Texas Administrative Code › Title 25 - HEALTH SERVICES › Part 1 - DEPARTMENT OF STATE HEALTH SERVICES › Chapter 421 - HEALTH CARE INFORMATION › Subchapter D - COLLECTION AND RELEASE OF OUTPATIENT SURGICAL AND RADIOLOGICAL PROCEDURES AT HOSPITALS AND AMBULATORY SURGICAL CENTERS › Section 421.62 - Collection of Hospital Outpatient and Ambulatory Surgical Center Data

Current through Reg. 49, No. 28; July 12, 2024
(a) Each facility in operation for all or any of
											  the reporting periods described in §
										421.63 of this title (relating
											  to Schedule for Filing Event Files) shall submit to DSHS event claims as specified in §
										421.67 of this title
											  (relating to Event Files--Records, Data Fields and Codes) on all patient events in which the patient received
											  one or more of the surgical procedures or radiological services covered by the revenue codes or surgical and
											  radiological categories specified in §
										421.67(f) or
											  (g) of this title. All facilities that are exempt under the Health and
											  Safety Code, Chapter 108, but choose to participate in reporting under this subchapter, shall comply with the
											  requirements in this subchapter. To the extent the medical screening examination, triage, observation,
											  diagnosis or treatment is made by a health professional, other than a physician, data elements specified in
											  §421.67(d)(25) - (30) or (e)(19) of this title shall be filled accordingly or data elements in
											  §421.67(d)(26) or (29) in the modified ANSI 837 Institutional Guide or §421.67(e)(20) in the
											  modified ANSI 837 Professional Guide shall be marked with one of DSHS approved temporary "Physician" or
											  "Other health professional" code numbers and data elements in §421.67(d)(25)(A) - (C) or (28)(A) - (C)
											  in the ANSI 837 Institutional Guide format or §421.67(e)(19)(A) - (C) in the ANSI 837 Professional Guide
											  format may be left blank.
(b) All patient events in which the
											  patient received one or more of the surgical procedures or radiological services covered by the revenue codes
											  or surgical and radiological categories specified in §
										421.67(f)
											  or §
										421.67(g)
											  of this title shall be reported by the facility that prepares one or more bills for patient services.
(1) The facility shall submit an event claim corresponding to each bill
											  containing the data elements required by §
											421.67 of this
											  title. For all patients who received one or more of the surgical procedures or radiological services covered
											  by the revenue codes or surgical and radiological categories specified in §
											421.67(f)
											  or §
											421.67(g)
											  of this title for which the facility does not prepare a bill for patient services, the facility shall submit
											  an event claim containing the required minimum data set.
(2) For
											  all patients that are covered by
											  42 USC §
												290dd-2 and 42 CFR Part 2.1, a hospital or ambulatory surgical center shall
											  submit a discharge claim containing the required data elements specified by §
											421.67 of this
											  title. The hospital or ambulatory surgical center shall replace the patient identifying information with the
											  default values specified in §
											421.67(h)
											  of this title or submit the patient identifying information if release of patient identifying information is
											  authorized in writing by the patient or patient's guardian.