outpatient services - chemical dependency 0339 Radiology - therapeutic and/or chemotherapy adminstration - other

0907 Behavior health treatments/services - community behavioral health program 0340 Nuclear medicine - general 0909 Behavior health treatments - other 0341 Nuclear medicine - diagnostic procedures^0910 Reserved 0342 Nuclear medicine - therapeutic procedures^0911 Behavior health treatment/services - rehabilitation 0343 Nuclear medicine - diagnostic radiopharmaceuticals

0912 Behavior health treatment/services - partial hospitalization - less intensive 0344 Nuclear medicine - therapeutic radiopharmaceuticals

0913 Behavior health treatment/services - partial hospitalization - intensive 0349 Nuclear medicine - other 0914 Behavior health treatment/services - individual therapy 0350 CT scan - general^0915 Behavior health treatment/services - group therapy 0351 CT scan - head^0916 Behavior health treatment/services - family therapy 0352 CT scan - body^0917 Behavior health treatment/services - biofeedback 0359 CT scan - other^0918 Behavior health treatment/services - testing 0360 Operating room services - general^0919 Behavior health treatment/services - other 0361 Operating room services - minor surgery 0920 Other diagnostic services - general 0362 Operating room services - organ transplant other than kidney

0921 Other diagnostic services - peripheral vascular lab 0367 Operating room services - kidney transplant^0922 Other diagnostic services - electromyelogram 0369 Operating room services - other^0923 Other diagnostic services - pap smear 0370 Anesthesia - general^0924 Other diagnostic services - allergy test 0371 Anesthesia - incident to radiology^0925 Other diagnostic services - pregnancy test 0372 Anesthesia - incident to other diagnostic services

0929 Other diagnostic services - other 0374 Anesthesia - acupuncture^0931 Medical rehabilitation day program - half day 0379 Anesthesia - other^0932 Medical rehabilitation day program - full day 0380 Blood - general^0940 Other therapeutic services - general 0381 Blood - packed red cells^0941 Other therapeutic services - recreational therapy 0382 Blood - whole blood^0942 Other therapeutic services - education/training 0383 Blood - plasma^0943 Other therapeutic services - cardiac rehabilitation 0384 Blood - platelets^0944 Other therapeutic services - drug rehabilitation 0385 Blood - leukocytes^0945 Other therapeutic services - alcohol rehabilitation 0386 Blood - other components^0946 Other therapeutic services - complex medical equipment - routine 0387 Blood - other derivatives (cryoprecipitates)^0947 Other therapeutic services - complex medical equipment - ancillary 0389 Blood - other^0949 Other therapeutic services - other 0390 Blood amd blood component administration, storage and processing - general

0960 Professional fees - general 0391 Blood and blood component administration, storage and processing - administration

0961 Professional fees - psychiatric 0399 Blood and blood component administration, storage and processing - other

0962 Professional fees - ophthalmology 0400 Other imaging services - general^0963 Professional fees - anesthesiologist (MD) 0401 Other imaging services - diagnostic mammography

0964 Professional fees - anesthetist (CRNA) 0402 Other imaging services - ultrasound^0969 Professional fees - other 0403 Other imaging services - screening mammography

0970 Professional fees - general 0404 Other imaging services - PET^0971 Professional fees - laboratory 0409 Other imaging services - other^0972 Professional fees - radiology - diagnostic 0410 Respiratory services - general^0973 Professional fees - radiology - therapeutic 0412 Respiratory services - inhalation^0974 Professional fees - readiology - nuclear medicine 0413 Respiratory services - hyperbaric oxygen therapy

0975 Professional fees - operating room 0419 Respiratory services - other^0976 Professional fees - respiratory therapy 0420 Physical therapy - general^0977 Professional fees - physical therapy 0421 Physical therapy - visit charge^0978 Professional fees - occupational therapy 0422 Physical therapy - hourly charge^0979 Professional fees - speech therapy 0423 Physical therapy - group rate^0980 Professional fees - general 0424 Physical therapy - evaluation or reevaluation^0981 Professional fees - emergency room 0429 Physical therapy - other^0982 Professional fees - outpatient services 0430 Occupational therapy - general^0983 Professional fees - clinic 0431 Occupational therapy - visit charge^0984 Professional fees - medical social services 0432 Occupational therapy - hourly charge^0985 Professional fees - EKG 0433 Occupational therapy - group rate^0986 Professional fees - EEG 0434 Occupational therapy - evaluation or reevaluation

0987 Professional fees - hospital visit 0439 Occupational therapy - other^0988 Professional fees - consultation 0440 Speech-language pathology - general^0989 Professional fees - private duty nurse 0441 Speech-language pathology - visit charge^0990 Patient convenience items - general 0442 Speech-language pathology - hourly charge^0991 Patient convenience items - cafeteria/guest tray 0443 Speech-language pathology - group rate^0992 Patient convenience items - private linen service 0444 Speech-language pathology - evaluation or reevaluation

0993 Patient convenience items - telephone/telegraph 0449 Speech-language pathology - other^0994 Patient convenience items - TV/radio 0450 Emergency room - general^0995 Patient convenience items - nonpatient room rentals 0451 Emergency room - EMTALA emergency medical screening services

0996 Patient convenience items - late discharge charge 0452 Emergency room - beyond EMTALA screening^0997 Patient convenience items - admission kits 0456 Emergency room - urgent care^0998 Patient convenience items - beauty shop/barber 0459 Emergency room - other^0999 Patient convenience items - other 0460 Pulmonary function - general 1000 Behavior health accommodations - general 0469 Pulmonary function - other^1001 Behavior health accommodations - residential treatment - psychiatric 0470 Audiology - general^1002 Behavior health accommodations - residential treatment - chemical dependency 0471 Audiology - diagnostic^1003 Behavior health accommodations - supervised living 0472 Audiology - treatment^1004 Behavior health accommodations - halfway house 0479 Audiology - other^1005 Behavior health accommodations - group home 0480 Cardiology - general^2100 Alternative therapy services - general 0481 Cardiology - cardiac cath lab^2101 Alternative therapy services - acupuncture 0482 Cardiology - stress test^2102 Alternative therapy services - acupressure 0483 Cardiology - echocardiology^2103 Alternative therapy services - massage 0489 Cardiology - other^2104 Alternative therapy services - reflexology 0490 Ambulatory surgical care - general^2105 Alternative therapy services - biofeedback 0499 Ambulatory surgical care - other^2106 Alternative therapy services - hypnosis 0500 Outpatient services - general^2109 Alternative therapy services - other 0509 Outpatient services - other^3101 Adult day care, medical and social - hourly 0510 Clinic - general^3102 Adult day care, social - hourly 0511 Clinic - chronic pain^3103 Adult day care, medical and social - daily 0512 Clinic - dental^3104 Adult day care, social - daily 0513 Clinic - psychiatric^3105 Adult foster care - daily 0514 Clinic - OB/GYN^3109 Adult foster care - other 0515 Clinic - pediatric^ Beginning Position: 13 **Data Source:**Claim Length: 4 Type: Alphanumeric

Field 3: HCPCS_QUALIFIER Description: Beginning Position: 17 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 4 HCPCS_PROCEDURE_CODE Description: HCFA Common Procedure Coding System (HCPCS) code applicable to ancillary services or accommodations. Coding Scheme: See [http: www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp](http: www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp) for complete list. Beginning Position: 19 **Data Source:**Claim Length: 5 Type: Alphanumeric
Field 5: MODIFIER_1 Description: Identifies special circumstances related to the performance of the service Coding Scheme:^0 No assessment completed F2 Left hand, third digit 1 Medicare 5 day assessment (full) F3 Left hand, fourth digit 2 Medicare 30 day assessment (full) F4 Left hand, fifth digit 3 Medicare 60 day assessment (full) F5 Right hand, thumb 4 Medicare 90 day assessment (full) F6 Right hand, second digit 7 Medicare 14 day assessment (comprehensive or full)

F7 Right hand, third digit 8 Other Medicare required assessment (OMRA) F8 Right hand, fourth digit 11 Admission assessment - Medicare 5 day assessment (comprehensive) F9 Right hand, fifth digit 25 Significant, separately identifiable evaluation and management service by the same physician on the same day of the procedure o FA Left hand, thumb 31 SCSA or OMRA/Medicare 5 day assessment (replacement) G1 Most recent URR of less than 60% 32 SCSA or OMRA/Medicare 30 day assessment (replacement) G2 Most recent URR of 60% to 64% 33 SCSA or OMRA/Medicare 60 day assessment (replacement)

G3 Most recent URR of 65% to 69.9% 34 SCSA or OMRA/Medicare 90 day assessment (replacement)

G4 Most recent URR of 70% to 74.9% 37 SCSA or OMRA/Medicare 14 day assessment (replacement)

G5 Most recent URR of 75% or greater 38 Significant change in status assessment (SCSA) GN Service delivered personally by a speech- language pathologist or under an outpatient speech-language pathology plan of care. 41 Significant correction of prior full assessment/Medicare 5 day assessment

GO Service delivered personally by an occupational therapist or under an outpatient occupational therapy plan of care. 42 Significant correction of prior full assessment/Medicare 30 day assessment

GP Service delivered personally by an physical therapist or under an outpatient physical therapy plan of care. 43 Significant correction of prior full assessment/Medicare 60 day assessment

LC Left circulflex coronary artery 44 Significant correction of prior full assessment/Medicare 90 day assessment

LD Left anterior descending coronary artery 47 Significant correction of prior full assessment/Medicare 14 day assessment

LT Left side of the body procedure 48 Significant correction of prior full assessment/OMRA or SCSA

QM Ambulance service provided under arrangement by a provider of services 50 Bilateral procedure QN Ambulance service furnished directly by a provider of services 52 Reduced services QP Documentation exists showing that the laboratory test(s) was ordered individually, or as CPT-recognized panel other than profil 53 Discontinued procedure RC Right coronary artery 54 Quarterly review assessment - Medicare 90 assessment (full)

RT Right side of the body procedure 58 Staged or related procedure or service by the same physician during the postoperative period

T1 Left foot, second digit 59 Distinct procedural service T2 Left foot, third digit 76 Repeat procedure by same physician T3 Left foot, fourth digit 77 Repeat procedure by another physician T4 Left foot, fifth digit 78 Return to the operating room for a related procedure during the postoperative period

T5 Right foot, great toe 79 Unrelated procedure of service by the same physician during the postoperative period

T6 Right foot, second digit E1 Upper left eyelid T7 Right foot, third digit E2 Lower left eyelid T8 Right foot, fourth digit E3 Upper right eyelid T9^ Right foot, fifth digit E4 Lower right eyelid TA Left foot, great toe F1 Left hand, second digit^ Beginning Position: 24 **Data Source:**Claim Length: 2 Type: Alphanumeric

Field 6: MODIFIER_2 Description: Identifies special circumstances related to the performance of the service. Coding Scheme: Same as
Field 5 Beginning Position: 26 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 7: MODIFIER_3 Description: Identifies special circumstances related to the performance of the service. Coding Scheme: Same as
Field 5 Beginning Position: 28 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 8: MODIFIER_4 Description: Identifies special circumstances related to the performance of the service. Coding Scheme: Same as
Field 5 Beginning Position: 30 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 9: UNIT_MEASUREMENT_CODE Description: Code specifying the units in which a value is being expressed. Coding Scheme: DA Days F2 International unit UN Unit Beginning Position: 32 **Data Source:**Claim Length: 2 Type: Alphanumeric
Field 10: UNITS_OF_SERVICE Description: Numeric value of quantity Beginning Position: 34 **Data Source:**Claim Length: 7 Type: Numeric
Field 11: UNIT_RATE Description: Rate per unit Beginning Position: 41 **Data Source:**Claim Length: 12 Type: Numeric
Field 12: CHRGS_LINE_ITEM Description: Total amount of the charge Beginning Position: 53 **Data Source:**Assigned Length: 14 Type: Numeric
Field 13: CHRGS_NON_COV Description: Total non-covered amount of the charge Beginning Position: 67 **Data Source:**Assigned Length: 14 Type: Numeric

Facility Type Indicator File

Facility type indicators provided by the facilities. Provide the data user with information on the type of facility providing the outpatient service.

Field 1: THCIC_ID Description: Provider ID. Unique identifier assigned to the provider by DSHS. Beginning Position: 1 **Data Source:**Assigned Length: 6 Type: Alphanumeric
Field 2 PROVIDER_NAME Description: Hospital name provided by the hospital. Beginning Position: 7 **Data Source:**Provider Length: 55 Type: Alphanumeric
Field 3: FAC_TEACHING_IND Description: Teaching Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Coding Scheme: A Member, Council of Teaching Hospitals X Other teaching facility Beginning Position: 62 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 4: FAC_PSYCH_IND Description: Psychiatric Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 63 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 5: FAC_REHAB_IND Description: Rehabilitation Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 64 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 6: FAC_ACUTE_CARE_IND Description: Acute Care Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 65 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 7: FAC_SNF_IND Description: Skilled Nursing Facility Indicator. Hospital facility type indicator provided by the hospital. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 66 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 8: FAC_LONG_TERM_AC_IND Description: Long Term Acute Care Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 67 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 9: FAC_OTHER_LTC_IND Description: Other Long Term Care Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Beginning Position: 68 **Data Source:**Provider Length: 1 Type: Alphanumeric
Field 10: FAC_PEDS_IND Description: Pediatric Facility Indicator. Suppression: Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999'). Coding Scheme: C Member, National Association of Children’s Hospitals and Related Institutions (NACHRI) X Facilities that also treat children Beginning Position: 69 **Data Source:**Provider Length: 1 Type: Alphanumeric

Texas Hospital Inpatient Discharge