Virginia Administrative Code › Title 12 - HEALTH › Agency 5 - DEPARTMENT OF HEALTH › Chapter 218 - RULES AND REGULATIONS GOVERNING OUTPATIENT HEALTH DATA REPORTING › Section 12VAC5-218-20 - Reporting requirements for outpatient data elements

Current through Register Vol. 40, No. 24, July 15, 2024
Every reporting entity performing outpatient surgical
				  procedures shall submit each patient level data element listed in the table in
				  this section for each patient for which an outpatient surgical procedure is
				  performed and for which the data element is collected on the standard claim
				  form utilized by the reporting entity. Most of these data elements are
				  currently collected from a Uniform Billing Form (UB-04) located in the latest
				  publication of the Uniform Billing Manual prepared by the National Uniform
				  Billing Committee or from the Centers for Medicare and Medicaid (CMS) Health
				  Insurance Claim Form (CMS 1500). The Uniform Billing Form and the Uniform
				  Billing Manual are located on the National Uniform Billing Committee's website
				  at www.nubc.org. The Centers for Medicare and Medicaid Health Insurance Claim
				  Form is available on the CMS website at www.cms.gov. Every reporting entity
				  performing outpatient surgical procedures shall submit in an electronic data
				  format. The nonprofit organization will develop detailed record layouts for use
				  by reporting entities in reporting outpatient surgical data. This detailed
				  record layout will be based upon the type of base electronic or paper-billing
				  form utilized by the reporting entity. Outpatient surgical procedures reported
				  shall be those adopted by the board as referred by the nonprofit organization.
				  The nonprofit organization may recommend changes to the list of procedures to
				  be reported not more than annually.
Data Element Name
Instructions
Hospital Identifier
Hospitals and ambulatory care centers enter the
						  six-digit Medicare provider number, or when adopted by the board, the National
						  Provider Identifier or other number assigned by the board. Physicians, leave
						  blank.
Operating Physician or Oral and Maxillofacial Surgeon
						  Identifier
Enter the nationally assigned physician identification
						  number, either the Uniform Physician Identification Number (UPIN), National
						  Provider Identifier (NPI) or its successor as approved by the board for the
						  physician identified as the operating physician for the principal procedure
						  reported.
Payor Identifier
Enter the board approved payor designation which will be
						  the nationally assigned PAYERID, its successor, or English description of the
						  payor.
Employer Identifier
Enter the federally approved EIN, or employer name,
						  whichever is adopted by the board.
Patient Identifier
Enter the nine-digit social security number of the
						  patient. If a social security number has not been assigned, leave blank. The
						  nine-digit social security number is not required for patients under four years
						  of age.
Patient Sex
Date of Birth
Enter the code in MM/DD/YYYY format.
Street Address
City or County
Zip Code
Employment Status Code
Status at Discharge
Admission Date
Admission/start of care date
Admission Hour
Hour of admission in military time 00-24
Admission Diagnosis
Code sets- ICD 9 or CPT 4 or their successors to be
						  specified in detailed record layouts.
Principal Diagnoses
Code sets- ICD 9 or CPT 4 or their successors to be
						  specified in detailed record layouts.
Secondary Diagnoses
Code sets- ICD 9 or CPT 4 or their successors to be
						  specified in detailed record layouts.
External Cause of Injury
(E-code). Record all external cause of injury codes in
						  secondary diagnoses position after recording all treated secondary diagnoses.
Co-morbid Condition Existing but not Treated
Enter the code for any co-morbid conditions existing but
						  not treated. Code sets- ICD 9 or CPT 4 or their successors to be specified in
						  detailed record layouts.
*
*
Procedures
Code sets- ICD 9 or CPT 4 or their successors to be
						  specified in detailed record layouts.
Procedure Dates
Revenue Center Codes
As specified for UB-04 or its successor completion, not
						  available for CMS 1500 or its successor
Revenue Center Units
Revenue Center Charges
Total Charges
Statutory Authority: §§ 32.1-12 and 32.1-276.6
					 of the Code of Virginia.