Louisiana Administrative Code › Title 48 - PUBLIC HEALTH-GENERAL › Part V - Preventive Health Services › Subpart 53 - State Center for Health Statistics › Chapter 151 - State Health Care Data Clearinghouse › Section V-15125 - Guide-Data Elements

Current through Register Vol. 50, No. 6, June 20, 2024
A. Listed below
				  are required and conditionally required data elements. Submission of any other
				  data elements is optional; hospitals do not need to suppress or strip other
				  elements appearing in their claims files. All elements submitted will be
				  treated confidentially.
1. Required Data
				  Elements. If a hospital is currently or temporarily unable to provide any of
				  the data elements listed here, the hospital must apply for a waiver or
				  extension, as detailed in
				  §15119 of this
				  rule.
Data Element
Form Locator
1300 Record Number
1450
Record Type
Record Number
Patient Control Number· assigned by
								Provider
3
1
20
3
Type of Bill
4
2
40
4
Federal Tax ID (Facility EIN)· with Sub ID
								Number if applicable
5
3165
10
45
Statement Covers Period From
6
4
20
19
Statement Covers Period Thru
6
5
20
20
Patient Name
12
(none)
20
4-6
Patient Address
13
6(zip only)
20
12-16
Patient Date of Birth
14
7
20
8
Patient Sex
15
8
20
7
Admission Date
17
9
20
17
Type of Admission
19
11
20
10
Source of Admission
20
12
20
11
Patient Status at time of discharge
22
13
20
21
Medical/Health Record Number
23
14
20
25
Revenue Codes· Include all listed·
								Must be valid UB92 codes
42
Odd Number's15-59
6050
4, 13, 14, 4, 11, 12, 13
Units of Service· Include all listed
46
Odd Number's 97-141
60
8, 13, 14
Total Charges· Include all listed
47
Even Number's 16-60
6050
97
Payor Classification· Include all
								listed· HCFA Payor ID number preferred
50
156, 157, 158
30
5
Principal Diagnosis Code
67
69
70
4
Other Diagnosis codes· Include all listed
68-75
70-77
70
5-12
Admitting Diagnosis Code
76
78
70
25
External cause of injury code (E-code)·
								Must contain data if possible
77
79
70
26
Principal Procedure Code and Date
80
80-81
70
13-14
Other Procedure Codes and Dates· Include
								all listed
81
82-91
70
15-24
Attending Physician ID· State License
								Number
82
92
80
5
Operating Physician Number· State License
								Number· Required if present
83
93
80
6
Other Physician ID· State License
								Number· Required if present
84
94
80
7-8
Patient Social Security Number
60Only if insured
161
22
5a
Patient Race
none
155
22
7a
*Number of Claims
N/A
N/A
95
6
*Record Type
N/A
N/A
all
1
*Sequence Number
N/A
N/A
21-70, 72, 80-81
2
a. Elements
				  marked with an asterisk are required for submittals of the electronic 1450
				  only; they are included because they are essential to the 1450.
b. The definitions of most data elements
				  referred to in this rule can be found in the Louisiana UB-92 Users Manual
				  referenced in
				  §15109 of this
				  rule. Hospitals using data sources other than uniform billing should evaluate
				  their definitions for agreement with the definitions specified in this Guide
				  and the Louisiana UB-92 Users Manual. The exceptions to referenced definitions
				  are listed below.
i. Patient's Race-this
				  alphanumeric one-character element contains race category information based on
				  self-identification, which is to be obtained from the patient, a relative, or a
				  friend. The hospital should not categorize the patient based on observation or
				  personnel judgment. The patient may choose not to provide the information. If
				  the patient chooses not to answer, the hospital should enter the code for
				  unknown. If the hospital fails to request the information, the field should be
				  space filled. Code as follows: 1=Native American or Alaskan Native: A person
				  having origins in any of the original peoples of North America, and who
				  maintains cultural identification through tribal affiliation or community
				  recognition. 2=Asian or Pacific Islander: A person having origins in any of the
				  peoples of the Far East, South East Asia, the Indian Subcontinent, or the
				  Pacific Islands. This area includes, for example, China, India, Japan, Korea,
				  the Philippine Islands, and Samoa. 3=African American/Black: A person having
				  origins in any of the black racial groups of Africa. 4=Caucasian/White: A
				  person having origins in any of the Caucasian peoples of Europe, North Africa,
				  or the Middle East. 5=Other: Any possible options not covered in the above
				  categories. 6=Unknown: A person who chooses not to answer the question. Blank
				  Space: The hospital made no effort to obtain the information.
ii. Patient Social Security Number-numeric,
				  10-character entry containing the Social Security Number of the patient
				  receiving care. This field is to be right justified with zeroes to the left to
				  complete the field. The format of SSN is 0123456789 without hyphens. If the
				  patient is a newborn, use the mother's SSN. If a patient does not have a social
				  security number fill with zeroes. The field is edited for a valid
				  entry.