TEXAS DEPARTMENT OF STATE HEALTH SERVICES
CENTER FOR HEALTH STATISTICS
Health Care Information
USER MANUAL
TEXAS HOSPITAL INPATIENT DISCHARGE
PUBLIC USE DATA FILE (PUDF)
Base Data #1 File, Base Data #2 File
Charges File, and Facility Type Indicator File
2013
TABLE OF CONTENTS ............................................................... 1
BACKGROUND ........................................................................... 2
PUBLIC USE DATA FILE (PUDF)
................................... 2
DATA PROCESSING AND QUALITY ...................................... 3
PATIENT/PHYSICIAN CONFIDENTIALITY ........................... 4
RESTRICTIONS ON DATA USE ............................................... 5
DATA LIMITATIONS ................................................................. 6
Users are advised to become familiar with the data limitations.
HOSPITAL COMMENTS ............................................................ 8
Users are advised to consider hospital comments in any analysis of the data.
CITATION .................................................................................... 8
DATA DICTIONARY
Base Data #1 File .................................................................. 9
Base Data #2 File ................................................................ 34
Charges File.......................................................................... 48
DATA FIELD Tables…………………………………………… 58
REPORTING STATUS OF TEXAS HOSPITALS .................... 66
DSHS/THCIC
www.dshs.state.tx.us/THCIC
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DSHS Document # E25-14163
BACKGROUND
The Texas Health Care Information Council (THCIC) was created by Chapter 108 of the Texas
Health and Safety Code (THSC) and was responsible, under Sections 108.011 through 108.0135,
for collecting hospital discharge data from all state licensed hospitals except those that are
statutorily exempt from the reporting requirement. Exempt hospitals include those located in a
county with a population less than 35,000, or those located in a county with a population more than
35,000 and with fewer than 100 licensed hospital beds and not located in an area that is delineated
as an urbanized area by the United States Bureau of the Census (Section 108.0025). Exempt
hospitals also include hospitals that do not seek insurance payment or government reimbursement
(Section 108.009). THCIC became part of the Texas Department of State Health Services (DSHS)
effective September 1, 2004 and the DSHS Center for Health Statistics is now responsible for the
collection and release of hospital discharge data.
PUBLIC USE DATA FILE (PUDF)
Section 108.011(a) and 108.012 of the THSC requires DSHS to provide public use data for
computer-to-computer access. It also permits DSHS to charge the data requestor a standard fee for
using the Public Use Data File (PUDF). The PUDF contains patient-level information for inpatient
hospital stays. These data are extracted from DSHS’s Hospital Discharge Database (HDD).
The PUDF Base Data File is split into two (2) Base Data files for 2013 due to the addition of the 25
diagnosis present on admission indicator codes (POA) and the 10 POA indicators for the external
cause of injury codes. Base Data #1 File contains the required data elements. Base Data #2 File
contains most of the situationally required data elements and some calculated fields. The Record ID
allows for linking the files together. The providers/submitters have, by law, until the next quarter
(following the discharge) to submit their data. This means that the PUDF data is a snapshot in time
and each quarter may contain some discharges dated in the previous quarter (i.e. for calendar year
data be sure to check the first quarter of the following year also).
The Facility Type Indicator File is also included. This contains 10 variables including the THCIC
ID and facilitiy name and variables indicating whether the facility is a teaching facility or pediatric
hospital or other specialty facility.
Additionally, the submitter Comments File is included. This contains any comments that were
included by the submitter when the respective data was submitted and certified from a given
facility.
The 2013 PUDF is available in four fixed length format text files, Base Data #1 (logical record
length of 950 bytes), Base Data #2 (logical record length of 700 bytes), Charges (logical record
length of 80 bytes), and Facility Type Data (logical record length of 69 bytes) files. The files are
also available in tab-delimited format. The size of the files is as follows:
First quarter, 577 hospitals:
Base Data #1
Base Data #2
Charges
Facility Type Data
731,187
731,187
11,615,014
577
DSHS/THCIC
www.dshs.state.tx.us/THCIC
records
records
records
records
194
100
13
10
variables
variables
variables
variables
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Fixed field format
Fixed field format
Fixed field format
Fixed field format
680 MB
501 MB
930 MB
41 KB
Tab-delimited 310 MB
Tab-delimited 194 MB
Tab-delimited 540 MB
Tab-delimited 28 KB
DSHS Document # E25-14163
The data must be imported into a software package. No software is included with the PUDF. The
data file has been tested with several software packages, including Microsoft Access, 2010
Microsoft Excel (one quarter), SAS, and SPSS.
The PUDF, beginning with data collected for 2004, is formatted to accommodate additional data
elements available with the collection of data from hospitals using the THCIC 837 format. The
following data elements are available in the PUDF beginning with data for 2004 or are not
comparable to data collected in years prior to 2004:
BASE DATA #1 FILE (Separated Base File 2011)
FAC_LONG_TERM_AC_IND
PAT_COUNTRY
FIRST_PAYMENT_SRC
SECOND_PAYMENT_SRC
Added 2004
Added 2004
Replaces PAYMENT_SOURCE_1 and
SOURCE_PAYMENT_CODE_1
Replaces PAYMENT_SOURCE_2 and
SOURCE_PAYMENT_CODE_2
No longer available
Replaces TOTAL_CHARGES_23
Replaces CLAIM_CHARGES_ACCOMM
Replaces CLAIM_NON_COV_CHARGES_ACCOMM
Replaces CLAIM_CHARGES_ANCIL
Replaces CLAIM_NON_COV_CHARGES_ANCIL
Replaces EXTNAL_CAUSE_OF_INJURY
Added 2004
REVENUE_CODE_23
TOTAL_CHARGES
TOTAL_CHARGES_ACCOMM
TOTAL_NON_COV_CHARGES_ACCOMM
TOTAL_CHARGES_ANCIL
TOTAL_NON_COV_CHARGES_ANCIL
EXTERNAL_CAUSE_OF_INJURY_1
EXTERNAL_CAUSE_OF_INJURY_2 to
EXTERNAL_CAUSE_OF_INJURY_10
OTH_DIAG_CODE_9 to OTH_DIAG_CODE_25
Added 2004
OTH_SURG_PROC_CODE_6 to OTH_SURG_PROC_CODE_25
Added 2004
OTH_SURG_PROC_DAY_6 to OTH_SURG_PROC_DAY_25
Added 2004
OTH_ICD9_CODE_6 to OTH_ICD9_CODE_25
Added 2004
MS_MDC name changed from CMS_MDC (2011)
Added 2004
INBOUND_INDICATOR
Available 2004 only
POA_PRINC_DIAG _CODE
Added 2011
POA_OTH_DIAG_CODE_1 to POA_OTH_DIAG_CODE_24
Added 2011
POA_E_CODE_1 to POA_ E_CODE_10
Added 2011
MS_GROUPER_ ERROR _CODE
Added 2011
APR_GROUPER_ERROR_CODE
Added 2011
BASE DATA #2 FILE (added 2011) Moved calculated charge amounts andsSituational data elements to this file
CONDITION_CODE_1 to CONDITION_CODE_8
Added 2004
OCCUR_CODE_1 to OCCUR_CODE_12
Added 2004
OCCUR_DAY_1 to OCCUR_DAY_12
Added 2004
OCCUR_SPAN_CODE_1 to OCCUR_SPAN_CODE_4
Added 2004
OCCUR_SPAN_FROM_1 to OCCUR_SPAN_FROM_4
Added 2004
OCCUR_SPAN_THRU_1 to OCCUR_SPAN_THRU_4
Added 2004
VALUE_CODE_1 to VALUE_CODE_12
Added 2004
VALUE_AMOUNT_1 to VALUE_AMOUNT_12
Added 2004
CHARGES FILE
REVENUE_CODE
Added 2004
HCPCS_QUALIFIER
Added 2004
HCPCS_PROCEDURE_CODE
Added 2004
MODIFIER_1 to MODIFIER_4
Added 2004
UNIT_MEASUREMENT_CODE
Added 2004
UNITS_OF_SERVICE
Added 2004
UNIT_RATE
Added 2004
CHRGS_LINE_ITEM
Added 2004
CHRGS_NON_COV
Added 2004
DATA PROCESSING AND QUALITY
Beginning with data submitted for 2004 discharges hospitals required to submit discharged inpatient
claims data, moved from the submission of data in the uniform bill (UB-92) format to the THCIC
837 format. The data are validated through a process of automated auditing and verification. Each
individual hospital is responsible for the accuracy and completeness of its data. Even so, each
DSHS/THCIC
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DSHS Document # E25-14163
record is subjected by DSHS to a series of audits that check for consistency and conformity with the
definitions stated in the data specification manual. Records failing an audit check are returned to the
hospital for correction and resubmission. Following the correction process, DSHS uses valid claims
data to build files of “encounters” where one encounter contains the final discharge and all related
interim claims information for a patient. Then, each submitting hospital has an opportunity to
review, to make additional corrections, and to certify the encounter data with or without comments.
Finally, DSHS builds a final encounter file that includes all corrections submitted by the hospitals.
DSHS staff checks and adjusts for missing values and invalid codes in this file before the PUDF is
generated. Users are advised to examine every data element to be used for missing values and
invalid codes and to read accompanying notes, comments, and other descriptive text.
PATIENT/PHYSICIAN CONFIDENTIALITY
The legislative intent behind the creation of the Hospital Discharge Database (HDD) was that the
data and resulting information be used for the benefit of the public. This is specified in Section
108.013 of the Texas Health and Safety Code (THSC). Section 108.013 (c) also stipulates that
DSHS may not release and a person or entity may not gain access to any data that could reasonably
be expected to reveal the identity of a patient or physician. Any effort to determine the identity of
any person violates the Section 108.013 and may incur penalties as stated in Sections 108.014 and
108.0141. In addition, under Section 108.013(e) and (f), patient and/or physician information in the
HDD cannot be used for discovery, subpoena, or other means of legal compulsion or in any civil,
administrative, or criminal proceeding. Pursuant to the THSC, DSHS excludes all direct personal
and demographic identifiers (e.g., name, address, social security number, patient identifiers,
admission and discharge dates) that might lead to the identification of a specific patient from the
PUDF.
To protect patient identities, DSHS has suppressed these data elements in this release of the PUDF:
 The last two digits of the patient's ZIP code are suppressed if there are fewer than thirty
patients included in the ZIP code.
 The entire ZIP code is suppressed if a hospital has fewer than fifty discharges in a quarter.
 The ZIP code is changed to '88888' for patients from states other than Texas and the adjacent
states.
 The entire ZIP code and gender code are suppressed if the ICD-9-CM code indicates alcohol
or drug use or an HIV diagnosis.
 The entire ZIP code and provider name are suppressed if a hospital has fewer than five
discharges of a particular gender, including ‘unknown’. The provider ID is changed to
'999998'.
 The country code is suppressed if the country field has fewer than five discharges for that
quarter .
 The county code is suppressed if a county has fewer than five discharges for that quarter .
 Age is represented by 22 age group codes for the general patient population and 5 age group
codes for the HIV and alcohol and drug use patient populations.
 Race is changed to ‘Other’ and ethnicity is suppressed if a hospital has fewer than ten
discharges of a race.
 If a hospital has fewer than fifty discharges in a quarter, the provider ID is changed to
‘999999’.
DSHS/THCIC
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DSHS Document # E25-14163
To protect physician identities, the THSC requires creation of a uniform identification number for
physicians in practice. Uniform physician identifiers are available except when the number of
physicians represented in a DRG for a hospital is less than the minimum cell size of five.
It may be possible in rare instances, through complex analysis and with outside information, to
ascertain from the PUDF the identity of individual patients. Considerable harm could result if this
were done. PUDF users are required to sign and comply with the DSHS Hospital Discharge Data
Use Agreement in the Application before shipment of the PUDF. The Data Use Agreement
prohibits attempts to identify individual patients.
RESTRICTIONS ON DATA USE
Section 108.010(c) of the THSC prohibits DSHS from releasing provider quality reports until one
year of data is available. Users of the PUDF are cautioned about using less than a year of data to
make any hospital quality assumptions.
Sections 108.013(c)(1) and (2) and 108.013 (g) of the Texas Health and Safety Code (THSC)
prohibit the DSHS from releasing, and a person or entity from gaining access to, any data that could
reveal the identity of a patient or the identity of a physician unless specifically authorized by the
Act. Any effort to determine the identity of any person or to use the information for any purpose
other than for analysis and aggregate statistical reporting violates the THSC and the Data Use
Agreement. By virtue of the Agreement, the signer agrees that the data will not be used to identify
an individual patient or physician. Because of these restrictions, under no circumstances will users
of the data contact an individual patient or physician or hospital for the purpose of verifying
information supplied in the DSHS Hospital Discharge Data sets. Any questions about the data must
be referred to DSHS only. Data analysis assistance is not provided by DSHS. The data are protected
by United States copyright laws and international treaty provisions.
In the Data Use Agreement, the purchaser and end-user of the data are referred to as the “licensee”.
To acquire the data the licensee must give the following assurances with respect to the use of DSHS
Hospital Discharge Data sets:

The licensee will not release nor permit others to release the individual patient records or any
part of them to any person who is not a staff member of the organization that has acquired the
data, except with the written approval of DSHS;

The licensee will not attempt to link nor permit others to attempt to link the hospital stay records
of patients in this data set with personally identifiable records from any other source, including
any THCIC research data files;

The licensee will not release nor permit others to release any information that identifies persons,
directly or indirectly;

The licensee will not attempt to use nor permit others to use the data to learn the identity of any
physician;

The licensee will not permit others to copy, sell, rent, license, lease, loan, or otherwise grant
access to the data covered by this Agreement to any other person or entity, unless approved in
writing by DSHS;
DSHS/THCIC
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DSHS Document # E25-14163

The licensee agrees to read the User Manual and to be cognizant of the limitations of the data;

The licensee will use the following citation in any publication of information from this file:
Texas Hospital Inpatient Discharge Public Use Data File, [quarter and year of data]. Texas Department of State
Health Services, Center for Health Statistics, Austin, Texas. [date of publication];

The licensee will indemnify, defend, and hold the DSHS, its members, employees, and the
Department’s contract vendors harmless from any and all claims and losses accruing to any
person as a result of violation of this agreement; and

The licensee will make no statement nor permit others to make statements indicating or
suggesting that interpretations drawn from these data are those of DSHS.
The licensee understands that these assurances are collected by DSHS to assure compliance with its
statutory confidentiality requirement. The signature on behalf of the licensee indicates the
licensee’s agreement to comply with the above-stated requirements with the knowledge that under
Sections 108.014 and 108.0141 of the Texas Health and Safety Code to knowingly or negligently
release data in violation of this agreement is punishable by a fine of up to $10,000 and an offense is
a state jail felony. By signing the Data Use Agreement, the PUDF user has been informed that the
potential for both civil and criminal penalties exists.
Users of report generating software to access the PUDF are required to purchase a license to use the
data.
DATA LIMITATIONS
(Users are advised to become familiar with the data limitations.)






Section 108.009(h), THSC requires that a uniform submission format be used for reporting
purposes. Before 2004 data were collected in the UB-92 format. Data for 2004 were
collected in both UB-92 and THCIC 837 formats. Because these are billing forms, the data
collected are administrative data and not clinical data.
Records with MDC codes of 15 (newborns and other neonates with conditions originating in
the perinatal period), 20 (alcohol/drug induced organic mental disorders), or 22 (burns) and
Patient Status codes of 62 (discharged/transferred to inpatient rehabilitation), 71
(discharged/transferred to other outpatient service), or 72 (discharged/transferred to
institution outpatient service) contain an APR-DRG of 956 (ungroupable). These Patient
Status codes were not valid when version 15 of the 3M APR-DRG Grouper was developed.
A valid Patient Status code is required for these MDC codes for APR-DRG assignment and
Risk of Mortality and Severity of Illness scoring. Patient status codes 71 and 72 are no
longer valid as of October 2003. After October 2003 records with MDC codes of 15, 20, or
22 and Patient Status code of 62 contain an APR-DRG of 956.
Hospital charges data are available third quarter 2000. Earlier data were not reported
correctly by some hospitals.
Secondary source of payment data are available third quarter 2000. Earlier data were not
reported correctly by some hospitals.
Gender is suppressed for patients with an ICD-9-CM code that indicates drug or alcohol use
or an HIV diagnosis.
The last two digits of the ZIP code are suppressed if there are fewer than thirty patients
included in the zip code. All of the ZIP code is suppressed for patients with an ICD-9-CM
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












code that indicates drug or alcohol use or an HIV diagnosis or if a hospital has fewer than
five discharges of a particular gender, including ‘unknown’. ZIP code is changed to '88888'
for patients from a state other than Texas and not from an adjacent state. If ZIP is '88888' the
state abbreviation is changed to 'ZZ'. ZIP code is suppressed if a hospital has fewer than five
patients of a particular gender, including ‘unknown’.
Admission Source as reported by hospitals is suppressed, as recommended by the Council,
when the Admission Type is ‘newborn’. Data users can use ICD-9-CM codes to correctly
identify the clinical status of newborns.
Uniform identification numbers for physicians are available first quarter 2000 except for
cases less than the minimum cell size of five.
Hospitals must submit data no later than 60 days after the close of a calendar quarter.
Depending on hospitals’ collection and billing cycles, not all discharges may have been
billed or reported. This can affect the accuracy of source of payment data, particularly selfpay and charity that may later qualify for Medicaid or other payment sources.
Beginning with data for 2004 discharges, up to 25 diagnosis codes, up to 25 procedure
codes, and up to 10 E-codes can be submitted. For earlier years the number of diagnosis
codes collected per patient is limited to 9 and the number of procedure codes to 6. Because
of these limitations, sicker patients and the hospitals that treat them may not be accurately
represented in the data. This may also result in total volume and percentage calculations for
diagnoses and procedures not being complete.
Race and ethnicity data are generally not collected by hospitals and may be subjectively
captured.
Inaccuracies in the data and incompleteness of the data are addressed in the hospitals'
comments.
County of residence is not collected by hospitals. County Federal Information Processing
Standard (FIPS) codes are assigned by DSHS based on patient ZIP code.
DSHS assigns the Risk of Mortality and Severity of Illness scores using methodology
designed by 3M. These scores may be affected by the number of diagnoses and procedure
codes collected by DSHS or by the facility’s information system and may be understated.
Comparability of length of stay (LOS) across hospitals is affected by factors such as casemix and severity complexity, payer-mix, market areas and hospital ownership, affiliation or
teaching status. Any analysis of LOS at the hospital level should consider the above factors.
Length of stay is limited to 999 days prior to 2004 discharges.
Any analysis of mortality should note that the data reflect only patients who died in the
hospital and not those who died after discharge from the hospital.
Conditions present at time of admission cannot be distinguished from those occurring during
hospitalization prior to 2011 discharges. Diagnosis present on admission indicator codes
(POA) were required for all hospitals, except Critical Access Hospitals, Inpatient
Rehabilitation Hospitals, Inpatient Psychiatric Hospitals, Cancer Hospitals, Children's or
Pediatric Hospitals, and Long Term Care Hospitals. Some acute care hospitals that have
special units similar to the hospitals exempted from reporting POA may not include POA
codes for those patients.
Updates to any PUDF CD’s are available through the THCIC website,
http://www.dshs.state.tx.us/thcic/ ,which should be checked periodically as notifications of
an update will not be sent.
DSHS/THCIC
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DSHS Document # E25-14163


DSHS collects data from all hospitals in the state not specifically exempted by statute. This
hospital mix should be considered when drawing conclusions about the data or making
comparisons with other data.
Any conclusions drawn from the data are subject to errors caused by the inability of the
hospital to communicate complete data due to form constraints, subjectivity in the
assignment of codes, system mapping, and normal clerical error. The data are submitted by
hospitals as their best effort to meet statutory requirements.
HOSPITAL COMMENTS
(Users are advised to consider hospital comments in any analysis of the data.)
Included with the PUDF is a separate file containing the unedited comments submitted by hospitals
at the time of data certification. Comments relating to individual data elements should be considered
in any analysis of those data elements. These comments express the opinions of individual hospitals
and are not necessarily the views of the DSHS. Hospitals that submitted comments are identified in
‘Reporting Status of Texas Hospitals’.
CITATION
Any statistical reporting or analysis based on the data shall cite the source as the following:
Texas Hospital Inpatient Discharge Public Use Data File, [quarter and year of data]. Texas Department of State
Health Services, Center for Health Statistics, Austin, Texas. [date of publication].
DSHS/THCIC
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DSHS Document # E25-14163
Texas Hospital Inpatient Discharge
Public Use Data File
Data Dictionary
The purpose of this document is to provide the user with the necessary information to use and understand the data in the
Public Use Data File. The following information is provided:
Field
Unique, abbreviated name of the data element
Description
Brief explanation of the data element. Descriptions of data elements from the UB-92 are
taken from specifications manuals.
Data Source
Provided by the hospital on the claim form (Claim)
Assigned by DSHS (Assigned)
Calculated by DSHS (Calculated)
Note: For those data elements that have been temporarily suppressed, the quarter of data
for which the data element will be released is noted following the Data Source.
Type
Alphanumeric or numeric
Coding scheme
Valid codes for a data field. Values taken from specifications manuals.
Note a change: Any code provided by a hospital that has been determined to be invalid has been assigned the value ` .
Any data element that is blank should be interpreted as ‘missing’, no data provided, unless otherwise noted.
BASE DATA #1 FILE
Field 1:
Description:
Beginning Position:
Length:
Field 2:
Description:
Beginning Position:
Length:
Field 3:
Description:
Suppression:
Beginning Position:
Length:
Field 4:
Description:
Suppression:
Beginning Position:
Length:
RECORD_ID
Record Identification Number. Unique number assigned to identify the record. First available
1st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files
(RDF’s).
1
Assigned
Data Source:
12
Alphanumeric
Type:
DISCHARGE
Discharge Quarter. Year and quarter of discharge. yyyyQn.
13
Assigned
Data Source:
6
Alphanumeric
Type:
THCIC_ID
Provider ID. Unique identifier assigned to the provider by DSHS.
Hospitals with fewer than 50 discharges have been aggregated into the Provider ID '999999'.
If a hospital has fewer than 5 discharges of a particular gender, including ‘unknown’,
Provider ID is '999998'.
19
Assigned
Data Source:
6
Alphanumeric
Type:
PROVIDER_NAME
Hospital name provided by the hospital.
Hospitals with fewer than 50 discharges (Provider ID equals ‘999999’) are assigned the
name ‘Low Discharge Volume Hospital’. If a hospital has fewer than 5 discharges of a
particular gender, including ‘unknown’, Hospital Name is blank.
13
Provider
Data Source:
55
Alphanumeric
Type:
DSHS/THCIC
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DSHS Document # E25-14163
Field 5:
Description:
Coding Scheme:
TYPE_OF_ADMISSION
Code indicating the type of admission
Beginning Position:
Length:
Field 6:
Description:
Coding Scheme:
80
Data Source:
1
Type:
SOURCE_OF_ADMISSION
Code indicating source of the admission.
Beginning Position:
Length:
Field 7:
Description:
81
Claim
Data Source:
1
Alphanumeric
Type:
SPEC_UNIT_1
Specialty Units in which most days during stay occurred based on number of days by Type of
Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through
SPEC_UNIT_5 are combined in one field in the Tab Delimited file and can be accessed
individually in the fixed length file.
Coding Scheme:
C
D
I
H
N
B
O
Beginning Position:
Length:
Field 8:
Description:
82
Calculated
Data Source:
1
Alphanumeric
Type:
SPEC_UNIT_2
Specialty Units in which most days during stay occurred based on number of days by Type of
Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through
SPEC_UNIT_5 are combined in one field in the Tab Delimited file and can be accessed
individually in the fixed length file.
Coding Scheme:
C
D
I
H
N
B
O
Beginning Position:
Length:
Field 9:
Description:
83
Data Source:
1
Alphanumeric
Type:
SPEC_UNIT_3
Specialty Units in which most days during stay occurred based on number of days by Type of
1
2
3
4
5
9
`
Emergency
Urgent
Elective
Newborn
Trauma Center
Information not available
Invalid
Claim
Alphanumeric
1
2
4
5
6
8
9
0
B
D
Non-Healthcare Facility Point of Origin (Beginning July 1, 2010)
Clinic referral
Transfer from a hospital
Transfer from a skilled nursing facility, intermediate care facility or assisted living facility
Transfer from another health care facility
Court/Law Enforcement
Information not available
Transfer from psychiatric, substance abuse, rehab hospital
Transfer from another home health agency
Transfer from One distinct Unit of the Hospital to another Distinct Unit of the Same Hospital Resulting in
Separte Claim to the Payer
E
Transfer from Amubulatory Surgery Center
F
Transfer from a Hospice Facility
`
Invalid
If Type of Admission=4 (Newborn)
5
Born inside this hospital
6
Born outside this hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Coronary Care Unit
Detoxification Unit
Intensive Care Unit
Hospice Unit
Nursery
Obstetric Unit
Oncology Unit
Coronary Care Unit
Detoxification Unit
Intensive Care Unit
Hospice Unit
Nursery
Obstetric Unit
Oncology Unit
Page 10
P
Y
R
U
S
Blank
P
Y
R
U
S
Blank
Pediatric Unit
Psychiatric Unit
Rehabilitation Unit
Sub-acute Care Unit
Skilled Nursing Unit
Acute Care
Pediatric Unit
Psychiatric Unit
Rehabilitation Unit
Sub-acute Care Unit
Skilled Nursing Unit
Acute Care
DSHS Document # E25-14163
Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through
SPEC_UNIT_5 are combined in one field in the Tab Delimited file and can be accessed
individually in the fixed length file.
Coding Scheme:
C
D
I
H
N
B
O
Beginning Position:
Length:
Field 10:
Description:
84
Data Source:
1
Alphanumeric
Type:
SPEC_UNIT_4
Specialty Units in which most days during stay occurred based on number of days by Type of
Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through
SPEC_UNIT_5 are combined in one field in the Tab Delimited file and can be accessed
individually in the fixed length file.
Coding Scheme:
C
D
I
H
N
B
O
Beginning Position:
Length:
Field 11:
Description:
85
Data Source:
1
Alphanumeric
Type:
SPEC_UNIT_5
Specialty Units in which most days during stay occurred based on number of days by Type of
Bill or Revenue Code. In order by number of days in the unit. SPEC_UNIT_1 through
SPEC_UNIT_5 are combined in one field in the Tab Delimited file and can be accessed
individually in the fixed length file.
Coding Scheme:
C
D
I
H
N
B
O
Beginning Position:
Length:
Field 12:
Description:
86
Data Source:
1
Alphanumeric
Type:
PAT_STATE
State of the patient’s mailing address in Texas and contiguous states. Standard 2-character
Postal Service abbreviation.
Coding Scheme:
AR
LA
NM
OK
TX
ZZ
FC
XX
Beginning Position:
Length:
Field 13:
Description:
Suppression:
87
Claim
Data Source:
2
Alphanumeric
Type:
PAT_ZIP
Patient’s five-digit ZIP code.
Last two digits are blank if a ZIP code has fewer than 30 discharges. If state equals ‘ZZ’, ZIP
code equals ‘88888’. If state equals ‘FC’ (foreign country) ZIP code is blank. If ICD-9-CM
indicates alcohol or drug use or an HIV diagnosis the ZIP code is blank. If a hospital has
fewer than fifty discharges the ZIP code is blank. If a hospital has fewer than 5 discharges of
a particular gender, including ‘unknown’, the ZIP Code is blank.
89
Claim
Data Source:
Beginning Position:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Coronary Care Unit
Detoxification Unit
Intensive Care Unit
Hospice Unit
Nursery
Obstetric Unit
Oncology Unit
Coronary Care Unit
Detoxification Unit
Intensive Care Unit
Hospice Unit
Nursery
Obstetric Unit
Oncology Unit
Coronary Care Unit
Detoxification Unit
Intensive Care Unit
Hospice Unit
Nursery
Obstetric Unit
Oncology Unit
P
Y
R
U
S
Blank
P
Y
R
U
S
Blank
P
Y
R
U
S
Blank
Pediatric Unit
Psychiatric Unit
Rehabilitation Unit
Sub-acute Care Unit
Skilled Nursing Unit
Acute Care
Pediatric Unit
Psychiatric Unit
Rehabilitation Unit
Sub-acute Care Unit
Skilled Nursing Unit
Acute Care
Pediatric Unit
Psychiatric Unit
Rehabilitation Unit
Sub-acute Care Unit
Skilled Nursing Unit
Acute Care
Arkansas
Louisiana
New Mexico
Oklahoma
Texas
All other states and American Territories
Foreign country
Foreign country
Page 11
DSHS Document # E25-14163
Length:
Field 14:
Description:
Suppression:
Coding scheme:
Beginning Position:
Length:
Field 15:
Description:
Coding scheme:
5
Alphanumeric
Type:
PAT_COUNTRY
Country of patient’s residential address. List maintained by the International Organization for
Standardization (ISO).
Suppressed if fewer than 5 patients from one country.
See www.ISO.org for complete list.
94
Claim
Data Source:
2
Alphanumeric
Type:
PAT_COUNTY
FIPS code of patient’s county.
001
003
005
007
009
011
013
015
017
019
021
023
025
027
029
031
033
035
037
039
041
043
045
047
049
051
053
055
057
059
061
063
065
067
069
071
073
075
077
079
081
083
085
087
089
091
093
095
097
099
101
103
105
107
109
111
113
115
117
119
121
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Anderson
Andrews
Angelina
Aransas
Archer
Armstrong
Atascosa
Austin
Bailey
Bandera
Bastrop
Baylor
Bee
Bell
Bexar
Blanco
Borden
Bosque
Bowie
Brazoria
Brazos
Brewster
Briscoe
Brooks
Brown
Burleson
Burnet
Caldwell
Calhoun
Callahan
Cameron
Camp
Carson
Cass
Castro
Chambers
Cherokee
Childress
Clay
Cochran
Coke
Coleman
Collin
Collingsworth
Colorado
Comal
Comanche
Concho
Cooke
Coryell
Cottle
Crane
Crockett
Crosby
Culberson
Dallam
Dallas
Dawson
Deaf Smith
Delta
Denton
129
131
133
135
137
139
141
143
145
147
149
151
153
155
157
159
161
163
165
167
169
171
173
175
177
179
181
183
185
187
189
191
193
195
197
199
201
203
205
207
209
211
213
215
217
219
221
223
225
227
229
231
233
235
237
239
241
243
245
247
249
Donley
Duval
Eastland
Ector
Edwards
Ellis
El Paso
Erath
Falls
Fannin
Fayette
Fisher
Floyd
Foard
Fort Bend
Franklin
Freestone
Frio
Gaines
Galveston
Garza
Gillespie
Glasscock
Goliad
Gonzales
Gray
Grayson
Gregg
Grimes
Guadalupe
Hale
Hall
Hamilton
Hansford
Hardeman
Hardin
Harris
Harrison
Hartley
Haskell
Hays
Hemphill
Henderson
Hidalgo
Hill
Hockley
Hood
Hopkins
Houston
Howard
Hudspeth
Hunt
Hutchinson
Irion
Jack
Jackson
Jasper
Jeff Davis
Jefferson
Jim Hogg
Jim Wells
Page 12
257
259
261
263
265
267
269
271
273
275
283
277
279
281
285
287
289
291
293
295
297
299
301
303
305
307
309
311
313
315
317
319
321
323
325
327
329
331
333
335
337
339
341
343
345
347
349
351
353
355
357
359
361
363
365
367
369
371
373
375
377
Kaufman
Kendall
Kenedy
Kent
Kerr
Kimble
King
Kinney
Kleberg
Knox
La Salle
Lamar
Lamb
Lampasas
Lavaca
Lee
Leon
Liberty
Limestone
Lipscomb
Live Oak
Llano
Loving
Lubbock
Lynn
McCulloch
McLennan
McMullen
Madison
Marion
Martin
Mason
Matagorda
Maverick
Medina
Menard
Midland
Milam
Mills
Mitchell
Montague
Montgomery
Moore
Morris
Motley
Nacogdoches
Navarro
Newton
Nolan
Nueces
Ochiltree
Oldham
Orange
Palo Pinto
Panola
Parker
Parmer
Pecos
Polk
Potter
Presidio
385
387
389
391
393
395
397
399
401
403
405
407
409
411
413
415
417
419
421
423
425
427
429
431
433
435
437
439
441
443
445
447
449
451
453
455
457
459
461
463
465
467
469
471
473
475
477
479
481
483
485
487
489
491
493
495
497
499
501
503
505
DSHS Document # E25-14163
Real
Red River
Reeves
Refugio
Roberts
Robertson
Rockwall
Runnels
Rusk
Sabine
San Augustine
San Jacinto
San Patricio
San Saba
Schleicher
Scurry
Shackelford
Shelby
Sherman
Smith
Somervell
Starr
Stephens
Sterling
Stonewall
Sutton
Swisher
Tarrant
Taylor
Terrell
Terry
Throckmorton
Titus
Tom Green
Travis
Trinity
Tyler
Upshur
Upton
Uvalde
Val Verde
Van Zandt
Victoria
Walker
Waller
Ward
Washington
Webb
Wharton
Wheeler
Wichita
Wilbarger
Willacy
Williamson
Wilson
Winkler
Wise
Wood
Yoakum
Young
Zapata
123
125
127
Beginning Position:
Length:
Field 16:
Description:
251
253
255
Johnson
Jones
Karnes
379
381
383
Rains
Randall
Reagan
507
Zavala
`
Invalid
96
Data Source: Assigned; based on patient ZIP code
3
Alphanumeric
Type:
PUBLIC_HEALTH_REGION
Public Health Region of patient’s address.
1
2
3
4
5
6
7
8
9
10
11
`
Beginning Position:
Length:
Field 17:
Description:
Coding Scheme:
Dewitt
Dickens
Dimmit
Armstrong, Bailey, Briscoe, Carson, Castro, Childress, Cochran, Collingsworth, Crosby, Dallam, Deaf Smith,
Dickens, Donley, Floyd, Garza, Gray, Hale, Hall, Hansford, Hartley, Hemphill, Hockley, Hutchinson, King,
Lamb, Lipscomb, Lubbock, Lynn, Moore, Motley, Ochiltree, Oldham, Parmer, Potter, Randall, Roberts,
Sherman, Swisher, Terry, Wheeler, Yoakum counties
Archer, Baylor, Brown, Callahan, Clay, Coleman, Comanche, Cottle, Eastland, Fisher, Foard, Hardeman,
Haskell, Jack, Jones, Kent, Knox, Mitchell, Montague, Nolan, Runnels, Scurry, Shackleford, Stephens,
Stonewall, Taylor, Throckmorton, Wichita, Wilbarger, Young counties
Collin, Cooke, Dallas, Denton, Ellis, Erath, Fannin, Grayson, Hood, Hunt, Johnson, Kaufman, Navarro, Palo
Pinto, Parker, Rockwall, Somervell, Tarrant, Wise counties
Anderson, Bowie, Camp, Cass, Cherokee, Delta, Franklin, Gregg, Harrison, Henderson, Hopkins, Lamar,
Marion, Morris, Panola, Rains, Red River, Rusk, Smith, Titus, Upshur, Van Zandt, Wood counties
Angelina, Hardin, Houston, Jasper, Jefferson, Nacogdoches, Newton, Orange, Polk, Sabine, San Augustine,
San Jacinto, Shelby, Trinity, Tyler counties
Austin, Brazoria, Chambers, Colorado, Fort Bend, Galveston, Harris, Liberty, Matagorda, Montgomery,
Walker, Waller, Wharton counties
Bastrop, Bell, Blanco, Bosque, Brazos, Burleson, Burnet, Caldwell, Coryell, Falls, Fayette, Freestone, Grimes,
Hamilton, Hays, Hill, Lampasas, Lee, Leon, Limestone, Llano, McLennan, Madison, Milam, Mills, Robertson,
San Saba, Travis, Washington, Williamson counties
Atascosa, Bandera, Bexar, Calhoun, Comal, DeWitt, Dimmit, Edwards, Frio, Gillespie, Goliad, Gonzales,
Guadalupe, Jackson, Karnes, Kendall, Kerr, Kinney, La Salle, Lavaca, Maverick, Medina, Real, Uvalde, Val
Verde, Victoria, Wilson, Zavala counties
Andrews, Borden, Coke, Concho, Crane, Crockett, Dawson, Ector, Gaines, Glasscock, Howard, Irion, Kimble,
Loving, McCulloch, Martin, Mason, Menard, Midland, Pecos, Reagan, Reeves, Schleicher, Sterling, Sutton,
Terrell, Tom Green, Upton, Ward, Winkler counties
Brewster, Culberson, El Paso, Hudspeth, Jeff Davis, Presidio counties
Aransas, Bee, Brooks, Cameron, Duval, Hidalgo, Jim Hogg, Jim Wells, Kenedy, Kleberg, Live Oak,
McMullen, Nueces, Refugio, San Patricio, Starr, Webb, Willacy, Zapata counties
Invalid
99
Data Source: Assigned
2
Alphanumeric
Type:
PAT_STATUS
Code indicating patient status as of the ending date of service for the period of care reported
1
2
3
4
5
6
7
8
9
20
30
40
41
42
43
50
51
61
62
63
64
65
66
71
72
`
Discharged to home or self-care (routine discharge)
Discharged to other short term general hospital
Discharged to skilled nursing facility
Discharged to intermediate care facility
Discharged/transferred to a Designated Cancer Center or Children's Hospital (effective 10-1-2007)
Discharged to care of home health service
Left against medical advice
Discharged to care of Home IV provider
Admitted as inpatient to this hospital
Expired
Still patient
Expired at home
Expired in a medical facility
Expired, place unknown
Discharged/transferred to federal health care facility
Discharged to hospice–home
Discharged to hospice–medical facility
Discharged/transferred within this institution to Medicare-approved swing bed
Discharged/transferred to inpatient rehabilitation facility
Discharged/transferred to Medicare-certified long term care hospital
Discharged/transferred to Medicaid-certified nursing facility
Discharged/transferred to psychiatric hospital or psychiatric distinct part of a hospital
Discharged/transferred to Critical Access Hospital (CAH)
Discharged/transferred to other outpatient service
Discharged/transferred to institution outpatient
Invalid
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 13
DSHS Document # E25-14163
Beginning Position:
Length:
Field 18:
Description:
Suppression:
101
Data Source: Claim
2
Alphanumeric
Type:
SEX_CODE
Gender of the patient as recorded at date of admission or start of care.
Code is suppressed if an ICD-9-CM code indicates drug or alcohol use or an HIV diagnosis. If
a hospital has fewer than 5 patients of a particular gender, including unknown, Provider ID is
‘999998’ and Hospital Name and Patient ZIP Code are blank for those patients.
Coding Scheme:
M
F
U
`
Beginning Position:
Length:
Field 19:
Description:
Suppression:
Coding Scheme:
103
Claim
Data Source:
1
Alphanumeric
Type:
RACE
Code indicating the patient’s race.
If a hospital has fewer than ten patients of one race that race is changed to ‘Other’ (code equals 5).
Beginning Position:
Length:
Field 20:
Description:
Suppression:
104
Data Source: Claim
1
Alphanumeric
Type:
ETHNICITY
Code indicating the Hispanic origin of the patient.
If a hospital has fewer than ten patients of one race the ethnicity of patients of that race is
suppressed (code is blank).
Coding Scheme:
1
2
3
4
5
`
1
2
`
Male
Female
Unknown
Invalid
American Indian/Eskimo/Aleut
Asian or Pacific Islander
Black
White
Other
Invalid
Hispanic Origin
Not of Hispanic Origin
Invalid
Beginning Position:
Length:
Field 21:
Description:
Coding Scheme:
105
Data Source: Claim
1
Alphanumeric
Type:
ADMIT_WEEKDAY
Code indicating day of week patient is admitted
Beginning Position:
Length:
Field 22:
Description:
106
Data Source: Assigned
1
Alphanumeric
Type:
LENGTH_OF_STAY
Length of stay in days equals Statement covers period through date minus Admission/start of
care date. The minimum length of stay is 1 day. The maximum is 9999 days.
107
Data Source: Calculated
4
Alphanumeric
Type:
PAT_AGE
Code indicating age of patient in days or years on date of discharge.
Beginning Position:
Length:
Field 23:
Description:
Coding Scheme:
Beginning Position:
Length:
1
2
3
4
00
01
02
03
04
05
06
07
08
09
Monday
Tuesday
Wednesday
Thursday
1-28 days
29-365 days
1-4 years
5-9
10-14
15-17
18-19
20-24
25-29
30-34
111
2
DSHS/THCIC
www.dshs.state.tx.us/THCIC
5
6
7
`
10
11
12
13
14
15
16
17
18
19
Friday
Saturday
Sunday
Invalid
35-39
40-44
45-49
50-54
55-59
60-64
65-69
70-74
75-79
80-84
Data Source:
Type:
Page 14
20
85-89
21
90+
HIV and drug/alcohol use patients:
22
0-17
23
18-44
24
45-64
25
65-74
26
75+
`
Invalid
Assigned
Alphanumeric
DSHS Document # E25-14163
Field 24:
Description:
Coding Scheme:
FIRST_PAYMENT_SRC
Code indicating the expected primary source of payment.
09
10
11
12
13
14
15
16
AM
BL
CH
CI
DS
Self Pay Removed from 5010 format, use “ZZ”)
Central Certification
Other Non-federal Programs
Preferred Provider Organization (PPO)
Point of Service (POS)
Exclusive Provider Organization (EPO)
Indemnity Insurance
Health Maintenance Organization (HMO)
Medicare Risk
Automobile Medical
Blue Cross/Blue Shield
CHAMPUS
Commercial Insurance
Disability Insurance
HM
LI
LM
MA
MB
MC
TV
OF
Health Maintenance Organization
Liability
Liability Medical
Medicare Part A
Medicare Part B
Medicaid
Title V
Other Federal Program
VA
WC
ZZ
``
`
Veteran Administration Plan
Workers Compensation Health Claim
Charity, Indigent or Unknown
Codes 09 and ZZ, combined for 2004 & 2005
Invalid
Beginning Position:
Length:
Field 25:
Description:
Coding Scheme:
Beginning Position:
Length:
Field 26:
Description:
113
Data Source: Claim
2
Alphanumeric
Type:
SECONDARY_PAYMENT_SRC
Code indicating the expected secondary source of payment.
Same as field 24, FIRST_PAYMENT_SRC
115
Data Source: Claim
2
Alphanumeric
Type:
TYPE_OF_BILL
Provides specific information about the claim data submitted. First digit = type of facility.
Second digit = type of care. Third digit = sequence of the claim.
Coding Scheme:
1st digit–Type of Facility
1
Hospital
2
3
4
6
7
Skilled nursing
Home health
Religious non-medical health
care–Hospital
Religious non-medical health
care–Extended care
Intermediate care
Clinic
8
Special facility
5
Beginning Position:
Length:
Field 27:
Beginning Position:
Length:
Field 28:
Beginning Position:
Length:
Field 29:
Beginning Position:
Length:
Field 30:
Beginning Position:
Length:
Field 31:
2nd digit–Type of Care
1
Inpatient, including Medicare
Part A
2
Inpatient, Medicare Part B only
3
Outpatient
4
Outpatient Other, Medicare
Part B only
5
Intermediate Care–Level I
3rd digit–Sequence of claim
0
Non-payment/Zero claim
6
7
8
1
2
3
Admit through discharge claim
Interim–first claim
Interim–continuing claim
4
Interim–last claim
Intermediate Care–Level II
Sub-acute inpatient – Level III
5
6
Swing bed
7
8
Late charge(s) only claim
Adjustment of prior claim (Not
used by Medicare)
Replacement of prior claim
Void/cancel of prior claim
117
Data Source: Claim
3
Alphanumeric
Type:
TOTAL_CHARGES
Sum of accommodation charges, non-covered accommodation charges, ancillary charges, noncovered ancillary charges. Replaces TOTAL_CHARGES_23.
120
Data Source: Claim
12
Numeric
Type:
TOTAL_NON_COV_CHARGES
Sum of non-covered accommodation charges, non-covered ancillary charges.
132
Data Source: Claim
12
Numeric
Type:
TOTAL_CHARGES_ACCOMM
Sum of covered and non-covered accommodation charges.
144
Data Source: Claim
12
Numeric
Type:
TOTAL_NON_COV_CHARGES_ACCOMM
Sum of non-covered accommodations charges.
156
Data Source: Claim
12
Numeric
Type:
TOTAL_CHARGES_ANCIL
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 15
DSHS Document # E25-14163
Beginning Position:
Length:
Field 32:
Beginning Position:
Length:
Field 33:
Coding Scheme:
Beginning Position:
Length:
Field 34:
Beginning Position:
Length:
Field 35:
Beginning Position:
Length:
Field 36:
Coding Scheme:
Beginning Position:
Length:
Field 37:
Beginning Position:
Length:
Field 38:
Coding Scheme:
Beginning Position:
Length:
Field 39:
Sum of covered and non-covered ancillary charges.
168
Data Source: Claim
12
Numeric
Type:
TOTAL_NON_COV_CHARGES_ANCIL
Sum of non-covered ancillary charges.
180
Data Source: Claim
12
Numeric
Type:
POA_PROVIDER_INDICATOR
Indicator identifying whether facility is required to submit Diagnosis Present on Admission
(POA) codes. 25 TAC §421.9(e) identifies the following facility types as exempt from
reporting POA to the department: Critical Access Hospitals, Inpatient Rehabilitation Hospitals ,
Inpatient Psychiatric Hospitals, Cancer Hospitals ,Children's or Pediatric Hospitals and Long
Term Care Hospitals.
M
R
X
`
Mixed (Facility has sections that would be exempted from reporting POA for those patients)
Required
Exempt
Invalid
192
Data Source: Assigned
1
Alphanumeric
Type:
ADMITTING_DIAGNOSIS
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
193
Data Source: Claim
6
Alphanumeric
Type:
PRINC_DIAG_CODE
ICD-9-CM diagnosis code for the principal diagnosis, including the 4th and 5th digits if
applicable. Decimal is implied following the third character.
199
Data Source: Claim
6
Alphanumeric
Type:
POA_PRINC_DIAG_CODE
Code identifying whether Principal Diagnonsis code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
205
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_1
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
206
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_1
Code identifying whether Oth_Diag_Code_1 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
212
1
OTH_DIAG_CODE_2
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Data Source:
Type:
Page 16
Claim
Alphanumeric
DSHS Document # E25-14163
Beginning Position:
Length:
Field 40:
Coding Scheme:
Beginning Position:
Length:
Field 41:
Beginning Position:
Length:
Field 42:
Coding Scheme:
Beginning Position:
Length:
Field 43:
Beginning Position:
Length:
Field 44:
Coding Scheme:
Beginning Position:
Length:
Field 45:
Beginning Position:
Length:
Field 46:
Coding Scheme:
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
213
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_2
Code identifying whether Oth_Diag_Code_2 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
219
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_3
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
220
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_
Code identifying whether Oth_Diag_Code_3 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
226
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_4
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
227
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_4
Code identifying whether Oth_Diag_Code_4 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
233
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_5
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
234
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_5
Code identifying whether Oth_Diag_Code_5 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 17
DSHS Document # E25-14163
`
Beginning Position:
Length:
Field 47:
Beginning Position:
Length:
Field 48:
Coding Scheme:
Beginning Position:
Length:
Field 49:
Beginning Position:
Length:
Field 50:
Coding Scheme:
Beginning Position:
Length:
Field 51:
Beginning Position:
Length:
Field 52:
Coding Scheme:
Beginning Position:
Length:
Field 53:
Beginning Position:
Length:
Field 54:
Invalid
240
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_6
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
241
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_6
Code identifying whether Oth_Diag_Code_6 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
247
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_7
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
248
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_7
Code identifying whether Oth_Diag_Code_7 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
254
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_8
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
255
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_8
Code identifying whether Oth_Diag_Code_8 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
261
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_9
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
262
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_9
Code identifying whether Oth_Diag_Code_9 code was present at the time the patient was
admitted to the hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 18
DSHS Document # E25-14163
Coding Scheme:
Beginning Position:
Length:
Field 55:
Beginning Position:
Length:
Field 56:
Coding Scheme:
Beginning Position:
Length:
Field 57:
Beginning Position:
Length:
Field 58:
Coding Scheme:
Beginning Position:
Length:
Field 59:
Beginning Position:
Length:
Field 60:
Coding Scheme:
Beginning Position:
Length:
Field 61:
Beginning Position:
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
268
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_10
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
269
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_10
Code identifying whether Oth_Diag_Code_10 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
275
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_11
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
276
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_11
Code identifying whether Oth_Diag_Code_11 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
282
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_12
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
283
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_12
Code identifying whether Oth_Diag_Code_12 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
289
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_13
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
290
Data Source: Claim
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 19
DSHS Document # E25-14163
Length:
Field 62:
Coding Scheme:
Beginning Position:
Length:
Field 63:
Beginning Position:
Length:
Field 64:
Coding Scheme:
Beginning Position:
Length:
Field 65:
Beginning Position:
Length:
Field 66:
Coding Scheme:
Beginning Position:
Length:
Field 67:
Beginning Position:
Length:
Field 68:
Coding Scheme:
Beginning Position:
Length:
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_13
Code identifying whether Oth_Diag_Code_13 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
296
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_14
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
297
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_14
Code identifying whether Oth_Diag_Code_14 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
303
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_15
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
304
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_15
Code identifying whether Oth_Diag_Code_15 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
310
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_16
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
311
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_16
Code identifying whether Oth_Diag_Code_16 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
317
1
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Data Source:
Type:
Page 20
Claim
Alphanumeric
DSHS Document # E25-14163
Field 69:
Beginning Position:
Length:
Field 70:
Coding Scheme:
Beginning Position:
Length:
Field 71:
Beginning Position:
Length:
Field 72:
Coding Scheme:
Beginning Position:
Length:
Field 73:
Beginning Position:
Length:
Field 74:
Coding Scheme:
Beginning Position:
Length:
Field 75:
Beginning Position:
Length:
Field 76:
Coding Scheme:
OTH_DIAG_CODE_17
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
318
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_17
Code identifying whether Oth_Diag_Code_17 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
324
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_18
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
325
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_18
Code identifying whether Oth_Diag_Code_18 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
331
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_19
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
332
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_19
Code identifying whether Oth_Diag_Code_19 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
338
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_20
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
339
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_20
Code identifying whether Oth_Diag_Code_20 code was present at the time the patient was
admitted to the hospital
Y
N
U
Yes
No
Unknown
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 21
DSHS Document # E25-14163
W
1
`
Beginning Position:
Length:
Field 77:
Beginning Position:
Length:
Field 78:
Coding Scheme:
Beginning Position:
Length:
Field 79:
Beginning Position:
Length:
Field 80:
Coding Scheme:
Beginning Position:
Length:
Field 81:
Beginning Position:
Length:
Field 82:
Coding Scheme:
Beginning Position:
Length:
Field 83:
Beginning Position:
Length:
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
345
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_21
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
346
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_21
Code identifying whether Oth_Diag_Code_21 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
352
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_22
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
353
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_22
Code identifying whether Oth_Diag_Code_22 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
359
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_23
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
360
Data Source: Claim
6
Alphanumeric
Type:
POA_OTH_DIAG_CODE_23
Code identifying whether Oth_Diag_Code_23 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
366
Data Source: Claim
1
Alphanumeric
Type:
OTH_DIAG_CODE_24
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable. Decimal is implied
following the third character.
367
Data Source: Claim
6
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 22
DSHS Document # E25-14163
Field 84:
Coding Scheme:
Beginning Position:
Length:
Field 85:
Beginning Position:
Length:
Field 86:
Coding Scheme:
Beginning Position:
Length:
Field 87:
Beginning Position:
Length:
Field 88:
Coding Scheme:
Beginning Position:
Length:
Field 89:
Beginning Position:
Length:
Field 90:
Coding Scheme:
Beginning Position:
Length:
POA_OTH_DIAG_CODE_24
Code identifying whether Oth_Diag_Code_24 code was present at the time the patient was
admitted to the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
373
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_1
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of the primary
external cause of injury. A decimal is implied following the third character.
374
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_1
Code identifying whether E_Code_1 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
380
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_2
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
381
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_2
Code identifying whether E_Code_2 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
387
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_3
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
388
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_3
Code identifying whether E_Code_3 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
394
1
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Data Source:
Type:
Page 23
Claim
Alphanumeric
DSHS Document # E25-14163
Field 91:
Beginning Position:
Length:
Field 92:
Coding Scheme:
Beginning Position:
Length:
Field 93:
Beginning Position:
Length:
Field 94:
Coding Scheme:
Beginning Position:
Length:
Field 95:
Beginning Position:
Length:
Field 96:
Coding Scheme:
Beginning Position:
Length:
Field 97:
Beginning Position:
Length:
Field 98:
Coding Scheme:
E_CODE_4
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
395
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_4
Code identifying whether E_Code_4 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
401
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_5
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
402
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_5
Code identifying whether E_Code_5 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
408
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_6
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
409
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_6
Code identifying whether E_Code_6 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
415
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_7
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
416
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_7
Code identifying whether E_Code_7 code was present at the time the patient was admitted to
the hospital
Y
N
U
Yes
No
Unknown
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 24
DSHS Document # E25-14163
W
1
`
Beginning Position:
Length:
Field 99:
Beginning Position:
Length:
Field 100:
Coding Scheme:
Beginning Position:
Length:
Field 101:
Beginning Position:
Length:
Field 102:
Coding Scheme:
Beginning Position:
Length:
Field 103:
Beginning Position:
Length:
Field 104:
Coding Scheme:
Beginning Position:
Length:
Field 105:
Beginning Position:
Length:
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
422
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_8
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
423
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_8
Code identifying whether E_Code_8 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
429
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_9
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
430
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_9
Code identifying whether E_Code_9 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
436
Data Source: Claim
1
Alphanumeric
Type:
E_CODE_10
ICD-9-CM diagnosis code, including the 4th and 5th digits if applicable, of an additional
external cause of injury. Decimal is implied following the third character.
437
Data Source: Claim
6
Alphanumeric
Type:
POA_E_CODE_10
Code identifying whether E_Code_10 code was present at the time the patient was admitted to
the hospital
Y
N
U
W
1
`
Yes
No
Unknown
Clinically Undetermined
Space (1st & 2nd Qtr 2012 only)
Invalid
443
Data Source: Claim
1
Alphanumeric
Type:
PRINC_SURG_PROC_CODE
Code for the principal surgical or other procedure performed during the period covered by the
bill. ICD-9, HCPCS, or CPT code.
444
Data Source: Claim
7
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 25
DSHS Document # E25-14163
Field 106:
Beginning Position:
Length:
Field 107:
Beginning Position:
Length:
Field 108:
Beginning Position:
Length:
Field 109:
Beginning Position:
Length:
Field 110:
Beginning Position:
Length:
Field 111:
Beginning Position:
Length:
Field 112:
Beginning Position:
Length:
Field 113:
Beginning Position:
Length:
Field 114:
Beginning Position:
Length:
Field 115:
Beginning Position:
Length:
Field 116:
Beginning Position:
Length:
PRINC_SURG_PROC_DAY
Day of principal surgical or other procedure equals Principal Surgical Procedure Date minus
Admission/Start of Care Date
451
Data Source: Calculated
4
Alphanumeric
Type:
PRINC_ICD9_CODE
ICD-9-CM code for principal surgical or other procedure, including the 4th and 5th digits if
applicable. Decimal is implied following the third character.
455
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_1
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
460
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_1
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
467
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_1
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
471
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_2
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
476
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_2
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
483
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_2
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
487
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_3
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
492
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_3
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
499
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_3
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
503
Data Source: Assigned
5
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 26
DSHS Document # E25-14163
Field 117:
Beginning Position:
Length:
Field 118:
Beginning Position:
Length:
Field 119:
Beginning Position:
Length:
Field 120:
Beginning Position:
Length:
Field 121:
Beginning Position:
Length:
Field 122:
Beginning Position:
Length:
Field 123:
Beginning Position:
Length:
Field 124:
Beginning Position:
Length:
Field 125:
Beginning Position:
Length:
Field 126:
Beginning Position:
Length:
Field 127:
Beginning Position:
Length:
OTH_SURG_PROC_CODE_4
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
508
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_4
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
515
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_4
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
519
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_5
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
524
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_5
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
531
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_5
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
535
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_6
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
540
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_6
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
547
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_6
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
551
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_7
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
556
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_7
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
563
Data Source: Calculated
4
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 27
DSHS Document # E25-14163
Field 128:
Beginning Position:
Length:
Field 129:
Beginning Position:
Length:
Field 130:
Beginning Position:
Length:
Field 131:
Beginning Position:
Length:
Field 132:
Beginning Position:
Length:
Field 133:
Beginning Position:
Length:
Field 134:
Beginning Position:
Length:
Field 135:
Beginning Position:
Length:
Field 136:
Beginning Position:
Length:
Field 137:
Beginning Position:
Length:
Field 138:
Beginning Position:
Length:
OTH_ICD9_CODE_7
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
567
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_8
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
572
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_8
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date
579
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_8
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
583
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_9
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
588
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_9
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
595
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_9
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
599
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_10
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
604
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_10
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
611
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_10
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
615
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_11
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
620
Data Source: Claim
7
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 28
DSHS Document # E25-14163
Field 139:
Beginning Position:
Length:
Field 140:
Beginning Position:
Length:
Field 141:
Beginning Position:
Length:
Field 142:
Beginning Position:
Length:
Field 143:
Beginning Position:
Length:
Field 144:
Beginning Position:
Length:
Field 145:
Beginning Position:
Length:
Field 146:
Beginning Position:
Length:
Field 147:
Beginning Position:
Length:
Field 148:
Beginning Position:
Length:
Field 149:
Beginning Position:
Length:
OTH_SURG_PROC_DAY_11
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
627
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_11
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
631
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_12
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
636
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_12
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
643
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_12
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
647
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_13
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
652
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_13
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
659
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_13
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
663
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_14
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
668
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_14
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
675
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_14
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
679
Data Source: Assigned
5
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 29
DSHS Document # E25-14163
Field 150:
Beginning Position:
Length:
Field 151:
Beginning Position:
Length:
Field 152:
Beginning Position:
Length:
Field 153:
Beginning Position:
Length:
Field 154:
Beginning Position:
Length:
Field 155:
Beginning Position:
Length:
Field 156:
Beginning Position:
Length:
Field 157:
Beginning Position:
Length:
Field 158:
Beginning Position:
Length:
Field 159:
Beginning Position:
Length:
Field 160:
Beginning Position:
Length:
OTH_SURG_PROC_CODE_15
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
684
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_15
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
691
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_15
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
695
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_16
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
700
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_16
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
707
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_16
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
711
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_17
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
716
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_17
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
723
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_17
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
727
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_18
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
732
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_18
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
739
Data Source: Calculated
4
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 30
DSHS Document # E25-14163
Field 161:
Beginning Position:
Length:
Field 162:
Beginning Position:
Length:
Field 163:
Beginning Position:
Length:
Field 164:
Beginning Position:
Length:
Field 165:
Beginning Position:
Length:
Field 166:
Beginning Position:
Length:
Field 167:
Beginning Position:
Length:
Field 168:
Beginning Position:
Length:
Field 169:
Beginning Position:
Length:
Field 170:
Beginning Position:
Length:
Field 171:
Beginning Position:
Length:
OTH_ICD9_CODE_18
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
743
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_19
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
748
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_19
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
755
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_19
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
759
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_20
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
764
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_20
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
771
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_20
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
775
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_21
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
780
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_21
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
787
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_21
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
791
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_22
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
796
Data Source: Claim
7
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 31
DSHS Document # E25-14163
Field 172:
Beginning Position:
Length:
Field 173:
Beginning Position:
Length:
Field 174:
Beginning Position:
Length:
Field 175:
Beginning Position:
Length:
Field 176:
Beginning Position:
Length:
Field 177:
Beginning Position:
Length:
Field 178:
Beginning Position:
Length:
Field 179:
Beginning Position:
Length:
Field 180:
Beginning Position:
Length:
Field 181:
Beginning Position:
Length:
Field 182:
OTH_SURG_PROC_DAY_22
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
803
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_22
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
807
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_23
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
812
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_23
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
819
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_23
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
823
Data Source: Assigned
5
Alphanumeric
Type:
OTH_SURG_PROC_CODE_24
Code for surgical or other procedure other than the principal procedure performed during the
period covered by the bill. ICD-9, HCPCS, or CPT code.
828
Data Source: Claim
7
Alphanumeric
Type:
OTH_SURG_PROC_DAY_24
Day of other surgical or other procedure equals Other Surgical Procedure Date minus
Admission/Start of Care Date.
835
Data Source: Calculated
4
Alphanumeric
Type:
OTH_ICD9_CODE_24
ICD-9-CM code for surgical or other procedure other than the principal procedure, including
the 4th and 5th digits if applicable. Decimal is implied following the third character.
839
Data Source: Assigned
5
Alphanumeric
Type:
MS-MDC
Major Diagnostic Category (MDC) as assigned by Centers for Medicare and Medicaid Services
(CMS) (formerly Health Care Financing Administration (HCFA)) for hospital payment for
Medicare beneficiaries. First available 2004.
844
Data Source: Assigned
2
Alphanumeric
Type:
MS-DRG
Centers for Medicare and Medicaid Services (CMS) Diagnosis Related Group (DRG), as
assigned for hospital payment for Medicare beneficiaries.
846
Data Source: Assigned
3
Alphanumeric
Type:
MS_GROUPER_VERSION_NBR
CMS Medicare Severity Diagnosis Related Grouper (formerly CMS DRG Grouper and
previously reported as HCFA_GROUPER_VERSION_NBR) version used to assign MS DRG
and, MS MDC codes
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 32
DSHS Document # E25-14163
Beginning Position:
Length:
Field 183:
Coding Scheme:
Beginning Position:
Length:
Field 184:
Beginning Position:
Length:
Field 185:
Beginning Position:
Length:
Field 186:
Coding Scheme:
Beginning Position:
Length:
Field 187:
Coding Scheme:
Beginning Position:
Length:
Field 188:
849
Data Source: Assigned
5
Alphanumeric
Type:
MS_GROUPER_ERROR_CODE
Error codes identify potential variations with MS DRG code assignment
11
00
No errors. DRG successfully
Invalid Principal Diagnosis
assigned.
01
19
Diagnosis code cannot be used as
DisableHac = 0 and at least one HAC
principal diagnosis
POA is invalid or exempt
20
02
Record does not meet criteria for any
DisableHac is invalid and at least one
DRG
HAC POA is N or U
03
21
Invalid Age
DisableHac is invalid and at least one
HAC POA is invalid or exempt
04
22
Invalid Sex
DisableHac = 0 and at least one HAC
POA is exempt
05
23
Invalid Discharge Status
DisableHac is invalid and at least one
HAC POA is exempt
10
24
Illogical Principal Diagnosis (CMS
DisableHac = 0 and there are multiple
only)
HACs that have different HAC POA
values that are not Y, W, N, U
11
25
Invalid Principal Diagnosis
DisableHac is invalid and there are
multiple HACs that have different
HAC POA values that are not Y or W
10
Illogical Principal Diagnosis (CMS
only)
854
Data Source: Assigned
2
Alphanumeric
Type:
APR-MDC
Major Diagnostic Category (MDC) as assigned by 3M APR-DRG Grouper.
856
Data Source: Assigned
2
Alphanumeric
Type:
APR-DRG
All Patient Refined (APR) Diagnosis Related Group (DRG) as assigned by 3M APR-DRG
Grouper
858
Data Source: Assigned
4
Alphanumeric
Type:
RISK_MORTALITY
Assignment of a risk of mortality score from the All Patient Refined (APR) Diagnosis Related
Group (DRG) from the 3M APR-DRG Grouper. Indicates the likelihood of dying.
1
2
3
4
Minor
Moderate
Major
Extreme
862
Data Source: Assigned
1
Alphanumeric
Type:
ILLNESS_SEVERITY
Assignment of a severity of illness score from the All Patient Refined (APR) Diagnosis Related
Group (DRG) from the 3M APR-DRG Grouper. Indicates the extent of physiologic
decompensation.
1
2
3
4
Minor
Moderate
Major
Extreme
863
Data Source: Assigned
1
Alphanumeric
Type:
APR_GROUPER_VERSION_NBR
3M™ All Patient Refined Diagnosis Related Grouper version used to assign APR DRG codes,
APR MDC codes, Risk of Mortality rankings and,Severity of Illness rankings
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 33
DSHS Document # E25-14163
Beginning Position:
Length:
Field 189:
Coding Scheme:
Beginning Position:
Length:
Field 190:
Suppression:
Beginning Position:
Length:
Field 191:
Suppression:
864
Data Source: Assigned
5
Alphanumeric
Type:
APR_GROUPER_ERROR_CODE
Error codes identify potential variations with APR DRG code assignment
12
00
No errors. DRG successfully
Gestational age/birth weight conflict
assigned.
(APR only)
01
19
Diagnosis code cannot be used as
DisableHac = 0 and at least one HAC
principal diagnosis
POA is invalid or exempt
20
02
Record does not meet criteria for any
DisableHac is invalid and at least one
DRG
HAC POA is N or U
03
21
Invalid Age
DisableHac is invalid and at least one
HAC POA is invalid or exempt
04
22
Invalid Sex
DisableHac = 0 and at least one HAC
POA is exempt
05
23
Invalid Discharge Status
DisableHac is invalid and at least one
HAC POA is exempt
06
24
Invalid birthweight (AP & APR
DisableHac = 0 and there are multiple
only)
HACs that have different HAC POA
values that are not Y, W, N, U
09
25
Invalid discharge age in days (AP &
DisableHac is invalid and there are
APR only)
multiple HACs that have different
HAC POA values that are not Y or W
11
Invalid Principal Diagnosis
869
Data Source: Assigned
2
Alphanumeric
Type:
ATTENDING_PHYSICIAN_UNIF_ID
Attending Physician Uniform Identifier. Unique identifier assigned to the licensed physician
expected to certify medical necessity of services rendered, with primary responsibility for the
patient’s medical care and treatment. Physician is an individual licensed to practice medicine
under the Medical Practice Act. Can include an individual other than a physician who admits
patients to hospitals or who provides diagnostic or therapeutic procedures to inpatients,
including psychologists, chiropractors, dentists, nurse practitioners, nurse midwives, and
podiatrists authorized by the hospital to admit or treat patients.
Suppressed when the number of physicians represented in a DRG for a hospital is less than the
minimum cell size of five.
871
Data Source: Assigned
10
Alphanumeric
Type:
OPERATING_PHYSICIAN_UNIF_ID
Operating or other Physician Uniform Identifier (if applicable). Unique identifier assigned to
the operating physician or physician other than the attending physician. Physician is an
individual licensed to practice medicine under the Medical Practice Act. Can include an
individual other than a physician who admits patients to hospitals or who provides diagnostic or
therapeutic procedures to inpatients, including psychologists, chiropractors, dentists, nurse
practitioners, nurse midwives, and podiatrists authorized by the hospital to admit or treat
patients.
Suppressed when the number of physicians represented in a DRG for a hospital is less than the
minimum cell size of five.
Coding Scheme:
9999999998
9999999999
Beginning Position:
Length:
Field 192:
Description:
Beginning Position:
Length:
881
Data Source: Assigned
10
Alphanumeric
Type:
ENCOUNTER_INDICATOR
Indicates the number of claims used to create the encounter
891
Calculated
Data Source:
2
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Cell size less than 5
Temporary license or license number could not be matched
Page 34
DSHS Document # E25-14163
Field 193:
Coding Scheme:
Beginning Position:
Length:
Field 194:
Description:
Beginning Position:
Length:
CERT_STATUS
Assignment of a code to indicate the certification of data and submission of comments by the
hospital. First available 3rd quarter 1999.
1
2
3
4
5
6
Certified, without comment
Certified, with comment
Certified, with comment, comment not received by deadline
Hospital elected not to certify
Hospital closed, data not certified
Hospital out of compliance, did not certify data
893
Data Source: Assigned
1
Alphanumeric
Type:
FILLER_SPACE
Indicates the number of claims used to create the encounter
894
Data Source: Calculated
57
Alphanumeric
Type:
BASE DATA #2 FILE
Field 1:
Description:
Beginning Position:
Length:
Field 2:
Description:
Beginning Position:
Length:
Field 3:
Beginning Position:
Length:
Field 4:
Beginning Position:
Length:
Field 5:
Beginning Position:
Length:
Field 6:
Beginning Position:
Length:
RECORD_ID
Record Identification Number. Unique number assigned to identify the record. First available
1st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files (RDF’s).
1
Assigned
Data Source:
12
Alphanumeric
Type:
PRIVATE_AMOUNT
Accommodation Charge, Private Room Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 11X, 14X
13
Data Source: Calculated
12
Numeric
Type:
SEMI_PRIVATE_AMOUNT
Accommodation Charge, Semi-private Room Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 10X, 12X14X, 16X-19X
25
Data Source: Calculated
12
Numeric
Type:
WARD_AMOUNT
Accommodation Charge, Ward Charge Amount. Calculated using MEDPAR algorithm. Sum of
charges associated with revenue codes 0100-0219, revenue center 15X.
37
Data Source: Calculated
12
Numeric
Type:
ICU_AMOUNT
Accommodation Charge, Intensive Care Unit Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 20X.
49
Data Source: Calculated
12
Numeric
Type:
CCU_AMOUNT
Accommodation Charge, Coronary Care Unit Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes 0100-0219, revenue center 21X.
61
Data Source: Calculated
12
Numeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 35
DSHS Document # E25-14163
Field 7:
Beginning Position:
Length:
Field 8:
Beginning Position:
Length:
Field 9:
Beginning Position:
Length:
Field 10:
Beginning Position:
Length:
Field 11:
Beginning Position:
Length:
Field 12:
Beginning Position:
Length:
Field 13:
Beginning Position:
Length:
Field 14:
Beginning Position:
Length:
Field 15:
Beginning Position:
Length:
OTHER_AMOUNT
Ancillary Service Charge, Other Charge Amount. Calculated using MEDPAR algorithm. Sum
of charges associated with revenue codes other than 0100-0219, revenue center 002-099, 22X24X, 52X-53X, 55X-60X, 64X-70X, 76X-78X, 90X-95X, 99X.
73
Data Source: Calculated
12
Numeric
Type:
PHARM_AMOUNT
Ancillary Service Charge, Pharmacy Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 25X, 26X,
and 63X.
85
Data Source: Calculated
12
Numeric
Type:
MEDSURG_AMOUNT
Ancillary Service Charge, Medical/Surgical Supply Charge Amount. Calculated using
MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219,
revenue center 27X, 62X.
97
Data Source: Calculated
12
Numeric
Type:
DME_AMOUNT
Ancillary Service Charge, Durable Medical Equipment Charge Amount. Calculated using
MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219,
revenue centers 290-292, 294-299.
109
Data Source: Calculated
12
Numeric
Type:
USED_DME_AMOUNT
Ancillary Service Charge, Used Durable Medical Equipment Charge Amount. Calculated
using MEDPAR algorithm. Sum of charges associated with revenue codes other than 01000219, revenue center 293.
121
Data Source: Calculated
12
Numeric
Type:
PT_AMOUNT
Ancillary Service Charge, Physical Therapy Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
42X.
133
Data Source: Calculated
12
Numeric
Type:
OT_AMOUNT
Ancillary Service Charge, Occupational Therapy Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
42X.
145
Data Source: Calculated
12
Numeric
Type:
SPEECH_AMOUNT
Ancillary Service Charge, Speech Pathology Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
44X, 47X.
157
Data Source: Calculated
12
Numeric
Type:
IT_AMOUNT
Ancillary Service Charge, Inhalation Therapy Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
41X, 46X.
169
Data Source: Calculated
12
Numeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 36
DSHS Document # E25-14163
Field 16:
Beginning Position:
Length:
Field 17:
Beginning Position:
Length:
Field 18:
Beginning Position:
Length:
Field 19:
Beginning Position:
Length:
Field 20:
Beginning Position:
Length:
Field 21:
Beginning Position:
Length:
Field 22:
Beginning Position:
Length:
Field 23:
Beginning Position:
Length:
Field 24:
Beginning Position:
Length:
Field 25:
Beginning Position:
Length:
BLOOD_AMOUNT
Ancillary Service Charge. Calculated using MEDPAR algorithm. Sum of charges associated
with revenue codes other than 0100-0219, revenue center 38X.
181
Data Source: Calculated
12
Numeric
Type:
BLOOD_ADMIN_AMOUNT
Ancillary Service Charge. Calculated using MEDPAR algorithm. Sum of charges associated
with revenue codes other than 0100-0219, revenue center 39X.
193
Data Source: Calculated
12
Numeric
Type:
OR_AMOUNT
Ancillary Service Charge, Operating Room Charge amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
36X, 71X-72X.
205
Data Source: Calculated
12
Numeric
Type:
LITH_AMOUNT
Ancillary Service Charge, Lithotripsy Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 79X.
217
Data Source: Calculated
12
Numeric
Type:
CARD_AMOUNT
Ancillary Service Charge, Cardiology Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 48X, 73X.
229
Data Source: Calculated
12
Numeric
Type:
ANES_AMOUNT
Ancillary Service Charge, Anesthesia Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 37X.
241
Data Source: Calculated
12
Numeric
Type:
LAB_AMOUNT
Ancillary Service Charge, Laboratory Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 30X-31X,
74X-75X.
253
Data Source: Calculated
12
Numeric
Type:
RAD_AMOUNT
Ancillary Service Charge, Radiology Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 28X, 32X35X, 40X.
265
Data Source: Calculated
12
Numeric
Type:
MRI_AMOUNT
Ancillary Service Charge, MRI Charge Amount. Calculated using MEDPAR algorithm. Sum of
charges associated with revenue codes other than 0100-0219, revenue center 61X.
277
Data Source: Calculated
12
Numeric
Type:
OP_AMOUNT
Ancillary Service Charge, Outpatient Services Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
49X-50X.
289
Data Source: Calculated
12
Numeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 37
DSHS Document # E25-14163
Field 26:
Beginning Position:
Length:
Field 27:
Beginning Position:
Length:
Field 28:
Beginning Position:
Length:
Field 29:
Beginning Position:
Length:
Field 30:
Beginning Position:
Length:
Field 31:
Beginning Position:
Length:
Field 186:
Coding Scheme:
ER_AMOUNT
Ancillary Service Charge, Emergency Room Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
45X.
301
Data Source: Calculated
12
Numeric
Type:
AMBULANCE_AMOUNT
Ancillary Service Charge, Ambulance Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 54X.
313
Data Source: Calculated
12
Numeric
Type:
PRO_FEE_AMOUNT
Ancillary Service Charge, Professional Fee Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
96X-98X.
325
Data Source: Calculated
12
Numeric
Type:
ORGAN_AMOUNT
Ancillary Service Charge, Organ Acquisition Charge Amount. Calculated using MEDPAR
algorithm. Sum of charges associated with revenue codes other than 0100-0219, revenue center
81X, 89X.
337
Data Source: Calculated
12
Numeric
Type:
ESRD_AMOUNT
Ancillary Service Charge, End Stage Renal Dialysis Charge Amount. Calculated using
MEDPAR algorithm. Sum of charges associated with revenue codes other than 0100-0219,
revenue center 80X, 82X-88X.
349
Data Source: Calculated
12
Numeric
Type:
CLINIC_AMOUNT
Ancillary Service Charge, Clinic Visit Charge Amount. Calculated using MEDPAR algorithm.
Sum of charges associated with revenue codes other than 0100-0219, revenue center 51X.
361
Data Source: Calculated
12
Numeric
Type:
OCCUR_CODE_1
Code describing a significant event relating to the claim.
1
2
3
4
5
6
9
10
11
12
16
17
18
19
20
21
22
24
25
26
Auto accident
No Fault Insurance Involved - Including Auto
Accident/Other
Accident/ Tort Liability
Accident/ Employment Related
Other accident
Crime Victim
Start of Infertility Treatment Cycle
Last Menstrual Period
Onset of Symptoms/ Illness
Date of Onset for a Chronically Dependent
Individual
Date of Last Therapy
Date Outpatient OT Plan Established or Last
Reviewed
Date of Retirement - Patient/Beneficiary
Date of Retirement - Spouse
Date Guarantee of Payment Began
Date UR Notice Received
Date Active Care Ended
Date Insurance Denied
Date Benefits Terminated by Primary Payer
Date SNF Bed Became Available
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 38
40
41
Scheduled date of admission
Date of first test of pre-admission testing
42
43
44
45
46
47
A1
A2
Date of discharge (hospice only)
Scheduled date of canceled surgery
Date treatment started - OT
Date treatment started - ST
Date treatment started - Cardiac rehabiliation
Date cost outlier status begins
Birthdate - Insured A
Effective Date - Insured A Policy
A3
A4
Payer A benefits exhausted
Split Bill Date
B1
B2
B3
C1
C2
C3
DR
E1
Birthdate - Insured B
Effective date - Insured B Policy
Payer B benefits exhausted
Birthdate - Insured C
Effective date - Insured C Policy
Payer C benefits exhausted
Katrina disaster related
Birthdate - Insured D
DSHS Document # E25-14163
27
28
29
30
31
32
37
38
39
Beginning Position:
Length:
Field 33:
Beginning Position:
Length:
Field 34:
Coding Scheme:
Beginning Position:
Length:
Field 35:
Beginning Position:
Length:
Field 36:
Coding Scheme:
Beginning Position:
Length:
Field 37:
Beginning Position:
Length:
Field 38:
Coding Scheme:
Beginning Position:
Length:
Field 39:
Beginning Position:
Length:
Field 40:
Coding Scheme:
Beginning Position:
Length:
Field 41:
Beginning Position:
Length:
Date Home Health Plan Established or Last
Reviewd
Date Comprehensive Outpatient Rehabilitation
Plan Established or Last Reviewed
Date Outpatient PT Plan established or last
reviewed
Date Outpatient ST Plan established or last
reviewed
Date beneficiary notified of intent to bill
(accommodations)
Date beneficiary notified of intent to bill
(procedures or treatments)
Date of inpatient hospital discharge for noncovered transplant patients
Date treatment started for home IV therapy
Date discharged on a continuous course if IV
therapy
E2
Effective date - Insured D Policy
E3
Payer D benefits exhausted
F1
Birthdate - Insured E
F2
Effective date - Insured E Policy
F3
Payer E benefits exhausted
G1
Birthdate - Insured F
G2
Effective date - Insured F Policy
G3
Payer F benefits exhausted
373
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_1
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
375
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_2
Code describing a significant event relating to the claim.
Same as Field 186.
379
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_2
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
381
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_3
Code describing a significant event relating to the claim.
Same as Field 186.
385
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_3
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
387
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_4
Code describing a significant event relating to the claim.
Same as Field 186.
391
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_4
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
393
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_5
Code describing a significant event relating to the claim.
Same as Field 186.
397
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_5
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
399
Data Source: Calculated
4
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 39
DSHS Document # E25-14163
Field 42:
Coding Scheme:
Beginning Position:
Length:
Field 43:
Beginning Position:
Length:
Field 44:
Coding Scheme:
Beginning Position:
Length:
Field 45:
Beginning Position:
Length:
Field 46:
Coding Scheme:
Beginning Position:
Length:
Field 47:
Beginning Position:
Length:
Field 48:
Coding Scheme:
Beginning Position:
Length:
Field 49:
Beginning Position:
Length:
Field 50:
Coding Scheme:
Beginning Position:
Length:
Field 51:
Beginning Position:
Length:
Field 52:
Coding Scheme:
Beginning Position:
Length:
Field 53:
Beginning Position:
Length:
OCCUR_CODE_6
Code describing a significant event relating to the claim.
Same as Field 186.
403
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_6
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
405
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_7
Code describing a significant event relating to the claim.
Same as Field 186.
409
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_7
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
411
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_8
Code describing a significant event relating to the claim.
Same as Field 186.
415
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_8
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
417
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_9
Code describing a significant event relating to the claim.
Same as Field 186.
421
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_9
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
423
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_10
Code describing a significant event relating to the claim.
Same as Field 186.
427
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_10
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
429
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_CODE_11
Code describing a significant event relating to the claim.
Same as Field 186.
433
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_11
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
435
Data Source: Calculated
4
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 40
DSHS Document # E25-14163
Field 54:
Coding Scheme:
Beginning Position:
Length:
Field 55:
Beginning Position:
Length:
Field 56:
Coding Scheme:
Beginning Position:
Length:
Field 57:
Beginning Position:
Length:
Field 58:
Beginning Position:
Length:
Field 59:
Coding Scheme:
Beginning Position:
Length:
Field 60:
Beginning Position:
Length:
Field 61:
Beginning Position:
Length:
Field 62:
Coding Scheme:
Beginning Position:
Length:
Field 63:
Beginning Position:
Length:
Field 64:
Beginning Position:
Length:
Field 65:
OCCUR_CODE_12
Code describing a significant event relating to the claim.
Same as Field 186.
439
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_DAY_12
Occurrence Day equals Occurrence Date minus Admission/Start of Care Date.
441
Data Source: Calculated
4
Alphanumeric
Type:
OCCUR_SPAN_CODE_1
Code describing a significant event relating to the claim that may affect payer processing.
70
71
72
73
74
75
76
77
Qualifying stay dates (for SNF use only)
Prior stay dates
First/Last Visit
Benefit eligibility period
Noncovered level of care/Leave of absence
SNF level of care
Patient Liability Period
Provider Liability - Utilization Charged
78
79
DR
M0
M1
M2
M3
M4
SNF prior stay dates
Payer use codes
Katrina disaster related
PRO/UR approved stay dates
Provider liability - no utilization
Inpatient respite dates
ICF level of care
Residential level of care
445
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_SPAN_FROM_1
Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date.
447
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_THRU_1
Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date.
453
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_CODE_2
Code describing a significant event relating to the claim that may affect payer processing.
Same as Field 210.
459
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_SPAN_FROM_2
Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date.
461
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_THRU_2
Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date.
467
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_CODE_3
Code describing a significant event relating to the claim that may affect payer processing.
Same as Field 210.
473
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_SPAN_FROM_3
Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date.
475
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_THRU_3
Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date.
481
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_CODE_4
Code describing a significant event relating to the claim that may affect payer processing.
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 41
DSHS Document # E25-14163
Coding Scheme:
Beginning Position:
Length:
Field 66:
Beginning Position:
Length:
Field 67:
Beginning Position:
Length:
Field 68:
Coding Scheme:
Same as Field 210.
487
Data Source: Claim
2
Alphanumeric
Type:
OCCUR_SPAN_FROM_4
Occurrence Span From equals Beginning Date of Event minus Admission/Start of Care Date.
489
Data Source: Calculated
6
Alphanumeric
Type:
OCCUR_SPAN_THRU_4
Occurrence Span Thru equals Ending Date of Event minus Admission/Start of Care Date.
495
Data Source: Calculated
6
Alphanumeric
Type:
CONDITION_CODE_1
Code describing a condition relating to the claim.
1
2
Military service related
Condition is employment related
76
77
3
4
5
6
78
79
80
A0
A1
EPSDT/CHAP
A2
Physically handicapped children's program
A3
A4
Special Federal Funding
Family planning
A5
Disability
17
18
19
20
21
22
23
Patient covered by insurance not reflected here
Information only bill.
Lien has been filed
ESRD patient in first 18 months of entitlement
covered by EGHP
Treatment of non-terminal condition for hospice
patient
Beneficiary would not provide information
concerning other insurance coverage
Neither patient or spouse is employed
Patient and/or spouse is employed but no EGHP
exists
Disabled beneficiary but no LGHP coverage
exists
Patient is homeless
Maiden name retained
Child retains mother's name
Beneficiary requested billing
Billing for denial notice
Patient on multiple drug regimen
Home care giver available
Back-up in facility dialysis
Provider accepts or is obligated/required due to a
contractual arrangement or law to accept
payment by a primary payer as payment
New coverage not implemented by HMO
CORF services provided offsite
Home dialysis - nursing facility
CHAMPUS external partnership program
A6
A7
A8
A9
AA
AB
AC
24
Home IV patient also receiving HHA services
AD
25
Patient is non-US resident
AE
26
AF
AH
AI
Sterilization
AJ
Payer responsible for co-payment
AJ
AK
Payer responsible for co-payment
Air ambulance required
33
34
VA eligible patient chooses to receive services in
a Medicare certified facility
Patient referred to a sole community hospital for
a diagnostic laboratory test
Patient and/or spouse's EGHP is secondary to
Medicare
Disabled beneficiary and/or family member's
LGHP is secondary to Medicare
Non-research services provided to patients
enrolled in a qualified clinical trial
Patient is student (full time - day)
Patient is student (cooperative/work study
program)
Patient is student (full time - night)
Patient is student (part-time)
Vaccines/Medicare 100% payment
Induced abortion - danger to life
Induced abortion - victim rape/incest
Second opinion surgery
Abortion performed due to rape
Abortion performed due to incest
Abortion performed due to serious fatal genetic
defect, deformity, or abnormality
Abortion performed due to life endangering
physical condition caused by, arising from or
exacerbated by the pregnancy itself
Abortion performed due to physical health of
mother that is not life endangering
Abortion performed due to
emotional/psychological health of mother
Abortion performed due to social or economic
reasons
Elective abortion
AL
AM
36
37
38
General care patient in a special unit
Ward accommodation at patient request
Semi-private room not available
AN
B0
B1
Specialized treatment/bed unavailable
Non-emergency medically necessary stretcher
transport required
Pre-admission screening not required
Medicare coordinated care demonstration claim
Beneficiary is ineligible for demonstration
program
7
8
9
10
11
27
28
29
30
31
32
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 42
AG
DSHS Document # E25-14163
39
40
41
42
43
44
45
46
47
48
49
55
56
57
58
59
60
61
66
67
Coding Scheme:
Beginning Position:
Length:
Field 70:
Coding Scheme:
Beginning Position:
Length:
Field 71:
Coding Scheme:
Beginning Position:
Length:
Field 72:
Coding Scheme:
Beginning Position:
SNF readmission
Terminated Medicare+Choice organization
enrollee
Non-primary ESRD facility
Day outlier
B2
B3
B4
C1
Critical access hospital ambulance attestation
Pregnancy indicator
Admission unrelated to discharge on same day
Approved as billed
C2
Automatic approval as billed based on focused
review
Partial approval
Admission/services denied
Postpayment review applicable
Admission Preauthorization
Extended Authorization
C3
C4
C5
C6
C7
D0
D1
D2
D7
D8
D9
Changes to Service Dates
Changes to Charges
Changes in Revenue Codes/HCPCS/HIPPS rate
code
Second or Subsequent Interim PPS Bill
Change in ICD-9-CM diagnosis and/or procedure
codes.
Cancel to correct HICN or Provider ID
Cancel Only to Repay a Duplicate or OIG
Overpayment
Change to Make Medicare the Secondary Payer
Change to Make Medicare the Primary Payer
Any Other Change
DR
Katrina disaster related
E0
G0
H0
M0
M1
Changes in Patient Status
Distinct Medical Visit
Delayed Filing, Statement of Intent Submitted
All inclusive rate for outpatient services
Roster billed influenza virus vaccine or
pneumococcal pneumonia vaccine (PPV)
HHA payment significantly exceeds total charges
Do not Resuscitate Order (DNR)
United Mine Workers of America (UMWA)
Demonstration Indicator
D3
D4
D5
D6
69
70
71
72
73
Cost outlier
Provider does not wish cost outlier payment
Beneficiary elects not to use life time reserve
(LTR) days
Beneficiary elects to use life time reserve (LTR)
days
IME/DGME/N&AH Payment Only
Self-administered anemia management drug
Full care in unit
Self care in unit
Self care training
74
75
Home
Home - 100% reimbursement
68
Beginning Position:
Length:
Field 69:
Private room medically necessary
Same day transfer
Partial hospitalization
Continuing care not related to inpatient
admission
Continuing care not provided within prescribed
postdischarge window
Inpatient admission changed to outpatient
Reserved
Non-availability statement on file
Reserved for CHAMPUS
Psychiatric residential treatment centers for
children and adolescents (RTCs)
Product replacement within product lifecycle
SNF bed not available
Medical appropriateness
M2
P1
WO
501
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_2
Code describing a condition relating to the claim.
Same as Field 68.
503
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_3
Code describing a condition relating to the claim.
Same as Field 68.
505
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_4
Code describing a condition relating to the claim.
Same as Field 68.
507
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_5
Code describing a condition relating to the claim.
Same as Field 68.
509
Data Source: Claim
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 43
DSHS Document # E25-14163
Length:
Field 73:
Coding Scheme:
Beginning Position:
Length:
Field 74:
Coding Scheme:
Beginning Position:
Length:
Field 75:
Coding Scheme:
Beginning Position:
Length:
Field 76:
Coding Scheme:
2
Alphanumeric
Type:
CONDITION_CODE_6
Code describing a condition relating to the claim.
Same as Field 68.
511
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_7
Code describing a condition relating to the claim.
Same as Field 68.
513
Data Source: Claim
2
Alphanumeric
Type:
CONDITION_CODE_8
Code describing a condition relating to the claim.
Same as Field 68.
515
Data Source: Claim
2
Alphanumeric
Type:
VALUE_CODE_1
Code describing information that may affect payer processing.
1
2
4
5
6
8
9
10
11
12
13
14
15
16
21
22
23
24
25
Most common semi-private rate
Hospital has no semi-private rooms
Inpatient professional component charges which
are combined billed
Professional component included in charges and
also billed separately to carrier
Medicare blood deductible
Medicare life time reserve amount in the first
calendar year
Medicare coinsurance amount in the first
calendar year
Medicare lifetime reserve amount in the second
calendar year
Medicare coinsurance amount in the second
calendar year
Working aged beneficiary/spouse with employer
group health plan
ESRD beneficiary in a Medicare coordination
period with an employer group health plan
No fault, including auto/other
Worker's compensation
Public health service (PHS) or other federal
agency
Catastrophic
66
67
68
Medicaid spenddown amount
Peritoneal dialysis
EPO-drug
69
State charity care percentage
72
73
Flat rate surgery charge
Drug deductible
74
Drug coinsurance
77
New technology add-on payment
A0
Special zip code reporting
A1
Deductible payer A
A2
Coinsurance payer A
A3
A4
A5
B1
Estimated responsibility payer A
Covered self-administrable drugs - emergency
Covered self-administrable drugs - administrable
in form and situation furnished to patient
Covered self-administrable drugs - diagnostic
study and other
Co-payment payer A
Patient weight
Patient height
Regulatory surcharges, assessments, allowances
or health care related taxes - payer A
Other assessments or allowances (e.g., medical
eduction) - payer A
Deductible payer B
B2
Coinsurance payer B
B3
Estimated responsibility payer B
B7
BA
Co-payment payer B
Regulatory surcharges, assessments, allowances
or health care related taxes - payer B
Other assessments or allowances (e.g., medical
eduction) - payer B
Deductible payer C
A6
A7
A8
A9
AA
30
31
Surplus
Recurring monthly income
Medicaid Rate Code
Offset to the patient - payment amount prescription drugs
Offset to the patient - payment amount - hearing
and ear services
Offset to the patient - payment amount - vision
and eye services
Offset to the patient - payment amount - dental
services
Offset to the patient - payment amount chiropractic services
Preadmission testing
Patient Liability Amount
32
Multiple patient ambulance transport
BB
33
Offset to the patient - payment amount - podiatric
services
C1
26
27
28
29
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 44
AB
DSHS Document # E25-14163
34
37
38
Offset to the patient - payment amount - other
medical services
Offset to the patient - payment amount - health
insurance premiums
Pints of blood furnished
Blood deductible pints
39
Pints of blood replaced
CB
40
41
42
43
44
D3
DR
E1
E2
E3
45
46
New coverage not implemented by HMO
Black lung
VA
Disabled beneficiary under age 65 with LGHP
Amount provider agreed to accept from primary
payer when this amount is less than charges but
higher than payment received
Accident hour
Number of grace days
47
Any liability insurance
EB
48
49
50
51
52
Hemoglobin reading
Hematocrit reading
PT visits
OT visits
ST visits
F1
F2
F3
F7
FA
53
Cardiac rehab visits
FB
54
55
56
57
58
59
Newborn birth weight in grams
Eligibility threshold for charity care
Skilled nurse - home visit hours
Home health aide - home visit hours
Arterial blood gas
Oxygen saturation
G1
G1
G2
G3
G7
GA
60
HHA branch MSA
GB
61
Location where service is furnished (HHA and
hospice)
P1
35
C2
Coinsurance payer C
C3
Estimated responsibility payer C
C7
CA
Co-payment payer C
Regulatory surcharges, assessments, allowances
or health care related taxes - payer C
Other assessments or allowances (e.g., medical
eduction) - payer C
Patient estimated responsibility
Katrina disaster related
Deductible Payer D
Coinsurance Payer D
Coinsurance Payer D
E7
EA
Y1
Y2
Y3
Y4
Beginning Position:
Length:
Field 77:
Beginning Position:
Length:
Field 78:
Coding Scheme:
Beginning Position:
Length:
Field 79:
Beginning Position:
Length:
Co-payment payer D
Regulatory surcharges, assessments, allowances
or health care related taxes - payer D
Other assessments or allowances (e.g. medical
education) - payer D
Deductible Payer E
Coinsurance Payer E
Coinsurance Payer E
Co-payment payer E
Regulatory surcharges, assessments, allowances
or health care related taxes - payer E
Other assessments or allowances (e.g. medical
education) - payer E
Deductible Payer F
Deductible Payer F
Coinsurance Payer F
Coinsurance Payer F
Co-payment payer F
Regulatory surcharges, assessments, allowances
or health care related taxes - payer F
Other assessments or allowances (e.g. medical
education) - payer F
Do not resuscitate order (DNR)
Part A Demonstration Payment
Part B Demonstration Payment
Part B Coinsurance
Conventional Provider Payment Amount for
Non-Demonstration Claims
517
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_1
Dollar amount that may be affected.
519
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_2
Code describing information that may affect payer processing.
Same as Field 222.
528
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_2
Dollar amount that may be affected.
530
Data Source: Claim
9
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 45
DSHS Document # E25-14163
Field 80:
Coding Scheme:
Beginning Position:
Length:
Field 81:
Beginning Position:
Length:
Field 82:
Coding Scheme:
Beginning Position:
Length:
Field 83:
Beginning Position:
Length:
Field 84:
Coding Scheme:
Beginning Position:
Length:
Field 85:
Beginning Position:
Length:
Field 86:
Coding Scheme:
Beginning Position:
Length:
Field 87:
Beginning Position:
Length:
Field 88:
Coding Scheme:
Beginning Position:
Length:
Field 89:
Beginning Position:
Length:
Field 90:
Coding Scheme:
Beginning Position:
Length:
Field 91:
Beginning Position:
Length:
VALUE_CODE_3
Code describing information that may affect payer processing.
Same as Field 76.
539
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_3
Dollar amount that may be affected.
541
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_4
Code describing information that may affect payer processing.
Same as Field 76.
550
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_4
Dollar amount that may be affected.
552
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_5
Code describing information that may affect payer processing.
Same as Field 76.
561
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_5
Dollar amount that may be affected.
563
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_6
Code describing information that may affect payer processing.
Same as Field 76.
572
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_6
Dollar amount that may be affected.
574
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_7
Code describing information that may affect payer processing.
Same as Field 76.
583
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_7
Dollar amount that may be affected.
585
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_8
Code describing information that may affect payer processing.
Same as Field 76.
594
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_8
Dollar amount that may be affected.
596
Data Source: Claim
9
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 46
DSHS Document # E25-14163
Field 92:
Beginning Position:
Length:
Field 100:
VALUE_CODE_9
Code describing information that may affect payer processing.
Same as Field 76.
605
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_9
Dollar amount that may be affected.
607
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_10
Code describing information that may affect payer processing.
Same as Field 76.
616
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_10
Dollar amount that may be affected.
618
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_11
Code describing information that may affect payer processing.
Same as Field 76.
627
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_11
Dollar amount that may be affected.
629
Data Source: Claim
9
Alphanumeric
Type:
VALUE_CODE_12
Code describing information that may affect payer processing.
Same as Field 76.
638
Data Source: Claim
2
Alphanumeric
Type:
VALUE_AMOUNT_12
Dollar amount that may be affected.
640
Data Source: Claim
9
Alphanumeric
Type:
FILLER_SPACE
Beginning Position:
Length:
649
52
Coding Scheme:
Beginning Position:
Length:
Field 93:
Beginning Position:
Length:
Field 94:
Coding Scheme:
Beginning Position:
Length:
Field 95:
Beginning Position:
Length:
Field 96:
Coding Scheme:
Beginning Position:
Length:
Field 97:
Beginning Position:
Length:
Field 98:
Coding Scheme:
Beginning Position:
Length:
Field 99:
Data Source:
Type:
Claim
Alphanumeric
References:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 47
DSHS Document # E25-14163
CHARGES DATA FILE
Field 1:
Description:
Beginning Position:
Length:
Field 2:
Description:
Coding Scheme:
RECORD_ID
Record Identification Number. Unique number assigned to identify the record. First available
1st quarter 2002. Does NOT match the RECORD_ID in THCIC Research Data Files (RDF’s).
1
Assigned
Data Source:
12
Alphanumeric
Type:
REVENUE_CODE
Code corresponding to each specific accommodation, ancillary service or billing calculation
related to the services being billed.
0100
0101
0110
0111
0516
0517
0519
0520
Clinic - urgent care
Clinic - family practice
Clinic - other
Freestanding Clinic - general
0112
All-inclusive room charges plus ancillary
All-inclusive room charges
Room charges for private rooms - general
Room charges for private rooms medical/surgical/GYN
Room charges for private rooms - obstetrics
0521
0113
Room charges for private rooms - pediatric
0522
0114
0115
Room charges for private rooms - psychiatric
Room charges for private rooms - hospice
0523
0524
0116
Room charges for private rooms - detoxification
0525
0117
0118
Room charges for private rooms - oncology
Room charges for private rooms - rehabilitation
0526
0527
0119
Room charges for private rooms - other
0528
0120
0121
Room charges for semi-private rooms - general
Room charges for semi-private rooms medical/surgical/GYN
Room charges for semi-private rooms obstetrics
Room charges for semi-private rooms pediatric
Room charges for semi-private rooms psychiatric
Room charges for semi-private rooms - hospice
Room charges for semi-private rooms detoxification
Room charges for semi-private rooms oncology
Room charges for semi-private rooms rehabilitation
Room charges for semi-private rooms - other
Room charges for semi-private - 3/4 beds rooms - general
Room charges for semi-private - 3/4 beds rooms - medical/surgical/GYN
Room charges for semi-private - 3/4 beds rooms - obstetrics
Room charges for semi-private - 3/4 beds rooms - pediatric
Room charges for semi-private - 3/4 beds rooms - psychiatric
Room charges for semi-private - 3/4 beds rooms - hospice
Room charges for semi-private - 3/4 beds rooms - detoxification
Room charges for semi-private - 3/4 beds rooms - oncology
0529
0530
Freestanding Clinic - Clinic Visit by Member to
RHC/FQHC
Freestanding Clinic - Home Visit by
RHC/FQHC Practitioner
Freestanding Clinic - family practice
Freestanding Clinic - Visit by RHC/FQHC
Practitioner to a Member in a Covered Part A
Stay at SNF
Freestanding Clinic - Visit by RHC/FQHC
Practitioner to a Member in a SNF (not Covered
Part A Stay) or NF or ICF MR or Other
Residential Facility
Freestanding Clinic - urgent care
Freestanding Clinic - Visiting Nurse Services(s)
to a Member's Home when in a Home Health
Shortage Area
Freestanding Clinic – Visit by RHC/FQHC
Practitioner to Other non RHC/FQHC Site (e.g.
Scene of Accident)
Freestanding Clinic - other
Osteopathic service - general
0531
Osteopathic service - therapy
0539
Osteopathic service - other
0540
Ambulance service - general
0541
0542
Ambulance service - supplies
Ambulance service - medical transport
0543
Ambulance service - heart mobile
0544
Ambulance service - oxygen
0545
0546
Ambulance service - air ambulance
Ambulance service - neonatal
0547
Ambulance service - pharmacy
0548
0549
Ambulance service - telephone transmission
EKG
Ambulance service - other
0550
Skilled nursing - general
0551
Skilled nursing - visit charge
0552
Skilled nursing - hourly charge
0559
Skilled nursing - other
0122
0123
0124
0125
0126
0127
0128
0129
0130
0131
0132
0133
0134
0135
0136
0137
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 48
DSHS Document # E25-14163
0138
0152
0153
0154
Room charges for semi-private - 3/4 beds rooms - rehabilitation
Room charges for semi-private - 3/4 beds rooms - other
Room charges for private (deluxe) rooms general
Room charges for private (deluxe) rooms medical/surgical/GYN
Room charges for private (deluxe) rooms obstetrics
Room charges for private (deluxe) rooms pediatric
Room charges for private (deluxe) rooms psychiatric
Room charges for private (deluxe) rooms hospice
Room charges for private (deluxe) rooms detoxification
Room charges for private (deluxe) rooms oncology
Room charges for private (deluxe) rooms rehabilitation
Room charges for private (deluxe) rooms other
Room charges for ward rooms - general
Room charges for ward rooms medical/surgical/GYN
Room charges for ward rooms - obstetrics
Room charges for ward rooms - pediatric
Room charges for ward rooms - psychiatric
0155
Room charges for ward rooms - hospice
0602
0156
Room charges for ward rooms - detoxification
0603
0157
0158
0159
0160
0161
0604
0610
0611
0612
0619
0162
0163
Room charges for ward rooms - oncology
Room charges for ward rooms - rehabilitation
Room charges for ward rooms - other
Room charges for other rooms - general
Room charges for other rooms medical/surgical/GYN
Room charges for other rooms - obstetrics
Room charges for other rooms - pediatric
0164
0165
Room charges for other rooms - psychiatric
Room charges for other rooms - hospice
0623
0624
0166
0167
Room charges for other rooms - detoxification
Room charges for other rooms - oncology
0630
0631
0168
Room charges for other rooms - rehabilitation
0632
0169
Room charges for other rooms - other
0633
0170
Room charges for nursery - general
0634
0171
Room charges for nursery - newborn level I
0635
0172
Room charges for nursery - newborn level II
0636
0173
Room charges for nursery - newborn level III
0637
0174
0179
Room charges for nursery - newborn level IV
Room charges for nursery - other
0640
0641
0180
Room charges for LOA - general
0642
0139
0140
0141
0142
0143
0144
0145
0146
0147
0148
0149
0150
0151
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 49
0560
Medical social services - general
0561
Medical social services - visit charge
0562
Medical social services - hourly charge
0569
Medical social services - other
0570
Home health aide - general
0571
Home health aide - visit charge
0572
Home health aide - hourly charge
0579
Home health aide - other
0580
Other visits (home health) - general
0581
Other visits (home health) - visit charge
0582
Other visits (home health) - hourly charge
0583
Other visits (home health) - assessment
0589
0590
Other visits (home health) - other
Units of service (home health) - general
0599
0600
0601
Units of service (home health) - other
Oxygen (home health) - general
Oxygen (home health) - stat/equip/supply or
contents
Oxygen (home health) - stat/equip/supply under
1 liter per minute
Oxygen (home health) - stat/equip/supply over 4
liters per minute
Oxygen (home health) - portable add-in
MRI - general
MRI - brain (including brain stem)
MRI - spinal cord (including spine)
MRI - other
0621
0622
Medical/surgical supplies - incident to radiology
Medical/surgical supplies - incident to other
diagnostic services
Medical/surgical supplies - surgical dressings
Medical/surgical supplies - FDA investigational
devices
Drugs requiring specific identification - general
Drugs requiring specific identification - single
source
Drugs requiring specific identification - multiple
source
Drugs requiring specific identification restrictive prescription
Drugs requiring specific identification - EPO,
less than 10,000 units
Drugs requiring specific identification - EPO,
10,000 or more units
Drugs requiring specific identification requiring detailed coding
Drugs requiring specific identification - selfadminstrable nto requiring detailed coding
Home IV therapy services - general
Home IV therapy services - nonroutine nursing,
central line
Home IV therapy services - IV site care, central
line
DSHS Document # E25-14163
0182
Room charges for LOA - patient convenicecharges billable
Room charges for LOA - therapeutic leave
0643
0645
0185
Room charges for LOA - ICF mentally retarded
- any reason
Room charges for LOA - hospitalization
0189
Room charges for LOA - other
0647
0190
Room charges for subacute care - general
0648
0191
0649
0650
Hospice services - general
0651
Hospice services - routine home care
0652
Hospice services - continuous home care
0199
0200
Room charges for subacute care - Level I
(skilled care)
Room charges for subacute care - Level II
(comprehensive care)
Room charges for subacute care - Level III
(complex care)
Room charges for subacute care - Level IV
(intensive care)
Room charges for subacute care - other
Room charges for intensive care - general
Home IV therapy services - IV start/change,
peripheral line
Home IV therapy services - nonroutine nursing,
peripheral line
Home IV therapy services - training
patient/caregiver, central line
Home IV therapy services - traning, disabled
patient, central line
Home IV therapy services - training,
patient/caregiver, peripheral
Home IV therapy services - training, disabled
patient, peripheral
Home IV therapy services - other
0655
0656
0201
0202
Room charges for intensive care - surgical
Room charges for intensive care - medical
0657
0658
0203
0204
0206
Room charges for intensive care - pediatric
Room charges for intensive care - psychiatric
Room charges for intensive care - intermediate
intensive care unit (ICU)
Room charges for intensive care - burn care
0659
0660
0661
Hospice services - inpatient respite care
Hospice services - general inpatient care
(nonrespite)
Hospice services - physician services
Hospice services - room and board - nursing
facility
Hospice services - other
Respite care - general
Respite care - hourly charge/skilled nursing
Room charges for intensive care - trauma
Room charges for intensive care - other
Room charges for coronary care - general
Room charges for coronary care - myocardial
infarction
Room charges for coronary care - pulmonary
care
Room charges for coronary care - heart
transplant
Room charges for coronary care - intermediate
coronary care unit (CCU)
Room charges for coronary care - other
Special charges - general
Special charges - admission charge
Special charges - technical support charge
Special charges - UR service charge
Special charges - late discharge, medically
necessary
Special charges - other
Incremental nursing care - general
Incremental nursing care - nursery
Incremental nursing care - OB
Incremental nursing care - ICU (includes
transitional care)
Incremental nursing care - CCU (includes
transitional care)
Incremental nursing care - hospice
Incremental nursing care - other
All-inclusive ancillary - general
All-inclusive ancillary - other
Pharmacy - general
Pharmacy - generic drugs
0663
0669
0670
0671
Respite care - hourly
charge/aide/homemaker/companion
Respite care - daily charge
Respite care - other
Outpatient special residence - general
Outpatient special residence - hospital based
0672
Outpatient special residence - contracted
0679
Outpatient special residence - other
0681
Trauma response - level I
0682
0683
0684
0689
0700
0709
Trauma response - level II
Trauma response - level III
Trauma response - level IV
Trauma response - other
Cast Room services - general
Cast Room services - other
0710
0719
0720
0721
0722
Recovery Room services - general
Recovery Room services - other
Labor/Delivery Room services - general
Labor/Delivery Room services - labor
Labor/Delivery Room services - delivery
0723
Labor/Delivery Room services - circumcision
0724
0729
0730
0731
0732
0739
Labor/Delivery Room services - birthing center
Labor/Delivery Room services - other
EKG/ECG services - general
EKG/ECG services - holter monitor
EKG/ECG services - telemetry
EKG/ECG services - other
0183
0184
0192
0193
0194
0207
0208
0209
0210
0211
0212
0213
0214
0219
0220
0221
0222
0223
0224
0229
0230
0231
0232
0233
0234
0235
0239
0240
0249
0250
0251
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 50
0644
0646
0662
DSHS Document # E25-14163
0252
0253
0254
0740
0749
0750
EEG services - general
EEG services - other
Gastrointestinal services - general
0255
0256
Pharmacy - nongeneric drugs
Pharmacy - take-home drugs
Pharmacy - drugs incident to other diagnostic
services
Pharmacy - drugs incident to radiology
Pharmacy - experimental drugs
0759
0760
0257
Pharmacy - nonprescription
0761
0258
Pharmacy - IV solutions
0762
Gastrointestinal services - other
Treatment or observation room services general
Specialty Room - Treatment/ Observation Room
- Treatment Room
Specialty Room - Treatment/ Observation Room
- Observation Room
0259
0260
0261
0262
Pharmacy - other
IV Therapy - general
IV Therapy - infusion pump
IV Therapy - pharmacy services
0769
0770
0771
0263
0264
0269
0270
0271
0779
0780
0789
0790
0799
0800
Inpatient renal dialysis services - general
0801
Inpatient renal dialysis services - hemodialysis
0802
0279
0280
0289
0290
0291
0292
IV Therapy - durg/supply delivery
IV Therapy - supplies
IV Therapy - other
Medical surgical supplies and devices - general
Medical surgical supplies and devices nonsterile
Medical surgical supplies and devices - sterile
Medical surgical supplies and devices - takehome
Medical surgical supplies and devices prosthetic/orthotic
Medical surgical supplies and devices pacemaker
Medical surgical supplies and devices intraocular lens (IOL)
Medical surgical supplies and devices - oxygen
- take-home
Medical surgical supplies and devices - other
implants
Medical surgical supplies and devices - other
Oncology - general
Oncology - other
DME - general
DME - rental
DME - purchase of new
Treatment or observation room services - other
Preventive care services - general
Preventive care services - vaccine
administration
Preventive care services - other
Telemedicine services - general
Telemedicine services - other
Extra-corporeal shockwave therapy - general
Extra-corporeal shockwave therapy - other
0293
0294
0299
DME - purchase of used
DME - supplies/drugs for DME effectiveness
DME - other equipment
0819
0820
0821
0300
Laboratory - general
0825
0301
0302
Laboratory - chemistry
Laboratory - immunology
0829
0830
0303
Laboratory - renal patient (home)
0831
0304
Laboratory - nonroutine dialysis
0835
0305
0306
0307
Laboratory - hemotology
Laboratory - bacteriology and microbiology
Laboratory - urology
0839
0840
0841
0309
0310
0311
0312
Laboratory - other
Laboratory pathological - general
Laboratory pathological - cytology
Laboratory pathological - histology
0845
0849
0850
0851
Inpatient renal dialysis services - peritoneal
(non-CAPD)
Inpatient renal dialysis services - continuous
ambulatory peritoneal dialysis (CAPD)
Inpatient renal dialysis services - continuous
cycling peritoneal dialysis (CAPD)
Inpatient renal dialysis services - other
Organ acquisition - general
Organ acquisition - living donor
Organ acquisition - cadaver donor
Organ acquisition - unknown donor
Organ acquisition - unsuccessful organ searchdonor bank charges
Organ acquisition - other donor
Hemodialysis - outpatient or home - general
Hemodialysis - outpatient or home - composite
or other rate
Hemodialysis - outpatient or home - support
services
Hemodialysis - outpatient or home - other
Peritoneal dialysis - outpatient or home general
Peritoneal dialysis - outpatient or home composite or other rate
Peritoneal dialysis - outpatient or home support services
Peritoneal dialysis - outpatient or home - other
CAPD - outpatient or home - general
CAPD - outpatient or home - composite or other
rate
CAPD - outpatient or home - support services
CAPD - outpatient or home - other
CCPD - outpatient or home - general
CCPD - outpatient or home - composite or other
rate
0272
0273
0274
0275
0276
0277
0278
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 51
0803
0804
0809
0810
0811
0812
0813
0814
DSHS Document # E25-14163
0313
0319
0320
0321
0322
0323
0324
0329
Laboratory pathological - biopsy
Laboratory pathological - other
Radiology - diagnostic - general
Radiology - diagnostic - angiocardiography
Radiology - diagnostic - arthrography
Radiology - diagnostic - arteriography
Radiology - diagnostic - chest x-ray
Radiology - diagnostic - other
0855
0859
0880
0881
0882
0889
0900
0901
0330
Radiology - therapeutic and/or chemotherapy
adminstration - general
Radiology - therapeutic and/or chemotherapy
adminstration - chemotherapy - injected
Radiology - therapeutic and/or chemotherapy
adminstration - chemotherapy - oral
Radiology - therapeutic and/or chemotherapy
adminstration - radiation therapy
Radiology - therapeutic and/or chemotherapy
adminstration - chemotherapy - IV
Radiology - therapeutic and/or chemotherapy
adminstration - other
Nuclear medicine - general
Nuclear medicine - diagnostic procedures
Nuclear medicine - therapeutic procedures
0902
0331
0332
0333
0335
0339
0340
0341
0342
0343
0903
0904
0905
0906
0907
0909
0910
0911
0912
0349
Nuclear medicine - diagnostic
radiopharmaceuticals
Nuclear medicine - therapeutic
radiopharmaceuticals
Nuclear medicine - other
0350
CT scan - general
0915
0351
CT scan - head
0916
0352
CT scan - body
0917
0359
0360
0361
0362
0918
0919
0920
0921
0374
0379
0380
0381
0382
0383
CT scan - other
Operating room services - general
Operating room services - minor surgery
Operating room services - organ transplant
other than kidney
Operating room services - kidney transplant
Operating room services - other
Anesthesia - general
Anesthesia - incident to radiology
Anesthesia - incident to other diagnostic
services
Anesthesia - acupuncture
Anesthesia - other
Blood - general
Blood - packed red cells
Blood - whole blood
Blood - plasma
0931
0932
0940
0941
0942
0943
0384
0385
Blood - platelets
Blood - leukocytes
0944
0945
0386
Blood - other components
0946
0387
Blood - other derivatives (cryoprecipitates)
0947
0389
Blood - other
0949
0344
0367
0369
0370
0371
0372
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 52
0913
0914
0922
0923
0924
0925
0929
CCPD - outpatient or home - support services
CCPD - outpatient or home - other
Miscellaneous dialysis - general
Miscellaneous dialysis - ultrafiltration
Miscellaneous dialysis - home aide visit
Miscellaneous dialysis - other
Behavior health reatments/services - general
Behavior health treatments/services electroshock
Behavior health treatments/services - milieu
therapy
Behavioral health treatments/services - play
therapy
Behavior health treatments/services - activity
therapy
Behavior health treatments/services - intensive
outpatient services - psychiatric
Behavior health treatments/services - intensive
outpatient services - chemical dependency
Behavior health treatments/services community behavioral health program
Behavior health treatments - other
Reserved
Behavior health treatment/services rehabilitation
Behavior health treatment/services - partial
hospitalization - less intensive
Behavior health treatment/services - partial
hospitalization - intensive
Behavior health treatment/services - individual
therapy
Behavior health treatment/services - group
therapy
Behavior health treatment/services - family
therapy
Behavior health treatment/services biofeedback
Behavior health treatment/services - testing
Behavior health treatment/services - other
Other diagnostic services - general
Other diagnostic services - peripheral vascular
lab
Other diagnostic services - electromyelogram
Other diagnostic services - pap smear
Other diagnostic services - allergy test
Other diagnostic services - pregnancy test
Other diagnostic services - other
Medical rehabilitation day program - half day
Medical rehabilitation day program - full day
Other therapeutic services - general
Other therapeutic services - recreational therapy
Other therapeutic services - education/training
Other therapeutic services - cardiac
rehabilitation
Other therapeutic services - drug rehabilitation
Other therapeutic services - alcohol
rehabilitation
Other therapeutic services - complex medical
equipment - routine
Other therapeutic services - complex medical
equipment - ancillary
Other therapeutic services - other
DSHS Document # E25-14163
0390
0391
0399
0400
0401
0402
0403
0404
0409
0410
0412
0413
0419
0420
0421
0422
0423
0424
0429
0430
0431
0432
0433
0434
0439
0440
0441
0442
0443
0444
0449
0450
0451
Blood amd blood component administration,
storage and processing - general
Blood and blood component administration,
storage and processing - administration
Blood and blood component administration,
storage and processing - other
Other imaging services - general
Other imaging services - diagnostic
mammography
Other imaging services - ultrasound
Other imaging services - screening
mammography
Other imaging services - PET
Other imaging services - other
Respiratory services - general
Respiratory services - inhalation
Respiratory services - hyperbaric oxygen
therapy
Respiratory services - other
Physical therapy - general
Physical therapy - visit charge
Physical therapy - hourly charge
Physical therapy - group rate
Physical therapy - evaluation or reevaluation
Physical therapy - other
Occupational therapy - general
Occupational therapy - visit charge
Occupational therapy - hourly charge
Occupational therapy - group rate
Occupational therapy - evaluation or
reevaluation
Occupational therapy - other
Speech-language pathology - general
Speech-language pathology - visit charge
Speech-language pathology - hourly charge
Speech-language pathology - group rate
Speech-language pathology - evaluation or
reevaluation
Speech-language pathology - other
Emergency room - general
0960
Professional fees - general
0961
Professional fees - psychiatric
0962
Professional fees - ophthalmology
0963
0964
Professional fees - anesthesiologist (MD)
Professional fees - anesthetist (CRNA)
0969
0970
Professional fees - other
Professional fees - general
0971
0972
0973
0974
0975
Professional fees - laboratory
Professional fees - radiology - diagnostic
Professional fees - radiology - therapeutic
Professional fees - readiology - nuclear
medicine
Professional fees - operating room
0976
0977
0978
0979
0980
0981
0982
0983
0984
0985
0986
0987
Professional fees - respiratory therapy
Professional fees - physical therapy
Professional fees - occupational therapy
Professional fees - speech therapy
Professional fees - general
Professional fees - emergency room
Professional fees - outpatient services
Professional fees - clinic
Professional fees - medical social services
Professional fees - EKG
Professional fees - EEG
Professional fees - hospital visit
0988
0989
0990
0991
0992
0993
Professional fees - consultation
Professional fees - private duty nurse
Patient convenience items - general
Patient convenience items - cafeteria/guest tray
Patient convenience items - private linen service
Patient convenience items - telephone/telegraph
0994
0995
Patient convenience items - TV/radio
Patient convenience items - nonpatient room
rentals
Patient convenience items - late discharge
charge
Patient convenience items - admission kits
Patient convenience items - beauty shop/barber
Patient convenience items - other
Behavior health accommodations - general
Behavior health accommodations - residential
treatment - psychiatric
Behavior health accommodations - residential
treatment - chemical dependency
Behavior health accommodations - supervised
living
Behavior health accommodations - halfway
house
Behavior health accommodations - group home
Alternative therapy services - general
Alternative therapy services - acupuncture
Alternative therapy services - acupressure
Alternative therapy services - massage
Alternative therapy services - reflexology
0452
0456
0459
0460
0469
Emergency room - EMTALA emergency
medical screening services
Emergency room - beyond EMTALA screening
Emergency room - urgent care
Emergency room - other
Pulmonary function - general
Pulmonary function - other
0997
0998
0999
1000
1001
0470
Audiology - general
1002
0471
Audiology - diagnostic
1003
0472
Audiology - treatment
1004
0479
0480
0481
0482
0483
0489
Audiology - other
Cardiology - general
Cardiology - cardiac cath lab
Cardiology - stress test
Cardiology - echocardiology
Cardiology - other
1005
2100
2101
2102
2103
2104
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 53
0996
DSHS Document # E25-14163
0490
0499
0500
0509
0510
0511
0512
0513
0514
0515
Beginning Position:
Length:
Field 3:
Description:
Beginning Position:
Length:
Field 4
Description:
Coding Scheme:
Beginning Position:
Length:
Field 5:
Description:
Coding Scheme:
Ambulatory surgical care - general
Ambulatory surgical care - other
Outpatient services - general
Outpatient services - other
Clinic - general
Clinic - chronic pain
Clinic - dental
Clinic - psychiatric
Clinic - OB/GYN
Clinic - pediatric
13
4
HCPCS_QUALIFIER
2105
2106
2109
3101
3102
3103
3104
3105
3109
Alternative therapy services - biofeedback
Alternative therapy services - hypnosis
Alternative therapy services - other
Adult day care, medical and social - hourly
Adult day care, social - hourly
Adult day care, medical and social - daily
Adult day care, social - daily
Adult foster care - daily
Adult foster care - other
Claim
Alphanumeric
Data Source:
Type:
17
Claim
Data Source:
2
Alphanumeric
Type:
HCPCS_PROCEDURE_CODE
HCFA Common Procedure Coding System (HCPCS) code applicable to ancillary services or
accommodations.
See http://www.cms.hhs.gov/HCPCSReleaseCodeSets/ANHCPCS/list.asp for complete list.
19
Claim
Data Source:
5
Alphanumeric
Type:
MODIFIER_1
Identifies special circumstances related to the performance of the service
0
1
2
3
4
7
8
11
25
31
32
33
34
37
38
No assessment completed
Medicare 5 day assessment (full)
Medicare 30 day assessment (full)
Medicare 60 day assessment (full)
Medicare 90 day assessment (full)
Medicare 14 day assessment (comprehensive or
full)
Other Medicare required assessment (OMRA)
Admission assessment - Medicare 5 day
assessment (comprehensive)
Significant, separately identifiable evaluation and
management service by the same physician on
the same day of the procedure o
SCSA or OMRA/Medicare 5 day assessment
(replacement)
SCSA or OMRA/Medicare 30 day assessment
(replacement)
SCSA or OMRA/Medicare 60 day assessment
(replacement)
SCSA or OMRA/Medicare 90 day assessment
(replacement)
SCSA or OMRA/Medicare 14 day assessment
(replacement)
Significant change in status assessment (SCSA)
F2
F3
F4
F5
F6
F7
Left hand, third digit
Left hand, fourth digit
Left hand, fifth digit
Right hand, thumb
Right hand, second digit
Right hand, third digit
F8
F9
Right hand, fourth digit
Right hand, fifth digit
FA
Left hand, thumb
G1
Most recent URR of less than 60%
G2
Most recent URR of 60% to 64%
G3
Most recent URR of 65% to 69.9%
G4
Most recent URR of 70% to 74.9%
G5
Most recent URR of 75% or greater
GN
41
Significant correction of prior full
assessment/Medicare 5 day assessment
GO
42
Significant correction of prior full
assessment/Medicare 30 day assessment
GP
43
Significant correction of prior full
assessment/Medicare 60 day assessment
Significant correction of prior full
assessment/Medicare 90 day assessment
Significant correction of prior full
assessment/Medicare 14 day assessment
Significant correction of prior full
assessment/OMRA or SCSA
LC
Service delivered personally by a speechlanguage pathologist or under an outpatient
speech-language pathology plan of care.
Service delivered personally by an occupational
therapist or under an outpatient occupational
therapy plan of care.
Service delivered personally by an physical
therapist or under an outpatient physical therapy
plan of care.
Left circulflex coronary artery
LD
Left anterior descending coronary artery
LT
Left side of the body procedure
QM
Ambulance service provided under arrangement
by a provider of services
44
47
48
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 54
DSHS Document # E25-14163
50
Bilateral procedure
QN
52
Reduced services
QP
53
54
Discontinued procedure
Quarterly review assessment - Medicare 90
assessment (full)
Staged or related procedure or service by the
same physician during the postoperative period
Distinct procedural service
Repeat procedure by same physician
Repeat procedure by another physician
Return to the operating room for a related
procedure during the postoperative period
Unrelated procedure of service by the same
physician during the postoperative period
Upper left eyelid
Lower left eyelid
Upper right eyelid
Lower right eyelid
Left hand, second digit
RC
RT
Ambulance service furnished directly by a
provider of services
Documentation exists showing that the
laboratory test(s) was ordered individually, or as
CPT-recognized panel other than profil
Right coronary artery
Right side of the body procedure
T1
Left foot, second digit
T2
T3
T4
T5
Left foot, third digit
Left foot, fourth digit
Left foot, fifth digit
Right foot, great toe
T6
Right foot, second digit
T7
T8
T9
TA
Right foot, third digit
Right foot, fourth digit
Right foot, fifth digit
Left foot, great toe
58
59
76
77
78
79
E1
E2
E3
E4
F1
Beginning Position:
Length:
Field 6:
Description:
Coding Scheme:
Beginning Position:
Length:
Field 7:
Description:
Coding Scheme:
Beginning Position:
Length:
Field 8:
Description:
Coding Scheme:
Beginning Position:
Length:
Field 9:
Description:
Coding Scheme:
24
Claim
Data Source:
2
Alphanumeric
Type:
MODIFIER_2
Identifies special circumstances related to the performance of the service.
Same as Field 5
26
Claim
Data Source:
2
Alphanumeric
Type:
MODIFIER_3
Identifies special circumstances related to the performance of the service.
Same as Field 5
28
Claim
Data Source:
2
Alphanumeric
Type:
MODIFIER_4
Identifies special circumstances related to the performance of the service.
Same as Field 5
30
Claim
Data Source:
2
Alphanumeric
Type:
UNIT_MEASUREMENT_CODE
Code specifying the units in which a value is being expressed.
Beginning Position:
Length:
Field 10:
Description:
Beginning Position:
Length:
Field 11:
Description:
Beginning Position:
Length:
Field 12:
Description:
Beginning Position:
Length:
32
2
UNITS_OF_SERVICE
Numeric value of quantity
34
7
UNIT_RATE
Rate per unit
41
12
CHRGS_LINE_ITEM
Total amount of the charge
53
14
DA
F2
UN
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Days
International unit
Unit
Data Source:
Type:
Claim
Alphanumeric
Data Source:
Type:
Claim
Numeric
Data Source:
Type:
Claim
Numeric
Data Source:
Type:
Assigned
Numeric
Page 55
DSHS Document # E25-14163
Field 13:
Description:
Beginning Position:
Length:
CHRGS_NON_COV
Total non-covered amount of the charge
67
Data Source:
14
Type:
Assigned
Numeric
Facility Type Indicator File
Facility type indicators provided by the facilities. Provide the data user with information on the type of facility
providing the outpatient service.
Field 1:
THCIC_ID
Provider ID. Unique identifier assigned to the provider by DSHS.
Description:
1
Assigned
Beginning Position:
Data Source:
6
Alphanumeric
Length:
Type:
Field 2
PROVIDER_NAME
Hospital name provided by the hospital.
Description:
7
Provider
Beginning Position:
Data Source:
55
Alphanumeric
Length:
Type:
Field 3:
FAC_TEACHING_IND
Teaching Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
A Member, Council of Teaching Hospitals
Coding Scheme:
X Other teaching facility
62
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 4:
FAC_PSYCH_IND
Psychiatric Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
63
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 5:
FAC_REHAB_IND
Rehabilitation Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
64
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 6:
FAC_ACUTE_CARE_IND
Acute Care Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
65
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 7:
FAC_SNF_IND
Skilled Nursing Facility Indicator. Hospital facility type indicator provided by the hospital.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
66
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 8:
FAC_LONG_TERM_AC_IND
Long Term Acute Care Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
67
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 9:
FAC_OTHER_LTC_IND
Other Long Term Care Facility Indicator.
Description:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
Suppression:
68
Provider
Beginning Position:
Data Source:
1
Alphanumeric
Length:
Type:
Field 10:
FAC_PEDS_IND
Pediatric Facility Indicator.
Description:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 56
DSHS Document # E25-14163
Suppression:
Coding Scheme:
Beginning Position:
Length:
Suppressed for hospitals with fewer than 50 discharges (Provider ID equals '999999').
C Member, National Association of Children’s Hospitals and Related Institutions (NACHRI)
X Facilities that also treat children
69
Provider
Data Source:
1
Alphanumeric
Type:
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 57
DSHS Document # E25-14163
Texas Hospital Inpatient Discharge
Public Use Data File
Base Data #1 File, Base Data #2 File,
Charges Data File, and Facility Type Indicator File
Data Fields
Fields that are shaded are not available in this release of data.
Base Data #1 File
Number
1
FIELD NAME (Base Data #1 File)
RECORD_ID Does NOT match the RECORD_ID
Position
1
Length
12
Field Type
Alphanumeric
13
19
25
80
81
82
83
84
85
86
87
89
94
96
99
101
103
104
105
106
107
111
113
115
117
120
132
144
156
168
180
192
6
6
55
1
1
1
1
1
1
1
2
5
2
3
2
2
1
1
1
1
4
2
2
2
3
12
12
12
12
12
12
1
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Alphanumeric
in THCIC Research Data Files (RDF’s).
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
DISCHARGE
THCIC_ID
PROVIDER_NAME
TYPE_OF_ADMISSION
SOURCE_OF_ADMISSION
SPEC_UNIT_1
SPEC_UNIT_2
SPEC_UNIT_3
SPEC_UNIT_4
SPEC_UNIT_5
PAT_STATE
PAT_ZIP
PAT_COUNTRY
COUNTY
PUBLIC_HEALTH_REGION
PAT_STATUS
SEX_CODE
RACE
ETHNICITY
ADMIT_WEEKDAY
LENGTH_OF_STAY
PAT_AGE
FIRST_PAYMENT_SRC
SECONDARY_PAYMENT_SRC
TYPE_OF_BILL
TOTAL_CHARGES
TOTAL_NON_COV_CHARGES
TOTAL_CHARGES_ACCOMM
TOTAL_NON_COV_CHARGES_ACCOMM
TOTAL_CHARGES_ANCIL
TOTAL_NON_COV_CHARGES_ANCIL
POA_PROVIDER_INDICATOR
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 58
DSHS Document # E25-14163
Number
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
FIELD NAME (Base Data #1 File)
ADMITTING_DIAGNOSIS
PRINC_DIAG_CODE
POA_PRINC_DIAG_CODE
OTH_DIAG_CODE_1
POA_OTH_DIAG_CODE_1
OTH_DIAG_CODE_2
POA_OTH_DIAG_CODE_2
OTH_DIAG_CODE_3
POA_OTH_DIAG_CODE_3
OTH_DIAG_CODE_4
POA_OTH_DIAG_CODE_4
OTH_DIAG_CODE_5
POA_OTH_DIAG_CODE_5
OTH_DIAG_CODE_6
POA_OTH_DIAG_CODE_6
OTH_DIAG_CODE_7
POA_OTH_DIAG_CODE_7
OTH_DIAG_CODE_8
POA_OTH_DIAG_CODE_8
OTH_DIAG_CODE_9
POA_OTH_DIAG_CODE_9
OTH_DIAG_CODE_10
POA_OTH_DIAG_CODE_10
OTH_DIAG_CODE_11
POA_OTH_DIAG_CODE_11
OTH_DIAG_CODE_12
POA_OTH_DIAG_CODE_12
OTH_DIAG_CODE_13
POA_OTH_DIAG_CODE_13
OTH_DIAG_CODE_14
POA_OTH_DIAG_CODE_14
OTH_DIAG_CODE_15
POA_OTH_DIAG_CODE_15
OTH_DIAG_CODE_16
POA_OTH_DIAG_CODE_16
OTH_DIAG_CODE_17
POA_OTH_DIAG_CODE_17
OTH_DIAG_CODE_18
POA_OTH_DIAG_CODE_18
OTH_DIAG_CODE_19
POA_OTH_DIAG_CODE_19
OTH_DIAG_CODE_20
POA_OTH_DIAG_CODE_20
OTH_DIAG_CODE_21
POA_OTH_DIAG_CODE_21
OTH_DIAG_CODE_22
POA_OTH_DIAG_CODE_22
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 59
Position
193
199
205
206
212
213
219
220
226
227
233
234
240
241
247
248
254
255
261
262
268
269
275
276
282
283
289
290
296
297
303
304
310
311
317
318
324
325
331
332
338
339
345
346
352
353
359
Length
6
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
DSHS Document # E25-14163
Number
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127
FIELD NAME (Base Data #1 File)
OTH_DIAG_CODE_23
POA_OTH_DIAG_CODE_23
OTH_DIAG_CODE_24
POA_OTH_DIAG_CODE_24
E_CODE_1
POA_E_CODE_1
E_CODE_2
POA_E_CODE_2
E_CODE_3
POA_E_CODE_3
E_CODE_4
POA_E_CODE_4
E_CODE_5
POA_E_CODE_5
E_CODE_6
POA_E_CODE_6
E_CODE_7
POA_E_CODE_7
E_CODE_8
POA_E_CODE_8
E_CODE_9
POA_E_CODE_9
E_CODE_10
POA_E_CODE_10
PRINC_SURG_PROC_CODE
PRINC_SURG_PROC_DAY
PRINC_ICD9_CODE
OTH_SURG_PROC_CODE_1
OTH_SURG_PROC_DAY_1
OTH_ICD9_CODE_1
OTH_SURG_PROC_CODE_2
OTH_SURG_PROC_DAY_2
OTH_ICD9_CODE_2
OTH_SURG_PROC_CODE_3
OTH_SURG_PROC_DAY_3
OTH_ICD9_CODE_3
OTH_SURG_PROC_CODE_4
OTH_SURG_PROC_DAY_4
OTH_ICD9_CODE_4
OTH_SURG_PROC_CODE_5
OTH_SURG_PROC_DAY_5
OTH_ICD9_CODE_5
OTH_SURG_PROC_CODE_6
OTH_SURG_PROC_DAY_6
OTH_ICD9_CODE_6
OTH_SURG_PROC_CODE_7
OTH_SURG_PROC_DAY_7
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 60
Position
360
366
367
373
374
380
381
387
388
394
395
401
402
408
409
415
416
422
423
429
430
436
437
443
444
451
455
460
467
471
476
483
487
492
499
503
508
515
519
524
531
535
540
547
551
556
563
Length
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
6
1
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
DSHS Document # E25-14163
Number
128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
FIELD NAME (Base Data #1 File)
OTH_ICD9_CODE_7
OTH_SURG_PROC_CODE_8
OTH_SURG_PROC_DAY_8
OTH_ICD9_CODE_8
OTH_SURG_PROC_CODE_9
OTH_SURG_PROC_DAY_9
OTH_ICD9_CODE_9
OTH_SURG_PROC_CODE_10
OTH_SURG_PROC_DAY_10
OTH_ICD9_CODE_10
OTH_SURG_PROC_CODE_11
OTH_SURG_PROC_DAY_11
OTH_ICD9_CODE_11
OTH_SURG_PROC_CODE_12
OTH_SURG_PROC_DAY_12
OTH_ICD9_CODE_12
OTH_SURG_PROC_CODE_13
OTH_SURG_PROC_DAY_13
OTH_ICD9_CODE_13
OTH_SURG_PROC_CODE_14
OTH_SURG_PROC_DAY_14
OTH_ICD9_CODE_14
OTH_SURG_PROC_CODE_15
OTH_SURG_PROC_DAY_15
OTH_ICD9_CODE_15
OTH_SURG_PROC_CODE_16
OTH_SURG_PROC_DAY_16
OTH_ICD9_CODE_16
OTH_SURG_PROC_CODE_17
OTH_SURG_PROC_DAY_17
OTH_ICD9_CODE_17
OTH_SURG_PROC_CODE_18
OTH_SURG_PROC_DAY_18
OTH_ICD9_CODE_18
OTH_SURG_PROC_CODE_19
OTH_SURG_PROC_DAY_19
OTH_ICD9_CODE_19
OTH_SURG_PROC_CODE_20
OTH_SURG_PROC_DAY_20
OTH_ICD9_CODE_20
OTH_SURG_PROC_CODE_21
OTH_SURG_PROC_DAY_21
OTH_ICD9_CODE_21
OTH_SURG_PROC_CODE_22
OTH_SURG_PROC_DAY_22
OTH_ICD9_CODE_22
OTH_SURG_PROC_CODE_23
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 61
Position
567
572
579
583
588
595
599
604
611
615
620
627
631
636
643
647
652
659
663
668
675
679
684
691
695
700
707
711
716
723
727
732
739
743
748
755
759
764
771
775
780
787
791
796
803
807
812
Length
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
4
5
7
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
DSHS Document # E25-14163
Number
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191
192
193
194
FIELD NAME (Base Data #1 File)
OTH_SURG_PROC_DAY_23
OTH_ICD9_CODE_23
OTH_SURG_PROC_CODE_24
OTH_SURG_PROC_DAY_24
OTH_ICD9_CODE_24
MS_MDC
MS_DRG
MS_GROUPER_VERSION_NBR
MS_GROUPER_ERROR_CODE
APR_MDC
APR_DRG
RISK_MORTALITY
ILLNESS_SEVERITY
APR_GROUPER_VERSION_NBR
APR_GROUPER_ERROR_CODE
ATTENDING_PHYSICIAN_UNIF_ID
OPERATING_PHYSICIAN_UNIF_ID
ENCOUNTER_INDICATOR
CERT_STATUS
FILLER_SPACE
Position
819
823
828
835
839
844
846
849
854
856
858
862
863
864
869
871
881
891
893
894
Length
4
5
7
4
5
2
3
5
2
2
4
1
1
5
2
10
10
2
1
57
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
950
RECORD_LENGTH
Base Data #2 File
Number
1
FIELD NAME (Base Data #2 File)
RECORD_ID Does NOT match the RECORD_ID in
Position
1
Length
12
13
25
37
49
61
73
85
97
109
121
133
145
157
169
181
193
205
217
229
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
12
Field Type
Alphanumeric
THCIC Research Data Files (RDF’s).
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
PRIVATE_AMOUNT
SEMI_PRIVATE_AMOUNT
WARD_AMOUNT
ICU_AMOUNT
CCU_AMOUNT
OTHER_AMOUNT
PHARM_AMOUNT
MEDSURG_AMOUNT
DME_AMOUNT
USED_DME_AMOUNT
PT_AMOUNT
OT_AMOUNT
SPEECH_AMOUNT
IT_AMOUNT
BLOOD_AMOUNT
BLOOD_ADM_AMOUNT
OR_AMOUNT
LITH_AMOUNT
CARD_AMOUNT
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 62
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
DSHS Document # E25-14163
Number
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63
64
65
66
67
FIELD NAME (Base Data #2 File)
ANES_AMOUNT
LAB_AMOUNT
RAD_AMOUNT
MRI_AMOUNT
OP_AMOUNT
ER_AMOUNT
AMBULANCE_AMOUNT
PRO_FEE_AMOUNT
ORGAN_AMOUNT
ESRD_AMOUNT
CLINIC_AMOUNT
OCCUR_CODE_1
OCCUR_DAY_1
OCCUR_CODE_2
OCCUR_DAY_2
OCCUR_CODE_3
OCCUR_DAY_3
OCCUR_CODE_4
OCCUR_DAY_4
OCCUR_CODE_5
OCCUR_DAY_5
OCCUR_CODE_6
OCCUR_DAY_6
OCCUR_CODE_7
OCCUR_DAY_7
OCCUR_CODE_8
OCCUR_DAY_8
OCCUR_CODE_9
OCCUR_DAY_9
OCCUR_CODE_10
OCCUR_DAY_10
OCCUR_CODE_11
OCCUR_DAY_11
OCCUR_CODE_12
OCCUR_DAY_12
OCCUR_SPAN_CODE_1
OCCUR_SPAN_FROM_1
OCCUR_SPAN_THRU_1
OCCUR_SPAN_CODE_2
OCCUR_SPAN_FROM_2
OCCUR_SPAN_THRU_2
OCCUR_SPAN_CODE_3
OCCUR_SPAN_FROM_3
OCCUR_SPAN_THRU_3
OCCUR_SPAN_CODE_4
OCCUR_SPAN_FROM_4
OCCUR_SPAN_THRU_4
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 63
Position
241
253
265
277
289
301
313
325
337
349
361
373
375
379
381
385
387
391
393
397
399
403
405
409
411
415
417
421
423
427
429
433
435
439
441
445
447
453
459
461
467
473
475
481
487
489
495
Length
12
12
12
12
12
12
12
12
12
12
12
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
4
2
6
6
2
6
6
2
6
6
2
6
6
Field Type
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Numeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
DSHS Document # E25-14163
Number
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
FIELD NAME (Base Data #2 File)
CONDITION_CODE_1
CONDITION_CODE_2
CONDITION_CODE_3
CONDITION_CODE_4
CONDITION_CODE_5
CONDITION_CODE_6
CONDITION_CODE_7
CONDITION_CODE_8
VALUE_CODE_1
VALUE_AMOUNT_1
VALUE_CODE_2
VALUE_AMOUNT_2
VALUE_CODE_3
VALUE_AMOUNT_3
VALUE_CODE_4
VALUE_AMOUNT_4
VALUE_CODE_5
VALUE_AMOUNT_5
VALUE_CODE_6
VALUE_AMOUNT_6
VALUE_CODE_7
VALUE_AMOUNT_7
VALUE_CODE_8
VALUE_AMOUNT_8
VALUE_CODE_9
VALUE_AMOUNT_9
VALUE_CODE_10
VALUE_AMOUNT_10
VALUE_CODE_11
VALUE_AMOUNT_11
VALUE_CODE_12
VALUE_AMOUNT_12
FILLER_SPACE
Length
2
2
2
2
2
2
2
2
2
9
2
9
2
9
2
9
2
9
2
9
2
9
2
9
2
9
2
9
2
9
2
9
52
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
Numeric
Alphanumeric
700
RECORD_LENGTH
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Position
501
503
505
507
509
511
513
515
517
519
528
530
539
541
550
552
561
563
572
574
583
585
594
596
605
607
616
618
627
629
638
640
649
Page 64
DSHS Document # E25-14163
Charges Data File
Number
1
2
3
4
5
6
7
8
9
10
11
12
13
FIELD NAME
RECORD_ID Does NOT match the RECORD_ID in
THCIC Research Data Files (RDF’s).
REVENUE_CODE
HCPCS_QUALIFIER
HCPCS_PROCEDURE_CODE
MODIFIER_1
MODIFIER_2
MODIFIER_3
MODIFIER_4
UNIT_MEASUREMENT_CODE
UNITS_OF_SERVICE
UNIT_RATE
CHRGS_LINE_ITEM
CHRGS_NON_COV
Position
Length
1
13
17
19
24
26
28
30
32
34
41
53
67
12
4
2
5
2
2
2
2
2
7
12
14
14
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Numeric
Numeric
Numeric
Numeric
80
RECORD_LENGTH
Facility Type Indicator File
Number
1
2
3
4
5
6
7
8
9
10
FIELD NAME
THCIC_ID
PROVIDER_NAME
FAC_TEACHING_IND
FAC_PSYCH_IND
FAC_REHAB_IND
FAC_ACUTE_CARE_IND
FAC_SNF_IND
FAC_LONG_TERM_AC_IND
FAC_OTHER_LTC_IND
FAC_PEDS_IND
Position
1
7
62
63
64
65
66
67
68
69
Field Type
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
Alphanumeric
69
RECORD_LENGTH
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Length
6
55
1
1
1
1
1
1
1
1
Page 65
DSHS Document # E25-14163
Texas Hospital Inpatient Discharge Data
Public Use Data File
Reporting Status of Texas Hospitals, 2013
Reports
With
Abilene
091001 Abilene Regional Medical Center
500000 Hendrick Medical Center
688000 Hendrick Center–Extended Care
846000 Acadia Abilene
920000 Reliant Rehab Hospital Abilene
Addison
750000 Methodist Hospital for Surgery
Alice
689401 CHRISTUS Spohn Hospital Alice
Allen
724200 Texas Health Presbyterian Hospital Allen
854000 Twin Creeks Hospital
Alpine
711900 Big Bend Regional Medical Center
Amarillo
001000 Baptist St Anthonys Health System–Baptist
Campus
318000 Northwest Texas Hospital
318001 The Pavilion
714000 Northwest Texas Surgery Center
796000 Plum Creek Specialty Hospital
818000 Kindred Hospital Amarillo
841400 Kindred Rehabilitation Hospital Amarillo
852900 Physicians Surgical Hospital–Quail Creek
852901 Physicians Surgical Hospital–Panhandle
Campus
Anahuac
442000 Bayside Community Hospital
Andrews
187000 Permian Regional Medical Center
Angleton
126000 Angleton Danbury Medical Center
Anson
016000 Anson General Hospital
Aransas Pass
239001 Care Regional Medical Center
Arlington
100084 Sundance Hospital
422000 Texas Health Arlington Memorial Hospital
502000 Medical Center–Arlington
660000 HEALTHSOUTH Rehab Hospital–
Arlington
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
With
Comment
2Q13
With
Comment
3Q13
x
x
x
x
x
x
x
x
xOC
x
x
x
x
x
318000
xlv
x
x
x
x
x
*
*
x
*
x
x
x
x
x
Page 66
x
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
1Q13
690000 Kindred Hospital–Tarrant County
x
730001 Texas Health Heart & Vascular Hospital
x
765001 Millwood Hospital
x
799001 USMD Hospital–Arlington
x
831800 Kindred Rehabilitation Hospital Arlington
x
936000 Baylor Orthopedic and Spine Hospital–
x
Arlington
Aspermont
666000 Stonewall Memorial Hospital
*
Athens
374000 East Texas Medical Center–Athens
x
Atlanta
788003 Christus St Michael Hospital Atlanta
x
Aubrey
873200 Baylor Emergency Medical Center at Aubrey
xlv
Austin
000100 Austin State Hospital
x
035000 St Davids Hospital
x
335000 University Medical Center–Brackenridge
x
497000 Seton Medical Center
x
602000 St Davids South Austin Hospital
x
622001 Texas NeuroRehab Center
x
649000 St Davids Rehab Center
x
663000 HEALTHSOUTH Rehab Hospital–Austin
x
700000 Cornerstone Hospital–Austin
x
739001 Texas NeuroRehab Center
x
770000 Seton Shoal Creek Hospital
x
794000 Northwest Hills Surgical Hospital
x
797500 Seton Southwest Hospital
x
797600 Seton Northwest Hospital
x
798500 Austin Surgical Hospital
xOC
822800 Westlake Medical Center
x
829000 Heart Hospital–Austin
x
829900 North Austin Medical Center
xOC
852000 Dell Childrens Medical Center
x
854400 Central Texas Rehab Hospital
x
855200 Austin Lakes Hospital
x
970200 Lakeway Regional Medical Center
x
970800 Reliant Austin
x
Azle
469000 Texas Health Harris Methodist Hospital Azle
x
Ballinger
234000 Ballinger Memorial Hospital District
*x
Bay City
006000 Matagorda Regional Medical Center
x
006001 Matagorda Regional Medical Center
xlv
Baytown
405000 San Jacinto Methodist Hospital
x
405000
405002 San Jacinto Methodist Hospital–Alexander
Campus
720401 Kindred Hospital Baytown
x
Beaumont
389000 Baptist Hospitals of Southeast Texas
x
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 67
With
Comment
2Q13
With
Comment
3Q13
x
x
x
x
x
x
x
x
x
x
x
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
1Q13
389002 Baptist Hospitals of Southeast Texas Fannin 389000
Behavioral Ctr
444001 CHRISTUS St Elizabeth Hospital
xOC
671000 HEALTHSOUTH Rehab Hospital–Beaumont
x
708000 CHRISTUS Dubuis Hospital–Beaumont
x
826500 Beaumont Bone & Joint Institute
xlv
861900 Kate Dishman Rehab Hospital
x
Bedford
182000 Texas Health Harris Methodist HEB
x
700003 Reliant Rehab Hospital Mid–Cities
x
778000 Texas Health Springwood Hospital
x
Beeville
429001 CHRISTUS Spohn Hospital–Beeville
x
Bellaire
831900 Houston Orthopedic & Spine Hospital
x
840100 First Street Hospital
x
Bellville
552000 Bellville General Hospital
*
Belton
806002 Cedar Crest Hospital
x
Big Lake
343000 Reagan Memorial Hospital
*
Big Spring
000101 Big Spring State Hospital
x
221000 Scenic Mountain Medical Center
x
Bonham
106001 Red River Regional Hospital
x
Borger
654000 Golden Plains Community Hospital
x
Bowie
440000 Bowie Memorial Hospital
*
Brady
362000 Heart of Texas Healthcare System
*
Breckenridge
430000 Stephens Memorial Hospital
*
Brenham
066000 Scott & White Hospital–Brenham
x
Brownfield
078000 Brownfield Regional Medical Center
*
Brownsville
019000 Valley Regional Medical Center
x
314001 Valley Baptist Medical Center–Brownsville
x
314001
314002 Valley Baptist Medical Center–Brownsville
Psych Unit
724900 Brownsville Doctors Hospital
xlv
821100 South Texas Rehab Hospital
x
847500 Solara Hospital–Brownsville Campus
x
Brownwood
058000 Brownwood Regional Medical Center
x
Bryan
002001 St Joseph Regional Health Center
x
002001
002002 St Joseph Regional Rehab Center
717500 Physicians Centre Hospital
x
864800 CHRISTUS Dubuis Hospital–Bryan
x
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 68
With
Comment
2Q13
With
Comment
3Q13
x
x
x
x
x
x
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
Burnet
559000 Seton Highland Lakes Hospital
Caldwell
679000 Burleson St Joseph Health Center–Caldwell
Canadian
457000 Hemphill County Hospital
Carrizo Springs
156000 Dimmit Regional Hospital
Carrollton
042000 Baylor Medical Center at Carrollton
969500 Carrollton Springs
Carthage
484000 East Texas Medical Center–Carthage
Cedar Park
858300 Cedar Park Regional Medical Center
Channelview
720400 Kindred Hospital East Houston
Childress
026000 Childress Regional Medical Center
Chillicothe
523000 Chillicothe Hospital
Clarksville
292000 East Texas Medical Center–Clarksville
Cleburne
323000 Texas Health Harris Methodist Hospital
Cleburne
Cleveland
108000 Cleveland Regional Medical Center
840400 Doctors Diagnostic Hospital
Clifton
070000 Goodall–Witcher Healthcare Foundation
Coleman
049000 Coleman County Medical Center
College Station
071000 College Station Medical Center
Colorado City
075000 Mitchell County Hospital
Columbus
014000 Columbus Community Hospital
Comanche
495001 Comanche County Medical Center
Commerce
087000 Hunt Regional Community Hospital
Conroe
100087 Montgomery County Mental Health
Treatment Facility
508001 Conroe Regional Medical Center
695000 HEALTHSOUTH Rehab Hospital The
Woodlands
854100 Solara Hospital Conroe
915000 Aspire Behavioral Health–Conroe
Corpus Christi
398000 CHRISTUS Spohn Hospital Corpus Christi
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
With
Comment
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x
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2Q13
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x
x
x
x
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x
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x
*
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x
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x
Page 69
DSHS Document # E25-14163
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4Q13
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Comment
Reports
With
398001 CHRISTUS Spohn Hospital Corpus Christi–
Shoreline
398002 CHRISTUS Spohn Hospital Corpus Christi–
South
488000 Driscoll Childrens Hospital
703000 Corpus Christi Medical Center–Bay Area
703002 Corpus Christi Medical Center–Doctors
Regional
703003 Corpus Christi Medical Center–Heart
Hospital
703005 Bayview Behavioral Hospital
704004 Corpus Christi Medical Center–Northwest
797001 Dubuis Hospital–Corpus Christi
804100 Kindred Hospital–Corpus Christi
931000 South Texas Surgical Hospital
970700 Esplanade Rehab Hospital
Corsicana
141000 Navarro Regional Hospital
Crane
467000 Crane Memorial Hospital
Crockett
185000 East Texas Medical Center–Crockett
Crosbyton
176000 Crosbyton Clinic Hospital
Cuero
074000 Cuero Community Hospital
Cypress
114100 Lone Star Behavioral Health Cypress
843200 North Cypress Medical Center
Dalhart
262000 Coon Memorial Hospital & Home
Dallas
008001 Baylor Medical Center at Uptown
028000 Kindred Hospital–Dallas
054000 Texas Scottish Rite Hospital for Children
142000 Methodist Charlton Medical Center
143000 Childrens Medical Center–Dallas
255000 Methodist Dallas Medical Center
331000 Baylor University Medical Center
340000 Medical City Dallas Hospital
431000 Texas Health Presbyterian Hospital Dallas
448001 UT Southwestern University Hospital–St Paul
449000 Dallas Medical Center
474000 Parkland Memorial Hospital
511000 Doctors Hospital–White Rock Lake
586000 Baylor Specialty Hospital
642000 Baylor Institute for Rehab
653001 UT Southwestern University Hospital–Zale
Lipshy
661001 Texas Specialty Hospital–Dallas
672000 Select Specialty Hospital–Dallas
680001 Reliant Rehab Hospital Dallas
710000 Our Childrens House Baylor
717000 LifeCare Hospital–Dallas
DSHS/THCIC
www.dshs.state.tx.us/THCIC
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x
*
*
x
x
*
x
x
*
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x
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Page 70
DSHS Document # E25-14163
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4Q13
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With
719400 Kindred Hospital–White Rock
752000 Timberlawn Mental Health System
766000 Green Oaks Hospital
784400 Baylor Heart & Vascular Center
813100 Texas Institute for Surgery–Texas Health
Presbyterian–D
818200 Pine Creek Medical Center
839100 Vibra Specialty Hospital
860600 North Central Surgical Center
862000 Methodist Rehab Hospital
872100 Baylor Institute for Rehab Northwest Dallas
900000 Forest Park Medical Center
908000 South Hampton Community Hospital
914000 Kindred Hospital Dallas Central
De Soto
785900 Select Specialty Hospital–South Dallas
837800 Hickory Trail Hospital
Decatur
254000 Wise Regional Health System
254001 Wise Regional Health System
Del Rio
462000 Val Verde Regional Medical Center
Denison
847000 Texoma Medical Center
847001 Reba McEntire Center–Rehab
864600 Carrus Specialty Hospital
Denton
336001 Denton Regional Medical Center
820800 Texas Health Presbyterian Hospital–Denton
826800 University Behavioral Health–Denton
831700 Mayhill Hospital
844200 Integrity Transitional Hospital
847200 Atrium Medical Center–Corinth
871500 Select Rehab Hospital–Denton
Denver City
485000 Yoakum County Hospital
Dimmitt
260000 Plains Memorial Hospital
Dumas
199000 Memorial Hospital
Eagle Lake
560000 Rice Medical Center
Eagle Pass
547001 Fort Duncan Regional Medical Center
Eastland
222000 Eastland Memorial Hospital
Eden
202000 Concho County Hospital
Edinburg
140002 Edinburg Regional Medical Center
797100 Doctors Hospital–Renaissance
797101 Womens Hospital–Renaissance
797102 Behavioral Medicine–Renaissance
797103 Rehab Center at Renaissance
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
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x
x
xlv
x
x
x
x
x
x
847000
xlv
x
x
x
xOC
x
xlv
x
x
*
*
*x
x
x
*
*
x
x
797100
797100
797100
Page 71
DSHS Document # E25-14163
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4Q13
With
Comment
Reports
With
802001
802004 South Texas Behavioral Health Center
830000 Cornerstone Regional Hospital
816301 Solara Hospital
Edna
017000 Jackson Healthcare Center
El Campo
426000 El Campo Memorial Hospital
El Paso
000118 El Paso Psychiatric Center
130000 Providence Memorial Hospital
180000 Las Palmas Medical Center
180000
180001 Las Palmas Rehab Hospital
263000 University Medical Center of El Paso
266000 Sierra Medical Center
319000 Del Sol Medical Center
701000 Mesa Hills Specialty Hospital
718002 Highlands Regional Rehab Hospital
727100 Kindred Hospital El Paso
728200 El Paso Specialty Hospital
801300 East El Paso Physicians Medical Center
841300 El Paso LTAC Hospital
858600 University Behavioral Health–El Paso
865000 Sierra Providence East Medical Center
969700 El Paso Childrens Hospital
Eldorado
136000 Schleicher County Medical Center
Electra
490000 Electra Memorial Hospital
Ennis
714500 Ennis Regional Medical Center
Fairfield
401000 East Texas Medical Center–Fairfield
Floresville
433000 Connally Memorial Medical Center
Flower Mound
100082 Continuum Rehabilitation Hospital North
Texas
943000 Texas Health Presbyterian Hospital Flower
Mound
Fort Stockton
356000 Pecos County Memorial Hospital
Fort Worth
047000 Huguley Memorial Medical Center
235000 Texas Health Harris Methodist Hospital–Fort
Worth
332000 Cook Childrens Medical Center
363000 Baylor All Saints Medical Center–Fort Worth
409000 John Peter Smith Hospital
477000 Plaza Medical Center–Fort Worth
627000 Texas Health Harris Methodist Hospital–
Southwest Fort Worth
652000 Texas Health Specialty Hospital–Fort Worth
659000 HEALTHSOUTH Rehab Hospital
662000 HEALTHSOUTH City View Rehab Hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 72
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x
x
x
x
x
x
x
x
x
x
x
x
x
xlv
x
x
x
x
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xN
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x
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x
x
DSHS Document # E25-14163
With
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4Q13
With
Comment
Reports
With
690600 LifeCare Hospital–Fort Worth
800000 Kindred Hospital Tarrant County Fort Worth
SW
800700 Kindred Hospital–Fort Worth
804500 Baylor Surgical Hospital–Fort Worth
839200 Regency Hospital–Fort Worth
861400 USMD Hospital Fort Worth
873800 Baylor Institute for Rehab–Fort Worth
902200 Texas Rehabilitation Hospital–Fort Worth
972900 Texas Health Harris Methodist Hospital
Alliance
Fredericksburg
219000 Hill Country Memorial Hospital
Friona
200000 Parmer Medical Center
Frisco
100093 Baylor Institute for Rehab Frisco
787400 Baylor Medical Center–Frisco
806300 Centennial Medical Center
971800 Forest Park Medical Center Frisco
Gainesville
298000 North Texas Medical Center
Galveston
000102 UT Medical Branch Hospital
247000 Shriners Hospital for Children-Galveston
Garland
027000 Baylor Medical Center–Garland
Gatesville
346000 Coryell Memorial Hospital
Georgetown
835700 St Davids Georgetown Hospital
Gilmer
806800 East Texas Medical Center–Gilmer
Glen Rose
059000 Glen Rose Medical Center
Gonzales
103000 Memorial Hospital
Graham
094000 Graham Regional Medical Center
Granbury
424000 Lake Granbury Medical Center
Grand Prairie
115100 Texas General Hospital
Grapevine
513000 Baylor Regional Medical Center–Grapevine
858200 Ethicus Hospital DFW
Greenville
085000 Hunt Regional Medical Center Greenville
754000 Glen Oaks Hospital
1Q13
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x
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x
x
x
x
x
x
x
*
x
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x
x
*
x
x
x
x
OC
x
x
*
*
*
x
x
x
x
x
x
x
Groesbeck
052000 Limestone Medical Center
Groves
907000 Renaissance Hospital–Groves
DSHS/THCIC
www.dshs.state.tx.us/THCIC
*
xOC
Page 73
DSHS Document # E25-14163
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Hallettsville
527000 Lavaca Medical Center
Hamilton
640000 Hamilton General Hospital
Hamlin
305000 Hamlin Memorial Hospital
Harker Heights
971000 Seton Medical Center Harker Heights
Harlingen
000104 Rio Grande State Center
400000 Valley Baptist Medical Center
788002 Harlingen Medical Center
840700 Solara Hospital Harlingen
Haskell
572000 Haskell Memorial Hospital
Hemphill
522000 Sabine County Hospital
Henderson
248000 East Texas Medical Center Henderson
Henrietta
193000 Clay County Memorial Hospital
Hereford
420000 Hereford Regional Medical Center
Hillsboro
383000 Hill Regional Hospital
Hondo
427000 Medina Regional Hospital
Houston
000105 UT MD Anderson Cancer Center
000115 Harris County Psychiatric Center
007000 Womans Hospital–Texas
030000 Doctors Hospital–Tidwell
112100 Healthsouth Rehabilitation Hospital of
Cypress
117000 Texas Childrens Hospital
117002 Texas Childrens Hospital West Campus
117100 Texas Childrens Hospital–Pavilion for
Women
118000 St Lukes Episcopal Hospital
119000 Memorial Hermann Southeast Hospital
124000 Methodist Hospital
164000 TIRR Memorial Hermann
172000 Memorial Hermann Northwest Hospital
206003 Select Specialty Hospital–Houston Heights
206004 Select Specialty Hospital–Houston West
206005 Select Specialty Hospital–Houston Medical
Center
229000 Houston Northwest Medical Center
302000 Memorial Hermann Memorial City Medical
Center
337001 West Houston Medical Center
347000 Memorial Hermann Hospital
384000 Lyndon B Johnson General Hospital
390000 Park Plaza Hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
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*
*
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x
x
x
x
x
*
x
x
*
*
x
*
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
Page 74
DSHS Document # E25-14163
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With
407000 Memorial Hermann Southwest Hospital
458001 East Houston Regional Medical Center
459000 Ben Taub General Hospital
459001 Quentin Mease Community Hospital
460000 Riverside General Hospital
526000 Shriners Hospitals For Children
606000 Cypress Fairbanks Medical Center
674000 TOPS Surgical Specialty Hospital
676000 Kindred Hospital–Houston Medical Center
678000 Kindred Hospital Midtown
698005 Cornerstone Hospital Houston–Bellaire
706000 Kindred Hospital Houston NW
712500 HealthBridge Childrens Hospital–Houston
713400 Kindred Hospital North Houston
715001 Texas Specialty Hospital–Houston
724700 Methodist Willowbrook Hospital
740000 St Lukes Hospital at the Vintage
744001 Cypress Creek Hospital
755001 West Oaks Hospital
758000 Houston Hospital for Specialized Surgery
763000 Plaza Specialty Hospital
782001 Intracare North Hospital
792000 Texas Orthopedic Hospital
792600 Kindred Hospital Spring
792702 Kindred Hospital Town & Country
794200 Menninger Clinic
800010 Methodist West Houston Hospital
838400 Memorial Hermann Rehab Hospital Katy
838600 St Joseph Medical Center
840200 University General Hospital
909000 St Anthonys Hospital
941000 Kindred Hospital The Heights
956000 Westbury Community Hospital
969200 Behavioral Hospital–Bellaire
970160 Red Oak Hospital
970600 Reliant Rehab Hospital Northwest Houston
971100 Efficacy Health Services
971700 Cambridge Hospital
972200 Cornerstone Hospital of South Houston
972970 Victory Surgical Hospital East Houston
973100 St Joseph Medical Center-Heights
Humble
616000 HEALTHSOUTH Rehab Hospital Humble
847100 Memorial Hermann Northeast
865900 Icon Hospital
901100 Humble Surgical Hospital
969600 Kindred Rehab Hospital Northeast Houston
Huntsville
061000 Huntsville Memorial Hospital
Hurst
850200 Cook Childrens Northeast Hospital
972990 Victory Medical Center Mid-Cities
Iraan
258000 Iraan General Hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
x
xOC
x
x
xlv
x
x
x
x
xlv
x
x
x
x
xOC
x
x
x
x
x
x
x
x
x
x
x
x
x
x
x
OC
x
x
x
xlv
x
***
x
x
xlv
x
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xlv
xlv
*
Page 75
DSHS Document # E25-14163
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1Q13
Irving
300000 Baylor Medical Center–Irving
x
799500 Irving Coppell Surgical Hospital
x
814000 Las Colinas Medical Center
x
Jacksboro
046000 Faith Community Hospital
*
Jacksonville
416000 East Texas Medical Center–Jacksonville
x
725400 Mother Frances Hospital–Jacksonville
x
Jasper
038001 CHRISTUS Jasper Memorial Hospital
xOC
Jourdanton
334002 South Texas Regional Medical Center
x
Junction
205000 Kimble Hospital
x
Katy
534001 Memorial Hermann Katy Hospital
x
715901 CHRISTUS St Catherine Hospital
x
Kaufman
303000 Texas Health Presbyterian Hospital–Kaufman
x
Kenedy
357000 Otto Kaiser Memorial Hospital
*
Kermit
062000 Winkler County Memorial Hospital
x
Kerrville
000106 Kerrville State Hospital
xlv
406000 Peterson Regional Medical Center
x
Kilgore
031001 Allegiance Specialty Hospital–Kilgore
x
Killeen
397001 Metroplex Hospital
x
397001
397002 Metroplex Pavilion
Kingsville
216001 CHRISTUS Spohn Hospital–Kleberg
x
Kingwood
675000 Kingwood Medical Center
xOC
813800 Memorial Hermann Specialty Hospital
xlv
Kingwood
818600 Kingwood Pines Hospital
x
Knox City
568000 Knox County Hospital
*
Kyle
921000 Seton Medical Center Hays
x
La Grange
823400 St Marks Medical Center
x
Lake Jackson
436000 Brazosport Regional Health System
x
Lamesa
341000 Medical Arts Hospital
*
Lampasas
397000 Rollins Brooks Community Hospital
x
Laredo
207001 Laredo Medical Center
x
301000 Doctors Hospital–Laredo
x
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 76
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DSHS Document # E25-14163
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1Q13
301000
804400 Providence Hospital
836300 Laredo Specialty Hospital
x
League City
718000 Devereux Texas Treatment Network
xlv
Levelland
307000 Covenant Hospital–Levelland
x
Lewisville
394000 Medical Center–Lewisville
x
Liberty
089001 Liberty–Dayton Regional Medical Center
x
Linden
822100 Good Shepherd Medical Center–Linden
x
Littlefield
217000 Lamb Healthcare Center
*
Livingston
466000 Memorial Medical Center–Livingston
x
Llano
476000 Scott & White Hospital Llano
x
Lockney
010000 WJ Mangold Memorial Hospial
*
Longview
029000 Good Shepherd Medical Center
x
106100 Audubon Behavioral Healthcare of Longview
xOC
525000 Longview Regional Medical Center
x
794600 Select Specialty Hospital–Longview
x
944000 Behavioral Hospital Longview
x
Lubbock
013001 Grace Medical Center
xOC
109000 Covenant Medical Center–Lakeside
x
145000 University Medical Center
x
465000 Covenant Medical Center
x
686000 Covenant Childrens Hospital
x
786001 Llano Specialty Hospital
xlv
801500 Lubbock Heart Hospital
xN
804000 Sunrise Canyon
x
846200 Covenant Specialty Hospital
x
865800 Trustpoint Hospital
xN
940000 Texas Specialty Hospital Lubbock
x
Lufkin
107100 Audubon Behavioral Healthcare of Lufkin
xOC
129000 Memorial Medical Center East Texas
x
481000 Woodland Heights Medical Center
x
691000 Memorial Specialty Hospital
x
Luling
597000 Seton Edgar B Davis Hospital
x
848200 Warm Springs Specialty Hospital–Luling
x
Madisonville
041000 Madison St Joseph Health Center
x
Mansfield
657000 Kindred Hospital–Mansfield
x
842800 Methodist Mansfield Medical Center
x
Marlin
517000 Falls Community Hospital & Clinic
*
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 77
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x
x
x
DSHS Document # E25-14163
With
Comment
4Q13
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Comment
Reports
With
Marshall
020000 Good Shepherd Medical Center–Marshall
McAllen
601000 Rio Grande Regional Hospital
802001 McAllen Medical Center
802003 McAllen Heart Hospital
816300 Solara Hospital
821001 LifeCare Hospital–South Texas–South
821002 LifeCare Hospitals–South Texas–North
McCamey
240000 McCamey Hospital
McKinney
246000 Columbia Medical Center–McKinney
246001 Medical Center McKinney–Wysong Campus
937000 Methodist McKinney Hospital
971900 Baylor Medical Center McKinney
Mesquite
315003 Dallas Regional Medical Center
670001 Mesquite Rehab Hospital
840000 Mesquite Specialty Hospital
Mexia
505000 Parkview Regional Hospital
Midland
452000 Midland Memorial Hospital
693000 HEALTHSOUTH Rehab Hospital–
Midland/Odessa
789900 Select Specialty Hospital–Midland
Mineral Wells
034000 Palo Pinto General Hospital
Mission
370000 Mission Regional Medical Center
1Q13
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Comment
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x
2Q13
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Comment
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x
x
802001
x
x
x
*
x
246000
x
x
x
xOC
x
x
x
x
x
x
x
x
Missouri City
609001 Memorial Hermann Sugar Land
Monahans
468000 Ward Memorial Hospital
Morton
159000 Cochran Memorial Hospital
Mount Pleasant
137000 Titus Regional Medical Center
Mount Vernon
282000 East Texas Medical Center–Mount Vernon
Muenster
365000 Muenster Memorial Hospital
Muleshoe
631000 Muleshoe Area Medical Center
Nacogdoches
392000 Nacogdoches Medical Center
478000 Nacogdoches Memorial Hospital
478001 Cecil R Bomar Rehab Center
Nassau Bay
600001 CHRISTUS St John Hospital
Navasota
728800 Grimes St Joseph Health Center
DSHS/THCIC
www.dshs.state.tx.us/THCIC
x
*
*
*
x
*
*
x
x
478000
x
x
Page 78
x
DSHS Document # E25-14163
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1Q13
Nederland
127000 Mid-Jefferson Extended Care Hospital
x
New Braunfels
124100 Warm Springs Specialty Hospital New
x
Braunfels
786200 New Braunfels Regional Rehab Hospital
x
863300 CHRISTUS Santa Rosa Hospital New
x
Braunfels
Nocona
348000 Nocona General Hospital
*
Odessa
181000 Medical Center Hospital
x
425000 Odessa Regional Medical Center
x
938000 Basin Healthcare Center
xOC
Olney
294000 Hamilton Hospital
*
Orange
121000 Baptist Orange Hospital
x
851400 Harbor Hospital–Southeast Texas
x
Palacios
574001 Palacios Community Medical Center
x
Palestine
629001 Palestine Regional Medical Center
x
629002 Palestine Regional Medical Center Rehab & 629001
Psych Campus
Pampa
832900 Pampa Regional Medical Center
xOC
Paris
095002 Paris Regional Medical Center South Campus
x
095003 Paris Regional Medical Center North Campus 095002
787500 Dubuis Hospital–Paris
x
Pasadena
349001 Bayshore Medical Center
xOC
694100 Surgery Specialty Hospitals of America–
xlv
Southeast Houston
801000 Kindred Hospital Bay Area
x
846100 St Lukes Patients Medical Center
x
972700 Pristine Hospital of Pasadena
xOC
Pearsall
441000 Frio Regional Hospital
*
Pecos
367000 Reeves County Hospital
*
Perryton
098000 Ochiltree General Hospital
*
Pittsburg
438000 East Texas Medical Center–Pittsburg
x
Plainview
146000 Covenant Hospital–Plainview
x
816001 Allegiance Behavioral Health Center–
x
Plainview
Plano
143001 Childrens Medical Center Legacy
x
214000 Medical Center–Plano
x
664000 Texas Health Presbyterian Hospital–Plano
x
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 79
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3Q13
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DSHS Document # E25-14163
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Comment
4Q13
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Comment
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With
1Q13
670000 HEALTHSOUTH Plano Rehab Hospital
x
720000 Texas Health Seay Behavioral Health Center
x
789800 LifeCare Hospital–Plano
x
805000 Plano Specialty Hospital
x
814001 Baylor Regional Medical Center–Plano
x
815300 Texas Health Center–Diagnostics & Surgery
x
Plano
844000 Heart Hospital Baylor Plano
x
971200 Accel Rehab Hospital of Plano
x
972910 Victory Medical Center Plano
x
Port Arthur
299001 CHRISTUS Hospital–St Mary
xOC
464002 Medical Center–Southeast Texas
x
708001 CHRISTUS Dubuis Hospital–Port Arthur
xlv
Port Lavaca
487000 Memorial Medical Center
*
Quanah
102000 Hardeman County Memorial Hospital
*
Quitman
411000 East Texas Medical Center–Quitman
x
Rankin
290000 Rankin County Hospital District
*
Refugio
368000 Refugio County Memorial Hospital District
*
Richardson
549000 Methodist Richardson Medical Center
x
549001 Bush Renner
***
861300 Reliant Rehab Hospital North Texas
x
Richland Hills
437000 North Hills Hospital
x
Richmond
230000 Oakbend Medical Center
x
230001 Oakbend Medical Center
x
Rio Grande City
393000 Starr County Memorial Hospital
x
Rockdale
369000 Little River Healthcare
x
Rockwall
859900 Texas Health Presbyterian Hospital–Rockwall
x
Rotan
355000 Fisher County Hospital District
*
Round Rock
608000 Round Rock Medical Center
x
852600 Scott & White Hospital Round Rock
x
861700 Seton Medical Center Williamson
x
866100 Reliant Rehab Hospital Central Texas
x
Rowlett
625000 Lake Pointe Medical Center
x
Rusk
000107 Rusk State Hospital
x
San Angelo
056000 San Angelo Community Medical Center
xN
168000 Shannon West Texas Memorial Hospital
x
168000
445000 Shannon Medical Center–St Johns Campus
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 80
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Comment
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3Q13
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x
x
x
x
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x
x
x
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
1Q13
With
Comment
2Q13
With
Comment
3Q13
OC
747000 River Crest Hospital
x
San Antonio
000108 Texas Center for Infectious Disease
xlv
000110 San Antonio State Hospital
x
081001 Mission Trail Baptist Hospital
x
114001 Baptist Medical Center
x
134001 Northeast Baptist Hospital
x
154000 Methodist Hospital
x
154001 Methodist Specialty & Transplant Hospital
x
154002 Northeast Methodist Hospital
x
154003 Methodist Texsan Hospital
x
158000 University Hospital
x
228001 Southwest General Hospital
x
283000 Metropolitan Methodist Hospital
x
339001 CHRISTUS Santa Rosa Medical Center
x
339002 CHRISTUS Santa Rosa Hospital–Westover
x
Hills
339003 CHRISTUS Santa Rose-Alamo Heights
xlv
396002
396001 Nix Specialty Health Center
396002 Nix Health Care System
x
503001 St Lukes Baptist Hospital
x
634000 Childrens Hospital of San Antonio
x
636000 HEALTHSOUTH Rehab Institute–San Antonio
x
645000 Kindred Hospital–San Antonio
x
647000 Baptist Emergency Hospital Thousand Oaks
xlv
677001 North Central Baptist Hospital
x
681001 Methodist Ambulatory Surgery Hospital–
x
Northwest
702001 Acuity Hospital South Texas
xlv
719300 Select Specialty Hospital–San Antonio
x
723001 Laurel Ridge Treatment Center
x
737000 Clarity Child Guidance Center
x
786800 South Texas Spine & Surgical Hospital
x
815000 LifeCare Hospital–San Antonio
x
820600 Innova Hospital–San Antonio
x
844600 Warm Springs Rehab Hospital–San Antonio
x
844601 Warm Springs Rehab Hospital Thousand
x
Oaks
844602 Warm Springs Rehab Hospital Westover Hills
x
852100 Foundation Bariatric Hospital–San Antonio
x
874100 Methodist Stone Oak Hospital
x
939000 GlobalRehab Hospital–San Antonio
x
972810 Baptist Emergency Hospital Overlook
xlv
972960 Warm Springs Specialty Hospital San
x
Antonio
973000 Baptist Emergency Hospital Westover Hills
xlv
San Augustine
072000 Memorial Medical Center–San Augustine
x
San Marcos
556000 Central Texas Medical Center
x
Seguin
155000 Guadalupe Regional Medical Center
x
Seminole
113000 Memorial Hospital
*
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 81
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x
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x
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DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
Seymour
546000 Seymour Hospital
Shamrock
571000 Shamrock General Hospital
Shenandoah
795000 Nexus Specialty Hospital Shenandoah Campus
873700 Reliant Rehab Hospital North Houston
Sherman
100076 Heritage Park Surgical Hospital
297000 Texas Health Presbyterian Hospital – WNJ
297000
297002 Texas Health Presbyterian Hospital – WNJ
Behavioral Health
847000
847002 Texoma Medical Center Behavioral Health
Center
957000 Carrus Rehab Hospital
Smithville
424500 Seton Smithville Regional Hospital
Snyder
439000 Cogdell Memorial Hospital
Sonora
147000 Lillian M Hudspeth Memorial Hospital
Southlake
812800 Texas Health Harris Methodist Hospital
Southlake
Spearman
395000 Hansford County Hospital
Spring
945500 Victory Medical Center Houston
Stafford
874000 Atrium Medical Center
Stamford
043000 Stamford Memorial Hospital
Stanton
388000 Martin County Hospital District
Stephenville
256000 Texas Health Harris Methodist Hospital–
Stephenville
Sugar Land
790500 Sugar Land Surgical Hospital
792700 Kindred Hospital Sugar Land
823000 Methodist Sugar Land Hospital
869700 St Lukes Sugar Land Hospital
916000 Emerus Hospital
969000 HEALTHSOUTH Sugar Land Rehab
Hospital
Sulphur Springs
280000 Hopkins County Memorial Hospital
Sunnyvale
919000 Texas Regional Medical Center Sunnyvale
Sweeny
178000 Sweeny Community Hospital
Sweetwater
471000 Rolling Plains Memorial Hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 82
1Q13
With
Comment
2Q13
With
Comment
3Q13
*
*
x
x
x
x
x
x
x
*
*x
x
x
*
x
x
*
*
x
x
x
x
x
xlv
x
x
x
*
x
x
x
*
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
1Q13
Tahoka
192000 Lynn County Hospital District
*
Taylor
044000 Scott & White Hospital Taylor
x
Temple
537000 Scott & White Memorial Hospital
x
537000
537001 Scott & White Santa Fe Center
537000
537002 Scott & White Pavilion
537003 Scott & White Memorial Hospital–SNF
x
537005 Scott & White Memorial Hospital–Psych
x
537006 McLane Childrens Hospital Scott & White
x
850300 Scott & White Continuing Care
x
Terrell
000111 Terrell State Hospital
x
Texarkana
144000 Wadley Regional Medical Center
x
684000 HEALTHSOUTH Rehab Hospital–Texarkana
x
713001 CHRISTUS St Michael Rehab Hospital
x
788001 CHRISTUS St Michael Health System
x
822000 Dubuis Hospital–Texarkana
x
847600 Dubuis Hospital–Texarkana–Wadley
x
Texas City
793000 Mainland Medical Center
x
The Woodlands
615000 Memorial Hermann The Woodlands Hospital
x
793100 St Lukes The Woodlands Hospital
x
795001 Nexus Specialty Hospital
xlv
923000 St Lukes Lakeside Hospital
x
Throckmorton
428000 Throckmorton County Memorial Hospital
*
Tomball
076000 Tomball Regional Medical Center
xOC
792601 Kindred Hospital Tomball
x
Trinity
287000 East Texas Medical Center–Trinity
x
Trophy Club
805100 Baylor Medical Center Trophy Club
x
Tulia
273000 Swisher Memorial Hospital
*
Tyler
000112 UT Health Center–Tyler
x
286000 Mother Frances Hospital
x
410000 East Texas Medical Center
x
410001 East Texas Medical Center Behavioral Health 410000
Center
692000 Trinity Mother Frances Rehab Hospital
x
777000 East Texas Medical Center Specialty Hospital
x
790200 Texas Spine & Joint Hospital
x
799000 East Texas Medical Center Rehab Hospital
x
806500 Tyler Continue Care Hospital
x
Uvalde
063000 Uvalde Memorial Hospital
x
Van Horn
139000 Culberson Hospital
xlv
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 83
With
Comment
2Q13
With
Comment
3Q13
x
x
x
x
x
x
x
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
Vernon
000113 North Texas State Hospital–Vernon
084000 Wilbarger General Hospital
Victoria
064000 Citizens Medical Center
453000 DeTar Hospital–Navarro
453001 DeTar Hospital–North
812000 Kindred Hospital Victoria
848100 Warm Springs Specialty Hospital–Victoria
Waco
000117 Waco Center for Youth
040000 Providence Health Center
506000 Hillcrest Baptist Medical Center
506001 Hillcrest Baptist Medical Center
736000 DePaul Center
Waxahachie
285000 Baylor Medical Center–Waxahachie
Weatherford
844800 Weatherford Regional Medical Center
Webster
212000 Clear Lake Regional Medical Center
680000 Kindred Rehab Hospital Clear Lake
698004 Cornerstone Hospital Houston–Clear Lake
720402 Kindred Hospital Clear Lake
822001 Houston Physicians Hospital
Wellington
195000 Collingsworth General Hospital
Weslaco
480000 Knapp Medical Center
808500 Weslaco Rehab Hospital
Wharton
833000 Gulf Coast Medical Center
Wheeler
116000 Parkview Hospital
Wichita Falls
000114 North Texas State Hospital
417000 United Regional Health Care System
681400 Kell West Regional Hospital
685000 HEALTHSOUTH Rehab Hospital–Wichita
Falls
709001 Red River Hospital
820002 Texas Specialty Hospital–Wichita Falls
Winnie
781400 Winnie Community Hospital
Winnsboro
446001 Mother Frances Hospital Winnsboro
Winters
151000 North Runnels Hospital
Woodville
569000 Tyler County Hospital
Yoakum
023000 Yoakum Community Hospital
DSHS/THCIC
www.dshs.state.tx.us/THCIC
1Q13
With
Comment
2Q13
With
Comment
3Q13
000114
*
x
x
x
453000
x
x
xlv
x
x
x
506000
x
x
x
x
x
x
x
x
x
x
x
x
x
*
x
x
x
x
x
x
x
x
*
x
*
*
x
Page 84
DSHS Document # E25-14163
With
Comment
4Q13
With
Comment
Reports
With
1Q13
Total exempt hospitals
82
Total exempt hospitals voluntarily reporting
3
Total hospitals not in compliance. No data submitted
2
Total hospitals with discharges reported by another
hospital
28
Total reporting
577
With
Comment
2Q13
With
Comment
3Q13
With
Comment
4Q13
With
Comment
Note: Hospitals that report discharge data with another hospital are so indicated in the ‘Reports With’ column.
C Closed, no data submitted.
CN Closed, data not certified.
NC
Certification comments not submitted to DSHS.
OC Not in compliance for this quarter. No data submitted.
x Hospital submitted and certified data, submitted comments.
xlv Hospital with fewer than fifty discharges in the quarter. The hospital IDs for these hospitals have been changed to
'999999' in the Public Use Data File, but their comments are listed under their actual THCIC ID. Other changes to
the patient records for these hospitals are indicated in the 'Data Dictionary'.
xN Hospital elected not to certify data.
xOC Hospital did not certify data. Not in compliance for this quarter.
*
Exempt hospital. Includes those located in a county with a population less than 35,000, or those located in a county
with a population more than 35,000 and with fewer than 100 licensed hospital beds and not located in an area that is
delineated as an urbanized area by the United States Bureau of the Census (Section 108.0025). Also includes
hospitals that do not seek insurance payment or government reimbursement (Section 108.009).
***
No discharges for this quarter.
DSHS/THCIC
www.dshs.state.tx.us/THCIC
Page 85
DSHS Document # E25-14163