Inpatient / Outpatient
Data Collection Manual
August 15th, 2008 - Version 9
© Vermont Explor August 18, 2008
Table of Contents
ATTACHMENTS ...............................................................................................................................................V
GLOSSARY OF TERMS ................................................................................................................................ VI
UB04 DATA ELEMENT NAME:
PATIENT CONTROL NUMBER ...................................................... 1
UB04 DATA ELEMENT NAME:
BILL TYPE ........................................................................................... 2
UB04 DATA ELEMENT NAME:
FEDERAL TAX NUMBER ................................................................. 3
UB04 DATA ELEMENT NAME:
STATEMENT COVERS FROM ........................................................ 4
UB04 DATA ELEMENT NAME:
STATEMENT COVERS THRU ......................................................... 5
UB04 DATA ELEMENT NAME:
PATIENT ZIP CODE .......................................................................... 6
UB04 DATA ELEMENT NAME:
PATIENT’S BIRTH DATE ................................................................. 7
UB04 DATA ELEMENT NAME:
PATIENT SEX ...................................................................................... 8
UB04 DATA ELEMENT NAME:
ADMISSION DATE ............................................................................. 9
UB04 DATA ELEMENT NAME:
ADMISSION HOUR .......................................................................... 10
UB04 DATA ELEMENT NAME:
ADMISSION TYPE............................................................................ 11
UB04 DATA ELEMENT NAME:
SOURCE OF ADMISSION ............................................................... 12
ii
UB04 DATA ELEMENT NAME:
PATIENT STATUS ............................................................................ 14
UB04 DATA ELEMENT NAME:
MEDICAL RECORD NUMBER ...................................................... 16
UB04 DATA ELEMENT NAME:
REVENUE CODE LINE 1-23 ........................................................... 17
UB04 DATA ELEMENT NAME:
CHARGES LINE 1-23........................................................................ 18
UB04 DATA ELEMENT NAME:
UNITS AND DATES OF SERVICE LINES 1-23 ............................ 19
UB04 DATA ELEMENT NAME:
PRINCIPAL DIAGNOSIS CODE .................................................... 20
UB04 DATA ELEMENT NAME:
OTHER DIAGNOSIS CODE 1-8 ...................................................... 21
UB04 DATA ELEMENT NAME:
ADMISSION DIAGNOSIS CODE ................................................... 22
UB04 DATA ELEMENT NAME:
E CODE ............................................................................................... 23
UB04 DATA ELEMENT NAME:
PRINCIPAL PROCEDURE CODE ................................................. 24
UB04 DATA ELEMENT NAME:
PRINCIPAL PROCEDURE DATE .................................................. 25
UB04 DATA ELEMENT NAME:
OTHER PROCEDURES CODES ..................................................... 26
UB04 DATA ELEMENT NAME:
OTHER PROCEDURE DATE.......................................................... 27
UB04 DATA ELEMENT NAME:
ATTENDING PHYSICIAN LICENSE NUMBER.......................... 28
iii
UB04 DATA ELEMENT NAME:
SURGEON PRINCIPAL PROCEDURE ......................................... 29
UB04 DATA ELEMENT NAME:
OTHER PHYSICIAN LICENSE NUMBER 2 ................................ 30
UB04 DATA ELEMENT NAME:
SCU DAYS........................................................................................... 31
UB04 DATA ELEMENT NAME:
BIRTH WEIGHT ............................................................................... 32
UB04 DATA ELEMENT NAME:
PATIENT RACE ................................................................................ 33
UB04 DATA ELEMENT NAME:
PRIMARY, SECOND AND THIRD PAYER CLASSIFICATION CODES
34
UB04 DATA ELEMENT NAME:
MEDICAID PROVIDER NUMBER ................................................ 35
UB04 DATA ELEMENT NAME:
MEDICARE PROVIDER NUMBER ............................................... 36
UB04 DATA ELEMENT NAME:
SOCIAL SECURITY NUMBER ....................................................... 37
UB04 DATA ELEMENT NAME:
READMISSION FLAG ...................................................................... 38
UB04 DATA ELEMENT NAME:
TOWN/COUNTY CODE ................................................................... 39
UB04 DATA ELEMENT NAME:
HCPCS CODES .................................................................................. 40
UB04 DATA ELEMENT NAME:
PATIENT TYPE ................................................................................. 41
VERMONT EXPLOR DATA ELEMENT NAME: PAYER SUB ID ......................................................... 43
iv
VERMONT EXPLOR DATA ELEMENT NAME: HIC NUMBER .......................................................... 44
Attachments
A. Payer and related Payer Sub ID Codes
B. Continuation Records
C. Valid Revenue Codes
D. Valid County/Town Codes
E. Revised 1300 Flat File Layout
F. Policies and Procedures for Submitting Data Files
G. Transmittal Form
H. Revenue Codes Requiring HCPCS Codes
v
Glossary of Terms
Inpatient Definition: Patients who are classified by your hospital as inpatient at the time of discharge. All
records are classified by date of discharge.
Outpatient Definition: Includes ambulatory surgeries coded within range ICD9-CM (01.00 -86.99)
performed in the operating room, on-site clinic, surgical suites or ambulatory surgery center. In addition, all
emergency room visits and observation only patients are required to be submitted.
The Data Element Description has information for each data element on the following:
UB04 Data Element Name: The name of the element on the UB04 form.
1500 Field Number: The number of the element on the 1500 layout.
UHDDS – Data Element Name: The name of the element on the old UHDDS layout.
Record Position: The location of this data element in the 1500 submission file.
Format – Length: Describes the type of data and its length in the submission file.
Type of data
X – any character (numbers or letters)
9 – a digit (0-9)
Length
Is either described by repeating the type of data, for example X is 1 character, XX is
two characters, 999 is 3 digits
Or by putting the length in parentheses following the type of data, for example 9(8) is
an 8-digit number, X(20) is 20 characters.
Charges are described as S9(8)V99
S – a sign may be added
V – a decimal point is implied (but not included)
Thus, charges are 10 characters long. The last two digits are the cents portion
of the charges.
Effective Date: The date this definition first became effective.
Revision Number – Date: The number of times this element definition has been revised, and the date
the current revision became effective.
Definition: The definition of the element.
Codes and Values: The acceptable codes and/or values for the data element and what they mean.
vi
Edit Applications:
Edit checks which are applied to the data. There are three levels of edits:
1)
Vermont Explor checks each record for valid codes. This document lists the error
numbers, and their error descriptions. These are the codes returned to you.
2)
Vermont Explor runs aggregate edits on your data throughout the data collection cycle,
which look at the overall frequencies from each hospital.
3)
The Vermont Department of Health runs aggregate edits after the data has been closed
and transmitted to them. The results of these edits are transmitted to your medical
records director in tables comparing your hospital to the other hospitals in the state.
Uses of the Data: A list of possible ways the data element is used by researchers.
Diagnoses and procedure codes, an overview
Diagnosis codes describe the diseases and illnesses:
V-Codes are a supplementary classification of factors influencing health status and
contact with health services.
E-Codes are a supplementary classification of external causes of injury and poisoning.
Procedure codes describe surgical operations and procedures.
These codes are used to calculate Diagnosis Related Groups (DRGs), Major Diagnostic
Categories (MDCs) and Injury Severity Scores (ISS).
Diagnoses, procedures, and E-codes are coded to the International Classification of Disease,
9th Revision, with Clinical Modification (ICD-9-CM).
Diagnosis codes: Describe the diseases and illnesses. Codes have 3 digits before the decimal, and
up to 2 digits following the decimal. Before the decimal, codes should have leading zeros, so
that all codes have 3 digits before the decimal. Do not enter the decimal point. Digits beyond
the decimal are ONLY added if they exist. Left-justify the entire code.
Examples of valid codes:
0010: (001.0 – Cholera due to Vibrio cholerae): Leading zeros before the decimal,
decimal point assumed; valid code only has one digit after the decimal.
024: (024 - Glanders): Leading zero before the decimal, decimal point assumed, no
valid code beyond the decimal.
55129 (551.29 – Ventral hernia with gangrene, other); 3 digits before the decimal,
decimal point assumed, valid code has 2 digits beyond the decimal.
V-Codes are a supplementary classification of factors influencing health status and contact
with health services. They are usually reported in the secondary diagnosis fields. V-Codes
begin with a V. They have 3 characters before the decimal (including the V) and up to 2
following the decimal. Rules match those for diagnoses above – omit the decimal, only
include valid digits beyond the decimal, left-justify the entire code.
Example of valid code:
V270: (V27.0 – Outcome of delivery, single liveborn): Code begins with V, decimal
point is assumed, one valid digit beyond the decimal.
vii
E-Codes are a supplementary classification of external causes of injury and poisoning. The
primary E-code is entered in the E-code field. Additional E-codes are entered as secondary
diagnoses. Any record with an injury, poisoning or adverse effect diagnosis code should have
an E-code. They begin with an E, have 4 characters before the decimal, and only one after.
All E-codes fall in the range E800-E999.9. Rules match those for diagnoses above, omit the
decimal, only include valid digits beyond the decimal, left-justify the entire code.
Example of valid code:
E8801: (E880.1 – Fall on or from sidewalk curb) Code begins with E, decimal point
assumed, one valid digit beyond the decimal.
Procedure codes describe surgical operations and procedures. Codes have 2 digits before the
decimal, and up to 2 following the decimal. Rules match those for diagnoses above: zero fill
before the decimal, omit the decimal, only include valid digits beyond the decimal, left-justify
the entire code. Examples of valid codes:
0601: (06.01 - Aspiration of thyroid): Leading zero, decimal point assumed, valid code
has 2 digits beyond the decimal.
526: (52.6- Total pancreatectomy): 2 digits before the decimal, decimal point assumed,
one valid digit beyond the decimal.
viii
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Control Number
1500 Field Number: 01
UHDDS - Data Element Name:
Record Positions:
1-20
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 2, 3/17/04
Definition:
X (20)
The number assigned to the patient’s medical encounter by the hospital. Unique to each
encounter.
Codes and Values:
Edit Applications:
Edits:
0101 Duplicate record key, check patient control number and discharge date
0102 Patient control number is missing
Uses of Data:
Allows VT Explor and submitting hospital to identify questionable records.
Notes:
Not a public field. Not released to Vermont Department of Health (VDH) or data
vendors.
Other:
1
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Bill Type
1500 Field Number: 02
UHDDS - Data Element Name: Not a UHDDS data element
Record Positions:
21-23
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 3/28/00
Definition:
999
A code indicating the specific type of bill (inpatient, ambulatory surgery, outpatient)
Codes and Values:
111- Hospital based, inpatient, final bill
131- Hospital based, outpatient, final bill
831- Hospital based, ambulatory surgery, final bill
Edit Applications:
Edits:
4101
4102
4103
4104
Bill type is missing
Bill type is not numeric
Bill type is invalid
Verify bill type
Notes:
New with UB04.
Other:
One is the only valid last digit. We only accept final bills.
2
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Federal Tax Number
1500 Field Number: 03
UHDDS - Data Element Name: Hospital ID
Record Positions:
24-33
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 3/28/00
Definition:
X (10)
Not required, blank fill
Codes and Values:
Edit Applications:
Uses of Data:
Notes:
Other:
3
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Statement Covers From
1500 Field Number:
04
UHDDS - Data Element Name:
Record Positions:
34 - 41
Effective Date:
1/1/99
Definition:
Admission Date (if no prior treatment)
Format - Length:
9 (8) MMDDYYYY
Revision Number – Date:
If the patient had tests or procedures performed prior to treatment (3 days), record date on
which these were performed. If this is not the case, then default to the date patient was
admitted/seen for treatment.
Codes and Values:
Edit Applications:
Uses of Data:
Notes:
Other:
4
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Statement Covers Thru
1500 Field Number: 05
UHDDS - Data Element Name:
Discharge Date
Record Positions:
42-49
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
MMDDYYYY
This is the date that the patient leaves the hospital.
Codes and Values:
A valid date in the format MMDDYYYY
Edit Applications:
Edits:
0201
0202
0203
0204
1201
Discharge date is missing, length of stay incalculable
Discharge date is not a valid date, length of stay incalculable
Discharge date is prior to admit date, check admit date
Verify discharge date
Length of stay is greater than 100 days, verify discharge and admit dates
VDH edits:
Discharge date before date of birth.
Look at month of discharge frequencies by hospital – all should be between 9% and
12% of total.
Once length of stay (LOS) has been calculated, records with high LOS are examined
by diagnosis and charges.
LOS frequencies by hospital are compared with previous years and the state as a whole
Uses of data: Used to calculate length of stay and age of patient.
Used in DRG determination.
Used to pick cohorts for studies.
Used to look at seasonal patterns of hospitalization
Notes:
Uses a 4-digit year.
Other:
5
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Zip Code
1500 Field Number: 06
UHDDS - Data Element Name:
Zip Code
Record Positions:
50-58
Format - Length:
X(9)
Effective Date:
1/1/99
Revision Number – Date: 1, 3/1/2001
Definition:
Mailing Zip Code.
Codes and Values:
Standard US ZIP code
Standard Canadian ZIP code
XXXXX - Foreign resident
YYYYY - Unknown
Edit Applications:
Edits:
2001
2002
2003
2004
Zip code is missing
Zip code is invalid
US Zip code is not numeric
Verify zip code
VDH Edits:
VT ZIPs (05000-05999) must be valid USPS ZIPs.
Look at overall frequencies by hospital – compare it with previous years, and the state
as a whole.
Compare ZIP and town/county codes.
Calculate Hospital Service Areas and counties, then compare their frequencies by
hospital with previous years and the state as a whole.
Uses of data: This is the primary field used to determine the residence of the patient, and hence, forms the
basis of all geographic studies of the data. It is used to calculate hospital service area, and
county of residence. It is used to select cohorts for studies, and is used extensively in
marketing analyses.
Notes:
Other:
6
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient’s Birth Date
1500 Field Number: 07
UHDDS - Data Element Name: Birth Date
Record Positions:
59-66
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
MMDDYYYY
Patient’s date of birth.
Codes and Values:
MMDDYYYY
Edit Applications:
Edits:
0701
0702
0703
0704
0901
Birth date is missing, age incalculable
Birth date is not a valid date, age is incalculable
Birth date is after admit date, check admit date
Verify birth date
Age is greater than 110, check birth date and admit date
VDH Edits:
Look at month of birth frequencies by hospital, each month should have between 9 and
12% of the total.
Birth date should not be higher than discharge date.
After age calculation, diagnoses that are age-dependent are verified. Births to those
under 15 and over 44 are verified with Vital Records. The mean and standard
deviation of ages by hospital are compared with previous years and the state as
a whole. Very old ages are noted in letters to medical records directors.
Uses of data :
Used to calculate age. Age is a major variable in many research studies.
Notes:
Other:
Unknown will produce a fatal error.
7
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Sex
1500 Field Number: 08
UHDDS - Data Element Name: Sex
Record Positions:
67-67
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
X
Patients designated sex as recorded at date of admission, outpatient service or start of care.
Codes and Values:
M
F
U
Male
Female
Unknown
Edit Applications:
Edits:
0501 Sex is missing
0502 Sex is not valid
0503 Verify sex
VDH Edits:
Look at overall frequencies by hospital – compare them to previous years, and the
state as a whole.
Diagnoses that are sex-dependent are verified.
Uses of data :
Sex is a major variable in many research studies.
Notes:
Other:
8
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Admission Date
1500 Field Number: 09
UHDDS - Data Element Name: Admission Date
Record Positions:
68-75
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
MMDDYYYY
The date the patient was admitted for inpatient care, outpatient service or start of care.
Codes and Values: MMDDYYYY
Edit Applications:
Edits:
1101 Admit date is missing, age and length of stay incalculable
1102 Admit date is not a valid date, age and length of stay incalculable
1103 Verify admit date
VDH Edits:
Admission date should not be greater than discharge date
Admission date should not be less than date of birth
Look at month of admission frequencies by hospital – all months should have between
9 and 12% of the records.
Uses of data:
Notes:
Used with discharge date to calculate length of stay, and important factor in many
studies.
Uses a 4-digit year
Other:
9
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Admission Hour
1500 Field Number: 10
UHDDS - Data Element Name: Admission Hour
Record Positions:
76-77
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
99
The hour during which the patient was admitted for inpatient or outpatient surgery care.
Codes and Values:
00-23
Edit Applications:
Edits:
2901 Admission hour is not numeric
2902 Admission hour is not valid
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Uses of data: Used to determine length of stay for those staying under one day.
Notes:
Other:
Unknowns will produce a fatal error.
10
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Admission Type
1500 Field Number: 11
UHDDS - Data Element Name: Admission Type
Record Positions:
78-78
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
X
A code indicating the priority of this admission.
Codes and Values:
1 Emergency The patient requires immediate medical intervention as a
result of severe, life-threatening or potentially disabling conditions.
Generally, the patient is admitted through the emergency room.
2 Urgent
The patient requires immediate attention for the care and treatment of a
physical or mental disorder. Generally the patient is admitted to the
first available and suitable accommodation.
3 Elective
The patient’s condition permits adequate time to schedule the
availability of a suitable accommodation.
4 Newborn
9 Unknown Information not available. The hospital cannot classify the type of
admission. This code should only be used on rare occasions.
Edit Applications:
Edits:
2801
2802
2803
2804
2805
2806
Admission type is missing
Admission type is not valid
Admit type is newborn and birth date is more than two days before admit date
Admit type is newborn but principal diagnosis code is not newborn
Principal diagnosis is newborn but admit type is not newborn
Verify admit type
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Uses of data: Used to study types of admissions for specific illnesses, such as ER asthma admissions.
11
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Source of Admission
1500 Field Number: 12
UHDDS - Data Element Name:
Admission From (includes from ER)
Record Positions:
79-79
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 1/1/2001
Definition:
X
The source of this admission
Codes and Values:
For those other than newborns:
1. Physician referral The patient was admitted to this hospital upon recommendation
of his or her personal physician.
2. Clinical referral
The patient was admitted to this hospital upon recommendation
of this hospital’s clinic physician.
3. HMO referral
The patient was admitted to this hospital upon recommendation
of a health maintenance organization physician.
4. Transfer from a hospital
The patient was admitted to this hospital as a transfer from an
acute care facility where he or she was an inpatient.
5. Transfer from a skilled nursing facility
The patient was admitted to this hospital from a skilled nursing
facility where he or she was an inpatient.
6. Transfer from another health care facility
The patient was admitted to this hospital as a transfer from a
health care facility other than an acute care facility or a skilled
nursing facility.
7. Emergency Room The patient was admitted to this hospital upon recommendation
of this hospital’s emergency room physician.
8. Court/Law Enforcement
The patient was admitted to this hospital upon the direction of a
court of law, or upon the request of a law enforcement agency
representative.
9. Unknown
Information not available. The means by which the patient was
admitted to this hospital is not known.
A - Transfer from a critical access hospital
The patient was admitted to this hospital as a transfer from a
critical access hospital.
12
For Newborns Only
1 Normal delivery
A baby delivered without complications
2 Premature delivery A baby delivered with time and/or weight factors qualifying it
for premature status.
3 Sick baby
A baby delivered with medical complications other than those
relating to premature status.
4 Extramural birth
A newborn born in a nonsterile environment
9 Unknown
Information not available
Edit Applications:
Edits:
2201 Admission source is missing
2202 Admission source is not valid
2203 Admit type is newborn, but admit source is not 1 to 4
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Uses of data: Used to study patients transferred from one hospital to another. Used to select records for
study. Often those transferred from one hospital to another are excluded from studies, to
avoid counting them twice.
Notes:
Expanded codes with UB04.
Other:
13
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Status
1500 Field Number: 13
UHDDS - Data Element Name:
Disposition
Record Positions:
80-81
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 4, 9/3/2004
Definition:
99
A code indicating patient status at the statement, covers through date (discharge date.)
Special Note: Hospitals referring a patient for outpatient surgery services to another institution
should use code 01- discharged to home or self care, in lieu of the current code 05discharges/transferred to another type of institution or referred for outpatient services to another
institution. In another situation, if someone is admitted from a group home, and is discharged back to
the home, the record should be coded to home (01).
Codes
and Values:
01
02
03
04
05
06
07
08
09
20
43
50
51
61
62
63
64
65
71
72
Discharged to home or self care (routine discharge)
Discharged/transferred to another short-term general hospital for inpatient care.
Discharged/transferred to skilled nursing facility (SNF)
Discharged/transferred to intermediate care facility (ICF)
Discharged/transferred to another type of institution for inpatient care or referred for outpatient services to
another institution
Discharged/transferred to home under home health service organization
Left against medical advice or discontinued care
Discharged/transferred to home under care of a home IV drug therapy provider
Admitted as an inpatient to this hospital.
Died
Discharged or transferred to a Federal Hospital
Hospice - home
Hospice - medical facility
Discharged/transferred within this institution to hospital-based Medicare approved Swing bed.
Discharged/transferred to another type of institution for inpatient care or referred for Rehabilitation Services
(Effective - 10/1/2001)
Discharged/transferred to another type of institution or referred for Long Term Care Services. (Effective 10/1/2001)
Discharged/transferred to a nursing facility cert. under Medicaid, but not Medicare
Discharged/Transferred to a Psychiatric Hospital or Psychiatric Distinct Part Unit of a
Hospital (Effective – 4/1/2004)
Discharged/transferred/referred to another institution for outpatient services as specified by the discharge
plan of care.(Discontinued)
Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of
care. .(Discontinued)
14
Edit Applications: Edits:
1001 Patient status is missing
1002 Patient status is not numeric
1003 Patient status is not valid
VDH Edits:
Frequencies by hospital are compared with previous years and the state as
a whole.
Diagnoses that are disposition-dependent are verified.
Uses of data:
Used in studies of specific illnesses – for example, a recent study looked at the disposition
of patients with hip fracture, finding that 72% went from the hospital to another care
facility.
Notes:
Use of codes 10-16 will be considered a fatal error.
Other:
15
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Medical Record Number
1500 Field Number: 14
UHDDS - Data Element Name: Medical Record Number
Record Positions:
82-98
Format - Length:
Effective Date:
1/1/04
Revision Number – Date: 1, 3/17/04
Definition:
X (17)
The number assigned to the patient’s medical record by the hospital. Unique and permanent
to each patient.
Codes and Values:
Edit Applications:
Edits:
0301 Medical record number is missing
Uses of Data:
Allows VT Explor and submitting hospital to identify questionable records.
May be used in the future to set readmit flag.
Eventually this field may also be used to track patient’s continuum of care, and to
examine individual patterns of care.
Notes:
Not a public field. Not released to Vermont Department of Health (VDH) or data
vendors.
Other:
16
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Revenue Code Line 1-23
1500 Field Number: 15 -59 (see 1500)
UHDDS - Data Element Name: Not a UHDDS data element
Record Positions:
99-410 (see 1500)
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 5, 11/11/2003
Definition:
A code which identifies a specific accommodation, ancillary service or billing calculation.
Codes and Values:
See Attachment C for a complete list of codes.
Edit Applications:
Edits:
3701
3702
3703
3705
3706
3801
3901
Notes:
9(4)
Revenue code is not valid
Revenue code is missing
Revenue code is not numeric
Verify revenue code
More than one total revenue code was provided
Revenue units are missing
Revenue charge is missing
Grouping inpatient/outpatient surgery and revenue specific reporting. Use continuation
records to record more than 23 revenue codes (see Attachment B).
Specific HCPCS codes should be tied to the appropriate Revenue code to reflect the exact
services provided in that revenue center; e.g., if Revenue code 360 appears on Line 6, the
corresponding HCPCS code should appear on HCPCS code Line 6.
If more than one HCPCS code is reported for one revenue center, the Revenue code should be
repeated for each HCPCS code.
All Revenue codes/HCPCS should be submitted as defined by the Uniform Billing Manual.
Exception: Revenue codes for Professional Fees (960-989 inclusive). Professional Fees
should also be excluded from Total Charges.
Other:
FAQ 16-001 The sum of the revenue charges except Revenue Code 001 should equal charges
for Revenue Code 001. If newborn charges are included on the mothers record (i.e.,
Medicaid), then a $0.00 amount for Revenue Code 001 will be accepted. HOWEVER,
discharge records for all newborns must be submitted.
17
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Charges Line 1-23
1500 Field Number: 16-60 (See 1500)
UHDDS - Data Element Name:
Record Positions:
103-420 (See 1500)
Effective Date:
1/1/99
Definition:
Format - Length:
Revision Number – Date:
S9(8)V99
4, 11/11/2003
Charge by revenue code.
Codes and Values:
Exclude charges (and revenue codes) for Professional Fees (960-989 inclusive).
Edit Applications:
Edits:
2501
2502
2504
2505
2506
2507
2508
2509
3901
3902
3903
The total charges revenue code is missing
Total charges revenue code is not numeric
Individual line item charges do not add up to total charges
Patient type is inpatient, but total charges are less than $150 or more than
$7500 per day
Patient type is outpatient but total charges less than $40 or more than $20000
No accommodations charges for this patient
Total charges for outpatient is more than $25,000 for patient type X
Total charges for outpatient is more than $25,000 for patient type E
Revenue charge is missing
Revenue charge is not numeric
Verify revenue charge
VDH Edits:
Mean and standard deviation by hospital are compared with previous years and the
state as a whole.
“No charges” and those with charges of under $100 are examined, and included in the
letter to the medical record directors.
Charges of $0 are changed to unknowns in the VDH database.
High charges are examined by length of stay, diagnosis, and procedures.
Notes:
Use continuation records to record more than 23 Charges (see Attachment B).
18
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Units and Dates of Service Lines 1-23
1500 Field Number: 97-142 (see 1500)
UHDDS - Data Element Name: Not a UHDDS data element
Record Positions:
747-1045 (see 1500)
Effective Date:
1/1/99
Definition:
Format - Length:
9(6) for units,
MMDDYY for dates
Revision Number – 3, 11/1/2001
The number of billed service units for this revenue code, and the date of the service.
Codes and Values:
Edit Applications:
Edits:
3801
3802
3803
6002
6003
Revenue units are missing
Revenue units are non-numeric
Verify revenue units
Revenue Date of Service invalid
Revenue Date of Service is not between Admit and Discharge Dates
VDH Edits:
Mean, standard deviation and outliers for ICU and CCU days by hospital are compared
with previous years and the state as a whole.
Notes:
Each revenue code that has a HCPCS code should also have a corresponding “unit and date of
service.” If additional revenue codes are added on a continuation record, they should also
have a corresponding “unit and date of service.”
ICU and CCU days are calculated from using revenue codes and units of service.
Use continuation records to record more than 23 units of service (see Attachment B).
Any Date of Service that is available on either Inpatient or Outpatient records should be
submitted. We will use this data primarily for Outpatient APC calculations and/or correct
coding edits.
All Dates of Service should be submitted as defined by Uniform Billing Guidelines.
19
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Principal Diagnosis Code
1500 Field Number: 69
UHDDS - Data Element Name: Principal Diagnosis Code
Record Positions:
534-539
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
X(6)
The ICD-9-CM codes describing the principal diagnosis i.e. the condition established after
study to be chiefly responsible for the admission of the patient for care.
Codes and Values:
ICD-9-CM – omit the decimal (See Glossary)
Edit Applications:
Edits
1501
1502
1503
1505
1506
1507
1508
1510
1512
1514
1515
1517
1519
1523
1525
1527
1528
Principal diagnosis is missing
E-code cannot be used as the principal diagnosis
Principal diagnosis is not valid
Manifestation code was given for principal diagnosis
Normal delivery diagnosis is inconsistent with a Cesarean Section procedure
Non-specific principal diagnosis was given.
Age is greater than 0 and principal diagnosis appropriate for infants only
Age is greater than 17 and principal diagnosis appropriate for children only
Age is less than 15 and principal diagnosis is appropriate for adults only
Principal diagnosis is inconsistent with Medicare as primary payer
Age is not 12 to 55 and principal diagnosis is appropriate for women of
childbearing age only
Principal diagnosis indicates injury or poisoning but no E-code present
Patient was discharged alive but a non-specific principal diagnosis was given
Sex is inconsistent with principal diagnosis
Verify principal diagnosis
Principal diagnosis suggests questionable admission
Invalid as principal diagnosis without a secondary diagnosis
VDH edits:
All records must have a principal diagnosis
Notes:
Used to calculate Diagnosis Related Group (DRG) and Major Diagnostic Category (MDC).
20
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Other Diagnosis Code 1-8
1500 Field Number: 70-77
UHDDS - Data Element Name: Secondary Diagnoses (Up to 8)
Record Positions:
540-587
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 3/28/00
Definition:
X(6)
The ICD-9-CM diagnoses codes corresponding to additional conditions that co-exist at the
time of admission, or develop subsequently and which have an effect on the treatment
received or the length of stay. All secondary diagnoses should be reported. If there are more
than 8 secondary diagnoses, code them on continuation records. (See Attachment B- pg. VIII30 for continuation record format)
Codes and Values:
ICD-9-CM codes– Omit the decimal (See Glossary)
Edit Applications:
Edits
1504
1509
1511
1513
1516
1518
1520
1521
1522
1524
1526
1529
Diagnosis is a duplicate of the principal diagnosis
Age is greater than 0 and other diagnosis appropriate for infants only
Age is greater than 17 and other diagnosis is appropriate for children only
Age is less than 15 and other diagnosis is appropriate for adults only
Age is not 12 to 55 and other diagnosis is appropriate for women of
childbearing age only
Other diagnosis is not valid
Other diagnosis indicates poisoning or injury, but no E-code is present
A non-specific other diagnosis was given
Other diagnosis is inconsistent with Medicare as primary payer
Sex is inconsistent with other diagnosis
Verify other diagnosis
Enter E-code diagnosis
Notes: Use continuation record to code additional diagnoses if needed (see Attachment B).
Other:
21
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Admission Diagnosis Code
1500 Field Number: 78
UHDDS - Data Element Name: Admission Diagnosis Code
Record Positions:
588-593
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
The diagnosis provided by the physician at the time of admission which describes the patient’s
condition upon admission to the hospital.
Codes and Values:
ICD-9-CM code – Omit the decimal (See Glossary)
Edit Applications:
Edits
4301
4302
4303
4304
4305
4306
4307
Notes:
X(6)
Admitting diagnosis is missing
Admitting diagnosis is not valid
Sex is inconsistent with admitting diagnosis
Age is greater than 0 and admitting diagnosis is appropriate infants only
Age is greater than 17 and admitting diagnosis appropriate for children only
Age is less than 15 and admitting diagnosis appropriate for adults only
Age is not 12 to 55 and admitting diagnosis is appropriate for women of
childbearing age only
Since the admitting diagnosis is formulated before all tests and examinations are complete, it
may differ from any of the final diagnoses recorded in the medical record.
Other:
22
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: E Code
1500 Field Number: 79
UHDDS - Data Element Name: No Separate E-code field in old UHDDS format
Record Positions:
594-599
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 7/1/2001
Definition:
X(6)
The ICD-9-CM code for the external cause of injury, poisoning, or adverse effect.
Codes and Values:
ICD-9-CM E-code– Omit the decimal (See Glossary)
Edit Applications:
Edits
Any record with an ICD-9-CM diagnosis code between 800-989.99 except
905-909.99: Late effects of injuries, poisonings, toxic effects and other external causes
and 958-959.99: Certain traumatic complications and unspecified injuries must have
an E-Code.
Notes:
Complete this item whenever there is a diagnosis in the range above. The priorities for this
field are 1) the E-code relating to the principal diagnosis 2) a secondary diagnosis directly
related to the principal diagnosis and 3) other diagnosis with an external cause. Only one Ecode is recorded in this field. Additional E-codes should be recorded in the secondary
diagnosis fields.
Other:
23
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Principal Procedure Code
1500 Field Number: 80
UHDDS - Data Element Name:
Primary Procedure Code
Record Positions:
600-606
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 3, 7/25/2002
Definition:
X(7)
The code that identifies the principal procedure performed during this admission.
Codes and Values:
Inpatient and Outpatient: ICD-9-CM procedure code – Omit the decimal (See
Glossary)
If no procedures were performed, leave blank.
Edit Applications:
Edits
1601
1602
1604
1606
1608
1610
1612
Notes:
Operating physician present, but principal procedure is missing
Principal procedure is not valid
A non-specific principal procedure was given
Principal procedure date is present but principal procedure is missing
Age is not 12 to 55 and principal procedure is appropriate for women of
childbearing age only
Sex is inconsistent with principal procedure
Verify principal procedure
When more than one procedure was performed, the principal procedure is one performed for
definitive treatment rather than for diagnostic or exploratory purposes. If two procedures
appear to meet this definition, the one most closely related to the principal diagnosis should be
selected.
Error 1601 is generated when no procedures are found in fields 80-90 and when
no CPT4 codes ranging from 10000 to 69999 are found in fields 168-190.
Other:
24
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Principal Procedure Date
1500 Field Number: 81
UHDDS - Data Element Name: Principal Procedure Day
Record Positions:
607-612
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
The code that identifies the principal procedure performed during the period covered by this
bill and the date on which the principal procedure described on the bill was performed.
Codes and Values:
MMDDYY
Edit Applications:
Edits:
1701
1703
1705
1707
Notes:
MMDDYY
Principal procedure date is missing
Principal procedure date is invalid
Principal procedure date is not between admit date and discharge date
Verify principal procedure date
2-digit year (this is okay, software makes this field Year 2000 compliant without any input
changes.)
Other:
25
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Other Procedures Codes
1500 Field Number: 82-90 (see 1500)
UHDDS - Data Element Name: Secondary Procedures (Up to 9)
Record Positions:
613-671 (see 1500)
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 2, 7/25/2002
Definition:
X(7)
All other significant procedures should be reported. If there are more than 5 secondary
procedures, code them on continuation records.
(See Attachment B- pg. VIII-30 for continuation record format)
Codes and Values:
Inpatient and Outpatient: ICD-9-CM procedure code – Omit the decimal (See
Glossary)
If no procedures were performed, leave blank.
Edit Applications:
Edits:
1603
1605
1607
1609
1611
1613
Other procedure is not valid
A non-specific other procedure was given
Other procedure date is present but other procedure is missing
Age is not 12 to 55 and other procedure is appropriate for women of
childbearing age only
Sex is inconsistent with other procedure
Verify other procedure
Notes: Use continuation record to code additional procedures if needed (see Attachment B).
Space for 5 on 1500 – Use continuation records to record more than 5.
Other:
26
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Other Procedure Date
1500 Field Number: 83-91 (see 1500)
UHDDS - Data Element Name: Secondary Procedure Day (9)
Record Positions:
620-677 (see 1500)
MMDDYY
Revision Number – Date: 1, 3/28/00
Effective Date:
Definition:
Format - Length:
The date of each secondary procedure reported.
Codes and Values:
MMDDYY
Edit Applications:
Edits:
1702 Other procedure date is missing
1704 Other procedure date is invalid
1706 Other procedure date is not between admit date and discharge date
Notes: Use continuation record to code additional procedure dates (See Attachment B).
Use continuation records for more than 5 secondary procedures and their dates.
Other:
27
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Attending Physician License Number
1500 Field Number: 92
UHDDS - Data Element Name: Attending Physician
Record Positions:
678-699
Effective Date:
1/1/99
Definition:
Format - Length:
X(22)
Revision Number – Date:
Hospital specific number identifying the supervising physician.
Codes and Values:
Edit Applications:
Edits
2601 Attending physician code is missing
Notes:
Other:
28
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Surgeon Principal Procedure
1500 Field Number: 93
UHDDS - Data Element Name: Surgeon Principal Procedure
Record Positions:
700-721
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1- 1/1/2001
Definition:
X(22)
The number of the licensed Surgeon performing the principal procedure, or the number of
other licensed physicians other than the attending physician (hospital generated number)
Codes and Values:
Edit Applications:
Edits:
2701 Principal procedure is present, but no operating physician found
2702 Verify operating physician
Notes:
Other:
29
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Other Physician License Number 2
1500 Field Number: 94
UHDDS - Data Element Name: Assisting or Surgeon of Secondary Procedure
Record Positions:
722-743
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1 – 10/1/2001
Definition:
X(22)
The number of the licensed physician other than the attending physician or Surgeon Principal
Procedure (hospital generated number).
Codes and Values:
Edit Applications:
Notes:
Other:
30
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: SCU Days
1500 Field Number: 95
UHDDS - Data Element Name: SCU Days
Record Positions:
744-745
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
99
Hospital specific codes for special care units.
Codes and Values:
Number of days patient spent in the SCU
Edit Applications:
Edits:
4501 Special care unit days greater than length of stay
4502 Special care unit days not numeric
VDH Edits:
Must not be larger than the total length of stay
Mean, standard deviation, and outliers by hospital are compared with previous years
and the state as a whole.
Notes:
Hospital needs to inform Vermont Explor of use of this field. There is no Revenue Code for
SCU Days. Total SCU Days needs to be recorded in Field 95, if applicable.
Other:
31
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Birth Weight
1500 Field Number:
153
UHDDS - Data Element Name:
Birth Weight
Record Positions:
1204 - 1207
Effective Date:
1/1/99
Definition:
Infant Birth Weight in grams.
Format - Length:
9 (4)
Revision Number – Date:
Codes and Values:
Edit Applications:
Edits:
4601 Birth weight is missing
4602 Birth weight not numeric
4603 Birth weight inconsistent with weight range specified by diagnosis
Uses of Data:
.
Notes:
Other:
32
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Race
1500 Field Number: 155
UHDDS - Data Element Name: Race
Record Positions:
1212-1212
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
9
Patient’s designated race.
Codes and Values:
1
2
3
4
5
6
7
8
American Indian/Alaska Native
Asian or Pacific Islander
Black/Non-Hispanic
White/Non-Hispanic
Other Race
Unknown
Hispanic-White
Hispanic-Black
Edit Applications:
Edits:
0601 Race is missing
0602 Race is invalid
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Race of mothers are compared with Vital Records information.
Uses of Data:
Used in studies of diseases for minorities.
Notes:
Other:
How are hospitals obtaining this information?
33
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Primary, Second and Third Payer classification codes
1500 Field Number: 156-158 (See 1500)
UHDDS - Data Element Name: Principal Payer (Second and Third are new fields)
Record Positions:
1213-1218 (See 1500)
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 3/28/00
Definition:
XX
The payment source expected to pay the majority of the patient’s bill at discharge is
considered the Primary Payer. Although not the primary payer, the Second and Third payers
follow the same coding rules.
Codes and Values:
See Attachment A – Pay special attention to completing the payer Sub-ID codes
entered in fields 162, 163 and 164. Medically Indigent/Free must be included, if
applicable.
Edit Applications:
Edits:
0401
0402
0403
0404
0405
0406
Principal payer is missing
Payer code is invalid
Verify primary payer
Secondary payer is missing
Secondary payer code is invalid
Tertiary payer code is invalid
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Most records of age 65 and over, (90%+) should be Medicare
Uses of data:
Very important in studies of the impact of managed care on outcomes.
Notes:
These codes are new. If you have questions about how to code a specific record, call
Vermont Explor. Vermont Explor will keep a list of questionable payers, and how to
code them.
Other:
34
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Medicaid Provider Number
1500 Field Number: 159
UHDDS - Data Element Name: Not a UHDDS data element
Record Positions:
1219-1230
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 1, 3/28/00
Definition:
X(12)
Not required, blank fill
Codes and Values:
Edit Applications:
Notes:
Other:
35
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Medicare Provider Number
1500 Field Number: 160
UHDDS - Data Element Name: Not a UHDDS data element
Record Positions:
1231-1242
Format - Length:
Effective Date:
1/1/99
Revision Number – Date:
Definition:
X(12)
Unique number assigned to each hospital assigned by CMS
Codes and Values:
Edit Applications:
Edits:
2301 Invalid format for Medicare provider number
2302 Medicare provider number missing
Notes:
Other:
36
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Social Security Number
1500 Field Number: 161
UHDDS - Data Element Name: Social Security Number
Record Positions:
1243-1251
Format - Length:
Effective Date:
1/1/04
Revision Number – Date:
Definition:
9(9)
Unique number assigned to each patient by the Social Security Administration.
Codes and Values:
Nine digits, numeric only.
Edit Applications:
Edits:
3301 Social Security Number is missing.
3302 Social Security Number in invalid format.
Notes:
Other:
Not a public data element. Not released to Vermont Department of Health.
37
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Readmission Flag
1500 Field Number: 166
UHDDS - Data Element Name: Readmission
Record Positions:
1268-1268
Format - Length:
Effective Date:
1/1/01
Definition:
Inpatient readmitted to your hospital within 30 days.
Not Required for Outpatient Data Collection
Codes and Values:
Y=Yes
N=No
U= Unknown
Edit Applications:
Edits:
5101 Readmission flag must be Y, N or U
Revision Number / Date:
X
4 - 3/1/2001
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Uses of data:
Used in studies examining quality of care, especially those analyzing the impact of
managed care on quality. Used to eliminate records from some studies to avoid
counting patients twice.
Other:
38
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Town/County Code
1500 Field Number: 167
UHDDS - Data Element Name: Town/County Code
Record Positions:
1269-1272
Format - Length:
Effective Date:
1/1/99
Revision Number – Date: 2, 7/1/2001
Definition:
9(4)
The four-digit town/county code for the town in which the patient resides.
Codes and Values:
See Attachment D
Edit Applications:
Edits:
5201 Town/County code is missing
5202 Town/County code is invalid
5203 Town/County code is 1700 but zip is not Canadian
VDH Edits:
Frequencies by hospital are compared with previous years and the state as a whole.
Uses of data:
Used with ZIP to determine geographical residence of patient.
Notes:
Must relate to patient’s zip code. (What if they have a PO Box in Burlington, but live
in Winooski?)
Other:
39
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: HCPCS Codes
1500 Field Number: 168-190 (see 1500)
UHDDS - Data Element Name:
HCPCS Codes
Record Positions:
1273-1479
Format - Length:
Effective Date:
1/1/2001
Revision Number – Date: 2, 10/1/2001
Definition:
X (9)
The HCFA Common Procedure Coding System (HCPCS) applicable to the ancillary services
and outpatient bills.
Codes and Values:
Consists of the five-digit HCPCS code and up to two two-digit modifiers
Edit Applications:
Edits:
6301
6302
6303
6502
Invalid HCPCS Code
HCPCS Code required for payer
Invalid HCPCS modifier
HCPCS required for revenue code by Medicare
Uses of Data:
Notes:
Applicable for outpatient records only.
Specific CPT codes should be tied to the appropriate Revenue code to reflect the exact
services provided in that revenue center; e.g., if Revenue code 360 appears on Line 6,
the corresponding CPT code should appear on HCPCS code Line 6.
All HCPCS should be submitted as defined by the Uniform Billing Manual.
Corresponding units and dates of service must accompany HCPCS.
Other:
40
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Patient Type
1500 Field Number: 191
UHDDS - Data Element Name:
Record Positions:
1480-1480
Format - Length:
X (1)
Effective Date:
1/1/2001
Revision Number – Date: 2, 10/1/2002
Definition: Patient type should be based on the primary place of service
Codes and Values:
All records should contain the letter X, A, O, E or Blank
The patient type indicators are as follows: (*See Ranking Logic)
X
for Other
A
for Ambulatory Surgery
O
for Observation
E
for Emergency Room
Blank for Inpatient
Edit Applications:
Edits:
6401 Must contain the letter X, A, O, or E for Outpatient.
6402 Must be blank for Inpatient.
Uses of Data:
Notes:
If at any time during the patient encounter, the patient is admitted as an INPATIENT their patient type should
be blank and their Bill Type should be 111.
Coding Logic for Outpatients
Assigns patient type value based on a precedence ranking order as follows:
1. Since series patients are billed once a month and usually for more than one encounter, this creates a
problem of overstating the data related to these patients in relationship to other single encounter patients.
Because of this problem, series patients that are required to be reported should be submitted using Patient
Type X so they can be separated from the other patient types.
2. If the patient receives ER care: classify as an E - EMERGENCY ROOM PATIENT.
3. If at any time the patient undergoes a procedure, be it principal or secondary, that is coded ICD-9 (CM)
01.00-86.99, classify as an A – AMBULATORY SURGERY.
41
4. If the patient receives observation care with no other higher ranking patient services, classify as an O –
OBSERVATION PATIENT.
42
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Vermont Explor Data Element Name: Payer Sub ID
1500 Field Number: 162, 163, 164
UHDDS - Data Element Name:
Record Positions:
1252-1263
Effective Date:
1/1/2001
Definition:
Additional payer detail.
Codes and Values:
See Attachment A
Edit Applications:
Edits: None
Format - Length:
9(4)
Revision Number – Date:
43
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Certificate/Social Security/Health Insurance Claim/Identification Number
Vermont Explor Data Element Name: HIC Number
1500 Field Number: 64, 146, 151
UHDDS - Data Element Name:
Record Positions:
461-479, 1086-1104, 1165-1183
Format - Length:
X(12)
Effective Date:
1/1/2004
Revision Number – Date:
Definition:
Insured’s unique identification number assigned by Medicare.
Codes and Values:
Medicare will accept up to 12 characters in this field. Assign to Field 64 if Medicare
is the primary payer, to Field 146 if secondary, and to Field 151 if tertiary.
Medicare requirements:
The format for the HIC # is dependent upon the total number of characters. For example, A123456 would be considered 7
characters and would need to meet the format for 7 characters. The most commonly used HIC numbers are 10 characters and the
alpha letter goes in the beginning.
7 characters:
First value must be UPPERCASE alpha character, followed by 6 digits
8 characters:
First 2 values must be UPPERCASE alpha followed by 6 digits
9 characters:
First 3 values must be UPPERCASE alpha followed by 6 digits OR
First 2 values must be UPPERCASE alpha followed by 7 digits
10 characters:
First value must be UPPERCASE alpha followed by 9 digits
OR 9 numeric digits followed by 1 UPPERCASE alpha character
11 characters:
Nine numeric digits followed by one UPPERCASE alpha followed by one digit
OR 9 numeric digits followed by 2 UPPERCASE alpha characters
OR 2 UPPERCASE alpha characters followed by 9 numeric digits
12 characters
First 3 values must be UPPERCASE alpha followed by 9 digits OR
First 2 values must be UPPERCASE alpha followed by 10 digits
Edit Applications:
Edits:
5301 HIC number is missing
5302 HIC number in invalid format
Notes:
Required for JCAHO reporting. Applies only to Vermont Explor members
participating in the QualityWorks program.
44
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Principal Present on Admission Code
1500 Field Number: 192 (see 1500)
UHDDS - Data Element Name: Principle Present on Admission Code
Record Positions:
1481-1481
Format - Length:
X (1)
Effective Date:
11/1/2008
Revision Number – Date:
Definition:
Present on admission is defined as present at the time the order for inpatient
admission occurs -- conditions that develop during an outpatient encounter,
including emergency department, observation, or outpatient surgery, are
considered as present on admission.
Codes and Values:
Y – Yes; present at the time of inpatient admission
N – No; not present at the time of inpatient admission
U – Unknown; documentation is insufficient to determine if condition is present at
time of inpatient admission
W – Clinically undetermined; provider is unable to clinically determine whether
condition was present at time of inpatient admission or not
1 – Unreported/Not used – exempt from POA reporting; this code is the
equivalent of a blank on the UB-04, but blanks are not desirable when
submitting data
Edit Applications:
1301
1302
1303
1304
1305
1306
Present on Admission indicator for Principal Diagnoses is missing
Present on Admission indicator for Principal Diagnoses is not valid
Present on Admission indicator for Other Diagnoses is missing
Present on Admission indicator for Other Diagnoses is not valid
Present on Admission indicator =1 for non-exempt Principal Diagnoses
Present on Admission indicator =1 for non-exempt Other Diagnoses
Uses of Data:
Notes:
Other:
45
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: Other Present on Admission Codes, 1-8
1500 Field Number: 193 - 200 (see 1500)
UHDDS - Data Element Name: Other Present on Admission Codes, 1-8
Record Positions:
1482-1489
Format - Length:
X (1)
Effective Date:
11/1/2008
Revision Number – Date:
Definition:
Present on admission is defined as present at the time the order for inpatient
admission occurs -- conditions that develop during an outpatient encounter,
including emergency department, observation, or outpatient surgery, are
considered as present on admission.
Codes and Values:
Y – Yes; present at the time of inpatient admission
N – No; not present at the time of inpatient admission
U – Unknown; documentation is insufficient to determine if condition is present at
time of inpatient admission
W – Clinically undetermined; provider is unable to clinically determine whether
condition was present at time of inpatient admission or not
1 – Unreported/Not used – exempt from POA reporting; this code is the
equivalent of a blank on the UB-04, but blanks are not desirable when
submitting data
Edit Applications:
1301
1302
1303
1304
1305
1306
Present on Admission indicator for Principal Diagnoses is missing
Present on Admission indicator for Principal Diagnoses is not valid
Present on Admission indicator for Other Diagnoses is missing
Present on Admission indicator for Other Diagnoses is not valid
Present on Admission indicator =1 for non-exempt Principal Diagnoses
Present on Admission indicator =1 for non-exempt Other Diagnoses
Uses of Data:
Notes:
Other:
46
DATA ELEMENT DESCRIPTION
UB04 Data Element Name: E Code Present on Admission Code
1500 Field Number: 201 (see 1500)
UHDDS - Data Element Name: E Code Present on Admission Code
Record Positions:
1490 - 1490
Format - Length:
X (1)
Effective Date:
11/1/2008
Revision Number – Date:
Definition:
Present on admission is defined as present at the time the order for inpatient
admission occurs -- conditions that develop during an outpatient encounter,
including emergency department, observation, or outpatient surgery, are
considered as present on admission.
Codes and Values:
Y – Yes; present at the time of inpatient admission
N – No; not present at the time of inpatient admission
U – Unknown; documentation is insufficient to determine if condition is present at
time of inpatient admission
W – Clinically undetermined; provider is unable to clinically determine whether
condition was present at time of inpatient admission or not
1 – Unreported/Not used – exempt from POA reporting; this code is the
equivalent of a blank on the UB-04, but blanks are not desirable when
submitting data
Edit Applications:
1301
1302
1303
1304
1305
1306
Present on Admission indicator for Principal Diagnoses is missing
Present on Admission indicator for Principal Diagnoses is not valid
Present on Admission indicator for Other Diagnoses is missing
Present on Admission indicator for Other Diagnoses is not valid
Present on Admission indicator =1 for non-exempt Principal Diagnoses
Present on Admission indicator =1 for non-exempt Other Diagnoses
Uses of Data:
Notes:
Other:
47