Data Element Justification
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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 Page 1 of 11 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 Page 2 of 11 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 Page 3 of 11 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 Page 4 of 11 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.