Get documents about "Data Element Justification
Document Sample
DATA ELEMENTS (HCUP Elements BOLDED)
Submitter Information
Submitter Name
Submitter Identifier
Submitter Fax
Submitter Telephone
Test/Production Indicator
Processing Date
Receiver Information
Receiver Name
Receiver Identification
Provider Information
Service Provider Name
Service Provider Identification Number
Patient Information
Patient's Last Name
Patient's First Name
Patient's Middle Name
Patient Control Number
Medical Record Number
Unique Personal Identifier / Social Security Number (encrypted in HCUP)
Patient's Race
Patient's Ethnicity
Patient Address Line 1
Patient Address Line 2
Patient's City
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Patient's County Code
Patient's State
Patient's Postal Service Zip Code and Extension Code
Patient Sex
Patient Birthdate
Claim Information
Source of Admission
Admission Date/Start of Care
Admission Hour
Statement Covers Period - From Date
Statement Covers Period - Thru Date
Discharge Date - Derived from Statement From Date & Type of Bill
Discharge Hour
Patient Status or Disposition
Facility Type Code
Claim Frequency Code
Accident Related Codes & Dates
Accident Hour
Observation stay flag
Insurance Information
Source of Payment Code
Payer Identification
Policy Number
Payer Estimated Amount Due
Payer Prior Payment
Service Line Information
Ancillary Revenue Code
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Ancillary Units of Service
Ancillary Total Charges
Ancillary Total Non-Covered Charges
Total Charges
Service Date and Time
Procedure Code - HCPCS or CPT4
Modifier 1 (HCPC & CPT4)
Modifier 2 (HCPC & CPT4)
Medical Information
Principal Diagnosis Code
Other Diagnosis Code
Other Diagnosis Emergent Indicator
Principal Procedure Code
Principal Procedure Date and Time
Other Procedure Code
Other Procedure Date
Admitting Diagnosis Code
Patient's Reason for Visit
External Cause-of-Injury Code
Place-of-Injury Code
Other E-Codes
Physician Information
Attending Physician License Number
Operating Physician License Number
Other Physician License Number
Referring Physician License Number
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Partner Proposed Data Gaps
Drug Names/ID (Including Tobacco, alcohol and recreational drug [if
known or can be determined])
Drug Dosage/Active ingredient strength
Drug usage (e.g., times per day, number of units per use)
Drug administration times
Cultural association (live in an area, not normally associated with
race or ethnic background reported, including national and or
religious affiliations, if possible) Hunza, Okinawans and some
religious groups have been reported to live longer and healthier lives,
while others have reduced lifespans and preliction to certain dis-ease
conditions.
Condition codes that include-Occupational and environmental
Hazards associated with the patient
Readmission Flag (Needs a nationally recognized standard)
Infections (Nosocomial)
Iatrogenic conditions
Climatologic Data including: Atmospheric, particulate counts for the
area the patient lives and works
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Issues What
Definition of Inpatient and Outpatient Services NUBC proposing using TOB on a
health claim as a category
designation
Defining outpatient types --- AS, ED, Other HCUP Definition for AS Presence
of ICD-9-CM or CPT-4 procedure
in the following ranges: 1) ICD-9-
CM range: 00.50-86.99 or 88.40-
88.59 OR CPT-4 range: 10040-
69999, 70496, 70498, 70544-
70549, 71275, 71555, 72159,
72191, 72198, 73206, 73225,
73580, 73706, 73725, 74175,
74185, 75600- 75790, 75893-
75898, 75952-75954, 75992-
75996, 78445, 92287, 92975,
92992-92993, 93501-93581 AND
2) Length of stay of 0 or 1 days
What are the gaps between provider capability and public health Documentation of data element
needs clarification into objective findings
for differentiation.
How do you integrate recent requests for inclusion of clinical This is dependent on how flexible
data into legacy data systems the legacy system is and whether
the system can be adapted to the
new data elements. For the
canned systems this generally is
not possible, thus smaller
facilities would be required to
obtain new systems, preferrably a
more flexible modulated system
that can be adapt and include
new data elements in a single
format. The ANSI and HL7
models that are segmented and
qualifier code driven appear to be
a good start.
What are "lessons learned" from states that have already
implemented outpatient data collection systems for a variety of
outpatient types
What are the barriers to collecting accurate and complete Need for available model
outpatient data statutory and rule language that
can readily be used and build on
for individual states. This
language would contain the core
issues necessary for a working
ED/AS data collection system.
States/stakeholders could take
this and modify according to state
needs and political pressures.
What needs to be done to get the information system vendors to Establish a true national data
incorporate additional public health data needs into the systems submissions standard in which
they market to providers data elements can be added and
included or left off and not effect
the rest of the data elements
being submitted.
This will probably become the
Electronic Health Record at some
point in time.
Enhancements capabilities Develop a Scalar or Modularized
enhancement process so that the
data sections can be easily added
or removed with out excessive
programming changes to existing
systems.
What we know
Comment that this will not work
in the long run, unless you create
and enforce that separate claims
for the different transitions of
patient during the episode of care
(e.g., Patient shows up at ER he
is triaged given prophylactics, put
in an observation ward after 72
hours they are required to be
admitted if any part of Medicare
is paying for the bill, then the
patient is considered and
inpatient). The identification and
categorization of these patients is
critical for reporting purposes, but
is not necessary for the treatment
of the patient. Therein lies the
problem.
HCUP Definition For ED 1)
Revenue code in the range of
450-459 OR 2) CPT procedure
code in the range of 99281-
99285 OR 3) Positive emergency
room charge, if revenue codes
are not available
Getting data elements and codes
into the existing format or code
standards.
Put Federal/State data element
requirements in the same file
format, so multiple files are not
required to be submitted to the
federal, state and/or local
governments. (e.g., Birth and
Death data, Cancer/Tumor
Registry, Diabetes data, Kidney
(ESRD), CODES, Laboratory,
Radiological [images and report],
Times for administration of tests,
procedures and creation of
reports from test etc...)
Description
The Data Element Justification sheet lists
potential data elements to be collected in
outpatient settings and defines uses cases to
justify how each of those data elements may
be used. The use case categories are listed
at the end of this sheet. There is also
columns in the spreadsheet to identify issues
with collection and use.
The Outpatient Collection Issues Sheet
identifies system wide issues and uses
subsequent columns to highlight "what we
know" about known solutions to those
problems.
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