27 July 2010
Comprehensive Ambulatory/Professional Encounter
Record (CAPER) Enhanced
for the
MHS Data Repository (MDR)
(Version 2.01.01)
Future Specification
Revision History
Version Date Originator Para/Tbl/Fig Description of Change
1.01.00 03/11/2009 Original.
1.01.01 07/31/2009 S. Rogers Appendix 1.3 Conversion from standard APC input formats
to custom format
Appendix 1.4 Conversion from standard APC output read
formats to custom format
Appendix 1, Table A1.2 Modified APC input format
Appendix 1, Table A1.3 Modified APC output format
Appendix 1.5. Revise application of APGs to telephone
Appendix 2.7.g consults.
Derive Appointment Status Type with
Appointment Data Walk-In
Appendix 2, Table A2. Change Enrollment DMIS ID Region from
Char(4) to Char(2)
Clarify descriptive language for variables
CLINSTAT and CLINZIP
Correct derivation of Appointment Status
Type.
Rename APPTSTAT to APPTSTAT1.
Add additional derived Appointment Status
Type that identifies a walk-in appointment by
the WALKIN flag in appointment data
Add gender logic to application of MDC.
Change field name for variable PRIME
Throughout Correct references to ―Appendix 5.
Completion Table for Appointment-Inferred
CAPERs‖
1.01.02 08/05/2009 S. Rogers Appendix 1.1 CPT-APC format applied by CY
Appendix 1, Table A1.1 APC variables from CHAR(4) to CHAR(5)
Correct name of Procedure Status Indicator
Appendix 2, Table A2. Drop PRIME
Add ACV Group.
1.01.03 09/15/2009 S. Rogers Appendix 2, Table A2. Add Sponsor Rank/ Paygrade Group.
(RANKPAY)
Correct derivation of PATCAT to rely on
PATCAT_R rather than previously incorrectly
referenced PATCAT1.
1.01.04 10/22/2009 S. Rogers Appendix 1.5 Correct references to values of APPTSTAT.
Appendix 2, Table A2. APPTSTAT1 and APPTSTAT: Correct
references to specific variable values.
Delete variable SPONSVC.
Clarify derivation of RSPONSVC.
1.01.05 12/17/09 S. Rogers Appendix 2.7.a Change references to values of INFRSADR in
the DMISID table from (1=keep, 0=omit) to
(Y=keep, N=omit).
1.01.06 01/21/10 S. Rogers II Administrative change to reflect weekly (vs
previous monthly) availability of appointment
file.
Version 2.01.01 MDR CAPER Enhanced - i 27 July 2010
Version Date Originator Para/Tbl/Fig Description of Change
1.01.07 02/25/10 S. Rogers Appendix 1, Table A1.2 Change the APC grouper input file as follows:
o Change the following fields to
20090401 when ENCDATE is before
that date:
From Date
To Date
Procedure Date
o Rearrange the order of Procedure
Code and Modifier fields based on 3M
changes to the grouper (V2010.0.1).
2.01.00 06/25/10 S. Rogers Throughout Updates for CAPER Enhanced Interim
Some changes to Administrative section
include update to APC grouper processing
(conversion to single set of APCs, additional
fields added during existing merges (fields
highlighted), field length changes, and
change to derivation of Underwritten Region.
Added fields formerly derived in M2
processing.
Added all fields required to generate SADR
replacement file in CAPER Enhanced Interim
Added the analytic processing Appendix to
add all raw and some derived and aggregate
measures.
Updated the completion table Appendix to
include all new and changed fields
Added a final field layout table
Added an Appendix with list of reference
tables used in CAPER processing
Note: All significant changes and additions
through Appendix 2 are highlighted. Only the
header line of the newly added sections
(Appendix 3+) are highlighted.
Version 2.01.01 MDR CAPER Enhanced - ii 27 July 2010
Version Date Originator Para/Tbl/Fig Description of Change
2.01.01 07/27/10 S. Rogers Appendix 2, Para 4 Removed reference to BPACATCH.
Table A2 Clarified derivations of MDC, SDS and
MEDFLAG for inferred CAPERs.
Clarified derivations for PATHSSC and
PATREGN.
Table A2.2 Corrected product line format file name.
Table A3.2 Corrected field names used in derivation of
APCAGGWT_S.
Appendix 5 Updates to the Final Field Layout Table:
o Corrected PROVROLE1 length and
information about APPTMTCH and
APPTTYPE
o Relabeled all Units of Care fields to Units
of Service
o Corrected labels for FPRVU9, NPRVU9 and
PERVU9
o Added APPTTYPE_R missing from the table
o Removed duplicate APPTSTAT entry.
Reference Table Appendix Updated the RVU table filenames to
distinguish 7-char key version from original
5-char key version (rvu7fmt.sas7bdat and
cpt7fmt.sas7bdat
Table A2, footnote 10 Clarified source for patient name
Version 2.01.01 MDR CAPER Enhanced - iii 27 July 2010
Table of Contents
I. SOURCE .......................................................................................................... 1
II. TRANSMISSION (Format and Frequency) ............................................................ 1
III. ORGANIZATION AND BATCHING ........................................................................ 1
IV. RECEIVING FILTERS ......................................................................................... 2
V. DATA PROCESSING AND FIELD TRANSFORMATION .............................................. 2
VI. DIRECTORY LOCATION ..................................................................................... 4
VII. DATA QUALITY ................................................................................................. 4
APPENDIX 1: Application of Ambulatory Groupers and Related Fields. .............................. 6
APPENDIX 2: Administrative Text Processing Steps and Field Additions .......................... 24
APPENDIX 3: Analytic Processing and Field Additions to the CAPER-Enhanced. ................ 40
APPENDIX 4: Completion Table for Appointment-Inferred CAPERs ................................. 59
APPENDIX 5: Final Field Layout Table ........................................................................ 62
APPENDIX TBD: Provider Table ................................................................................. 78
APPENDIX TBD: SCAPERs ......................................................................................... 79
APPENDIX TBD: Reference Tables ............................................................................. 80
Version 2.01.01 MDR CAPER Enhanced - i 27 July 2010
COMPREHENSIVE AMBULATORY/PROFESSIONAL ENCOUNTER RECORD (CAPER)
ENHANCED FOR THE MDR
This specification describes the process required to convert the CAPER-Basic, as generated
through the process described in the specification ―Comprehensive Ambulatory/Professional
Encounter Record (CAPER) – Basic for the MDR‖, into the CAPER-Enhanced1. CAPER-
Enhanced will be derived from the CAPER-Basic through the processes documented through
the remainder of this specification and referred to as Blending, Administrative Processing
and Field Additions, and Analytic Processing and Field Additions.
I. SOURCE
Source Data File Purpose
CHCS/AHLTA CAPER-Basic, Master, Collection of records for encounters/professional
MDR, current (after services in near raw form, prepared in accordance
weekly update with the specification ―CAPER-Basic for the MDR‖.
processing)
MDR CAPER-Enhanced,
Master, MDR, previous
(week)
CHCS/AHLTA Appointment File, Records to supplement CAPER-Basic when an
Master, MDR appointment was identified as complete but a
CAPER not submitted.
Interim file from Cancel File, Master, Cancelled records resulting from CAPER-Basic
Processor current (week) processing that divides weekly harvests into
―keepers‖ and ―cancels‖.
II. TRANSMISSION (Format and Frequency)
The most current CAPER-Basic file as it resides in PUB/APUB is used for CAPER Enhanced
processing.‖
Table for Multiple Input Feeds
Source Data File Periodicity Format
CHCS/AHLTA CAPER-Basic Weekly SAS
CHCS/AHLTA Appointment File Weekly SAS
III. ORGANIZATION AND BATCHING
Several files result from this process, each file type organized into fiscal year files.
MDR Table Location Description
CAPER Enhanced (Interim) Interim file Contains records from the CAPER-Basic
supplemented with fields supplied through
Administrative Processing (Appendix 2).
CAPER Enhanced MDR Contains records from the interim CAPER
Enhanced file supplemented with fields
supplied through Analytic Processing
(Appendix 3).
1
This version of the CAPER Enhanced specification refers to the CAPER Interim which is generally understood to be
the SADR replacement. This specification contains some placeholder information that is expected to be completed
in CAPER Interim Plus.
Version 2.01.01 MDR CAPER Enhanced - 1 27 July 2010
Current year CAPERs are processed weekly after the Appointment Master and the CAPER
Basic.
Frequency of updates, based on CAPER encounter date:
Current FY: Every week
Prior FY: weekly for one quarter (October, November, and December) then
semiannually (April, October)
All years prior to prior FY: Annually (October)
Retrofits: On an as needed basis when data corrections or updates are required.
IV. RECEIVING FILTERS
None.
V. DATA PROCESSING AND FIELD TRANSFORMATION
Generating a CAPER-Enhanced begins with the most recent version of the CAPER-Basic
master file for the period in question2. The file and included records pass through 2
processes—Administrative and Analytic—to create the new CAPER-Enhanced master for the
MDR.3
A. Administrative Processing:
1. Records from all four input files (See I.) are uniquely identified by the key
(HOSTDMIS || APPTIDNO).
2. Blending: The Blending process combines records from the refreshed CAPER-
Basic master file with information about newly identified cancellations, the
Appointment master file, and the previous CAPER Enhanced master file to
generate a refreshed file ready for Administrative processing and records to be
maintained in the M2 Drop Dataset. The file, referred to below as the Blended
CAPER, is an interim file retained for the duration of processing only and does not
reside in PUB/APUB. The Blending process has three steps:
a. Link records in the new CAPER-Basic master to records in the CAPER-
Enhanced master on the key HOSTDMIS||APPTIDNO.
In Relation of
In CAPER Value of
CAPER- Source
Enhanced Enhanced Action
Basic Processing
Master APPTINFR
Master Dates
Remove CAPER-Enhanced
No Yes N record.
Add key to M2DROP data set.
Retain CAPER-Enhanced record
No Yes Y in Blended CAPER.
Set M2CODE = ‗ ‘.
2
Refer to the specification ―Comprehensive Ambulatory/Professional Encounter Record (CAPER) – Basic for the
MDR‖ for a complete list of variables in the CAPER-BASIC file.
3
To be clear, the process of blending the data sets together as described through the remainder of this section
implies that all interim data sets in the CAPER-Enhanced processing will have all the final fields of a CAPER-
Enhanced data set because one of the input data sets, namely the previous CAPER-Enhanced data set, already
have all variables. Consequently, the fields are not technically added later in processing. Rather, they receive
values later in processing.
Version 2.01.01 MDR CAPER Enhanced - 2 27 July 2010
In Relation of
In CAPER Value of
CAPER- Source
Enhanced Enhanced Action
Basic Processing
Master APPTINFR
Master Dates
Add CAPER-Basic record to
Yes No Blended CAPER.
Set M2CODE = ‗N‘.
Basic Retain CAPER-Basic record in
SRCPROCDATE lieu of CAPER-Enhanced
Yes Yes N > record.
Enhanced Set M2CODE =‘U‘.
SRCPROCDATE
Basic Retain CAPER Enhanced
SRCPROCDATE record.
Yes Yes N Blended CAPER file.
Blended Set APPTINFR= ‗Y‘.
SRCPROCDATE Set M2CODE= ‗U‘.
Version 2.01.01 MDR CAPER Enhanced - 3 27 July 2010
Value of Relation of
In In
Blended Source
Appointment Blended Action
CAPER Processing
Master CAPER
APPTINFR Dates
Yes Yes Y Appt CHGDATE Retain Blended CAPER record.
0 and CPTUOS_J >
13
UOSLIM_J, set CPTUOS_ J = UOSSUB_J
(Required prior to APC Grouping)
Based on encounter date (ENCDATE)
Patient Age PATAGE and birth date (PATDOB).
(Required prior to APC Grouping)
From TRICARE APC Grouping of CPT
Packaging Flag, E&M1- procedures J=1 to 13, where J=1 to 3
E&M3, Proc1-Proc 10, represents the E&M positions and J=4 to
Char(1) APCPKGJ,
as assigned by the 13 represents procedure positions.
TRICARE APC Grouper.
Populated for FY09+ only.
From TRICARE APC Grouping
Overall Claim
Char(28) CLAIM_DISP
Disposition
Populated for FY09+ only.
8
Note change of field length from previous version.
Version 2.01.01 MDR CAPER Enhanced - 10 27 July 2010
Table A1.1: Field Values Added to Blended CAPER
during Grouper and APC Format Application
Field Type SAS Name Derivation
From TRICARE APC Grouping
Claim Denial Disposition Char(1) CLAIM_DEN
Populated for FY09+ only.
From TRICARE APC Grouping of CPT
APC Procedure Edits, procedures J=1 to 13, where J=1 to 3
E&M1-E&M3, Proc1-Proc represents the E&M positions and J=4 to
Char(40) APCEDITJ
10, as assigned by the 13 represents procedure positions.
TRICARE APC Grouper.
Populated for FY09+ only.
From APG Grouping of 1st procedural
APG – Proc 1 Char(3) APG3
CPT
From APG Grouping of 2nd procedural
APG – Proc 2 Char(3) APG4
CPT
From APG Grouping of 3rd procedural
APG – Proc 3 Char(3) APG5
CPT
From APG Grouping of 4th procedural
APG – Proc 4 Char(3) APG6
CPT
APG – E&M Char(3) APG1 From APG grouping of E&M Code 1
APG – Medical Char(3) APG2 From APG Grouping of Diagnosis 1
Table A1.2: Format for Input to APC Grouper
Field Variable Conversion/Format Start Lengt Occur
or Coded Value Position h s
Record Key Part 1 HOSTDMIS 1 4 1
Record Key Part 2 APPTIDNO 5 10 1
Blank filled 15 77 1
From Date ENCDATE mmddyyyy. If ENCDATE 92 8 1
current then do;
dobdate=' ';
end;
if tmpenc > current then do;
svcdate=' ';
end;
drop current;
*
* Format sex data element for grouper.
*;
length SEXNUM $1;
if patsex='M' then
sexnum='1';
else if patsex='F' then
sexnum='2';
else
sexnum='U';
*
* Initialize data elements for grouper.
*;
length sg01-sg0&numcpt $9;
Version 2.01.01 MDR CAPER Enhanced - 21 27 July 2010
Table A1.4: Preparing Input to the APG Grouper
sg01 = left(&cptpre.1);
sg02 = left(&cptpre.4);
sg03 = left(&cptpre.5);
sg04 = left(&cptpre.6);
sg05 = left(&cptpre.7);
length UK2 $15 filler $1;
uk2='';
filler='';
MEDIPASS='0';
REFERRAL='0';
AGE='000';
DISSTAT='01';
UK1='CAPER Sched ';
TOTCHRG='000000.00';
%mend apggrp_prep;
*
* Write the variables for the APG grouper
* and create the file.
*;
%macro apggrp_put(grprin,numdx,numcpt);
PUT
@1 hostdmis $4.
@5 apptidno $10.
@31 SVCDATE $8.
@39 DOBDATE $8.
@47 AGE $3.
@50 SEXNUM $1.
@51 DISSTAT $2.
@53 MEDIPASS $1.
@54 REFERRAL $1.
@55 UK1 $15.
@70 UK2 $15.
@85 TOTCHRG $9.
%do i=1 %to &numdx;
@%eval(94+(6*(&i.-1))) dx0&i $6.
%end;
%do i=1 %to &numcpt;
@%eval(154+(9*(&i.-1))) sg0&i $9.
%end;
@423 filler $1.
;
%mend apggrp_put;
Version 2.01.01 MDR CAPER Enhanced - 22 27 July 2010
Table A1.5: Reading Output from the APG Grouper
*
* Read in the variables from the output of APG grouper.
*;
%macro apggrp_input(numcpt);
input
@1 hostdmis $char4.
@5 apptidno $char10.
@426 napg2 $char3.
@443 napg1 $char3.
@446 napg3 $char3.
@449 napg4 $char3.
@452 napg5 $char3.
@455 napg6 $char3.
;
%mend apggrp_input;
Table A1.6: Format File Excerpt for Assigning CMS APC Fields by CPT/HCPCS Codes,
mdr/ref/caper/apc/cy##q#.dyymmdd.fmt where cy ##=06 to 08
PROC FORMAT;
value $APC07C
'0001F'='00000E0000.0000'
'0005F'='00000E0000.0000'
'00100'='00000N0000.0000'
'00102'='00000N0000.0000'
'00103'='00000N0000.0000'
'00104'='00000N0000.0000'
'00120'='00000N0000.0000'
'00124'='00000N0000.0000'
'00126'='00000N0000.0000'
.
.
.
' '=' '
OTHER ='09999 0000.0000';
run;
*See the APC Tables Spec (Ambulatory Payment Classification (APC) Reference Tables for the
MHS Data Repository (MDR)) for further detail.
Version 2.01.01 MDR CAPER Enhanced - 23 27 July 2010
APPENDIX 2: Administrative Text Processing Steps and Field Additions
The following processes will be applied to the CAPER-Basic, post blending and grouping.
Variables will be added according to Table A2. Fields Added to Blended CAPER through
Administrative Text Processing.
1. MPI Merge: See the MPI specification for appending EDIPN, SPONSSN, DDS, and PARC.
2. LVM Merge: Append the Enrollment DMISID (ENRDMIS), Alternate Care Value (ACV),
Health Care Delivery Program Code (HCDPLVM), Beneficiary Category (BENCATX), PCM
ID (PCMIDLVM), Sponsor Service from DEERS (SSVCLVM), Sponsor Service Aggregate
(SAGGLVM), and TPR Eligible Flag (TPRELIG) from the longitudinal LVM for CAPER data.
(This merge occurs after the MPI merge described above and occurs on the ―whole‖
CAPER dataset, not just the newly processed records):
a. Merge to the LVM by EDIPN for the FM of the encounter date.
b. If a match is found, assign all variables as described in Table A2. (If these values are
missing/blank from LVM, then the fields remain missing/blank).
3. DMIS Merge: Merge to the MDR DMIS ID Index based on encounter date and treatment
DMIS ID to append the MEPRS Parent DMIS ID (PARMEPRS), Cost Parent DMIS ID
(PARCOST), Clinic State (CLINSTAT), Clinic Zip Code (CLINZIP), Treatment Region
(TXREG), Treatment DMIS ID HSSC Region (TXHSSC), Treatment Service (TXSVC),
Multi-Service Market Area (MSMA) and PPS Treatment Parent Site (PPS_TPS).
Merge to the MDR DMIS ID Index based on encounter date and enrollment DMIS ID
(ENRDMIS) to append the Enrollment DMIS ID Region (ENRREG), Enrollment Parent
DMIS ID (PARENR) and PPS Enrollment Parent Site (PPS_EPS).
Although the DMIS ID and CAD feed processing will be accelerated so that tables are
available by the 5th working day of the month, this may cause a one or two day delay in
throughput for the first weekly CAPER batch of the month.
4. CAD Merge: Merge to the MDR CAD based on Patient Zip, Sponsor Service, and the CAD
matching the encounter date. (If Patient Zip is not usable, the Treatment DMIS ID Zip
Code is used in its place.) The fields Patient Catchment Area (CATCH), Patient Health
Service Region (PATREGN), Beneficiary HSSC Region (PATHSSC), and PRISM Area DMIS
ID (PRISM) are added in this process.
5. Reservist Merge: Merge to the Reservist Table File by Sponsor SSN based on encounter
date. Add Reservist Special Operation Code (SOC) and Reservist Status Code (STATUS).
6. Referral File Merge: Merge to the Referral File with Treatment DMSID and Record ID in
the CAPER (DMISID and APPTIDNO) to Appointment Clinic DMISID and Associated
Record ID (APPTDMISID and APPTIEN) in the referral data. Add Referral Number
(REFNUM) and Referral Provider (REF_PROV).
7. When the master file from CAPER is complete, compare records from the appointment
file with the CAPER file to identify appointment records that are candidates for addition
to the CAPER as appointment inferred CAPERs.
a. Omit all MEPRS ―A‖ records from the appointment file before starting the merge to
CAPER process. Omit all test records from the appointment file before starting the
merge to CAPER process where test records are identified as those with MEPRS 3-
level codes other than standard codes from the EAS-IV Repository Account Subset
Version 2.01.01 MDR CAPER Enhanced - 24 27 July 2010
Definition (ASD) table or from CHCS. Omit records from the appointment data based
on the INFRSADR flag from the DMISID table (Y=keep, N=omit).
b. Merge in limited fields from appointment records (only those needed by the
processor) using HOSTDMIS and APPTIDNO as the key.
c. Only keep Appointment Records where the Appointment Status=2 (Kept), 5 (Walk-
in), 6 (Sick Call), or 7 (TCON).
d. If only in CAPER, write out the record setting the Appointment Inferred CAPER Flag
(APPTINFR)=‘N‘.
e. If in CAPER and appointment, check the count visit flag (COUNTVIS) from the
appointment file and correct its value in the CAPER, if needed.
f. If CAPER is inferred, then update with most current appointment data and set
APPTINFR=‘Y‘ and APPTPFIX=‘I‘.
g. Add the Medicare Eligibility field (MELIGAPT) from the appointment data to the
CAPER and inferred CAPER.
h. Derive a modified Appointment Status Type (APPTSTAT) that identifies as a walk-in
appointment in any record with an appointment data WALKIN =‛Y‘.
i. Add the Patient Status (PATSTAT), Appointment Type (APPTTYPE)
j. If only in appointment but not in CAPER, derive fields as noted in Appendix 4:
Completion Table for Appointment-Inferred CAPERs.
8. Add other fields as detailed in Table A2.
9. During the process, all records are tracked in such a manner that they can be identified
as new, modified, cancelled, etc. These indicators must be retained through this and the
Analytic processing.
The table below reflects the fields added to the CAPER-Basic and appearing in the CAPER-
Enhanced after Administrative Processing. Other fields may be created to facilitate
processing, but will not be retained in the public use MDR file when it is posted.
Version 2.01.01 MDR CAPER Enhanced - 25 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
Unique Patient
Char(10) EDIPN MPI See MPI specification.
Identifier
Sponsor SSN Char(9) SPONSSN MPI See MPI specification.
DEERS
Dependent Char(2) DDS MPI See MPI specification
Suffix
Person
Association Char(2) PARC MPI See MPI specification.
Reason Code
Beneficiary First
Char(20) FIRSTNAME MPI See MPI specification.10
Name
Beneficiary Last
Char(26) LASTNAME MPI See MPI specification.10
Name
Concatenate:
Beneficiary
Char(74) PATNAME MPI LAST, FIRST MIDDLE, CADENCY (e.g.,
Name
SMITH, WILLIAM ROBERT, JR).10
Enrollment
Char(4) ENRDMIS LVM From merge to LVM.
DMIS ID
Merge to LVM by EDIPN.
If there is a match to the LVM by EDIPN,
and the date of the encounter is within
the date window of a LVM segment, and
the ACV on the segment is not (―Z‖ or
blank) then set ACV to the value
contained in the enrollment segment.
Alternate Care
Char(1) ACV LVM
Value Otherwise, if LVM R_BEN_CAT_CD = ACT
or GRD, ACV = ―M‖
else ACV = blank.
Note: If using BENCATX in lieu of
R_BEN_CAT_CD, it must be done prior to
populating BENCATX with BENCAT
values. See BENCATX derivation
HCDP Code From merge to LVM.
Char(3)11 HCDPLVM LVM
from LVM
From merge to LVM as described in
Beneficiary
paragraph 2, set equal to LVM
Category from
Char(3) BENCATX LVM Beneficiary Category (R_BEN_CAT_CD).
LVM and
If no match to LVM is found, then set
BENCAT
equal to BENCAT.
PCM ID from the From merge to LVM.
Char(18) PCMIDLVM LVM
LVM Data
Sponsor Service From merge to LVM.
Char(1) SSVCLVM LVM
from DEERS
Sponsor Service
From merge to LVM.
Aggregate from Char(1) SAGGLVM LVM
LVM
10
Use the M2 Beneficiary Name reference table for the various ―name‖ components.
11
Note change in field length from previous version.
Version 2.01.01 MDR CAPER Enhanced - 26 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
Merge to LVM (VM6) and add the field
TPR Eligible Flag Char(1) TPRELIG LVM D_TPR_ELG_CD.
From merge to the DMISID Index based
Enrollment on ENRDMIS, set to MOD_REG from
Char(2) ENRREG DMIS
DMIS ID Region corresponding entry in the DMIS ID
index table
Service-designated parent of Enrollment
Parent DMIS ID
Char(4) PARENR DMIS DMIS ID (from DMISID Index) matching
(enrollment)
fiscal year based on ENRDMIS.
Parent DMIS ID Costing Parent of Treatment DMIS ID
Char(4) PARCOST DMIS
(COST) (from DMISID Index) matching FY.
Multi-Service MSMA of Treatment DMIS ID (from
Char(3) MSMA DMIS
Market Area DMISID Index) matching FY.
Parent DMIS ID MEPRS Parent of Treatment DMIS ID
Char(4) PARMEPRS DMIS
(MEPRS) (from DMISID Index) matching FY.
Treatment DMIS Treatment DMIS ID (from DMISID Index)
Char(1) TXHSSC DMIS
ID HSSC Region matching FY.
Derived from Treatment DMIS ID and
Treatment
Char(2) TXREG DMIS merge to DMISID Index: modified UBU
Region
Region where MTF is located.
Treatment Derived from Treatment DMIS ID and
Char(1) TXSVC DMIS
Service merge to DMISID Index.
CLINSTAT of Treatment DMIS ID (from
Clinic State Char(2) CLINSTAT DMIS
DMISID Index) matching FY
CLINZIP of Treatment DMIS ID (from
Clinic Zip Char(5) CLINZIP DMIS
DMISID Index) matching FY
PPS Tmt Parent Joined to the DMIS Table by FY and Tmt
Char(4) PPS_TPS DMIS
Site DMISID (DMISID).
PPS Enr Parent Joined to the DMIS Table by FY and
Char(4) PPS_EPS DMIS
Site Enrollment Site (ENRDMIS).
Catchment DMIS ID of patient residence,
based on patient Zip, sponsor service,
Patient and the CAD matching the encounter
Char(4) CATCH CAD
Catchment Area date. (If patient Zip is not usable, the
treatment MTF Zip code is used in its
place.)
Version 2.01.01 MDR CAPER Enhanced - 27 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
HSSC Region, based on Patient Zip and
Patient
―World‖ Region in the Omni-CAD File. (If
(Beneficiary) Char(1) PATHSSC CAD
patient Zip is not usable, the treatment
HSSC Region
MTF Zip code is used in its place.)
Health Service Region, based on Patient
Zip and ―World‖ Region in the Omni-CAD
Patient Health
Char(2) PATREGN CAD File (If patient Zip is not usable, the
Service Region
treatment MTF Zip code is used in its
place.)
PRISM DMIS ID of patient residence,
based on patient Zip, sponsor service,
and the Omni-CAD matching the
PRISM area Char(4) PRISM CAD
encounter date. (If patient Zip is not
usable, the treatment MTF Zip code is
used in its place.)
Merge to the Reservist Table File by
Sponsor SSN. Reservist Special
Operation is appended to the encounter
Reservist record if the encounter date occurred
Special Char(2) SOC Reservist during the time frame in which the
Operation Code beneficiary is eligible to receive TRICARE
benefits, that is, is within the begin and
end dates inclusive on a matching
Reservist Table file record..
Merge to the Reservist Table File by
Sponsor SSN. Reservist Status Code is
appended to the encounter record if the
encounter date occurred during the time
Reservist Status
Char(1) STATUS Reservist frame in which the beneficiary is eligible
Code
to receive TRICARE benefits, that is, is
within the begin and end dates inclusive
on a matching Reservist Table file
record..
Appointment
Char(1)12 PROVROLE1 =substr(PROVROLE1,1,1)
Provider Role
REFNUM_R
Referral
Char(11) (formerly No transformation.
Number, Raw
REF_NO)
Merge to referral data based on
Treatment DMSID and Record ID in the
Referral Number CAPER (DMISID and APPTIDNO) to
from Referral Char(11) REFNUM Referral Appointment Clinic DMISID and
File Associated Record ID (APPTDMISID and
APPTIEN) in the referral data.
REF_PROV_R
Referring
Char(9) (formerly No transformation.
Provider, Raw
PROVIDREF)
12
Note change in field length from previous version.
Version 2.01.01 MDR CAPER Enhanced - 28 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
Merge to referral data based on
Treatment DMISID and Record ID in the
CAPER (DMISID and APPTIDNO) to
Appointment Clinic DMISID and
Associated Record ID (APPTDMISID and
Referring
APPTIEN) in the referral data.
Provider from Char(14) REF_PROV Referral
This field is purposely longer in length
the Referral File
than needed for Direct Care providers
because Purchased Care providers will
have longer IDs.
Called REFBYPRV_ID in referral file.
Patient Status
as reported in
Appointmen From appointment data.
the Char(1) PATSTAT
t No transformation.
Appointment
Data
Medicare
Eligibility as
Appointmen From the appointment data.
reported in the Char(2) MELIGAPT
t No transformation.
Appointment
Data
APPTTYPE_R
Appointment
Char(6) (formerly No transformation.
Type Raw
APPTTYPE)
Appointment
Type from Appointmen
Char(6) APPTTYPE From the appointment data merge.
Appointment t
Data
If in CAPER and appointment, check the
count visit flag from the appointment file
Count Visit and correct its value in the CAPER, if
Char(1) COUNTVIS
Indicator needed. If CAPER is inferred, then
update with most current appointment
data.
If ACV in(‗A‘ ‗E‘ ‗H‘ ‗J‘ ) then ‗Prime‘
Else if ACV in(‗B‘ ‗F‘) then ‗Overseas
Remote‘
Else if ACV in(‗G‘ ‗L‘) then ‗Plus‘
ACV Group Char(15) ACVGROUP
Else if ACV = ‗U‘ then ‗Desig Prov‘
Else if ACV in(‗M‘ ‗Q‘) OR COMBEN= ‗4‘
then ‗Reliant‘
Else ‗Other‘
Version 2.01.01 MDR CAPER Enhanced - 29 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
Based on PATAGE:
A = 0-4
B = 5-14
C = 15-17
D = 18-24
Age Group Char(1) AGEGRP
E = 25-34
F = 35-44
G = 45-64
H = 65+
X = all others
Appointment
Y if from Appointment File
Inferred CAPER Char(1) APPTINFR
Else N
Flag
No transformation in CAPER derived
Appointment
Char(1) APPTPFIX record.
Prefix
I implies appointment inferred record.
No transformation for CAPERs or for
Appointment inferred CAPERs.
That is:
APPTSTAT1 If Appt Data Appt Stat=2 then 2 (Kept)
Appointment
Char(1) (formerly If Appt Data Appt Stat=5 then 5 (Walk-
Status Type
APPTSTAT) in)
If Appt Data Appt Stat=6 then 6 (Sick
Call)
If Appt Data Appt Stat=7 then 7 (T-Con)
For FY04:
Appointment
APPTSTAT=APPTSTAT1
Status Type
For FY05 and forward:
with Char(1) APPTSTAT
If Appt Data WALKIN=‘Y‘ then
Appointment
APPTSTAT=5;
Data Walk-In
Else APPTSTAT=APPTSTAT1.
APV=Y, when MEPRSCD=B**5 or B**7
APV Flag Char(1) APV
for TXSVC=A, F, or N.
Beneficiary Derived from patient category code using
Char(3) BENCAT
Category universal PATCAT format table
Version 2.01.01 MDR CAPER Enhanced - 30 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
Derived from PATAGE:
A = 0-4
B = 5-14
C = 15-17
D = 18-24
E = 25-34
Age Group F = 35-44
Char(1) EXPAGE
Common G = 45-64
H = 65-69
I = 70-74
J = 75-79
K = 80-84
L = 85+
X = All others
Derived from BENCATX.
1 = Dep Active Duty / Guard
Beneficiary
2 = Retired
Category Char(1) COMBEN
3 = Dep of Retired / Survivor / Other /
(common)
Unknown/Blank/IGR/IDG
4 = Active Duty Guard
For FY05+ only:
Derived from the first 5 characters of
ICD-9-CM, Diagnosis 1 (ICD1) and
application of the MDC format that
Major Diagnostic contains assignments for that FY.
Char(2) MDC
Category IF MDC = ‗98‘ THEN DO;
IF PATSEX=‘F‘ THEN MDC = ‗13‘;
ELSE IF PATSEX = ‗M‘ THEN MDC=‘12‘;
END;
This field is left blank if APPTINFR=‘Y‘.
Use first three characters of Diagnosis 1
Diagnosis Group Char(2) DXGRP (DX1).
See Table A2.1 for derivation rules.
For FY04:
For APPTINFR=Y or N:
―N‖ if MELIGAPT field is N or S.
If MELIGAPT is blank then assign
―N‖ if patient age is = 65
Otherwise, assign value ―Y‖
Medicare
Char(1) MEDFLAG
Eligibility Flag
For FY05+:
For APPTINFR=Y or N:
―Y‖ if MELIGAPT is A, AB, or B.
If MELIGAPT is blank then assign
―N‖ if patient age is = 65
Otherwise, assign value ―N‖
Version 2.01.01 MDR CAPER Enhanced - 31 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
For FY04:
If an APPT record is found then
A if MELIGAPT = A
B if MELIGAPT = B
C if MELIGAPT = AB, D, L, Q, R,
E, O, P
C if MELIGAPT = blank and age >= 65
Else N.
If an APPT record is not found then
A if MEDELIG = A
B if MEDELIG = B, B1, B2, B3
C if MEDELIG = AB, D, L, Q, R, E, O, P
Medicare
C if MEDELIG = blank and age >= 65
Eligibility
Char(1) MEDELIG2 Else N.
Derived from
MEDELIG
For FY05+:
If an APPT record is found then
A if MELIGAPT = A
B if MELIGAPT = B
C if MELIGAPT = AB
C if MELIGAPT = blank and age >= 65
Else N.
If an APPT record is not found then
A if MEDELIG = A, E, O, P
B if MEDELIG = B, B1, B2, B3
C if MEDELIG = AB, D, L, Q, R
C if MEDELIG = blank and age >= 65
Else N.
First position of MEPRS4 Code
MEPRS1 Code Char(1) MEPR1
(MEPRSCD).
First two positions of MEPRS4 Code
MEPRS2 Code Char(2) MEPR2
(MEPRSCD).
First three positions of MEPRS4 Code
MEPRS3 Code Char(3) MEPR3
(MEPRSCD)
If APPTINFR=N:
PATCAT=SUBSTR(PATCAT_R,1,3);
IF HCDPLVM IN ('401' '402' '405' '406'
'407' '408' '409' '410' '411' '412') OR
HCDPCODE_R IN ('401' '402' '405' '406'
'407' '408' '409' '410' '411' '412') THEN
DO;
Patient Category Char(3) PATCAT IF FMP='20' THEN
PATCAT=SUBSTR(PATCAT_R,1,1)||'36';
ELSE
PATCAT=SUBSTR(PATCAT_R,1,1)||'37';
END;
If APPTINFR=Y, then PATCAT= PATCAT
as reported in the Appointment Data
Derived based on Clinic (MEPRS3). See
Product Line Char(7) PRODLINE
Table A2.2.
Version 2.01.01 MDR CAPER Enhanced - 32 27 July 2010
Table A2: Field Values Added or Modified to Blended CAPER through Administrative
Text Processing
Field Type SAS Name Source Derivation
If APPTINFR=N then
=SUBSTR(RANKPAY_R,2,3)
Sponsor Rank/
Char(3) RANKPAY Else if APPTINFR=Y then
Paygrade
=SUBSTR(RANKPAY,1,3) as Reported in
the Appointment Data
Sponsor Rank Derived based on RANKPAY or PATCAT.
Char(2) RANKGRP
Group See Table A2.3.
If APV=Y and any of the APGs is of OR
Same day intensity (see Table A2.4) then SDS=Y.‘
Char(1) SDS
surgery Else SDS=N.
This field is left blank for APPTINFR=Y.
Derived from 1st character of PATCAT.
If A, C, F, M, N then retain value.
Else if B then assign O.
Recoded Else if P then assign H.
Char(1) RSPONSVC
Sponsor Service Else if R then assign 4.
Else if PATCAT is K71 or K78 then assign
4.
Else assign X.
Underwritten See TableA2.5.
Char(1) UNDFLAG
Region .
Date record was last updated during
CAPER CAPERPROCD
Char(8) CAPER-Enhanced processing.
Processing Date ATE
Format yyyymmdd.
Date record was last updated during
source data processing.
Source SRCPROCDAT PROCDATE from the CAPER-Basic if
Char(8)
Processing Date E APPTINFR is 'N', and PROCDATE from the
appointment data if APPTINFR is 'Y'.
Format yyyymmdd."
Tracks record status through process and
relative to the last record of the
particular key saved in the CAPER-
Enhanced, Master, MDR. Values are:
M2 Code Char(1) M2CODE Blank = Record exists in Master
U=Record changed and represents
update to Master
N=Record is new, not before seen in
Master.
Version 2.01.01 MDR CAPER Enhanced - 33 27 July 2010
Table A2.1: Diagnosis Group Derivation
First 3 digits Category Number Disease Category Name
001-139 1 Infections & Parasites
140-239 2 Neoplasms
240-279 3 Endocrine & Metabolism
280-289 4 Blood
290-319 5 Mental
320-389 6 Nerves and Senses
390-459 7 Circulatory System
460-519 8 Respiratory System
520-579 9 Digestive System
580-629 10 Genitourinary
630-677 11 Pregnancy and Childbirth
678-709 12 Skin
710-739 13 Musculoskeletal
740-759 14 Congenital Anomalies
760-779 15 Perinatal
780-799 16 Ill-Defined
800-999 17 Injury & Poisoning
V** 18 Supplementary Classifications
All others 19 Unknown
Version 2.01.01 MDR CAPER Enhanced - 34 27 July 2010
Table A2.2: Product Line Derivation,
mdr/ref/caper/prodlineformat/fy##.dyymmdd.fmt
Product
Full Name Description Definition
Line
BGA, BHA, BDA, BAA, BJA, BHB, BHI, BDC,
PC Primary Care
BDB, BKA, BHZ, BGZ, BHH
BLA, BEA, BEF, BEZ, BEB, BEE, BEC, BED,
ORTHO Orthopedics
BLB
MH Mental Health BFD, BFE, BFF, BFA, BFB, BFC
OBGYN Obstetrics/Gynecology BCC, BCB, BCD, BCA
OPTOM Optometry BHC, BBD
BAG, BAC, BAL, BAK, BAB, BAN, BAQ, BAS,
IMSUB Internal Medicine Subspecialty BAM, BAF, BAJ, BAO, BAH, BAE, BAU, BAT,
BAV
ER Emergency Room BIA
SURG General Surgery BBA
BBI, BBG, BBC, BBK, BBJ, BBH, BBB, BBZ,
SURGSUB Surgical Subspecialty
BBE
ENT Otolaryngology BBF
DERM Dermatology BAP
OTHER Other All other MEPRS Codes
Table A2.3: Sponsor Rank (Pay Grade) Collapsing Algorithm13
Values Rank Group
PATCAT PATCAT = A14, C14, F14, N14 CD (Cadet)
E1-E4 EJ (Enlisted, Junior)
E5-E9 ES (Enlisted, Senior)
O1-O3 OJ (Officer, Junior)
O4 – O9, 10, 11 OS (Officer, Senior)
RANKPAY
W1 – W5 WO (Warrant Officer)
CD CD (Cadet)
XX – Other (students, civil servants, unknowns
All Others (e.g., those without distinction as to whether
officer or enlisted
13
From LEVELS OF ACCESS AND MASKING in MHS Mart (M2) specification.
Version 2.01.01 MDR CAPER Enhanced - 35 27 July 2010
Table A2.4: APGs Assigned Same Day Surgery When Occurring in APV Setting
APG Description
003 Complex incision and drainage
007 Complex excision, biopsy and debridement
008 Simple excision and biopsy
009 Complex skin repairs and antegument grafts
011 Simple incision and excision of breast
012 Breast reconstruction and mastectomy
021 Complex musculoskeletal procedures excluding hand and foot
023 Complex hand and foot musculoskeletal procedures
025 Arthroscopy
030 Open or percutaneous treatment of fractures
031 Bone or joint manipulation under anesthesia
033 Arthroplasty
034 Hand and foot tenotomy
035 Arthrocentesis and ligament or tendon injection
053 Complex endoscopy of the upper airway
054 Simple endoscopy of the upper airway
055 Endoscopy of the lower airway
076 Diagnostic cardiac catheterization
077 Angioplasty and transcatheter procedures
078 Pacemaker insertion and replacement
079 Removal and revision of pacemaker and vascular device
080 Minor vascular repair and fistula construction
082 Vascular ligation
113 Anoscopy with biopsy and diagnostic proctosimoidoscopy
114 Proctosigmoidoscopy with excision or biopsy
115 Diagnostic upper gi endoscopy or intubation
116 Therapeutic upper gi endoscopy or intubation
117 Lower gastrointestinal endoscopy
118 Ercp and miscellaneous gi endoscopy procedures
119 Hernia and hydrocele procedures
120 Complex anal and rectal procedures
123 Complex laparoscopic procedures
124 Simple laparoscopic procedures
153 Complex penile procedures
Version 2.01.01 MDR CAPER Enhanced - 36 27 July 2010
Table A2.4: APGs Assigned Same Day Surgery When Occurring in APV Setting
APG Description
176 Complex female reproductive procedures
178 Dilation and curettage
179 Hysteroscopy
196 Revision and removal of neurological device
197 Neurostimulator and ventricular shunt implant
198 Nerve repair and destruction
213 Laser eye procedures
214 Cataract procedures
215 Complex anterior segment eye procedures
216 Moderate anterior segment eye procedures
218 Complex posterior segment eye procedures
221 Complex repair and plastic procedures of eye
234 Complex facial and ent procedures
235 Simple facial and ent procedures
236 Tonsil and adenoid procedures
Version 2.01.01 MDR CAPER Enhanced - 37 27 July 2010
Table A2.5: Underwritten Region Derivation
Logic
Non-ambulatory work is not counted (based on MEPRs code, treated as not underwritten)
Remove USTF (based on ACV code)
Exclude Direct Care Only (based on beneficiary category)
Remove Active Duty (based on common beneficiary code)
Exclude Reserve Select (based on ACV code)
Remove Medicare Eligibles (based on age as a proxy)
Exclude Resource Sharing (based on DMISIDs beginning with 54**)
For Regional jurisdiction, Prime beneficiaries are assigned to each contractor based on
enrollment region and enrollment DMIS ids (for the 69XXs and 79XXs ids). Non Prime
beneficiaries are assigned based on residence region.
o The new 69XX (managed care contractor) and 79XX (remote) series of enrollment
DMIS ids are being assigned to enrollment region ―00‖. Thus, those enrollment DMIS
ids must be included with the enrollment regions.
SAS Code
SAS Variable Data Element (see CAPER Detail Layout Above)
MEPRSCD MEPRS code
COMBEN Common Beneficiary Category
BENCATX Beneficiary Category
PATAGE Patient Age
ACV Alternate Care Value
ENRREG Enrollment Region – from merge to the DMISID Index based on ENRDMIS, set to
MOD_REG from corresponding entry in the DMIS ID index table
ENRDMIS Enrollment DMISID
PATREGN Patient Region
UNDRFLAG Need to Create, Temporary Underwritten Flag
UNDFLAG Need to Create – underwritten region
Undrflag=1; /* underwritten flag*/
/* Flag non underwritten beneficiaries as ―0‖. */
/* Exclude non-ambulatory workload from underwritten counts */
if substr(meprscd,1,1) NE 'B' then undrflag=0;
if acv=‘U‘ then undrflag=0; /* Exclude USTFs */
if bencatx=‘DCO‘ then undrflag=0; /* Exclude Direct Care Only */
if comben=4 then undrflag=0; /* Exclude Active Duty */
if dmisage EQ ‗H‘ then undrflag=0; /* Exclude Medicare Eligibles */
if acv='R' then undrflag=0; /* Exclude Reserve Select */
/* Exclude resource sharing, all dmisids that start with '54' from underwritten */
if substr(dmisid,1,2)='54' then undrflag=0;
/* Define Prime based on ACV */
if acv in ('A' 'D' 'E' 'B' 'F' 'H' 'J') then prime='Y';
else prime='N';
/* Define Underwritten Region */
if undrflag=1 then do; /* underwritten */
if prime='Y' then do;
if enrreg in ('01' '02' '05' '17') or enrdmis in ('6917' '7917') then undflag='N';
Version 2.01.01 MDR CAPER Enhanced - 38 27 July 2010
Table A2.5: Underwritten Region Derivation
else if enrreg in ('03' '04' '06' '18') or enrdmis in ('6918' '7918') then undflag='S';
else if enrreg in ('07' '08' '09' '10' '11' '12' '19') or enrdmis in ('6919' '7919') then
undflag='W';
else undflag=' ';
end; /* if prime */
else if prime='N' then do;
if patregn in ('01' '02' '05' '17') then undflag='N';
else if patregn in ('03' '04' '06' '18') then undflag='S';
else if patregn in ('07' '08' '09' '10' '11' '12' '19') then undflag='W';
else undflag=' ';
end; /* if not prime */
end;
else do;
undflag=' '; /* Not underwritten to any region */
end;
/* Remove AK underwritten from West */
if undflag='W' and enrdmis in ('6919' '7919') and patregn='AK' then undflag=' ';
if undflag ~in ('N' 'S' 'W') then undflag=' ';
Version 2.01.01 MDR CAPER Enhanced - 39 27 July 2010
APPENDIX 3: Analytic Processing and Field Additions to the CAPER-Enhanced.
The following analytic processes will be applied to the CAPER-Enhanced after the
Administrative Text variables are added. Variables will be added according to Table A3.3:
Fields Added to CAPER through Analytic Processing. Where SADR variables are reproduced
using only the first E&M and Procedure 1-4 CPT codes, the variable name is appended with
_S.
1. APC. Aggregate APC weight is calculated for all care as the sum of the weights for all 13
APCs (APCAGGWT). SADR-calculated aggregate APC weight (APCAGGWT_S) is
computed for all care as a sum of just the first E&M APC and the APCs for the first four
procedures. No discounting is applied for these aggregate weights.
2. APG Aggregate Weight per the SADR (APGWGT_S) reproduces SADR aggregate APG
weight on CAPERs.
3. RVUs. Apply the MDR Direct Care CPT weight table format for each of the individual CPT
codes (CPT_J, J=1 to 13). The calendar year of the encounter date determines the
weight table to use. Apply the following RVU values, keeping those marked ―for
derivation but not retained‖ only for the duration of the calculation process. A summary
of how the raw, derived and aggregate fields are derived is in Table A3.1: Relative Value
Unit Fields.
Raw measures (based on MHS-updated RVU values) using modifiers for Lab/Rad codes
but not units of service:
Raw Work RVU, corresponding to each E&M and procedural CPT code (RRVUJ)
Raw Facility Practice Expense RVU, corresponding to each E&M and procedural
CPT code (FPRVUJ)
Raw Non-Facility Practice Expense RVU, corresponding to each E&M and
procedural CPT code (NPRVUJ)
Raw measures (based on MHS-updated RVU values). Do not use modifiers or units of
service. These measures are used for later derivations but are not retained (see Table
A3.2: Fields Derived but not Retained in Analytic Processing):
Raw Work, corresponding to each E&M and procedural CPT code (RRVUBJ)
Raw Facility Practice Expense RVU, corresponding to each E&M and procedural
CPT code (FPRVUBJ)
Raw Non-Facility Practice Expense RVU, corresponding to each E&M and
procedural CPT code (NPRVUBJ)
Derived measure:
Practice Expense RVU, based on Facility Flag, corresponding to each E&M and
procedural CPT code using modifiers for Lab/Rad (PERVUJ)
Aggregate measures:
Simple Work RVU, sum of the individual Raw Work RVU without modifiers or
units of service (RRVU and RRVU_S)
Simple Practice Expense RVU, sum of the individual Practice Expense RVUs,
Facility or Non-Facility based on Facility Flag, without modifiers or units of
service (PERVU and PERVU_S)
Enhanced Work RVU, sum of the Work RVU, with modifiers, multiplied by the
units of service (RVU_EW and RVU_EW_S)
Version 2.01.01 MDR CAPER Enhanced - 40 27 July 2010
Enhanced PE RVU, sum of the PE RVU, Facility or Non-Facility based on the
Facility Flag, with modifiers, multiplied by the units of service (RVU_EPE and
RVU_EPE_S)
Enhanced Total RVU, sum of Enhanced Work and Enhanced PE RVU (RVU_ET
and RVU_ET_S)
Individual Work RVU, discounting by 50% all but the highest RVU (without
modifiers or units of service) and summing (IWRVU and IWRVU_S)
Organizational Work RVU, discounting by 50% all but the highest RVU
(without modifiers or units of service) and summing, accounts for multiple
providers. (OWRVU and OWRVU_S)
Table A3.1: Relative Value Unit (RVU) Fields
Use Unit Use
RVU Description Use Modifiers? of FAC_FL Comment
service? AG?
Raw Fields
Raw Work RVU for YES (for lab NO N/A MDR and M2
all CPT 8xxxx/rad 7xxxx
only, mod 26
and TC only, any
modifier
position)
Raw Facility PE RVU YES (for lab NO N/A MDR only
for all CPT 8xxxx/rad 7xxxx
only, mod 26
and TC only, any
modifier position
Raw Non-Facility PE YES (for lab NO N/A MDR only
RVU for all CPT 8xxxx/rad 7xxxx
only, mod 26
and TC only, any
modifier position
Raw Work RVU for NO NO N/A Not Retained in MDR or M2
all CPT, no modifiers
Raw Facility PE RVU NO NO N/A Not Retained in MDR or M2
for all CPT, no
modifiers
Raw Non-Facility PE NO NO N/A Not Retained in MDR or M2
RVU for all CPT, no
modifiers
Derived/Aggregate Fields
PE RVU for all CPT YES (for lab NO YES MDR and M2
8xxxx/rad 7xxxx
only, mod 26
and TC only, any
modifier position
Simple Work RVU NO NO N/A MDR and M2
Simple PE RVU NO NO YES MDR and M2
Enhanced Work RVU YES (for lab YES (using N/A MDR and M2
8xxxx/rad 7xxxx UOS limits)
only, mod 26
and TC only, any
modifier position
Enhanced PE RVU YES (for lab YES (using YES MDR and M2
8xxxx/rad 7xxxx UOS limits)
Version 2.01.01 MDR CAPER Enhanced - 41 27 July 2010
Table A3.1: Relative Value Unit (RVU) Fields
Use Unit Use
RVU Description Use Modifiers? of FAC_FL Comment
service? AG?
only, mod 26
and TC only, any
modifier position
Enhanced Total RVU YES (for lab YES (using YES Calculated as Enh Work + Enh
8xxxx/rad 7xxxx UOS limits) PE.
only, mod 26 MDR and M2
and TC only, any
modifier position
Individual Work RVU NO NO N/A 100%; 50% discounting.
MDR and M2
Organizational Work NO NO N/A Multiplied by # of qualifying
RVU providers.
MDR and M2
4. Costs. For MEPR1=B, merge to the cost masters (by cost parent (PARCOST), APG, and
fiscal year, DHP sites only (If TXSVC = A, N, F)) to append the full cost less clinician
salary, variable cost less clinician salary, and components of full/variable cost (other
labor, laboratory, radiology, other ancillary, other, and pharmacy). Merge to the cost
master matching the cost parent and fiscal year to append the full and variable clinician
salary per Organizational Work RVU. This does not apply to inferred records.
5. If only in appointment but not in CAPER (APPTINFR=Y), derive fields as noted in
Appendix 4: Completion Table for Appointment-Inferred CAPERs.
Under consideration for CAPER Interim Plus:
Convert fields in the CAPER-Basic that describe connections between procedure and
providers to links resembling those in the SIDR.
Generate a provider production table containing treatment DMIS, Appointment ID
number, provider, procedures, units of service, modifiers, RVUs. This table would
contain one record per appointment per provider from appointments where the
provider and procedure are linked.
Table A3.2: Fields Derived but not Retained in Analytic Processing
Field Type SAS Name Derivation
Raw MHS-updated Work RVU for CPT
procedures J=1 to 13, where J=1 to 3
represents the E&M positions and J=4 to
13 represents procedure positions.
RVU, Raw Work, E&M1-
Derived from match with the CPT Weight
E&M3 and Procedure 1- N(8) RRVUBJ
Table (format wrkyyb) based on CY of
Procedure 10, no modifiers
encounter and CPT concatenated with 2
blanks for the CPT||Modifier key.
If APPTINFR=Y, see Appendix 4
Version 2.01.01 MDR CAPER Enhanced - 42 27 July 2010
Table A3.2: Fields Derived but not Retained in Analytic Processing
Field Type SAS Name Derivation
Raw MHS-updated Facility Practice
Expense RVU for CPT procedures J=1 to
13, where J=1 to 3 represents the E&M
positions and J=4 to 13 represents
RVU, Raw Facility Practice
procedure positions.
Expense, E&M1-E&M3 and
N(8) FPRVUBJ Derived from match with the CPT Weight
Procedure 1-Procedure 10,
Table (format facyyb) based on CY of
no modifiers
encounter and CPT concatenated with 2
blanks for the CPT||Modifier key.
If APPTINFR=Y, see Appendix 4
Raw MHS-updated Non-Facility Practice
Expense RVU for CPT procedures J=1 to
13, where J=1 to 3 represents the E&M
positions and J=4 to 13 represents
RVU, Raw Non-Facility
procedure positions.
Practice Expense, E&M1-
N(8) NPRVUBJ Derived from match with the CPT Weight
E&M3 and Procedure 1-
Table (format nfacyyb) based on CY of
Procedure 10, no modifiers
encounter and CPT concatenated with 2
blanks for the CPT||Modifier key.
If APPTINFR=Y, see Appendix 4
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
The total APG weight of the encounter,
found by adding 100% of the highest
weight APG to 50% of all other APGs
(except that the medical APG and E&M APG
Total APG Weight, per are not included except when either is the
N(8) APGWGT_S
SADR highest weight APG). Weights are obtained
from merge to APG Weight Table by APG,
FY.
Set to 0 (zero) for non ―B‖ records.
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 43 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
J=1 to 13, where J=1 to 3 represents the
E&M positions and J=4 to 13 represents
procedure positions.
FY07-08: Appended during APC Grouper
processing using a format file. See
Appendix 1.
APC Weight, E&M1-APC
FY09+: Look up of APCJ in the APC-to-
Weight, E&M3;
N(9,4) APCWTJ APC (5-char code) TRICARE weight
APC Weight, Proc1-APC
mapping in the /mdr/ref area.
Weight, Proc10
APCWTJ = input(APCJ,APCcyqW.)
where cy is the 2-digit calendar year of the
encounter; q is the 1-digit calendar quarter
(eg., APC091W. for CY09, CQ1). See
Table A3.3a.
If APPTINFR=Y, see Appendix 4.
Populated for FY07+ only.
Sum of APCWT1-APCWT13. No
discounting.
APC Aggregate Weight N(9,4) APCAGGWT
If APPTINFR=Y, see Appendix 4.
Populated for FY07+
Sum of APCWT1, APCWT4-APCWT7. No
APC Aggregate Weight, APCAGGWT discounting.
N(9,4)
per SADR _S If APPTINFR=Y, see Appendix 4.
Populated for FY07+
FAC_FLAG='F' for any of the following:
All A MEPRS
B**5, B**7
BIA
0124 (NMC Portsmouth) and B**6
Facility/NonFacility Flag Char(1) FAC_FLAG
Resource sharing DMISID (Branch
of Service/Authority Code in ('B' 'G'
'R' 'V' '1' '2' '3'))
Else FAC_FLAG='N'
See Table A3.3b.
Raw MHS-updated Work RVU for CPT
procedures J=1 to 13, where J=1 to 3
represents the E&M positions and J=4 to
13 represents procedure positions.
RVU, Raw Work, E&M1-
Derived from match with the CPT Weight
E&M3 and Procedure 1- N(8) RRVUJ
Table (format wrkyyb) based on CY of
Procedure 10
encounter and CPT||Modifier key derived
as described in Table A3.3c.
If APPTINFR=Y, see Appendix 4
Version 2.01.01 MDR CAPER Enhanced - 44 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Raw MHS-updated Facility Practice
Expense RVU for CPT procedures J=1 to
13, where J=1 to 3 represents the E&M
positions and J=4 to 13 represents
RVU, Raw Facility Practice procedure positions.
Expense, E&M1-E&M3 and N(8) FPRVUJ Derived from match with the CPT Weight
Procedure 1-Procedure 10 Table (format facyyb) based on CY of
encounter and CPT||Modifier key derived
as described in Table A3.3c.
If APPTINFR=Y, see Appendix 4
Raw MHS-updated Non-Facility Practice
Expense RVU for CPT procedures J=1 to
13, where J=1 to 3 represents the E&M
positions and J=4 to 13 represents
RVU, Raw Non-Facility
procedure positions.
Practice Expense, E&M1-
N(8) NPRVUJ Derived from match with the CPT Weight
E&M3 and Procedure 1-
Table (format nfacyyb) based on CY of
Procedure 10
encounter and CPT||Modifier key derived
as described in Table A3.3c.
If APPTINFR=Y, see Appendix 4
If FAC_FLAG=‖F‖ then PERVUJ = FPRVUJ
RVU, Practice Expense,
Else PERVUJ = NPRVUJ.
E&M1-E&M3 and Procedure N(8) PERVUJ
Note: If APPTINFR=Y, then inferred
1-Procedure 10
FPRVUJ and NPRVUJ must be applied first.
Raw MHS updated Work RVU, without
modifiers (RRVUBJ) summed for all CPT
RVU, Simple N(8) RRVU codes.
If APPTINFR=Y, see Appendix 4.
Raw MHS updated Work RVU, without
modifiers (RRVUBJ) summed for E&M1 and
RVU, Simple, per SADR N(8) RRVU_S Proc1-4 (CPT1 and CPT4-7).
If APPTINFR=Y, see Appendix 4.
If FAC_FLAG=‘F‘ then Raw MHS-updated
Facility Practice Expense RVUs, without
modifiers (FPRVUBJ), summed for all CPT
codes.
RVU, Simple Practice
N(8) PERVU Else Raw MHS-updated Non-Facility
Expense
Practice Expense RVUs, without modifiers
(NPRVUBJ), summed for all CPT codes.
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 45 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
For APPTINFR=‘N‘:
If FAC_FLAG=‘F‘ then Raw MHS-updated
Facility Practice Expense RVUs, without
modifiers (FPRVUBJ), summed for all E&M
and Proc1-4 (CPT1 and CPT4-7) codes.
RVU, Simple Practice
N(8) PERVU_S Else if FAC_FLAG=‘N‘ then Raw MHS-
Expense, per SADR
updated Non-facility Practice Expense RVU,
without modifiers (NPRVUBJ), summed for
E&M1 and Proc1-4 (CPT1 and CPT4-7).
If APPTINFR=Y, see Appendix 4.
For APPTINFR=N: After unit of service
adjustments: The Work RVU, with
modifiers, per code multiplied by the units
RVU, Enhanced Work N(8) RVU_EW of service; computed as:
∑(RRVUJ*CPTUOS_J) for all J CPT Codes
For APPTINFR=Y, see Appendix 4
For APPTINFR=N: After unit of service
adjustments: The Work RVU, with
modifiers, per code multiplied by the units
RVU, Enhanced Work, per
N(8) RVU_EW_S of service; computed as:
SADR
∑(RRVUJ*CPTUOS_J) for all E&M1 and Proc
1-4 (CPT_1 and CPT_4-CPT_7)
For APPTINFR=Y see Appendix 4.
For APPTINFR=N: After unit of service
adjustments: Sum of Practice Expense
RVU, with modifiers, chosen based on
RVU, Enhanced Practice designation as facility or non-facility care,
N(8) RVU_EPE
Expense multiplied by the units of service,
computed as:
∑(PERVUJ*CPTUOS_J) for all J CPT Codes.
For APPTINFR=‘Y‘ see Appendix 4.
For APPTINFR=N: After unit of service
adjustments: Sum of Practice Expense
RVU, with modifiers, chosen based on
designation as facility or non-facility care,
RVU, Enhanced Practice
N(8) RVU_EPE_S multiplied by the units of service,
Expense, per SADR
computed as:
∑(PERVUJ*CPTUOS_J) for all E&M1 and
Proc 1-4 (CPT_1 and CPT_4-CPT_7).
For APPTINFR=‘Y‘ see Appendix 4.
Sum of RVU_EW and RVU_EPE for both
RVU, Enhanced Total N(8) RVU_ET
APPTINFR Y and N.
RVU, Enhanced Total, per Sum of RVU_EW_S and RVU_EPE_S for
N(8) RVU_ET_S
SADR both APPTINFR Y and N.
Total Raw Work RVU, without modifiers,
with discounting (100% for highest of
RVU, Individual Work N(8) IWRVU
RRVUB1-RRVUB13, 50% for remaining).
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 46 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Total Raw Work RVU, without modifiers,
with discounting (100% for highest of
RVU, Individual Work, per
N(8) IWRVU_S RRVUB1 and RRVUB4-RRVUB7, 50% for
SADR
remaining).
If APPTINFR=Y, see Appendix 4.
Derived by multiplying discounted (100%
for highest of CPT1-CPT13, 50% for
remaining) Raw Work RVU, without
RVU, Organizational Work N(8) OWRVU modifiers (RRVUB1-RRVUB13) by the
number of qualifying providers based on
provider specialty codes (see Table A3.3d).
If APPTINFR=Y, see Appendix 4.
Derived by multiplying discounted (100%
for highest of EM1, Proc 1-4, 50% for next
4 among EM1 and Proc 1-4) MHS-updated
RVU, Organizational Work,
N(8) OWRVU_S Work RVU by the number of qualifying
Per SADR
providers (first 3 providers only) based on
provider specialty codes (see Table A3.3d).
If APPTINFR=Y, see Appendix 4.
ASC codes for CPT procedures J=1 to 13,
where J=1 to 3 represents the E&M
Ambulatory Surgical Center
positions and J=4 to 13 represents
Class (ASC) Codes, E&M1-
Char(2) ASCJ procedure positions.
E&M3 and Procedure 1-
Derived from match with the CPT Weight
Procedure 10
Table (format ascyyb) based on CY of
encounter and base CPT (no modifiers).
Sum of FCCLNSAL, FCOTHLBR, FCLAB,
FCRAD, FCOTHANC, FCOTHER, and FCRX.
Note: the individual components are
Full Cost N(8) FCOST
already discounted prior to summing.
If APPTINFR=Y, see Appendix 4.
Sum of the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from E&M1 APG and
most current cost masters for that FY (not
discounted).
Full Cost, E&M APG N(8) FCOST1
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Sum of all the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from the Medical APG
and most current cost masters for that FY
(not discounted).
Full Cost, Medical APG N(8) FCOST2
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 47 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Sum of all the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from the 1st
Procedural APG and most current cost
masters for that FY (not discounted).
Full Cost, Procedure 1 APG N(8) FCOST3
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Sum of all the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from the 2nd
Procedural APG and most current cost
masters for that FY (not discounted).
Full Cost, Procedure 2 APG N(8) FCOST4
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Sum of all the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from the 3rd
Procedural APG and most current cost
masters for that FY (not discounted).
Full Cost, Procedure 3 APG N(8) FCOST5
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Sum of all the component (FCOTHLBR,
FCLAB, FCRAD, FCOTHANC, FCOTHER, and
FCRX) pieces derived from the
4thProcedural APG and most current cost
masters for that FY (not discounted).
Full Cost, Procedure 4 APG N(8) FCOST6
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Based $/Organizational Work RVU, per
SADR (OWRVU_S) by Cost Parent DMISID.
Set to 0 (zero) for non ―B‖ records and for
Full Cost, Clinician Salary N(8) FCCLNSAL
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 48 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Laboratory N(8) FCLAB
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Other Ancillary N(8) FCOTHANC
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Other N(8) FCOTHER
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Other Labor N(8) FCOTHLBR
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Radiology N(8) FCRAD
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 49 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Full Cost, Pharmacy N(8) FCRX
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Sum of VCCLNSAL, VCOTHLBR, VCLAB,
VCRAD, VCOTHANC, VCOTHER, and VCRX.
Note: the individual components are
Variable Cost N(8) COST
already discounted prior to summing.
If APPTINFR=Y, see Appendix 4.
Sum of the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from E&M1 APG
and most current cost masters for that FY
(not discounted).
Variable Cost, E&M APG N(8) COST1
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Sum of all the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from Medical
APG and most current cost masters for
that FY (not discounted).
Variable Cost, Medical APG N(8) COST2
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Sum of all the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from 1st
Procedural APG and most current cost
Variable Cost, Procedure 1 masters for that FY (not discounted).
N(8) COST3
APG Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 50 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Sum of all the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from 2nd
Procedural APG and most current cost
Variable Cost, Procedure 2 masters for that FY (not discounted).
N(8) COST4
APG Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Sum of all the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from 3rd
Procedural APG and most current cost
Variable Cost, Procedure 3 masters for that FY (not discounted).
N(8) COST5
APG Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Sum of all the component (VCOTHLBR,
VCLAB, VCRAD, VCOTHANC, VCOTHER,
and VCRX) pieces derived from 4th
Procedural APG and most current cost
Variable Cost, Procedure 4 masters for that FY (not discounted).
N(8) COST6
APG Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F).
Does not include clinician salary.
If APPTINFR=Y, set to 0 (zero).
Based $/Organizational Work RVU, per
SADR (OWRVU_S) by Cost Parent DMISID.
Variable Cost, Clinician Set to 0 (zero) for non ―B‖ records and for
N(8) VCCLNSAL
Salary non-DHP sites (IF TXSVC ≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Variable Cost, Laboratory N(8) VCLAB
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 51 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
Variable Cost, Other E&M or Medical APG is dropped.
N(8) VCOTHANC
Ancillary
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Variable Cost, Other N(8) VCOTHER
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Variable Cost, Other Labor N(8) VCOTHLBR
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Variable Cost, Radiology N(8) VCRAD
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Based on $ by Cost Parent DMISID and
APG; it is the sum of the cost for the
highest weight APG, and half of the cost of
all other APGs after the lower weighted of
E&M or Medical APG is dropped.
Variable Cost, Pharmacy N(8) VCRX
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC≠ A, N, F).
If APPTINFR=Y, see Appendix 4.
Version 2.01.01 MDR CAPER Enhanced - 52 27 July 2010
Table A3.3: Fields Added to CAPER through Analytic Processing
Field Type SAS Name Derivation
Derived from APGs, APG weight table and
cost masters:
One universal charge master is applied to
represent the APG-based components and
is summed (price of the highest weight
APG and half of the price of any other
procedural APGs). For the clinician salary
component, one universal price per RVU is
Price N(8) PRICE
multiplied times the record‘s
Organizational Work RVUs. Price is sum of
the APG weight based components and
clinician salary component.
Set to 0 (zero) for non ―B‖ records and for
non-DHP sites (IF TXSVC ≠ A, N, F then
PRICE=0)
If APPTINFR=Y, see Appendix 4.
From merge to TPOC Rate table
corresponding to encounter date fiscal year
Third Party Collection Rate N(8) TPC
and the first three characters of MEPRS
code, and zero-filled if there is no match.
Version 2.01.01 MDR CAPER Enhanced - 53 27 July 2010
Table A3.3a: Format File Excerpt for Assigning TRICARE APC Weight to APC Grouper
Assigned APC Codes, mdr/ref/caper/apcwt/cy##q#.dyymmdd.fmt where
##=08+ and q # = 1 to 4.
PROC FORMAT;
invalue APC091W
'00001' = 0.5102
'00002' = 1.4324
'00003' = 3.1526
'00004' = 4.4727
'00005' = 7.3879
'00006' = 1.4128
'00007' = 12.5953
'00008' = 19.3874
'T9999' = 0.0000
' '=.
OTHER = 0;
run;
Table A3.3b: Facility/Non-Facility Flag Format Excerpt,
mdr/ref/caper/facflag/fy##.dyymmdd.fmt
****Facility care identified by any A MEPRS or B**5/7);
***FAC_FLAG='F' if input(meprs1,fm1_&fy.a.)=2 or (input(meprs1,fm1_&fy.a.)=1 and
input(substr(meprscd,4,1),fm4_&fy.a.)=1);
PROC FORMAT;
invalue FM1_09a
'A'=2
'B'=1
OTHER=0;
PROC FORMAT;
invalue FM4_09a
'5'=1
'7'=1
'6'=2
OTHER=0;
****Facility care identified by BIA*;
***FAC_FLAG ='F' if input(meprs3,FM3_&fya.)=1;
PROC FORMAT;
invalue FM3_09a
'BIA'=1
OTHER=0
;
****Facility care identified by – NMC Portsmouth(0124) and B**6;
***FAC_FLAG='F' if input(dmisid,fdmis&fy.b.)=1 and input(meprs1,fm1_&fy.a.)=1 and
input(substr(meprscd,4,1),fy4_&fy.a.)=2;
PROC FORMAT;
invalue FDMIS09b
'0124'=1
OTHER=0;
Version 2.01.01 MDR CAPER Enhanced - 54 27 July 2010
****Facility care identified by DMISID (resource sharing facilities);
***FAC_FLAG='F' if input(dmisid,FDMIS&fy.a.)=1 ;
***Source DMIS ID Resource Page - http://www.dmisid.com/cgi-dmis/download;
***All DMIS IDs with Branch of Service/Authority Code in ('B' 'G' 'R' 'V' '1' '2' '3')
*** are considered "Facility";
**FYyy (from FYyy Historical Year-End File);
PROC FORMAT;
invalue FDMISyya
'0660'=1
'0661'=1
'2001'=1
'2002'=1
'5401'=1
'5402'=1
'5404'=1
.
.
.
OTHER=0;
run;
Version 2.01.01 MDR CAPER Enhanced - 55 27 July 2010
Table A3.3c: Derive CPT Mod Key for the CPT Table Match
If the CPT does not begin with 7 or 8, use base level code (CPT appended with 2 blanks, e.g.,
'99211 ') for match.
If CPT begins with 7 or 8 and either both 26 and TC or neither 26 nor TC are in any of the
modifier positions, use the base level (CPT appended with 2 blanks, e.g., '75710 '). If 26 is
in any of the modifier positions (and no TC), use CPT appended with 26, e.g., '7571026'. If
TC is in any of the modifier positions (and no 26), use CPT appended with TC, e.g., '75710TC'.
data cptkey (drop=scoresum score1 - score3);
length cptmod_1-cptmod_13 $7;
set caper.fy&fy.;
if APPTINFR='N' then do; /* only non-inferred records */
%do i = 1 %to 13;
if substr(cpt_&i,1,1) in ('7' '8') then do;
scoresum=0;
%do k=1 %to 3;
if CPTMOD&k._&i = '26' then score&k = .6;
else if CPTMOD&k._&i='TC' then score&k = .4;
else score&k=0;
scoresum + score&k;
%end;
** if both 26 and TC are present for a CPT or neither 26 nor TC
are present, treat as base level. If 26 but not TC –
use 26. If TC but not 26, use TC. Default is base level.;
if scoresum in(0,1) then cptmod&i=cpt_&i||' ';
else if scoresum = .6 then cptmod&i=cpt_&i||'26';
else if scoresum = .4 then cptmod&i=cpt_&i||'TC';
else cptmod&i=cpt_&i||' ';
end;
else cptmod&i=cpt_&i||' '; /* if not in ('7' '8') */
%end;
end;
Version 2.01.01 MDR CAPER Enhanced - 56 27 July 2010
Table A3.3d: Format File for Identifying Qualifying Providers, mdr/ref/sadr.prov.txt
*These provider specialty codes qualify for Organizational Work RVU credit;
PROC FORMAT;
INVALUE PROV
'000'= 1
'001'= 1
'002'= 1
'004'= 1
'011'= 1
'012'= 1
'013'= 1
'014'= 1
'015'= 1
'016'= 1
'017'= 1
'018'= 1
'019'= 1
'020'= 1
'021'= 1
'022'= 1
'023'= 1
'024'= 1
'025'= 1
'026'= 1
'027'= 1
'040'= 1
'041'= 1
'042'= 1
'043'= 1
'044'= 1
'045'= 1
'046'= 1
'047'= 1
'048'= 1
'049'= 1
'050'= 1
'051'= 1
'053'= 1
'054'= 1
'060'= 1
'070'= 1
'071'= 1
'072'= 1
'080'= 1
'090'= 1
'091'= 1
'092'= 1
'100'= 1
'101'= 1
'102'= 1
'103'= 1
'104'= 1
'105'= 1
'106'= 1
'107'= 1
'110'= 1
'120'= 1
Version 2.01.01 MDR CAPER Enhanced - 57 27 July 2010
'130'= 1
'140'= 1
'141'= 1
'150'= 1
'151'= 1
'152'= 1
'153'= 1
'200'= 1
'204'= 1
'205'= 1
'206'= 1
'208'= 1
'300'= 1
'302'= 1
'320'= 1
'321'= 1
'322'= 1
'400'= 1
'401'= 1
'402'= 1
'403'= 1
'404'= 1
'405'= 1
'500'= 1
'501'= 1
'502'= 1
'503'= 1
'504'= 1
'505'= 1
'506'= 1
'507'= 1
'508'= 1
'509'= 1
'510'= 1
'511'= 1
'512'= 1
'513'= 1
'514'= 1
'515'= 1
'516'= 1
'517'= 1
'518'= 1
'800'= 1
'802'= 1
'804'= 1
'806'= 1
'808'= 1
'810'= 1
'812'= 1
'814'= 1
'815'= 1
OTHER = 0;
Run;
Version 2.01.01 MDR CAPER Enhanced - 58 27 July 2010
APPENDIX 4: Completion Table for Appointment-Inferred CAPERs
The Completion Tables for Appointment-Inferred CAPERs are SAS format files saved as MDR
reference tables. They are used to populate a host of fields in the appointment inferred
CAPER, listed below following the first five fields, which act as the key to the record.
In building and applying these formats, ―wild card‖ values are available for each FY and MTF
DMIS ID to be used whenever the MEPRS code of the appointment fails to find a matching
row of the completion table.
There are four basic methods by which the values in the DMIS ID tables are derived, plus
two extrapolation methods. The derivation column identifies the method below to be used
for each variable. The four basic methods are:
a. Take all SADRs14 for each fiscal year, and sort them into groups using either
the three key classifiers below (DMISID, MEPRS3, VISCLASS) or four key
classifiers (DMISID, MEPRS3, VISCLASS, FAC_FLAG). Average the raw
measures of the CAPER variables of the same name in those groups to get the
DMIS ID value for that variable.
b. Use the same method as above, but first collapse together all three E&M
values for the variable of the same name family. These will be the averages
for the ―E&M 1‖ measures in the table below. (To be implemented in CAPER
Interim Plus)
c. Use the same method as above, but first collapse together all 10 procedure
values for the variable of the same name family. These will be the averages
for the ―Procedure 1‖ measures in the table below. (To be implemented in
CAPER Interim Plus)
d. Use the same method as above, but first collapse together all four procedure
values for the variable of the same name family. These will be the averages
for the ―Procedure 1‖ measures in the table below.
The extrapolation method to create the ―wild card‖ values is to ignore the stratifier of
MEPRS3 to get averages that depend on visit class but not work center.
The extrapolation method to create values for a new fiscal year before sufficient concurrent
SADRs are available is to take the monetary measures of the previous fiscal year and inflate
them at the service-specific rate of inflation. Physical measures (workload) are not inflated
and use the same estimators as the previous fiscal year until better data are available.
Table A4.1 Completion Factor Derivations
Field Type SAS Name Derivation
Fiscal year of visit Char(4) FY FY
Treatment DMIS ID Char(4) DMISID DMISID
MEPRS Code Char(3) MEPRS3 MEPRS3
TEL where APPTSTAT=7
Visit Class Char(3) VISCLASS APV where APV=‘Y‘
OTH for all other encounters.
14
For CAPER Interim, SADR completion tables, with the new RVU fields added, will be used.
Version 2.01.01 MDR CAPER Enhanced - 59 27 July 2010
Table A4.1 Completion Factor Derivations
Field Type SAS Name Derivation
FAC_FLAG
Facility Flag Char(1) FAC_FLAG Note: Used in key only as noted
below.
APC Weight, E&M 1 N(8) APCWT1 Method a
APC Weight, Procedure 1 N(8) APCWT4 Method d
APC Aggregate Weight N(8) APCAGGWT Method a
APC Aggregate Weight, N(8)
APCAGGWT_S Method a
per SADR
Total APG Weight, per SADR N(8) APGWGT_S Method a
Full Cost N(8) FCOST Method a
Full Cost, E&M APG N(8) FCOST1 Method a
Full Cost, Medical APG N(8) FCOST2 Method a
Full Cost, Procedure 1 APG N(8) FCOST3 Method d
Full Cost, Clinician Salary N(8) FCCLNSAL Method a
Full Cost, Laboratory N(8) FCLAB Method a
Full Cost, Other N(8) FCOTHER Method a
Full Cost, Other Ancillary N(8) FCOTHANC Method a
Full Cost, Other Labor N(8) FCOTHLBR Method a
Full Cost, Pharmacy N(8) FCRX Method a
Full Cost, Radiology N(8) FCRAD Method a
Variable Cost N(8) COST Method a
Variable Cost, E&M APG N(8) COST1 Method a
Variable Cost, Medical APG N(8) COST2 Method a
Variable Cost, Procedure 1 APG N(8) COST3 Method d
Variable Cost, Clinician Salary N(8) VCCLNSAL Method a
Variable Cost, Laboratory N(8) VCLAB Method a
Variable Cost, Other N(8) VCOTHER Method a
Variable Cost, Other Ancillary N(8) VCOTHANC Method a
Variable Cost, Other Labor N(8) VCOTHLBR Method a
Variable Cost, Pharmacy N(8) VCRX Method a
Variable Cost, Radiology N(8) VCRAD Method a
RVU, Raw Work, E&M1 N(8) RRVU1 Method a
RVU, Raw Work, Procedure 1 N(8) RRVU4 Method d
Version 2.01.01 MDR CAPER Enhanced - 60 27 July 2010
Table A4.1 Completion Factor Derivations
Field Type SAS Name Derivation
RVU, Raw Facility Practice Expense,
N(8) FPRVU1 Method a
E&M1
RVU, Raw Facility Practice Expense,
N(8) FPRVU4 Method d
Procedure 1
RVU, Raw Non-Facility Practice
N(8) NPRVU1 Method a
Expense, E&M1
RVU, Raw Non-Facility Practice
N(8) NPRVU4 Method d
Expense, Procedure 1
RVU, Simple N(8) RRVU Method a
RVU, Simple, per SADR N(8) RRVU_S Method a
Method a
RVU, Simple Practice Expense N(8) PERVU
using FAC_FLAG in key
RVU, Simple Practice Expense, per Method a
N(8) PERVU_S
SADR using FAC_FLAG in key
RVU, Enhanced Work N(8) RVU_EW Method a
RVU, Enhanced Work, per SADR N(8) RVU_EW_S Method a
Method a
RVU, Enhanced Practice Expense N(8) RVU_EPE
using FAC_FLAG in key
RVU, Enhanced Practice Expense, per Method a
N(8) RVU_EPE_S
SADR using FAC_FLAG in key
RVU, Individual Work N(8) IWRVU Method a
RVU, Individual Work, per SADR N(8) IWRVU_S Method a
RVU, Organizational Work N(8) OWRVU Method a
RVU, Organizational Work, Per SADR N(8) OWRVU_S Method a
Version 2.01.01 MDR CAPER Enhanced - 61 27 July 2010
APPENDIX 5: Final Field Layout Table
Spec
Field Type SAS Name Source M2?
Reference
Actual Appointment
1 Char(10) ACTDUR CAPER Basic CAPER Basic Y
Duration
2 Alternate Care Value Char(1) ACV CAPER Enh Table A2 Y
3 ACV Group Char(15) ACVGROUP CAPER Enh Table A2 Y
4 Administrative Disposition Char(5) ADMDISP CAPER Basic CAPER Basic Y
5 Age Group Char(1) AGEGRP CAPER Enh Table A2 Y
6 Ambulatory Surgery Char(1) AMBSURG CAPER Basic CAPER Basic
7 APC - E&M1 Char(5) APC1 CAPER Enh Table A1.1 Y
8 APC - Procedure 7 Char(5) APC10 CAPER Enh Table A1.1 Y
9 APC - Procedure 8 Char(5) APC11 CAPER Enh Table A1.1 Y
10 APC - Procedure 9 Char(5) APC12 CAPER Enh Table A1.1 Y
11 APC - Procedure 10 Char(5) APC13 CAPER Enh Table A1.1 Y
12 APC - E&M2 Char(5) APC2 CAPER Enh Table A1.1 Y
13 APC - E&M3 Char(5) APC3 CAPER Enh Table A1.1 Y
14 APC - Procedure 1 Char(5) APC4 CAPER Enh Table A1.1 Y
15 APC - Procedure 2 Char(5) APC5 CAPER Enh Table A1.1 Y
16 APC - Procedure 3 Char(5) APC6 CAPER Enh Table A1.1 Y
17 APC - Procedure 4 Char(5) APC7 CAPER Enh Table A1.1 Y
18 APC - Procedure 5 Char(5) APC8 CAPER Enh Table A1.1 Y
19 APC - Procedure 6 Char(5) APC9 CAPER Enh Table A1.1 Y
20 APC Aggregate Weight N(8) APCAGGWT CAPER Enh Table A3.3 Y
APC Aggregate Weight per
21 N(8) APCAGGWT_S CAPER Enh Table A3.3 Y
SADR
22 APC Procedure Edit - E&M1 Char(40) APCEDIT1 CAPER Enh Table A1.1
APC Procedure Edit -
23 Char(40) APCEDIT10 CAPER Enh Table A1.1
Procedure 7
APC Procedure Edit -
24 Char(40) APCEDIT11 CAPER Enh Table A1.1
Procedure 8
APC Procedure Edit -
25 Char(40) APCEDIT12 CAPER Enh Table A1.1
Procedure 9
APC Procedure Edit -
26 Char(40) APCEDIT13 CAPER Enh Table A1.1
Procedure 10
27 APC Procedure Edit - E&M2 Char(40) APCEDIT2 CAPER Enh Table A1.1
28 APC Procedure Edit - E&M3 Char(40) APCEDIT3 CAPER Enh Table A1.1
APC Procedure Edit -
29 Char(40) APCEDIT4 CAPER Enh Table A1.1
Procedure 1
APC Procedure Edit -
30 Char(40) APCEDIT5 CAPER Enh Table A1.1
Procedure 2
APC Procedure Edit-
31 Char(40) APCEDIT6 CAPER Enh Table A1.1
Procedure 3
APC Procedure Edit-
32 Char(40) APCEDIT7 CAPER Enh Table A1.1
Procedure 4
APC Procedure Edit-
33 Char(40) APCEDIT8 CAPER Enh Table A1.1
Procedure 5
APC Procedure Edit-
34 Char(40) APCEDIT9 CAPER Enh Table A1.1
Procedure 6
35 APC Packaging Flag-E&M1 Char(1) APCPKG1 CAPER Enh Table A1.1
APC Packaging Flag-
36 Char(1) APCPKG10 CAPER Enh Table A1.1
Procedure 7
APC Packaging Flag-
37 Char(1) APCPKG11 CAPER Enh Table A1.1
Procedure 8
APC Packaging Flag-
38 Char(1) APCPKG12 CAPER Enh Table A1.1
Procedure 9
Version 2.01.01 MDR CAPER Enhanced - 62 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
APC Packaging Flag-
39 Char(1) APCPKG13 CAPER Enh Table A1.1
Procedure 10
40 APC Packaging Flag-E&M2 Char(1) APCPKG2 CAPER Enh Table A1.1
41 APC Packaging Flag-E&M3 Char(1) APCPKG3 CAPER Enh Table A1.1
APC Packaging Flag-
42 Char(1) APCPKG4 CAPER Enh Table A1.1
Procedure 1
APC Packaging Flag-
43 Char(1) APCPKG5 CAPER Enh Table A1.1
Procedure 2
APC Packaging Flag-
44 Char(1) APCPKG6 CAPER Enh Table A1.1
Procedure 3
APC Packaging Flag-
45 Char(1) APCPKG7 CAPER Enh Table A1.1
Procedure 4
APC Packaging Flag-
46 Char(1) APCPKG8 CAPER Enh Table A1.1
Procedure 5
APC Packaging Flag-
47 Char(1) APCPKG9 CAPER Enh Table A1.1
Procedure 6
48 APC Status Code-E&M1 Char(2) APCPSI1 CAPER Enh Table A1.1 Y
APC Status Code-Procedure
49 Char(2) APCPSI10 CAPER Enh Table A1.1 Y
7
APC Status Code-Procedure
50 Char(2) APCPSI11 CAPER Enh Table A1.1 Y
8
APC Status Code -
51 Char(2) APCPSI12 CAPER Enh Table A1.1 Y
Procedure 9
APC Status Code -
52 Char(2) APCPSI13 CAPER Enh Table A1.1 Y
Procedure 10
53 APC Status Code - E&M2 Char(2) APCPSI2 CAPER Enh Table A1.1 Y
54 APC Status Code - E&M3 Char(2) APCPSI3 CAPER Enh Table A1.1 Y
APC Status Code -
55 Char(2) APCPSI4 CAPER Enh Table A1.1 Y
Procedure 1
APC Status Code -
56 Char(2) APCPSI5 CAPER Enh Table A1.1 Y
Procedure 2
APC Status Code -
57 Char(2) APCPSI6 CAPER Enh Table A1.1 Y
Procedure 3
APC Status Code -
58 Char(2) APCPSI7 CAPER Enh Table A1.1 Y
Procedure 4
APC Status Code -
59 Char(2) APCPSI8 CAPER Enh Table A1.1 Y
Procedure 5
APC Status Code -
60 Char(2) APCPSI9 CAPER Enh Table A1.1 Y
Procedure 6
N(8) Tables
61 APC Weight - E&M1 APCWT1 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
62 APC Weight - Procedure 7 APCWT10 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
63 APC Weight - Procedure 8 APCWT11 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
64 APC Weight - Procedure 9 APCWT12 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
65 APC Weight - Procedure 10 APCWT13 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
66 APC Weight - E&M2 APCWT2 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
67 APC Weight - E&M3 APCWT3 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
68 APC Weight - Procedure 1 APCWT4 CAPER Enh
Z9.4 A1.1/A3.2
Version 2.01.01 MDR CAPER Enhanced - 63 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
N(8) Tables
69 APC Weight - Procedure 2 APCWT5 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
70 APC Weight - Procedure 3 APCWT6 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
71 APC Weight - Procedure 4 APCWT7 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
72 APC Weight - Procedure 5 APCWT8 CAPER Enh
Z9.4 A1.1/A3.2
N(8) Tables
73 APC Weight - Procedure 6 APCWT9 CAPER Enh
Z9.4 A1.1/A3.2
74 APG E&M Char(3) APG1 CAPER Enh Table A1.1 Y
75 APG Medical Char(3) APG2 CAPER Enh Table A1.1 Y
76 APG - Procedure 1 Char(3) APG3 CAPER Enh Table A1.1 Y
77 APG - Procedure 2 Char(3) APG4 CAPER Enh Table A1.1 Y
78 APG - Procedure 3 Char(3) APG5 CAPER Enh Table A1.1 Y
79 APG - Procedure 4 Char(3) APG6 CAPER Enh Table A1.1 Y
80 Total APG Weight N(8) APGWGT_S CAPER Enh Table A3.3 Y
81 Associated Appointment EIN Char(10) APPTIDNO CAPER Basic CAPER Basic Y
Appointment Inferred
82 Char(1) APPTINFR CAPER Enh Table A2
CAPER Flag
83 Appointment Record Match N(3) APPTMTCH CAPER Enh Para V.A.2c.
Appointment Prefix (Source CAPER Basic
84 Char(1) APPTPFIX CAPER Basic
System Flag) & Table A2 Y
Appointment Status Type
85 with Appointment Data Char(1) APPTSTAT CAPER Enh Table A2
Y
Walk-In
86 Appointment Status Type Char(1) APPTSTAT1 CAPER Enh Table A2
Appointment Type from
87 Char(6) APPTTYPE CAPER Enh Table A2
Appointment Data Y
CAPER Basic
88 Appointment Type Raw Char(6) APPTTYPE_R CAPER Enh
& Table A2
89 APV Flag Char(1) APV CAPER Enh Table A2 Y
90 ASC Code, E&M1 Char(2) ASC1 CAPER Enh Table A3.3
91 ASC Code, Procedure 7 Char(2) ASC10 CAPER Enh Table A3.3
92 ASC Code, Procedure 8 Char(2) ASC11 CAPER Enh Table A3.3
93 ASC Code, Procedure 9 Char(2) ASC12 CAPER Enh Table A3.3
94 ASC Code, Procedure 10 Char(2) ASC13 CAPER Enh Table A3.3
95 ASC Code, E&M 2 Char(2) ASC2 CAPER Enh Table A3.3
96 ASC Code, E&M 3 Char(2) ASC3 CAPER Enh Table A3.3
97 ASC Code, Procedure 1 Char(2) ASC4 CAPER Enh Table A3.3
98 ASC Code, Procedure 2 Char(2) ASC5 CAPER Enh Table A3.3
99 ASC Code, Procedure 3 Char(2) ASC6 CAPER Enh Table A3.3
100 ASC Code, Procedure 4 Char(2) ASC7 CAPER Enh Table A3.3
101 ASC Code, Procedure 5 Char(2) ASC8 CAPER Enh Table A3.3
102 ASC Code, Procedure 6 Char(2) ASC9 CAPER Enh Table A3.3
Assigned Appointment
103 N(8) ASSGNDUR CAPER Basic CAPER Basic Y
Duration
104 Beneficiary Category Char(3) BENCAT CAPER Enh Table A2
Beneficiary Category from
105 Char(3) BENCATX CAPER Enh Table A2 Y
LVM4
Appointment Cancellation
106 Char(1) CANCSTAT CAPER Basic CAPER Basic
Status Type
107 CAPER Processing Date Char(8) CAPERPROCDATE CAPER Enh Table A2
108 CAPER Status Char(1) CAPERSTAT CAPER Basic CAPER Basic Y
109 Patient Catchment Area Char(4) CATCH CAPER Enh Table A2 Y
Version 2.01.01 MDR CAPER Enhanced - 64 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
110 CCE Encounter Status Flag Char(1) CCESTAT CAPER Basic CAPER Basic Y
111 Claim Denial Disposition Char(1) CLAIM_DEN CAPER Enh Table A1.1
112 Overall Claim Disposition Char(2) CLAIM_DISP CAPER Enh Table A1.1
Clinic State (from DMIS
113 Char(2) CLINSTAT CAPER Enh Table A2
merge)
114 Clinic State Char(2) CLINSTAT_R CAPER Basic CAPER Basic
Clinic Zip Code (from DMIS
115 Char(5) CLINZIP CAPER Enh Table A2
merge)
116 Clinic Zip Code (Raw) Char(10) CLINZIP_R CAPER Basic CAPER Basic
117 Calendar Month Char(2) CM CAPER Basic CAPER Basic Y
Common Beneficiary
118 Char(1) COMBEN CAPER Enh Table A2 Y
Category
DX(ICD-9-CM) Code,
119 Char(5) COMPLAINT CAPER Basic CAPER Basic Y
Encounter Chief Complaint
120 Compliance Status Char(1) COMPSTAT CAPER Enh Table A2 Y
121 Variable Cost N(8) COST CAPER Enh Table A3.3 Y
122 Variable Cost, E&M APG N(8) COST1 CAPER Enh Table A3.3 Y
123 Variable Cost, Medical APG N(8) COST2 CAPER Enh Table A3.3 Y
Variable Cost, Procedure 1
124 N(8) COST3 CAPER Enh Table A3.3 Y
APG
Variable Cost, Procedure 2
125 N(8) COST4 CAPER Enh Table A3.3 Y
APG
Variable Cost, Procedure 3
126 N(8) COST5 CAPER Enh Table A3.3 Y
APG
Variable Cost, Procedure 4
127 N(8) COST6 CAPER Enh Table A3.3 Y
APG
CAPER Basic
128 Count Visit Indicator Char(1) COUNTVIS CAPER Basic Y
& Table A2
129 E&M Code 1 Char(5) CPT_1 CAPER Basic CAPER Basic Y
130 CPT/HCPCS Code 7 Char(5) CPT_10 CAPER Basic CAPER Basic Y
131 CPT/HCPCS Code 8 Char(5) CPT_11 CAPER Basic CAPER Basic Y
132 CPT/HCPCS Code 9 Char(5) CPT_12 CAPER Basic CAPER Basic Y
133 CPT/HCPCS Code 10 Char(5) CPT_13 CAPER Basic CAPER Basic Y
134 E&M Code 2 Char(5) CPT_2 CAPER Basic CAPER Basic Y
135 E&M Code 3 Char(5) CPT_3 CAPER Basic CAPER Basic Y
136 CPT/HCPCS Code 1 Char(5) CPT_4 CAPER Basic CAPER Basic Y
137 CPT/HCPCS Code 2 Char(5) CPT_5 CAPER Basic CAPER Basic Y
138 CPT/HCPCS Code 3 Char(5) CPT_6 CAPER Basic CAPER Basic Y
139 CPT/HCPCS Code 4 Char(5) CPT_7 CAPER Basic CAPER Basic Y
140 CPT/HCPCS Code 5 Char(5) CPT_8 CAPER Basic CAPER Basic Y
141 CPT/HCPCS Code 6 Char(5) CPT_9 CAPER Basic CAPER Basic Y
E&M Code 1-Diagnosis
142 Char(4) CPTDX_1 CAPER Basic CAPER Basic
Pointer
CPT/HCPCS Code 7-
143 Char(4) CPTDX_10 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 8-
144 Char(4) CPTDX_11 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 9-
145 Char(4) CPTDX_12 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 10-
146 Char(4) CPTDX_13 CAPER Basic CAPER Basic
Diagnosis Pointer
E&M Code 2-Diagnosis
147 Char(4) CPTDX_2 CAPER Basic CAPER Basic
Pointer
E&M Code 3-Diagnosis
148 Char(4) CPTDX_3 CAPER Basic CAPER Basic
Pointer
Version 2.01.01 MDR CAPER Enhanced - 65 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
CPT/HCPCS Code 1-
149 Char(4) CPTDX_4 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 2-
150 Char(4) CPTDX_5 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 3-
151 Char(4) CPTDX_6 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 4-
152 Char(4) CPTDX_7 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 5-
153 Char(4) CPTDX_8 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 6-
154 Char(4) CPTDX_9 CAPER Basic CAPER Basic
Diagnosis Pointer
CPT/HCPCS Code 7-Min of
155 N(8) CPTMIN_10 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 8-Min of
156 N(8) CPTMIN_11 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 9-Min of
157 N(8) CPTMIN_12 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 10-Min of
158 N(8) CPTMIN_13 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 1-Min of
159 N(8) CPTMIN_4 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 2-Min of
160 N(8) CPTMIN_5 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 3-Min of
161 N(8) CPTMIN_6 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 4-Min of
162 N(8) CPTMIN_7 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 5-Min of
163 N(8) CPTMIN_8 CAPER Basic CAPER Basic
Anesthesia
CPT/HCPCS Code 6-Min of
164 N(8) CPTMIN_9 CAPER Basic CAPER Basic
Anesthesia
165 E&M Code 1-Modifier 1 Char(2) CPTMOD1_1 CAPER Basic CAPER Basic Y
CPT/HCPCS Code 7-Modifier
166 Char(2) CPTMOD1_10 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 8-Modifier
167 Char(2) CPTMOD1_11 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 9-Modifier
168 Char(2) CPTMOD1_12 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 10-
169 Char(2) CPTMOD1_13 CAPER Basic CAPER Basic Y
Modifier 1
170 E&M Code 2-Modifier 1 Char(2) CPTMOD1_2 CAPER Basic CAPER Basic Y
171 E&M Code 3-Modifier 1 Char(2) CPTMOD1_3 CAPER Basic CAPER Basic Y
CPT/HCPCS Code 1-Modifier
172 Char(2) CPTMOD1_4 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 2-Modifier
173 Char(2) CPTMOD1_5 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 3-Modifier
174 Char(2) CPTMOD1_6 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 4-Modifier
175 Char(2) CPTMOD1_7 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 5-Modifier
176 Char(2) CPTMOD1_8 CAPER Basic CAPER Basic Y
1
CPT/HCPCS Code 6-Modifier
177 Char(2) CPTMOD1_9 CAPER Basic CAPER Basic Y
1
Version 2.01.01 MDR CAPER Enhanced - 66 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
178 E&M Code 1-Modifier 2 Char(2) CPTMOD2_1 CAPER Basic CAPER Basic Y
CPT/HCPCS Code 7-Modifier
179 Char(2) CPTMOD2_10 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 8-Modifier
180 Char(2) CPTMOD2_11 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 9-Modifier
181 Char(2) CPTMOD2_12 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 10-
182 Char(2) CPTMOD2_13 CAPER Basic CAPER Basic Y
Modifier 2
183 E&M Code 2-Modifier 2 Char(2) CPTMOD2_2 CAPER Basic CAPER Basic Y
184 E&M Code 3-Modifier 2 Char(2) CPTMOD2_3 CAPER Basic CAPER Basic Y
CPT/HCPCS Code 1-Modifier
185 Char(2) CPTMOD2_4 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 2-Modifier
186 Char(2) CPTMOD2_5 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 3-Modifier
187 Char(2) CPTMOD2_6 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 4-Modifier
188 Char(2) CPTMOD2_7 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 5-Modifier
189 Char(2) CPTMOD2_8 CAPER Basic CAPER Basic Y
2
CPT/HCPCS Code 6-Modifier
190 Char(2) CPTMOD2_9 CAPER Basic CAPER Basic Y
2
191 E&M Code 1-Modifier 3 Char(2) CPTMOD3_1 CAPER Basic CAPER Basic
CPT/HCPCS Code 7-Modifier
192 Char(2) CPTMOD3_10 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 8-Modifier
193 Char(2) CPTMOD3_11 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 9-Modifier
194 Char(2) CPTMOD3_12 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 10-
195 Char(2) CPTMOD3_13 CAPER Basic CAPER Basic
Modifier 3
196 E&M Code 2-Modifier 3 Char(2) CPTMOD3_2 CAPER Basic CAPER Basic
197 E&M Code 3-Modifier 3 Char(2) CPTMOD3_3 CAPER Basic CAPER Basic
CPT/HCPCS Code 1-Modifier
198 Char(2) CPTMOD3_4 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 2-Modifier
199 Char(2) CPTMOD3_5 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 3-Modifier
200 Char(2) CPTMOD3_6 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 4-Modifier
201 Char(2) CPTMOD3_7 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 5-Modifier
202 Char(2) CPTMOD3_8 CAPER Basic CAPER Basic
3
CPT/HCPCS Code 6-Modifier
203 Char(2) CPTMOD3_9 CAPER Basic CAPER Basic
3
E&M Code 1-Provider
204 Char(5) CPTPROV_1 CAPER Basic CAPER Basic
Pointers
CPT/HCPCS Code 7-Provider
205 Char(5) CPTPROV_10 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 8-Provider
206 Char(5) CPTPROV_11 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 9-Provider
207 Char(5) CPTPROV_12 CAPER Basic CAPER Basic
Linkage
Version 2.01.01 MDR CAPER Enhanced - 67 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
CPT/HCPCS Code 10-
208 Char(5) CPTPROV_13 CAPER Basic CAPER Basic
Provider Linkage
E&M Code 2-Provider
209 Char(5) CPTPROV_2 CAPER Basic CAPER Basic
Pointers
E&M Code 3-Provider
210 Char(5) CPTPROV_3 CAPER Basic CAPER Basic
Pointers
CPT/HCPCS Code 1-Provider
211 Char(5) CPTPROV_4 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 2-Provider
212 Char(5) CPTPROV_5 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 3-Provider
213 Char(5) CPTPROV_6 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 4-Provider
214 Char(5) CPTPROV_7 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 5-Provider
215 Char(5) CPTPROV_8 CAPER Basic CAPER Basic
Linkage
CPT/HCPCS Code 6-Provider
216 Char(5) CPTPROV_9 CAPER Basic CAPER Basic
Linkage
E&M Code 1-Units of
217 N(8) CPTUNITS_1 CAPER Basic CAPER Basic
Service15 (Raw)
CPT/HCPCS Code 7-Units of
218 N(8) CPTUNITS_10 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 8-Units of
219 N(8) CPTUNITS_11 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 9-Units of
220 N(8) CPTUNITS_12 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 10-Units
221 N(8) CPTUNITS_13 CAPER Basic CAPER Basic
of Service (Raw)
E&M Code 2-Units of
222 N(8) CPTUNITS_2 CAPER Basic CAPER Basic
Service (Raw)
E&M Code 3-Units of
223 N(8) CPTUNITS_3 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 1-Units of
224 N(8) CPTUNITS_4 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 2-Units of
225 N(8) CPTUNITS_5 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 3-Units of
226 N(8) CPTUNITS_6 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 4-Units of
227 N(8) CPTUNITS_7 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 5-Units of
228 N(8) CPTUNITS_8 CAPER Basic CAPER Basic
Service (Raw)
CPT/HCPCS Code 6-Units of
229 N(8) CPTUNITS_9 CAPER Basic CAPER Basic
Service (Raw)
E&M Code 1-Units of
230 N(8) CPTUOS_1 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 7-Units of
231 N(8) CPTUOS_10 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 8-Units of
232 N(8) CPTUOS_11 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 9-Units of
233 N(8) CPTUOS_12 CAPER Enh Table A1.1 Y
Service
15
Units of Care fields from CAPER Basic relabeled to Units of Service in CAPER Enhanced.
Version 2.01.01 MDR CAPER Enhanced - 68 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
CPT/HCPCS Code 10-Units
234 N(8) CPTUOS_13 CAPER Enh Table A1.1 Y
of Service
E&M Code 2-Units of
235 N(8) CPTUOS_2 CAPER Enh Table A1.1 Y
Service
E&M Code 3-Units of
236 N(8) CPTUOS_3 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 1-Units of
237 N(8) CPTUOS_4 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 2-Units of
238 N(8) CPTUOS_5 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 3-Units of
239 N(8) CPTUOS_6 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 4-Units of
240 N(8) CPTUOS_7 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 5-Units of
241 N(8) CPTUOS_8 CAPER Enh Table A1.1 Y
Service
CPT/HCPCS Code 6-Units of
242 N(8) CPTUOS_9 CAPER Enh Table A1.1 Y
Service
243 Calendar Year Char(4) CY CAPER Basic CAPER Basic Y
244 DEERS Dependent Suffix Char(2) DDS CAPER Enh Table A2 Y
245 Deployment Country Char(2) DEPLOYCNTRY CAPER Basic CAPER Basic
Deployment Related
246 Char(1) DEPLOYCOND CAPER Basic CAPER Basic
Illness/Condition
247 Deployed Relationship Char(1) DEPLOYRELN CAPER Basic CAPER Basic
248 Disposition Code Char(1) DISPCODE CAPER Basic CAPER Basic Y
249 Treatment DMIS ID Char(4) DMISID CAPER Basic CAPER Basic Y
250 DX (ICD-9-CM) Code #1 Char(7) DX1 CAPER Basic CAPER Basic Y
251 DX (ICD-9-CM) Code #10 Char(7) DX10 CAPER Basic CAPER Basic Y
252 DX (ICD-9-CM) Code #2 Char(7) DX2 CAPER Basic CAPER Basic Y
253 DX (ICD-9-CM) Code #3 Char(7) DX3 CAPER Basic CAPER Basic Y
254 DX (ICD-9-CM) Code #4 Char(7) DX4 CAPER Basic CAPER Basic Y
255 DX (ICD-9-CM) Code #5 Char(7) DX5 CAPER Basic CAPER Basic Y
256 DX (ICD-9-CM) Code #6 Char(7) DX6 CAPER Basic CAPER Basic Y
257 DX (ICD-9-CM) Code #7 Char(7) DX7 CAPER Basic CAPER Basic Y
258 DX (ICD-9-CM) Code #8 Char(7) DX8 CAPER Basic CAPER Basic Y
259 DX (ICD-9-CM) Code #9 Char(7) DX9 CAPER Basic CAPER Basic Y
DX (ICD-9-CM) Code #1-
260 Char(1) DXEXT1 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #10-
261 Char(1) DXEXT10 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #2-
262 Char(1) DXEXT2 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #3-
263 Char(1) DXEXT3 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #4-
264 Char(1) DXEXT4 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #5-
265 Char(1) DXEXT5 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #6-
266 Char(1) DXEXT6 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #7-
267 Char(1) DXEXT7 CAPER Basic CAPER Basic Y
DOD Extender
DX (ICD-9-CM) Code #8-
268 Char(1) DXEXT8 CAPER Basic CAPER Basic Y
DOD Extender
Version 2.01.01 MDR CAPER Enhanced - 69 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
DX (ICD-9-CM) Code #9-
269 Char(1) DXEXT9 CAPER Basic CAPER Basic Y
DOD Extender
270 Diagnosis Group Char(2) DXGRP CAPER Enh Table A2 Y
DX (ICD-9-CM) Code #1-
271 Char(1) DXPRI1 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #10-
272 Char(1) DXPRI10 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #2-
273 Char(1) DXPRI2 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #3-
274 Char(1) DXPRI3 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #4-
275 Char(1) DXPRI4 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #5-
276 Char(1) DXPRI5 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #6-
277 Char(1) DXPRI6 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #7-
278 Char(1) DXPRI7 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #8-
279 Char(1) DXPRI8 CAPER Basic CAPER Basic
Priority
DX (ICD-9-CM) Code #9-
280 Char(1) DXPRI9 CAPER Basic CAPER Basic
Priority
Unique Person Identifier
281 Char(10) EDIPN CAPER Enh Table A2 Y
(EDIPN)
Patient Identifier (EDIPN),
282 Char(10) EDIPN_R CAPER Basic CAPER Basic
Raw
Modified Appointment
283 Char(8) ENCDATE CAPER Basic CAPER Basic
(Encounter) Date Y
Raw Appointment
284 Char(8) ENCDATE_R CAPER Basic CAPER Basic
(Encounter) Date
285 Enrollment DMIS ID Char(4) ENRDMIS CAPER Enh Table A2 Y
286 Enrollment DMIS ID Raw Char(4) ENRDMIS_R CAPER Basic CAPER Basic
287 Enrollment DMIS ID Region Char(2) ENRREG CAPER Enh Table A2
288 End of Record Char(5) EOR CAPER Basic CAPER Basic
289 Ethnic Background Char(1) ETHNICGR CAPER Basic CAPER Basic
290 Age Group Common Char(1) EXPAGE CAPER Enh Table A2 Y
291 CAPER Extract Date Char(8) EXTRDATE CAPER Basic CAPER Basic
292 Facility/Non-Facility Flag Char(1) FAC_FLAG CAPER Enh Table A3.3 Y
293 Full Cost, Clinician Salary N(8) FCCLNSAL CAPER Enh Table A3.3 Y
294 Full Cost, Laboratory N(8) FCLAB CAPER Enh Table A3.3 Y
295 Full Cost N(8) FCOST CAPER Enh Table A3.3 Y
296 Full Cost, E&M APG N(8) FCOST1 CAPER Enh Table A3.3 Y
297 Full Cost, Medical APG N(8) FCOST2 CAPER Enh Table A3.3 Y
298 Full Cost, Procedure 1 APG N(8) FCOST3 CAPER Enh Table A3.3 Y
299 Full Cost, Procedure 2 APG N(8) FCOST4 CAPER Enh Table A3.3 Y
300 Full Cost, Procedure 3 APG N(8) FCOST5 CAPER Enh Table A3.3 Y
301 Full Cost, Procedure 4 APG N(8) FCOST6 CAPER Enh Table A3.3 Y
302 Full Cost, Other Ancillary N(8) FCOTHANC CAPER Enh Table A3.3 Y
303 Full Cost, Other N(8) FCOTHER CAPER Enh Table A3.3 Y
304 Full Cost, Other Labor N(8) FCOTHLBR CAPER Enh Table A3.3 Y
305 Full Cost, Radiology N(8) FCRAD CAPER Enh Table A3.3 Y
306 Full Cost, Pharmacy N(8) FCRX CAPER Enh Table A3.3 Y
307 Beneficiary First Name Char(??) FIRSTNAME CAPER Enh Table A2 Y
308 Fiscal Month Char(2) FM CAPER Basic CAPER Basic Y
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Spec
Field Type SAS Name Source M2?
Reference
309 Family Member Prefix Char(2) FMP CAPER Basic CAPER Basic Y
310 RVU, E&M 1 Facility Practice N(8) FPRVU1 CAPER Enh Table A3.3
RVU, Procedure 10 Facility
311 N(8) FPRVU10 CAPER Enh Table A3.3
Practice
RVU, Procedure 11 Facility
312 N(8) FPRVU11 CAPER Enh Table A3.3
Practice
RVU, Procedure 12 Facility
313 N(8) FPRVU12 CAPER Enh Table A3.3
Practice
RVU, Procedure 13 Facility
314 Practice, no modifiers, no N(8) FPRVU13 CAPER Enh Table A3.3
modifiers
315 RVU, E&M 2 Facility Practice N(8) FPRVU2 CAPER Enh Table A3.3
316 RVU, E&M 3 Facility Practice N(8) FPRVU3 CAPER Enh Table A3.3
RVU, Procedure 1 Facility
317 N(8) FPRVU4 CAPER Enh Table A3.3
Practice
RVU, Procedure 2 Facility
318 N(8) FPRVU5 CAPER Enh Table A3.3
Practice
RVU, Procedure 3 Facility
319 N(8) FPRVU6 CAPER Enh Table A3.3
Practice
RVU, Procedure 4 Facility
320 N(8) FPRVU7 CAPER Enh Table A3.3
Practice
RVU, Procedure 5 Facility
321 N(8) FPRVU8 CAPER Enh Table A3.3
Practice
RVU, Procedure 6 Facility
322 N(8) FPRVU9 CAPER Enh Table A3.3
Practice
323 Fiscal Year Char(4) FY CAPER Basic CAPER Basic Y
Health Care Delivery
324 Char(3) HCDPCODE_R CAPER Basic CAPER Basic
Program Code
325 HCDP Code from LVM4 Char(3) HCDPLVM CAPER Enh Table A2 Y
326 Patient Hospital Status Char(1) HOSPSTAT CAPER Basic CAPER Basic Y
327 CHCS Host Char(4) HOSTDMIS CAPER Basic CAPER Basic Y
Injury Related/Cause Code
328 Char(2) INJCODE1 CAPER Basic CAPER Basic Y
1
Injury Related/Cause Code
329 Char(2) INJCODE2 CAPER Basic CAPER Basic Y
2
Injury Related/Cause Code
330 Char(2) INJCODE3 CAPER Basic CAPER Basic Y
3
331 Date of Injury, CCYYMMDD Char(8) INJDATE CAPER Basic CAPER Basic Y
332 Injury Geographic Location Char(5) INJGEOGLOC CAPER Basic CAPER Basic Y
333 Injury Place of Accident Char(54) INJPOA CAPER Basic CAPER Basic Y
334 Injury Place of Employment Char(54) INJPOE CAPER Basic CAPER Basic Y
335 Injury Related Char(1) INJREL CAPER Basic CAPER Basic Y
336 Inpatient Appointment Char(1) INPAPPT CAPER Basic CAPER Basic Y
337 Medical Insurance Billable Char(1) INSBILL CAPER Basic CAPER Basic Y
338 RVU, Individual Work N(8) IWRVU CAPER Enh Table A3.3 Y
RVU, Individual Work per
339 N(8) IWRVU_S CAPER Enh Table A3.3 Y
SADR
340 Beneficiary Last Name Char(??) LASTNAME CAPER Enh Table A2 Y
CAPER Basic
341 M2 Code Char(1) M2CODE CAPER Basic
& Table A2
342 Marital Status Char(1) MARITAL CAPER Basic CAPER Basic Y
343 MCP Group ID Char(19) MCPID CAPER Basic CAPER Basic Y
344 Major Diagnostic Category Char(2) MDC CAPER Enh Table A2 Y
345 Medicare Eligibility Field Char(2) MEDELIG CAPER Basic CAPER Basic
Version 2.01.01 MDR CAPER Enhanced - 71 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
Medicare Eligibility
346 Char(1) MEDELIG2 CAPER Enh Table A2 Y
Aggregate
347 Medicare Eligibility Flag Char(1) MEDFLAG CAPER Enh Table A2
Medicare Eligibility as
348 Reported in the Char(2) MELIGAPT CAPER Enh Table A2
Appointment Data
349 MEPRS1 Code Char(1) MEPR1 CAPER Enh Table A2 Y
350 MEPRS2 Code Char(2) MEPR2 CAPER Enh Table A2 Y
351 MEPRS3 Code Char(3) MEPR3 CAPER Enh Table A2 Y
352 Treatment MEPRS Code Char(4) MEPRSCD CAPER Basic CAPER Basic Y
353 Multi-Service Market Area Char(3) MSMA CAPER Enh Table A2 Y
354 Treatment Parent DMIS ID Char(4) MTF_PAR CAPER Basic CAPER Basic Y
Inpatient DMISID & Patient
355 Char(11) MTF_PRN CAPER Basic CAPER Basic
Register Number Y
RVU, E&M 1 Non-Facility
356 N(8) NPRVU1 CAPER Enh Table A3.3
Practice
RVU, Procedure 10 Non-
357 N(8) NPRVU10 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 11 Non-
358 N(8) NPRVU11 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 12 Non-
359 N(8) NPRVU12 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 13 Non-
360 N(8) NPRVU13 CAPER Enh Table A3.3
Facility Practice
RVU, E&M 2 Non-Facility
361 N(8) NPRVU2 CAPER Enh Table A3.3
Practice
RVU, E&M 3 Non-Facility
362 N(8) NPRVU3 CAPER Enh Table A3.3
Practice
RVU, Procedure 1 Non-
363 N(8) NPRVU4 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 2 Non-
364 N(8) NPRVU5 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 3 Non-
365 N(8) NPRVU6 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 4 Non-
366 N(8) NPRVU7 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 5 Non-
367 N(8) NPRVU8 CAPER Enh Table A3.3
Facility Practice
RVU, Procedure 6 Non-
368 N(8) NPRVU9 CAPER Enh Table A3.3
Facility Practice
369 Patient OHI Indicator Char(1) OHI CAPER Basic CAPER Basic Y
370 RVU, Organizational Work N(8) OWRVU CAPER Enh Table A3.3 Y
RVU, Organizational Work
371 N(8) OWRVU_S CAPER Enh Table A3.3 Y
Per SADR
Person Association Reason
372 Char(2) PARC CAPER Enh Table A2 Y
Code
373 Parent DMIS ID (Cost) Char(4) PARCOST CAPER Enh Table A2
Parent DMIS ID
374 Char(4) PARENR CAPER Enh Table A2 Y
(Enrollment)
375 Parent DMIS ID (MEPRS) Char(4) PARMEPRS CAPER Enh Table A2
376 Patient Age N(8) PATAGE CAPER Enh Table A1.1 Y
377 Patient Category Char(3) PATCAT CAPER Enh Table A2 Y
378 Patient Category Raw Char(5) PATCAT_R CAPER Basic CAPER Basic
379 Patient Date of Birth Char(8) PATDOB CAPER Basic CAPER Basic Y
380 Beneficiary HSSC Region Char(1) PATHSSC CAPER Enh Table A2 Y
Version 2.01.01 MDR CAPER Enhanced - 72 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
381 Beneficiary Name Char(??) PATNAME CAPER Enh Table A2 Y
382 Patient Race Code Char(1) PATRACE CAPER Basic CAPER Basic Y
Patient Health Service
383 Char(2) PATREGN CAPER Enh Table A2 Y
Region
384 Patient Gender Char(1) PATSEX CAPER Basic CAPER Basic Y
Patient Social Security
385 Char(9) PATSSN CAPER Basic CAPER Basic Y
Number
Patient Status as Reported
386 Char(1) PATSTAT CAPER Enh Table A2
in the Appointment Data Y
387 Modified Patient Zip Code Char(9) PATZIP CAPER Basic CAPER Basic Y
388 Patient Zip Code (Raw) Char(10) PATZIP_R CAPER Basic CAPER Basic
389 PCM EDIPN Char(10) PCMEDIPN CAPER Basic CAPER Basic Y
390 PCM Group Tax ID Char(10) PCMGRP CAPER Basic CAPER Basic
Primary Care Manager
391 Char(10) PCMID CAPER Basic CAPER Basic Y
Provider ID
NED Primary Care Manager
392 Char(18) PCMID_NED CAPER Basic CAPER Basic
ID
PCM ID from the LVM
393 Char(18) PCMIDLVM CAPER Enh Table A2 Y
merge
Primary Care Manager
394 Char(2) PCMLOC CAPER Basic CAPER Basic
Location CD
395 Primary Care Manager NPI Char(10) PCMNPI CAPER Basic CAPER Basic Y
396 PCM NPI Type Char(1) PCMNPITYPE CAPER Basic CAPER Basic Y
397 NED PCM Type Code Char(1) PCMTYPE_NED CAPER Basic CAPER Basic
398 RVU, Simple PE N(8) PERVU CAPER Enh Table A3.3 Y
399 RVU, Simple PE per SADR N(8) PERVU_S CAPER Enh Table A3.3 Y
RVU, E&M 1 Practice
400 N(8) PERVU1 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 10 Practice
401 N(8) PERVU10 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 11 Practice
402 N(8) PERVU11 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 12 Practice
403 N(8) PERVU12 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 13 Practice
404 N(8) PERVU13 CAPER Enh Table A3.3 Y
Expense
RVU, E&M 2 Practice
405 N(8) PERVU2 CAPER Enh Table A3.3 Y
Expense
RVU, E&M 3 Practice
406 N(8) PERVU3 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 1 Practice
407 N(8) PERVU4 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 2 Practice
408 N(8) PERVU5 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 3 Practice
409 N(8) PERVU6 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 4 Practice
410 N(8) PERVU7 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 5 Practice
411 N(8) PERVU8 CAPER Enh Table A3.3 Y
Expense
RVU, Procedure 6 Practice
412 N(8) PERVU9 CAPER Enh Table A3.3 Y
Expense
413 PPS Enrollment Parent Site Char(4) PPS_EPS CAPER Enh Table A2
414 PPS Treatment Parent Site Char(4) PPS_TPS CAPER Enh Table A2
415 PRISM Service Area Char(4) PRISM CAPER Enh Table A2 Y
Version 2.01.01 MDR CAPER Enhanced - 73 27 July 2010
Spec
Field Type SAS Name Source M2?
Reference
416 Processing Date Char(8) PROCDATE CAPER Basic CAPER Basic
417 Product Line Char(7) PRODLINE CAPER Enh Table A2 Y
418 Appointment Provider Class Char(30) PROVCLAS1 CAPER Basic CAPER Basic
419 Referring Provider DMISID Char(4) PROVDMISREF CAPER Basic CAPER Basic Y
Appointment Provider
420 Char(10) PROVEDIPN1 CAPER Basic CAPER Basic Y
EDIPN
421 Additional Provider 1 EDIPN Char(10) PROVEDIPN2 CAPER Basic CAPER Basic Y
422 Additional Provider 2 EDIPN Char(10) PROVEDIPN3 CAPER Basic CAPER Basic Y
423 Additional Provider 3 EDIPN Char(10) PROVEDIPN4 CAPER Basic CAPER Basic Y
424 Additional Provider 4 EDIPN Char(10) PROVEDIPN5 CAPER Basic CAPER Basic Y
425 Referring Provider EDIPN Char(10) PROVEDIPNREF CAPER Basic CAPER Basic Y
Appointment Provider
426 Char(10) PROVHIPAA1 CAPER Basic CAPER Basic
HIPAA Taxonomy Y
Additional Provider 1 HIPAA
427 Char(10) PROVHIPAA2 CAPER Basic CAPER Basic
Taxonomy Y
Additional Provider 2 HIPAA
428 Char(10) PROVHIPAA3 CAPER Basic CAPER Basic
Taxonomy Y
Additional Provider 3 HIPAA
429 Char(10) PROVHIPAA4 CAPER Basic CAPER Basic
Taxonomy Y
Additional Provider 4 HIPAA
430 Char(10) PROVHIPAA5 CAPER Basic CAPER Basic
Taxonomy Y
431 Appointment Provider ID Char(9) PROVID1 CAPER Basic CAPER Basic Y
432 Additional Provider 1 ID Char(10) PROVID2 CAPER Basic CAPER Basic Y
433 Additional Provider 2 ID Char(10) PROVID3 CAPER Basic CAPER Basic Y
434 Additional Provider 3 ID Char(10) PROVID4 CAPER Basic CAPER Basic Y
435 Additional Provider 4 ID Char(10) PROVID5 CAPER Basic CAPER Basic Y
PROVIDREF /
436 Referring Provider ID, Raw Char(9) CAPER Basic CAPER Basic Y
REF_PROV_R
Assigned MEPRS Code for
437 Char(4) PROVMEPR1 CAPER Basic CAPER Basic
Appointment Provider Y
Assigned MEPRS Code for
438 Char(4) PROVMEPR2 CAPER Basic CAPER Basic
Additional Prov 1
Assigned MEPRS Code for
439 Char(4) PROVMEPR3 CAPER Basic CAPER Basic
Additional Prov 2
Assigned MEPRS Code for
440 Char(4) PROVMEPR4 CAPER Basic CAPER Basic
Additional Prov 3
Assigned MEPRS Code for
441 Char(4) PROVMEPR5 CAPER Basic CAPER Basic
Additional Prov 4
Assigned MTF for
442 Char(4) PROVMTF1 CAPER Basic CAPER Basic
Appointment Provider
Assigned MTF for Additional
443 Char(4) PROVMTF2 CAPER Basic CAPER Basic
Provider 1
Assigned MTF for Additional
444 Char(4) PROVMTF3 CAPER Basic CAPER Basic
Provider 2
Assigned MTF for Additional
445 Char(4) PROVMTF4 CAPER Basic CAPER Basic
Provider 3
Assigned MTF for Additional
446 Char(4) PROVMTF5 CAPER Basic CAPER Basic
Provider 4
447 Appointment Provider NPI Char(10) PROVNPI1 CAPER Basic CAPER Basic Y
448 Additional Provider 1 NPI Char(10) PROVNPI2 CAPER Basic CAPER Basic Y
449 Additional Provider 2 NPI Char(10) PROVNPI3 CAPER Basic CAPER Basic Y
450 Additional Provider 3 NPI Char(10) PROVNPI4 CAPER Basic CAPER Basic Y
451 Additional Provider 4 NPI Char(10) PROVNPI5 CAPER Basic CAPER Basic Y
452 Referring Provider NPI Char(10) PROVNPIREF CAPER Basic CAPER Basic Y
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Spec
Field Type SAS Name Source M2?
Reference
Appointment Provider NPI
453 Char(1) PROVNPITYPE1 CAPER Basic CAPER Basic Y
Type
Additional Provider 1 NPI
454 Char(1) PROVNPITYPE2 CAPER Basic CAPER Basic Y
Type
Additional Provider 2 NPI
455 Char(1) PROVNPITYPE3 CAPER Basic CAPER Basic Y
Type
Additional Provider 3 NPI
456 Char(1) PROVNPITYPE4 CAPER Basic CAPER Basic Y
Type
Additional Provider 4 NPI
457 Char(1) PROVNPITYPE5 CAPER Basic CAPER Basic Y
Type
458 Referring Provider NPI Type Char(1) PROVNPITYPEREF CAPER Basic CAPER Basic Y
459 Appointment Provider Role Char(1) PROVROLE1 CAPER Basic CAPER Basic Y
460 Additional Provider 1 Role Char(1) PROVROLE2 CAPER Basic CAPER Basic Y
461 Additional Provider 2 Role Char(1) PROVROLE3 CAPER Basic CAPER Basic Y
462 Additional Provider 3 Role Char(1) PROVROLE4 CAPER Basic CAPER Basic Y
463 Additional Provider 4 Role Char(1) PROVROLE5 CAPER Basic CAPER Basic Y
Appointment Provider
464 Char(3) PROVSPEC1 CAPER Basic CAPER Basic Y
Specialty Code
Additional Provider 1
465 Char(3) PROVSPEC2 CAPER Basic CAPER Basic Y
Specialty Code
Additional Provider 2
466 Char(3) PROVSPEC3 CAPER Basic CAPER Basic Y
Specialty Code
Additional Provider 3
467 Char(3) PROVSPEC4 CAPER Basic CAPER Basic Y
Specialty Code
Additional Provider 4
468 Char(3) PROVSPEC5 CAPER Basic CAPER Basic Y
Specialty Code
Appointment Provider
469 Char(13) PROVSTAT1 CAPER Basic CAPER Basic Y
Military Status
Additional Provider 1
470 Char(3) PROVSTAT2 CAPER Basic CAPER Basic Y
Military Status
Additional Provider 2
471 Char(3) PROVSTAT3 CAPER Basic CAPER Basic Y
Military Status
Additional Provider 3
472 Char(3) PROVSTAT4 CAPER Basic CAPER Basic Y
Military Status
Additional Provider 4
473 Char(3) PROVSTAT5 CAPER Basic CAPER Basic Y
Military Status
Appointment Provider Type
474 Char(1) PROVTYPE1 CAPER Basic CAPER Basic Y
Code
475 Sponsor Rank Group Char(2) RANKGRP CAPER Enh Table A2 Y
476 Sponsor Rank/Paygrade Char(3) RANKPAY CAPER Enh Table A2 Y
477 Military Grade/Rank Char(4) RANKPAY_R CAPER Basic CAPER Basic
478 Reason for Appointment Char(78) REASON CAPER Basic CAPER Basic
REF_NO/REFNUM
479 Referral Number, Raw Char(11) CAPER Basic CAPER Basic Y
_R
Referring Provider [from
480 Char(14) REF_PROV CAPER Enh Table A2 Y
Referral Database]
Referral Number [from
481 Char(11) REFNUM CAPER Enh Table A2
Referral Database]
482 RVU, Simple Work N(8) RRVU CAPER Enh Table A3.3 Y
RVU, Simple Work per
483 N(8) RRVU_S CAPER Enh Table A3.3 Y
SADR
484 RVU, E&M 1 Work N(8) RRVU1 CAPER Enh Table A3.3 Y
485 RVU, Procedure 7 Work N(8) RRVU10 CAPER Enh Table A3.3 Y
486 RVU, Procedure 8 Work N(8) RRVU11 CAPER Enh Table A3.3 Y
487 RVU, Procedure 9 Work N(8) RRVU12 CAPER Enh Table A3.3 Y
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Spec
Field Type SAS Name Source M2?
Reference
488 RVU, Procedure 10 Work N(8) RRVU13 CAPER Enh Table A3.3 Y
489 RVU, E&M 2 Work N(8) RRVU2 CAPER Enh Table A3.3 Y
490 RVU, E&M 3 Work N(8) RRVU3 CAPER Enh Table A3.3 Y
491 RVU, Procedure 1 Work N(8) RRVU4 CAPER Enh Table A3.3 Y
492 RVU, Procedure 2 Work N(8) RRVU5 CAPER Enh Table A3.3 Y
493 RVU, Procedure 3 Work N(8) RRVU6 CAPER Enh Table A3.3 Y
494 RVU, Procedure 4 Work N(8) RRVU7 CAPER Enh Table A3.3 Y
495 RVU, Procedure 5 Work N(8) RRVU8 CAPER Enh Table A3.3 Y
496 RVU, Procedure 6 Work N(8) RRVU9 CAPER Enh Table A3.3 Y
497 Recoded Sponsor Service Char(1) RSPONSVC CAPER Enh Table A2 Y
RVU, Enhanced Practice
498 N(8) RVU_EPE CAPER Enh Table A3.3 Y
Expense
RVU, Enhanced Practice
499 N(8) RVU_EPE_S CAPER Enh Table A3.3 Y
Expense per SADR
500 RVU, Enhanced Total N(8) RVU_ET CAPER Enh Table A3.3 Y
RVU, Enhanced Total per
501 N(8) RVU_ET_S CAPER Enh Table A3.3 Y
SADR
502 RVU, Enhanced Work N(8) RVU_EW CAPER Enh Table A3.3 Y
RVU, Enhanced Work per
503 N(8) RVU_EW_S CAPER Enh Table A3.3 Y
SADR
Sponsor Service Aggregate
504 Char(1) SAGGLVM CAPER Enh Table A2
from LVM
505 Scope of Care Char(1) SCOPE CAPER Basic CAPER Basic
506 Same Day Surgery Flag Char(1) SDS CAPER Enh Table A2 Y
Site Identifier from
507 Char(8) SITEID CAPER Basic CAPER Basic
Filename of Raw Feed
Reservist Special Operation
508 Char(2) SOC CAPER Enh Table A2 Y
Code
Special Operations Code
509 Char(2) SOC_R CAPER Basic CAPER Basic
(Raw)
Sponsor Social Security
510 Char(9) SPONSSN CAPER Enh Table A2 Y
Number
Sponsor Social Security
511 Char(9) SPONSSN_R CAPER Basic CAPER Basic
Number
512 Source Processing Date Char(8) SRCPROCDATE CAPER Enh Table A2
Sponsor Service from
513 Char(1) SSVCLVM CAPER Enh Table A2
DEERS
514 DOD Specific Injury Code Char(3) STANAG CAPER Basic CAPER Basic Y
515 Reservist Status Code Char(1) STATUS CAPER Enh Table A2 Y
Telemedicine/Remote
516 Char(1) TELEMED CAPER Basic CAPER Basic
Consult Code
517 Third Party Collection Rate N(8) TPC CAPER Enh Table A3.3
518 TPR Eligibility Flag Char(1) TPRELIG CAPER Enh Table A2 Y
519 Tmt DMIS ID HSSC Region Char(1) TXHSSC CAPER Enh Table A2 Y
520 Treatment Region Char(2) TXREG CAPER Enh Table A2 Y
521 Treatment Service Char(1) TXSVC CAPER Enh Table A2 Y
522 Underwritten Region Char(1) UNDFLAG CAPER Enh Table A2 Y
Variable Cost, Clinician
523 N(8) VCCLNSAL CAPER Enh Table A3.3 Y
Salary
524 Variable Cost, Laboratory N(8) VCLAB CAPER Enh Table A3.3 Y
Variable Cost, Other
525 N(8) VCOTHANC CAPER Enh Table A3.3 Y
Ancillary
526 Variable Cost, Other N(8) VCOTHER CAPER Enh Table A3.3 Y
527 Variable Cost, Other Labor N(8) VCOTHLBR CAPER Enh Table A3.3 Y
528 Variable Cost, Radiology N(8) VCRAD CAPER Enh Table A3.3 Y
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Spec
Field Type SAS Name Source M2?
Reference
529 Variable Cost, Pharmacy N(8) VCRX CAPER Enh Table A3.3 Y
Version 2.01.01 MDR CAPER Enhanced - 77 27 July 2010
APPENDIX TBD: Provider Table16
A Provider table will be created from the CAPER records to provide a provider-based view of
the encounter claims to describe connections between procedure and providers to links
resembling those in the SIDR.
Generate a provider production table containing treatment DMIS, Appointment ID
number, provider, procedures, units of service, modifiers, RVUs. This table would
contain one record per appointment per provider from appointments where the
provider and procedure are linked.
Table ATBD.1: Provider Table Fields
Field Type SAS Name Derivation
Treatment DMIS Char(4)
Appointment ID Number char(10) APPTIDNO
Raw Appointment (Encounter) char(8)
ENCDATE_R
Date yyyymmdd
MEPRS Code Char(4)
Provider, NPI
Provider, EDIPN
Provider, Name
Provider, Assigned MTF Char(4)
Provider, Branch of Service
[Other Provider info]
Which position, 1-13, is the
Procedure Position procedure on the CAPER
record.
E&M 1-3, Procedure 1-10 Code
E&M 1-3, Procedure 1-10
Modifier 1
E&M 1-3, Procedure 1-10
Modifier 2
E&M 1-3, Procedure 1-10
Modifier 3
E&M 1-3, Procedure 1-10 Units
of service
RVU, Work E&M 1-3, Procedure
1-10
RVU, Practice Expense E&M 1-3,
Procedure 1-10
Provider Role, E&M 1-3, Referring, Appointment,
Procedure 1-20 Additional Provider 1-4
Provider Specialty
16
Placeholder for CAPER Enhanced Interim Plus
Version 2.01.01 MDR CAPER Enhanced - 78 27 July 2010
APPENDIX TBD: SCAPERs17
A one time addition of SADR-based records to fill gaps in CAPERs is required. Approximately
x% of CAPER records are missing in FY04 and forward. SADRs will be used to fill in the gaps
for these missing CAPERs for current and previous years.
The SADR and CAPER tables are merged by Host ID and Appointment Number ID to
determine which CAPERs are missing. For any records found to be missing, the SADR to raw
CAPER field mapping (Table TBD.1) will be used as described.
17
Placeholder for CAPER Enhanced Interim Plus.
Version 2.01.01 MDR CAPER Enhanced - 79 27 July 2010
APPENDIX TBD: Reference Tables
Reference Table Spec Update
MDR Location Filename
Description Reference Schedule
APC; CPT to APC /mdr/ref/tapc.cyxx.txt apc.cy.txt N/A
APC/PSI/Weight Reference where cy=06-08 only
Format (CMS/3M – Tables for
4 char APCs) the MDR
APC; APC to APC APC mdr/ref/caper/apcwt/ apcwt.cqyyq.txt Quarterly
Weight Format Reference where yyq=084+
(TRICARE – 5 char Tables for only
APCs) the MDR
CY09 and CY10 Appendix 1, del09_map.sas N/A
Deleted Codes Para 2c., del10_map.sas
Table A1.2c
and A1.2d
RVU Tables Appendix 3, /mdr/ref/caper.rvu.cy rvu7fmt.sas7bdat Annually
Table A3.3
CPT Tables
for the MDR
APG to APG wt Appendix 3, sadr.apgwgts.fyfy.fmt As Needed
Table A3.3
Prov Spec code Appendix 3, mdr/ref/sadr.prov.txt sadr.prov.txt As Needed
Format Table A3.3d
Revenue Code Appendix 1, mdr/ref/caper/revcode cy##.dyymmdd.fmt Annually
Tables Table A1.2 where ##=09+
Cost tables Annually
Completion Factors Appendix 4, ctfmt_a_fy.sas7bdat Annually
Table 4.1 ctfmt_b_ fy.sas7bdat
ctfmt_c_ fy.sas7bdat
ASC Codes CPT Tables /mdr/ref/caper.rvu.cy cpt7fmt.sas7bdat Annually
for the MDR
Facility/Non Fac Table A3.3b facflagfy.sas Annually
Flag Format
MDC Appendix 2,
Table A2
Product Line Format Table A2.2 productlineformat.sas As Needed
Version 2.01.01 MDR CAPER Enhanced - 80 27 July 2010