CODE TABLES – APPENDIX – MedPAR R2K MEDPAR Beneficiary Age Age is grouped by the following values: 1 = less than 25 2 = 25 – 44 3 = 45 – 64 4 = 65 – 69 5 = 70 – 74 6 = 75 – 79 7 = 80 – 84 8 = 85 – 89 9 = 90 and over The beneficiary's age as of date of admission. BENE_MDCR_STUS_TB CWF Beneficiary Medicare Status Table 10 = Aged without ESRD 11 = Aged with ESRD 20 = Disabled without ESRD 21 = Disabled with ESRD 31 = ESRD only BENE_RACE_TB Beneficiary Race Table 0 = Unknown 1 = White 2 = Black 3 = Other 4 = Asian 5 = Hispanic 6 = North American Native BENE_SEX_IDENT_TB Beneficiary Sex Identification Table 1 = Male 2 = Female 0 = Unknown CLM_ADMTG_DGNS_VRSN_TB Claim Admitting Diagnosis Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_CARE_IMPRVMT_MODEL_TB Claim Care Improvement Model Table 61 = CLAIM CARE IMPROVEMENT MODEL 1 62 = CLAIM CARE IMPROVEMENT MODEL 2 63 = CLAIM CARE IMPROVEMENT MODEL 3 64 = CLAIM CARE IMPROVEMENT MODEL 4 CLM_DGNS_VRSN_TB Claim Diagnosis Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_HRR_PRTCPNT_IND_TB Claim HRR Participant Indicator Code Table 0 = Not participating 1 = Participating and not equal to 1.0000 2 = Participating and equal to 1.0000 CLM_PRCDR_VRSN_TB Claim Procedure Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_PTNT_RLTNSHP_TB Claim Patient Relationship Table 01 = Spouse 04 = Grandparent 05 = Grandchild 07 = Niece/Nephew 10 = Foster child 15 = Ward of the court 17 = Step child 18 = Patient is insured 19 = Natural child/insured financial responsibility 20 = Employee 21 = Unknown 22 = Handicapped dependent 23 = Sponsored dependent 24 = Minor dependent of a minor dependent 32 = Mother 33 = Father 39 = Organ donor 40 = Cadaver donor 41 = Injured plaintiff 43 = Natural child/insured does not have financial responsibility CLM_SRC_IP_ADMSN_TB Claim Source Of Inpatient Admission Table **For Inpatient/SNF Claims:** 0 = ANOMALY: invalid value, if present, translate to '9' 1 = Non-Health Care Facility Point of Origin (Physician Referral) – The patient was admitted to this facility upon an order of a physician. 2 = Clinic referral – The patient was admitted upon the recommendation of this facility's clinic physician. 3 = HMO referral – Reserved for national assignment. (eff. 3/08) Prior to 3/08, HMO referral – The patient was admitted upon the recommendation of an health maintenance organization (HMO) physician. 4 = Transfer from hospital (Different Facility) – The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient. 5 = Transfer from a skilled nursing facility (SNF) or Intermediate Care Facility (ICF) – The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident. 6 = Transfer from another health care facility – The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list where he or she was an inpatient. 7 = Emergency room – The patient was admitted to this facility after receiving services in this facility's emergency room department. Obsolete – eff. 7/1/10 8 = Court/law enforcement – The patient was admitted upon the direction of a court of law or upon the request of a law enforcement agency's representative. Includes transfers from incarceration facilities. 9 = Information not available – The means by which the patient was admitted is not known. A = Reserved for National Assignment. (eff. 3/08) Prior to 3/08 defined as: Transfer from a Critical Access Hospital – patient was admitted/referred to this facility as a transfer from a Critical Access Hospital. B = Transfer from Another Home Health Agency – The patient was admitted to this home health agency as a transfer from another home health agency.(Discontinued July 1,2010- See Condition Code 47) C = Readmission to Same Home Health Agency – The patient was readmitted to this home health agency within the same home health episode period. (Discontinued July 1,2010) D = Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer – The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer. E = Transfer from Ambulatory Surgery Center – The patient was admitted to this facility as a transfer from an ambulatory surgery center. (eff. 10/1/2007) F = Transfer from Hospice and is under a Hospice Plan of Care or Enrolled in a Hospice Program – The patient was admitted to this facility as a transfer from a hospice. (eff. 10/1/2007) ————————————— **For Newborn Type of Admission** 1 = Normal delivery – A baby delivered with out complications. Obsolete eff. 10/1/07 2 = Premature delivery – A baby delivered with time and/or weight factors qualifying it for premature status. Obsolete eff. 10/1/07 3 = Sick baby – A baby delivered with medical complications, other than those relating to premature status. Obsolete eff. 10/1/07 4 = Extramural birth – A baby delivered in a nonsterile environment. Obsolete eff. 10/1/07 5 = Born Inside this Hospital – eff. 10/1/07 6 = Born Outside of this Hospital – eff. 10/1/07 7-9 = Reserved for national assignment. CLM_VBP_PRTCPNT_IND_TB Claim VBP Participant Indicator Table Y = Participating in Hospital Value Based Purchasing N = Not participating in Hospital Value Based Purchasing Blank = same as 'N' CTGRY_EQTBL_BENE_IDENT_TB Category Equatable Beneficiary Identification Code (BIC) Table NCH BIC SSA Categories ——- ————– A = A;J1;J2;J3;J4;M;M1;T;TA B = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6; TB(F);TD(F);TE(F);TW(F) B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M) TD(M);TE(M);TW(M) B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2 W7;TG(F);TL(F);TR(F);TX(F) B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M) TL(M);TR(M);TX(M) B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4 W8;TH(F);TM(F);TS(F);TY(F) BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9 WC;TJ(F);TN(F);TT(F);TZ(F) BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF WJ;TK(F);TP(F);TU(F);TV(F) BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M) TY(M) BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M) TZ(M) BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M) TV(M) C1 = C1;TC C2 = C2;T2 C3 = C3;T3 C4 = C4;T4 C5 = C5;T5 C6 = C6;T6 C7 = C7;T7 C8 = C8;T8 C9 = C9;T9 F1 = F1;TF F2 = F2;TQ F3-F8 = Equatable only to itself (e.g., F3 IS equatable to F3) CA-CZ = Equatable only to itself. (e.g., CA is only equatable to CA) ————————————— RRB Categories 10 = 10 11 = 11 13 = 13;17 14 = 14;16 15 = 15 43 = 43 45 = 45 46 = 46 80 = 80 83 = 83 84 = 84;86 85 = 85 GEO_SSA_STATE_TB State Table 01 = Alabama 02 = Alaska 03 = Arizona 04 = Arkansas 05 = California 06 = Colorado 07 = Connecticut 08 = Delaware 09 = District of Columbia 10 = Florida 11 = Georgia 12 = Hawaii 13 = Idaho 14 = Illinois 15 = Indiana 16 = Iowa 17 = Kansas 18 = Kentucky 19 = Louisiana 20 = Maine 21 = Maryland 22 = Massachusetts 23 = Michigan 24 = Minnesota 25 = Mississippi 26 = Missouri 27 = Montana 28 = Nebraska 29 = Nevada 30 = New Hampshire 31 = New Jersey 32 = New Mexico 33 = New York 34 = North Carolina 35 = North Dakota 36 = Ohio 37 = Oklahoma 38 = Oregon 39 = Pennsylvania 40 = Puerto Rico 41 = Rhode Island 42 = South Carolina 43 = South Dakota 44 = Tennessee 45 = Texas 46 = Utah 47 = Vermont 48 = Virgin Islands 49 = Virginia 50 = Washington 51 = West Virginia 52 = Wisconsin 53 = Wyoming 54 = Africa 55 = California 56 = Canada & Islands 57 = Central America and West Indies 58 = Europe 59 = Mexico 60 = Oceania 61 = Philippines 62 = South America 63 = U.S. Possessions 64 = American Samoa 65 = Guam 66 = Commonwealth of the Northern Marianas Islands 67 = Texas 68 = Florida (eff. 10/2005) 69 = Florida (eff. 10/2005) 70 = Kansas (eff. 10/2005) 71 = Louisiana (eff. 10/2005) 72 = Ohio (eff. 10/2005) 73 = Pennsylvania (eff. 10/2005) 74 = Texas (eff. 10/2005) 80 = Maryland (eff. 8/2000) 97 = Northern Marianas 98 = Guam 99 = With 000 county code is American Samoa; otherwise unknown A0 = California (eff. 4/2019) A1 = California (eff. 4/2019) A2 = Florida (eff. 4/2019) A3 = Louisianna (eff. 4/2019) A4 = Michigan (eff. 4/2019) A5 = Mississippi (eff. 4/2019) A6 = Ohio (eff. 4/2019) A7 = Pennsylvania (eff. 4/2019) A8 = Tennessee (eff. 4/2019) A9 = Texas (eff. 4/2019) B0 = Kentucky (eff. 4/2020) B1 = West Virginia (eff. 4/2020) B2 = California (eff. 4/2020) MEDPAR_ADMSN_DAY_TB MEDPAR Admission Day Code Table 1 = Sunday 2 = Monday 3 = Tuesday 4 = Wednesday 5 = Thursday 6 = Friday 7 = Saturday MEDPAR_BENE_DEATH_DT_VRFY_TB MEDPAR Beneficiary Death Date Verified Code Table V = Date of death verified (EDB received DOD from SSA's MBR) B = Date of death taken from claim (EDB received DOD from claim) N = Date of death not verified (neither V or B applicable, but claim status code indicated death) Space = No date of death indicated MEDPAR_BENE_DSCHRG_STUS_TB MEDPAR Beneficiary Discharge Status Code Table A = Discharged alive (claim status code other than 20 or 30) B = Discharged dead C = Still a patient MEDPAR_BENE_PRMRY_PYR_TB MEDPAR Beneficiary Primary Payer Code Table A = Working aged bene/spouse with eghp B = ESRD bene in 18-month coordination period with eghp C = Conditional Medicare payment; future reimbursement expected D = Auto no-fault or any liability insurance E = Worker's compensation F = Phs or other federal agency (other than dept of veterans affairs) G = Working disabled H = Black lung I = Dept of veterans affairs J = Any liability insurance Z/BLANK = Medicare is primary payer MEDPAR_CRED_RCVD_RPLCD_DVC_TB MEDPAR Credit Received from Manufacturer for Replaced Medical Device Switch Table Y = The claim involved a credit from the device manufacturer for a Replaced Medical Device. N = The claim did not involve a credit from the device manufacturer for a Replaced Medical Device. MEDPAR_CRNRY_CARE_IND_TB MEDPAR Coronary Care Indicator Code Table BLANK = No coronary care indication 0 = General (revenue code 0210) 1 = Myocardial (revenue code 0211) 2 = Pulmonary care (revenue code 0212) 3 = Heart transplant (revenue code 0213) 4 = Intermediate CCU (revenue code 0214) MEDPAR_ESRD_COND_TB MEDPAR ESRD Condition Code Table 00 = No ESRD Condition Codes 70 = Self-Administered Epo 71 = Full Care In Unit 72 = Self-Care In Unit 73 = Self-Care Training 74 = Home Dialysis 75 = Home Dialysis/100% Reimbursement 76 = Backup-In-Facility Dialysis MEDPAR_ESRD_SETG_IND_TB MEDPAR ESRD Setting Indicator Code Table 00 = Ip renal dialysis-general (revenue code 0800) 01 = Ip renal dialysis-hemodialysis (revenue code 0801) 02 = Ip renal dialysis-peritoneal (non-capd: revenue code 0802) 03 = Ip renal dialysis-capd (revenue code 0803) 04 = Ip renal dialysis-ccpd (revenue code 0804) 09 = Ip renal dialysis-other (revenue code 0809) 20 = Hemodialysis-op-general (revenue code 0820) 21 = Hemodialysis-op-hemodialysis/composite (revenue code 0821) 22 = Hemodialysis-op-home supplies (revenue code 0822) 23 = Hemodialysis-op-home equipment (revenue code 0823) 24 = Hemodialysis-op-maintenance/100% (revenue code 0824) 25 = Hemodialysis-op-support services (revenue code 0825) 29 = Hemodialysis-op-other (revenue code 0829) 30 = Peritoneal-op/home-general (revenue code 0830) 31 = Peritoneal-op/home-peritoneal/composite (revenue 32 = Peritoneal-op/home-home supplies (revenue code 0832) 33 = Peritoneal-op/home-home equipment (revenue code 0833) 34 = Peritoneal-op/home-maintenance/100% (revenue code 0834) 35 = Peritoneal-op/home-support services (revenue code 0835) 39 = Peritoneal-op/home-other (revenue code 0839) 40 = Capd-op-capd/general (revenue code 0840) 41 = Capd-op-capd/composite (revenue code 0841) 42 = Capd-op-home supplies (revenue code 0842) 43 = Capd-op-home equipment (revenue code 0843) 44 = Capd-op-maintenance/100% (revenue code 0844) 45 = Capd-op-support services (revenue code 0845) 49 = Capd-op-other (revenue code 0849) 50 = Ccpd-op-ccpd/general (revenue code 0850) 51 = Ccpd-op-ccpd/composite (revenue code 0851) 52 = Ccpd-op-home supplies (revenue code 0852) 53 = Ccpd-op-home equipment (revenue code 0853) 54 = Ccpd-op-maintenance/100% (revenue code 0854) 55 = Ccpd-op-support services (revenue code 0855) 59 = Ccpd-op-other (revenue code 0859) 80 = Miscellaneous dialysis-general (revenue code 0880) 81 = Miscellaneous dialysis-ultrafiltration (revenue code 0881) 89 = Miscellaneous dialysis-other (revenue code 0889) BLANK = No ESRD setting indication MEDPAR_GHO_PD_TB MEDPAR GHO Paid Code Table 1 = GHO has paid the provider Blank Or 0 = GHO has not paid the provider MEDPAR_ICU_IND_TB MEDPAR Intensive Care Unit (ICU) Indicator Code Table 0 = General (revenue center 0200) 1 = Surgical (revenue center 0201) 2 = Medical (revenue center 0202) 3 = Pediatric (revenue center 0203) 4 = Psychiatric (revenue center 0204) MEDPAR_INFRMTL_ENCTR_IND_TB MEDPAR Informational Encounter Indicator Code Table Y = Beneficiary enrolled in MCO N = Beneficiary not enrolled in MCO MEDPAR_MA_TCHNG_IND_TB MEDPAR MA Teaching Indicator Code Table Y = Claim includes request for supplemental IME/DGME/N&AH payment. N = Claim does not include request for supplemental IME/DGME/N&AH payment. MEDPAR_OBSRVTN_TB MEDPAR Observation Switch Table Y = The claim involved treatment or observation in an observation room. N = The claim did not involve treatment or observation in an observation room. MEDPAR_OP_SRVC_IND_TB MEDPAR Outpatient Services Indicator Code Table 0 = No outpatient services/ambulatory surgical care (revenue code other than 049X, 050X) 1 = Outpatient services (revenue code 050X) 2 = Ambulatory surgical care (revenue code 049X) 3 = Outpatient services and ambulatory surgical care (revenue codes 049X and 050X) MEDPAR_ORGN_ACQSTN_IND_TB MEDPAR Organ Acquisition Indicator Code Table K1 = General classification (revenue code 0810) K2 = Living donor kidney (revenue code 0811) K3 = Cadaver donor kidney (revenue code 0812) K4 = Unknown donor kidney (revenue code 0813) K5 = Other kidney acquisition (revenue code 0814) H1 = Cadaver donor heart (revenue code 0815) H2 = Other heart acquisition (revenue code 0816) L1 = Donor liver (revenue code 0817) 01 = Other organ acquisition (revenue code 0819) 02 = General acquisition (revenue code 0890) B1 = Bone donor bank (revenue code 0891) 03 = Organ donor bank other than kidney (revenue code 0892) S1 = Skin donor bank (revenue code 0893) 04 = Other donor bank (revenue code 0899) BLANK = No organ acquisition indication MEDPAR_PHRMCY_IND_TB MEDPAR Pharmacy Indicator Code Table 0 = No drugs (revenue code other than those listed below) 1 = General drugs and/pr IV therapy (revenue code 025x, 026x) 2 = Erythropoietin (epoetin: revenue code 0630, 0635, 0637, 0639) 3 = Blood clotting drugs (revenue code 0636) 4 = General drugs and/or IV therapy; and epoetin (combination of values 1 and 2) 5 = General drugs and/or IV therapy; and blood clotting drugs (combination of values 1 and 3) MEDPAR_PPS_IND_TB MEDPAR PPS Indicator Code Table 0 = Non PPS 2 = PPS MEDPAR_PROD_RPLCMT_LIFECYC_TB MEDPAR Product Replacement within Lifecycle Switch Y = Claim involves the replacement of a product earlier than scheduled due to apparent malfunction. N = Claim does not involve the replacement of a product earlier than scheduled due to apparent malfunction. MEDPAR_PROD_RPLCMT_RCLL_TB MEDPAR Product Replacement for known Recall Switch Table Y = Claim involves the replacement of a product due to a recall of the product by the manufacturer or by the FDA. N = Claim does not involve the replacement of a product due to a recall of the product by the manufacturer or by the FDA. MEDPAR_PRVDR_NUM_SPCL_UNIT_TB MEDPAR Provider Number Special Unit Code M = PPS-exempt psychiatric unit in CAH R = PPS-exempt rehabilitation unit in CAH S = PPS-exempt psychiatric unit T = PPS-exempt rehabilitation unit U = Swing-bed short-term/acute care hospital W = Swing-bed long-term hospital Y = Swing-bed rehabilitation hospital Z = Swing-bed rural primary care hospital; eff 10/97 changed to critical access hospitals Blanks = Not PPS-exempt or swing-bed designation MEDPAR_RDLGY_CT_SCAN_IND_TB MEDPAR Radiology CT Scan Indicator Code Table 0 = No radiology CT scan (revenue code not 035X) 1 = Yes radiology CT scan (revenue code 035X) MEDPAR_RDLGY_DGNSTC_IND_TB MEDPAR Radiology Diagnostic Indicator Code Table 0 = No radiology-diagnostic (revenue code not 032x) 1 = Yes radiology-diagnostic (revenue code 032x) MEDPAR_RDLGY_NUCLR_MDCN_IND_TB MEDPAR Radiology Nuclear Medicine Indicator Code Table 0 = No nuclear medicine (revenue code not 034x) 1 = Yes nuclear medicine (revenue code 034x) MEDPAR_RDLGY_ONCLGY_IND_TB MEDPAR Radiology Oncology Indicator Code Table 0 = No radiology-oncology (revenue code not 028x) 1 = Yes radiology-oncology (revenue code 028x) MEDPAR_RDLGY_OTHR_IMGNG_IND_TB MEDPAR Radiology Other Imaging Indicator Code Table 0 = No other imaging services (revenue code not 040x) 1 = Yes other imaging services (revenue code 040x) MEDPAR_RDLGY_THRPTC_IND_TB MEDPAR Radiology Therapeutic Indicator Code Table 0 = No radiology-therapeutic (revenue code not 033X) 1 = Yes radiology-therapeutic (revenue code 033X) MEDPAR_SRGCL_PRCDR_IND_TB MEDPAR Surgical Procedure Indicator Code Table 0 = No surgery indicated 1 = Yes surgery indicated MEDPAR_SS_LS_SNF_IND_TB MEDPAR Short Stay/Long Stay/SNF Indicator Code Table N = SNF Stay (Prvdr3 = 5, 6, U, W, Y, or Z) S = Short-Stay (Prvdr3 = 0, M, R, S, T) L = Long-Stay (All Others) MEDPAR_TRNSPLNT_IND_TB MEDPAR Transplant Indicator Code Table 0 = No organ or kidney transplant (revenue code not 0362 or 0367) 2 = Organ transplant other than kidney (revenue code 0362) 7 = Kidney transplant (revenue code 0367) MEDPAR_WRNG_IND_TB MEDPAR Warning Indicators Code Table Warning indicator 1 ('adjustment indicator' derived from the presence of query code values noted below on any of the claim records included in the analysis): 0 = No adjustment (no query code = 0 or 5) 1 = Credit adjustment (query code = 0) 2 = Debit adjustment (query code = 5) 3 = Credit and debit adjustment (both query code = 0 and 5) Warning indicator 2 ('error condition' derived from checking the edit code trailer on the final action claims(s) that comprise the stay): 0 = No error 1 = Error condition Warning indicator 3 ('reimbursement/total charge indicator' derived after summing up fields on the final action claim(s) that comprise the stay; checks resulting Medicare payment amount (commonly called reimbursement), total charge amount, as well as beneificiary primary payer amount and utilization day count): 0 = Medicare payment amount and total charge amount > zeroes 1 = Medicare payment amount and total charge amount < zeroes 2 = Medicare payment amount is a credit 3 = Total charge amount is a credit 4 = Medicare payment amount, total charge amount, beneficiary primary payer claim payment amount, and utilization day count = zeroes Warning indicator 4 ('utilization day/los day indicator' derived after summing up fields on the final action claim(s) that comprise the stay; compares resulting utilization day count and length-of-stay count): 0 = Utilization day count = los day count 1 = Utilization day count < los day count 2 = Utilization day count > los day count warning indicator 5 ('single/multiple claim indicator' derived when the stay record is created by checking the number of final action claims that comprise the stay): 0 = Stay includes a single final action claim 1 = Stay includes multiple final action claims 2 = Stay includes multiple final action claims and beneficiary is still a patient (applicable to SNF stays only) Warning indicator 6 ('intermediary cancel indicator' derived from the presence of the values noted below for intermediary claim action code and intermediary- requested claim cancel reason code on any of the claims included in the analysis. If multiple claims contain these values, latest claim is used. If both specified action code and cancel reason code are present, cancel reason code takes priority.): 0 = No cancel action 1 = Cancel action by credit adjustment (action code = (2 or 6) 2 = Cancel action only (action code = 4) 3 = Coverage transfer (cancel reason code = C) 4 = Plan transfer (cancel reason code = P) 5 = Scramble (cancel reason code = S) 6 = Duplicate billing (cancel reason code = D) 7 = Other (cancel reason code = H) 8 = Combining 2 spells or 2 beneficiary records (cancel reason code = L) Warning indicator 7 ('state/county numeric indicator' derived from checking the format of the beneficiary residence SSA state code and beneficiary residence county code on the final action claim(s) that comprise the stay; determine if in numeric range): 0 = State and county codes are valid numeric values 1 = State and county codes are not in numeric range 2 = State code is not in numeric range 3 = County code is not in numeric range Warning indicator 8 ('duplicate indicator' derived from the presence of two claim records with the same claim number, admission date, provider number, claim from/ thru date, HCFA process date and query code; death/ admission date indicator derived by comparing the admission date on the final claim(s) that comprise the stay to the beneficiary death date): 0 = Do duplicate record 1 = Duplicate record 2 = Death date < admission date 3 = Death date < admission date and duplicate record Warning indicator 9 ('pass-thru indicator' derived from the presence of a pass thru per diem amount on the final action claim(s) that comprise the stay): 0 = No pass thru per diem present (Non-PPS) 1 = Pass thru per diem present on final action claim Warning indicator 10 (eff 3/96 update) (rugs indicator applicable to 'nhcmq rugs III SNF demo' stay records derived from the presence of 9,000 series revenue center codes.) 0 = No rugs 9,000 series revenue center codes 2 = Rugs 9,000 series revenue center code(s) with service date 1/1/96 or later 3 = Rugs 9,000 series revenue center code(s) with service date 7/1/96 or later 4 = Rugs 9,000 series revenue center code(s) with service date 1/1/97 or later Warning indicators 11 - 17 (not yet assigned; zeroes will be present) NCH_CLM_TYPE_TB NCH Claim Type Table 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient 'Full-Encounter' claim 62 = Medicare Advantage IME/GME Claims 63 = Medicare Advantage (no-pay) claims 64 = Medicare Advantage (paid as FFS) claims 71 = RIC O local carrier non-DMEPOS claim 72 = RIC O local carrier DMEPOS claim 81 = RIC M DMERC non-DMEPOS claim 82 = RIC M DMERC DMEPOS claim NOTE: In the data element NCH_CLM_TYPE_CD (derivation rules) the numbers for these claim types need to be changed - dictionary reflects 61 for all three. NG_ACO_IND_TB Next Generation (NG) Accountable Care Organization (ACO) Indicator Code Table 0 = Base record (no enhancements) 1 = Population Based Payments (PBP) 2 = Telehealth 3 = Post Discharge Home Health Visits 4 = 3-Day SNF Waiver 5 = Capitation 6 = CEC Telehealth 7 = Care Management Home Visits PTNT_DSCHRG_STUS_TB Patient Discharge Status Table 01 = Discharged to home/self care (routine charge). 02 = Discharged/transferred to other short term general hospital for inpatient care. 03 = Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care -- (For hospitals with an approved swing bed arrangement, use Code 61 - swing bed. For reporting discharges/ transfers to a non-certified SNF, the hospital must use Code 04 - ICF. 04 = Discharged/transferred to a facility that provides custodial or supportive care (includes intermediate care facilities (ICF). Also used to designate patients that are dischared/trans- ferred to a nursing facility with neither Medicare nor Medicaid certification and for discharges/transfers to Assisted Living Facilities. 05 = Discharged/transferred to a designated cancer center or children's hospital (eff. 10/09). Prior to 10/1/09, discharged/transferred to another type of institution for inpatient care (including distinct parts). NOTE: Effective 1/2005, psychiatric hospital or psychiatric distinct part unit of a hospital will no longer be identified by this code. New code is '65'. 06 = Discharged/transferred to home care of organized home health service organization in anticipation of covered skilled care. 07 = Left against medical advice or discontinued care. 08 = Discharged/transferred to home under care of a home IV drug therapy provider. (discontinued effective 10/1/05) 09 = Admitted as an inpatient to this hospital (effective 3/1/91). In situa- tions where a patient is admitted before midnight of the third day following the day of an outpatient service, the out- patient services are considered inpatient. 20 = Expired 21 = Discharged/transferred to Court/Law Enforcement. 30 = Still patient. 40 = Expired at home (Hospice claims only). 41 = Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only) 42 = Expired - place unknown (Hospice claims only) 43 = Discharged/transferred to a federal hospital (eff. 10/1/03). Discharges and transfers to a government operated health facility such as a Department of Defense hospital, a Veteran's Administration hospital or a Veteran's Administration nursing facility. To be used whenever the destination at discharge is a federal health care facility, whether the patient lives there or not. 50 = Hospice - home (eff. 10/96) 51 = Hospice - medical facility (certified) providing hospice level of care 61 = Discharged/transferred within this insti- tution to a hospital-based Medicare approved swing bed (eff. 9/01) 62 = Discharged/transferred to an inpatient rehabilitation facility including distinct parts units of a hospital. (eff. 1/2002) 63 = Discharged/transferred to a Medicare certified long term care hospital. (eff. 1/2002) 64 = Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare (eff. 10/2002) 65 = Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital (these types of hospitals were pulled from patient/discharge status code '05' and given their own code). (eff. 1/2005). 66 = Discharged/transferred to a Critical Access Hospital (CAH) (eff. 1/1/06) 69 = Discharge/transfers to a Designated Disaster Alternative Care site (eff. 10/2013) 70 = Discharged/transferred to another type of health care institution not defined elsewhere in code list. 71 = Discharged/transferred/referred to another institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05) 72 = Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05) 81 = Discharged to home or self-care with a planned acute care hospital inpatient (eff. 10/2013) 82 = Discharged/transferred to a short term general hospital for inpatient care readmission (eff. 10/2013) 83 = Discharged/transferred to a skilled nursing facility (SNF) with Medicare (eff. 10/2013) 84 = Discharged/transferred to a facility that provides custodial supportative care with a planned acute care hospital inpatient readmission certification with a planned acute care hospital inpatient readmission (eff. 10/2013) 85 = Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 86 = Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (eff. 10/2013) 87 = Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (eff. 10/2013) 88 = Discharged/transferred to a Federal health care facility with a planned acute care hospital inpatient readmission (eff. 10/2013) 89 = Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hosptial inpatient readmission (eff. 10/2013) 90 = Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct units of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 91 = Discharged/transferred to a Medicare certified Long Term Care Hospital (LTCH) with a planned acute care hospital inpatient readmission (eff. 10/2013) 92 = Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (eff. 10/2013) 93 = Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 94 = Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission (eff. 10/2013) 95 = Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission. (eff. 10/2013) RP_IND_TB Claim Representative Payee (RP) Indicator Code Table R = bypass representative payee Space RSDL_PMT_IND_TB Claim Residual Payment Indicator Code Table X = Residual Payment Space QUERY: RIFQQ11, RIFQQ21 ON DB2T *******END OF TOC APPENDIX FOR RECORD: MEDPAR_2000_REC********1 TABLE OF CODES APPENDIX FOR RECORD: MEDPAR_2000_REC, STATUS: PROD, VERSION: 20021 PRINTED: 03/06/2020, USER: F43D, DATA SOURCE: CA REPOSITORY ON DB2T BENE_IDENT_TB Beneficiary Identification Code (BIC) Table Social Security Administration: A = Primary claimant B = Aged wife, age 62 or over (1st claimant) B1 = Aged husband, age 62 or over (1st claimant) B2 = Young wife, with a child in her care (1st claimant) B3 = Aged wife (2nd claimant) B4 = Aged husband (2nd claimant) B5 = Young wife (2nd claimant) B6 = Divorced wife, age 62 or over (1st claimant) B7 = Young wife (3rd claimant) B8 = Aged wife (3rd claimant) B9 = Divorced wife (2nd claimant) BA = Aged wife (4th claimant) BD = Aged wife (5th claimant) BG = Aged husband (3rd claimant) BH = Aged husband (4th claimant) BJ = Aged husband (5th claimant) BK = Young wife (4th claimant) BL = Young wife (5th claimant) BN = Divorced wife (3rd claimant) BP = Divorced wife (4th claimant) BQ = Divorced wife (5th claimant) BR = Divorced husband (1st claimant) BT = Divorced husband (2nd claimant) BW = Young husband (2nd claimant) BY = Young husband (1st claimant) C1-C9,CA-CZ = Child (includes minor, student or disabled child) D = Aged widow, 60 or over (1st claimant) D1 = Aged widower, age 60 or over (1st claimant) D2 = Aged widow (2nd claimant) D3 = Aged widower (2nd claimant) D4 = Widow (remarried after attainment of age 60) (1st claimant) D5 = Widower (remarried after attainment of age 60) (1st claimant) D6 = Surviving divorced wife, age 60 or over (1st claimant) D7 = Surviving divorced wife (2nd claimant) D8 = Aged widow (3rd claimant) D9 = Remarried widow (2nd claimant) DA = Remarried widow (3rd claimant) DD = Aged widow (4th claimant) DG = Aged widow (5th claimant) DH = Aged widower (3rd claimant) DJ = Aged widower (4th claimant) DK = Aged widower (5th claimant) DL = Remarried widow (4th claimant) DM = Surviving divorced husband (2nd claimant) DN = Remarried widow (5th claimant) DP = Remarried widower (2nd claimant) DQ = Remarried widower (3rd claimant) DR = Remarried widower (4th claimant) DS = Surviving divorced husband (3rd claimant) DT = Remarried widower (5th claimant) DV = Surviving divorced wife (3rd claimant) DW = Surviving divorced wife (4th claimant) DX = Surviving divorced husband (4th claimant) DY = Surviving divorced wife (5th claimant) DZ = Surviving divorced husband (5th claimant) E = Mother (widow) (1st claimant) E1 = Surviving divorced mother (1st claimant) E2 = Mother (widow) (2nd claimant) E3 = Surviving divorced mother (2nd claimant) E4 = Father (widower) (1st claimant) E5 = Surviving divorced father (widower) (1st claimant) E6 = Father (widower) (2nd claimant) E7 = Mother (widow) (3rd claimant) E8 = Mother (widow) (4th claimant) E9 = Surviving divorced father (widower) (2nd claimant) EA = Mother (widow) (5th claimant) EB = Surviving divorced mother (3rd claimant) EC = Surviving divorced mother (4th claimant) ED = Surviving divorced mother (5th claimant EF = Father (widower) (3rd claimant) EG = Father (widower) (4th claimant) EH = Father (widower) (5th claimant) EJ = Surviving divorced father (3rd claimant) EK = Surviving divorced father (4th claimant) EM = Surviving divorced father (5th claimant) F1 = Father F2 = Mother F3 = Stepfather F4 = Stepmother F5 = Adopting father F6 = Adopting mother F7 = Second alleged father F8 = Second alleged mother J1 = Primary prouty entitled to HIB (less than 3 Q.C.) (general fund) J2 = Primary prouty entitled to HIB (over 2 Q.C.) (RSI trust fund) J3 = Primary prouty not entitled to HIB (less than 3 Q.C.) (general fund) J4 = Primary prouty not entitled to HIB (over 2 Q.C.) (RSI trust fund) K1 = Prouty wife entitled to HIB (less than 3 Q.C.) (general fund) (1st claimant) K2 = Prouty wife entitled to HIB (over 2 Q.C.) (RSI trust fund) (1st claimant) K3 = Prouty wife not entitled to HIB (less than 3 Q.C.) (general fund) (1st claimant) K4 = Prouty wife not entitled to HIB (over 2 Q.C.) (RSI trust fund) (1st claimant) K5 = Prouty wife entitled to HIB (less than 3 Q.C.) (general fund) (2nd claimant) K6 = Prouty wife entitled to HIB (over 2 Q.C.) (RSI trust fund) (2nd claimant) K7 = Prouty wife not entitled to HIB (less than 3 Q.C.) (general fund) (2nd claimant) K8 = Prouty wife not entitled to HIB (over 2 Q.C.) (RSI trust fund) (2nd claimant) K9 = Prouty wife entitled to HIB (less than 3 Q.C.) (general fund) (3rd claimant) KA = Prouty wife entitled to HIB (over 2 Q.C.) (RSI trust fund) (3rd claimant) KB = Prouty wife not entitled to HIB (less than 3 Q.C.) (general fund) (3rd claimant) KC = Prouty wife not entitled to HIB (over 2 Q.C.) (RSI trust fund) (3rd claimant) KD = Prouty wife entitled to HIB (less than 3 Q.C.) (general fund) (4th claimant) KE = Prouty wife entitled to HIB (over 2 Q.C (4th claimant) KF = Prouty wife not entitled to HIB (less than 3 Q.C.)(4th claimant) KG = Prouty wife not entitled to HIB (over 2 Q.C.)(4th claimant) KH = Prouty wife entitled to HIB (less than 3 Q.C.)(5th claimant) KJ = Prouty wife entitled to HIB (over 2 Q.C.) (5th claimant) KL = Prouty wife not entitled to HIB (less than 3 Q.C.)(5th claimant) KM = Prouty wife not entitled to HIB (over 2 Q.C.) (5th claimant) M = Uninsured-not qualified for deemed HIB M1 = Uninsured-qualified but refused HIB T = Uninsured-entitled to HIB under deemed or renal provisions TA = MQGE (primary claimant) TB = MQGE aged spouse (first claimant) TC = MQGE disabled adult child (first claimant) TD = MQGE aged widow(er) (first claimant) TE = MQGE young widow(er) (first claimant) TF = MQGE parent (male) TG = MQGE aged spouse (second claimant) TH = MQGE aged spouse (third claimant) TJ = MQGE aged spouse (fourth claimant) TK = MQGE aged spouse (fifth claimant) TL = MQGE aged widow(er) (second claimant) TM = MQGE aged widow(er) (third claimant) TN = MQGE aged widow(er) (fourth claimant) TP = MQGE aged widow(er) (fifth claimant) TQ = MQGE parent (female) TR = MQGE young widow(er) (second claimant) TS = MQGE young widow(er) (third claimant) TT = MQGE young widow(er) (fourth claimant) TU = MQGE young widow(er) (fifth claimant) TV = MQGE disabled widow(er) fifth claimant TW = MQGE disabled widow(er) first claimant TX = MQGE disabled widow(er) second claimant TY = MQGE disabled widow(er) third claimant TZ = MQGE disabled widow(er) fourth claimant T2-T9 = Disabled child (second to ninth claimant) W = Disabled widow, age 50 or over (1st claimant) W1 = Disabled widower, age 50 or over (1st claimant) W2 = Disabled widow (2nd claimant) W3 = Disabled widower (2nd claimant) W4 = Disabled widow (3rd claimant) W5 = Disabled widower (3rd claimant) W6 = Disabled surviving divorced wife (1st claimant) W7 = Disabled surviving divorced wife (2nd claimant) W8 = Disabled surviving divorced wife (3rd claimant) W9 = Disabled widow (4th claimant) WB = Disabled widower (4th claimant) WC = Disabled surviving divorced wife (4th claimant) WF = Disabled widow (5th claimant) WG = Disabled widower (5th claimant) WJ = Disabled surviving divorced wife (5th claimant) WR = Disabled surviving divorced husband (1st claimant) WT = Disabled surviving divorced husband (2nd claimant) Railroad Retirement Board: NOTE: Employee: a Medicare beneficiary who is still working or a worker who died before retirement Annuitant: a person who retired under the railroad retirement act on or after 03/01/37 Pensioner: a person who retired prior to 03/01/37 and was included in the railroad retirement act 10 = Retirement - employee or annuitant 80 = RR pensioner (age or disability) 14 = Spouse of RR employee or annuitant (husband or wife) 84 = Spouse of RR pensioner 43 = Child of RR employee 13 = Child of RR annuitant 17 = Disabled adult child of RR annuitant 46 = Widow/widower of RR employee 16 = Widow/widower of RR annuitant 86 = Widow/widower of RR pensioner 43 = Widow of employee with a child in her care 13 = Widow of annuitant with a child in her care 83 = Widow of pensioner with a child in her care 45 = Parent of employee 15 = Parent of annuitant 85 = Parent of pensioner 11 = Survivor joint annuitant (reduced benefits taken to insure benefits for surviving spouse) BENE_MDCR_STUS_TB CWF Beneficiary Medicare Status Table 10 = Aged without ESRD 11 = Aged with ESRD 20 = Disabled without ESRD 21 = Disabled with ESRD 31 = ESRD only BENE_RACE_TB Beneficiary Race Table 0 = Unknown 1 = White 2 = Black 3 = Other 4 = Asian 5 = Hispanic 6 = North American Native BENE_SEX_IDENT_TB Beneficiary Sex Identification Table 1 = Male 2 = Female 0 = Unknown CLM_ADMTG_DGNS_VRSN_TB Claim Admitting Diagnosis Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_CARE_IMPRVMT_MODEL_TB Claim Care Improvement Model Table 61 = CLAIM CARE IMPROVEMENT MODEL 1 62 = CLAIM CARE IMPROVEMENT MODEL 2 63 = CLAIM CARE IMPROVEMENT MODEL 3 64 = CLAIM CARE IMPROVEMENT MODEL 4 CLM_DGNS_VRSN_TB Claim Diagnosis Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_HRR_PRTCPNT_IND_TB Claim HRR Participant Indicator Code Table 0 = Not participating 1 = Participating and not equal to 1.0000 2 = Participating and equal to 1.0000 CLM_PRCDR_VRSN_TB Claim Procedure Version Code Table Valid Values: 9 = ICD-9 0 = ICD-10 CLM_PTNT_RLTNSHP_TB Claim Patient Relationship Table 01 = Spouse 04 = Grandparent 05 = Grandchild 07 = Niece/Nephew 10 = Foster child 15 = Ward of the court 17 = Step child 18 = Patient is insured 19 = Natural child/insured financial responsibility 20 = Employee 21 = Unknown 22 = Handicapped dependent 23 = Sponsored dependent 24 = Minor dependent of a minor dependent 32 = Mother 33 = Father 39 = Organ donor 40 = Cadaver donor 41 = Injured plaintiff 43 = Natural child/insured does not have financial responsibility CLM_SRC_IP_ADMSN_TB Claim Source Of Inpatient Admission Table **For Inpatient/SNF Claims:** 0 = ANOMALY: invalid value, if present, translate to '9' 1 = Non-Health Care Facility Point of Origin (Physician Referral) - The patient was admitted to this facility upon an order of a physician. 2 = Clinic referral - The patient was admitted upon the recommendation of this facility's clinic physician. 3 = HMO referral - Reserved for national assignment. (eff. 3/08) Prior to 3/08, HMO referral - The patient was admitted upon the recommendation of an health maintenance organization (HMO) physician. 4 = Transfer from hospital (Different Facility) - The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient. 5 = Transfer from a skilled nursing facility (SNF) or Intermediate Care Facility (ICF) - The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident. 6 = Transfer from another health care facility - The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list where he or she was an inpatient. 7 = Emergency room - The patient was admitted to this facility after receiving services in this facility's emergency room department. Obsolete - eff. 7/1/10 8 = Court/law enforcement - The patient was admitted upon the direction of a court of law or upon the request of a law enforcement agency's representative. Includes transfers from incarceration facilities. 9 = Information not available - The means by which the patient was admitted is not known. A = Reserved for National Assignment. (eff. 3/08) Prior to 3/08 defined as: Transfer from a Critical Access Hospital - patient was admitted/referred to this facility as a transfer from a Critical Access Hospital. B = Transfer from Another Home Health Agency - The patient was admitted to this home health agency as a transfer from another home health agency.(Discontinued July 1,2010- See Condition Code 47) C = Readmission to Same Home Health Agency - The patient was readmitted to this home health agency within the same home health episode period. (Discontinued July 1,2010) D = Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer - The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer. E = Transfer from Ambulatory Surgery Center - The patient was admitted to this facility as a transfer from an ambulatory surgery center. (eff. 10/1/2007) F = Transfer from Hospice and is under a Hospice Plan of Care or Enrolled in a Hospice Program - The patient was admitted to this facility as a transfer from a hospice. (eff. 10/1/2007) --------------------------------------- **For Newborn Type of Admission** 1 = Normal delivery - A baby delivered with out complications. Obsolete eff. 10/1/07 2 = Premature delivery - A baby delivered with time and/or weight factors qualifying it for premature status. Obsolete eff. 10/1/07 3 = Sick baby - A baby delivered with medical complications, other than those relating to premature status. Obsolete eff. 10/1/07 4 = Extramural birth - A baby delivered in a nonsterile environment. Obsolete eff. 10/1/07 5 = Born Inside this Hospital - eff. 10/1/07 6 = Born Outside of this Hospital - eff. 10/1/07 7-9 = Reserved for national assignment. CLM_VBP_PRTCPNT_IND_TB Claim VBP Participant Indicator Table Y = Participating in Hospital Value Based Purchasing N = Not participating in Hospital Value Based Purchasing Blank = same as 'N' CTGRY_EQTBL_BENE_IDENT_TB Category Equatable Beneficiary Identification Code (BIC) Table NCH BIC SSA Categories ------- -------------- A = A;J1;J2;J3;J4;M;M1;T;TA B = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6; TB(F);TD(F);TE(F);TW(F) B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M) TD(M);TE(M);TW(M) B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2 W7;TG(F);TL(F);TR(F);TX(F) B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M) TL(M);TR(M);TX(M) B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4 W8;TH(F);TM(F);TS(F);TY(F) BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9 WC;TJ(F);TN(F);TT(F);TZ(F) BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF WJ;TK(F);TP(F);TU(F);TV(F) BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M) TY(M) BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M) TZ(M) BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M) TV(M) C1 = C1;TC C2 = C2;T2 C3 = C3;T3 C4 = C4;T4 C5 = C5;T5 C6 = C6;T6 C7 = C7;T7 C8 = C8;T8 C9 = C9;T9 F1 = F1;TF F2 = F2;TQ F3-F8 = Equatable only to itself (e.g., F3 IS equatable to F3) CA-CZ = Equatable only to itself. (e.g., CA is only equatable to CA) --------------------------------------- RRB Categories 10 = 10 11 = 11 13 = 13;17 14 = 14;16 15 = 15 43 = 43 45 = 45 46 = 46 80 = 80 83 = 83 84 = 84;86 85 = 85 GEO_SSA_STATE_TB State Table 01 = Alabama 02 = Alaska 03 = Arizona 04 = Arkansas 05 = California 06 = Colorado 07 = Connecticut 08 = Delaware 09 = District of Columbia 10 = Florida 11 = Georgia 12 = Hawaii 13 = Idaho 14 = Illinois 15 = Indiana 16 = Iowa 17 = Kansas 18 = Kentucky 19 = Louisiana 20 = Maine 21 = Maryland 22 = Massachusetts 23 = Michigan 24 = Minnesota 25 = Mississippi 26 = Missouri 27 = Montana 28 = Nebraska 29 = Nevada 30 = New Hampshire 31 = New Jersey 32 = New Mexico 33 = New York 34 = North Carolina 35 = North Dakota 36 = Ohio 37 = Oklahoma 38 = Oregon 39 = Pennsylvania 40 = Puerto Rico 41 = Rhode Island 42 = South Carolina 43 = South Dakota 44 = Tennessee 45 = Texas 46 = Utah 47 = Vermont 48 = Virgin Islands 49 = Virginia 50 = Washington 51 = West Virginia 52 = Wisconsin 53 = Wyoming 54 = Africa 55 = California 56 = Canada & Islands 57 = Central America and West Indies 58 = Europe 59 = Mexico 60 = Oceania 61 = Philippines 62 = South America 63 = U.S. Possessions 64 = American Samoa 65 = Guam 66 = Commonwealth of the Northern Marianas Islands 67 = Texas 68 = Florida (eff. 10/2005) 69 = Florida (eff. 10/2005) 70 = Kansas (eff. 10/2005) 71 = Louisiana (eff. 10/2005) 72 = Ohio (eff. 10/2005) 73 = Pennsylvania (eff. 10/2005) 74 = Texas (eff. 10/2005) 80 = Maryland (eff. 8/2000) 97 = Northern Marianas 98 = Guam 99 = With 000 county code is American Samoa; otherwise unknown A0 = California (eff. 4/2019) A1 = California (eff. 4/2019) A2 = Florida (eff. 4/2019) A3 = Louisianna (eff. 4/2019) A4 = Michigan (eff. 4/2019) A5 = Mississippi (eff. 4/2019) A6 = Ohio (eff. 4/2019) A7 = Pennsylvania (eff. 4/2019) A8 = Tennessee (eff. 4/2019) A9 = Texas (eff. 4/2019) B0 = Kentucky (eff. 4/2020) B1 = West Virginia (eff. 4/2020) B2 = California (eff. 4/2020) MEDPAR_ADMSN_DAY_TB MEDPAR Admission Day Code Table 1 = Sunday 2 = Monday 3 = Tuesday 4 = Wednesday 5 = Thursday 6 = Friday 7 = Saturday MEDPAR_BENE_DEATH_DT_VRFY_TB MEDPAR Beneficiary Death Date Verified Code Table V = Date of death verified (EDB received DOD from SSA's MBR) B = Date of death taken from claim (EDB received DOD from claim) N = Date of death not verified (neither V or B applicable, but claim status code indicated death) Space = No date of death indicated MEDPAR_BENE_DSCHRG_STUS_TB MEDPAR Beneficiary Discharge Status Code Table A = Discharged alive (claim status code other than 20 or 30) B = Discharged dead C = Still a patient MEDPAR_BENE_PRMRY_PYR_TB MEDPAR Beneficiary Primary Payer Code Table A = Working aged bene/spouse with eghp B = ESRD bene in 18-month coordination period with eghp C = Conditional Medicare payment; future reimbursement expected D = Auto no-fault or any liability insurance E = Worker's compensation F = Phs or other federal agency (other than dept of veterans affairs) G = Working disabled H = Black lung I = Dept of veterans affairs J = Any liability insurance Z/BLANK = Medicare is primary payer MEDPAR_CRED_RCVD_RPLCD_DVC_TB MEDPAR Credit Received from Manufacturer for Replaced Medical Device Switch Table Y = The claim involved a credit from the device manufacturer for a Replaced Medical Device. N = The claim did not involve a credit from the device manufacturer for a Replaced Medical Device. MEDPAR_CRNRY_CARE_IND_TB MEDPAR Coronary Care Indicator Code Table BLANK = No coronary care indication 0 = General (revenue code 0210) 1 = Myocardial (revenue code 0211) 2 = Pulmonary care (revenue code 0212) 3 = Heart transplant (revenue code 0213) 4 = Intermediate CCU (revenue code 0214) MEDPAR_ESRD_COND_TB MEDPAR ESRD Condition Code Table 00 = No ESRD Condition Codes 70 = Self-Administered Epo 71 = Full Care In Unit 72 = Self-Care In Unit 73 = Self-Care Training 74 = Home Dialysis 75 = Home Dialysis/100% Reimbursement 76 = Backup-In-Facility Dialysis MEDPAR_ESRD_SETG_IND_TB MEDPAR ESRD Setting Indicator Code Table 00 = Ip renal dialysis-general (revenue code 0800) 01 = Ip renal dialysis-hemodialysis (revenue code 0801) 02 = Ip renal dialysis-peritoneal (non-capd: revenue code 0802) 03 = Ip renal dialysis-capd (revenue code 0803) 04 = Ip renal dialysis-ccpd (revenue code 0804) 09 = Ip renal dialysis-other (revenue code 0809) 20 = Hemodialysis-op-general (revenue code 0820) 21 = Hemodialysis-op-hemodialysis/composite (revenue code 0821) 22 = Hemodialysis-op-home supplies (revenue code 0822) 23 = Hemodialysis-op-home equipment (revenue code 0823) 24 = Hemodialysis-op-maintenance/100% (revenue code 0824) 25 = Hemodialysis-op-support services (revenue code 0825) 29 = Hemodialysis-op-other (revenue code 0829) 30 = Peritoneal-op/home-general (revenue code 0830) 31 = Peritoneal-op/home-peritoneal/composite (revenue 32 = Peritoneal-op/home-home supplies (revenue code 0832) 33 = Peritoneal-op/home-home equipment (revenue code 0833) 34 = Peritoneal-op/home-maintenance/100% (revenue code 0834) 35 = Peritoneal-op/home-support services (revenue code 0835) 39 = Peritoneal-op/home-other (revenue code 0839) 40 = Capd-op-capd/general (revenue code 0840) 41 = Capd-op-capd/composite (revenue code 0841) 42 = Capd-op-home supplies (revenue code 0842) 43 = Capd-op-home equipment (revenue code 0843) 44 = Capd-op-maintenance/100% (revenue code 0844) 45 = Capd-op-support services (revenue code 0845) 49 = Capd-op-other (revenue code 0849) 50 = Ccpd-op-ccpd/general (revenue code 0850) 51 = Ccpd-op-ccpd/composite (revenue code 0851) 52 = Ccpd-op-home supplies (revenue code 0852) 53 = Ccpd-op-home equipment (revenue code 0853) 54 = Ccpd-op-maintenance/100% (revenue code 0854) 55 = Ccpd-op-support services (revenue code 0855) 59 = Ccpd-op-other (revenue code 0859) 80 = Miscellaneous dialysis-general (revenue code 0880) 81 = Miscellaneous dialysis-ultrafiltration (revenue code 0881) 89 = Miscellaneous dialysis-other (revenue code 0889) BLANK = No ESRD setting indication MEDPAR_GHO_PD_TB MEDPAR GHO Paid Code Table 1 = GHO has paid the provider Blank Or 0 = GHO has not paid the provider MEDPAR_ICU_IND_TB MEDPAR Intensive Care Unit (ICU) Indicator Code Table 0 = General (revenue center 0200) 1 = Surgical (revenue center 0201) 2 = Medical (revenue center 0202) 3 = Pediatric (revenue center 0203) 4 = Psychiatric (revenue center 0204) MEDPAR_INFRMTL_ENCTR_IND_TB MEDPAR Informational Encounter Indicator Code Table Y = Beneficiary enrolled in MCO N = Beneficiary not enrolled in MCO MEDPAR_MA_TCHNG_IND_TB MEDPAR MA Teaching Indicator Code Table Y = Claim includes request for supplemental IME/DGME/N&AH payment. N = Claim does not include request for supplemental IME/DGME/N&AH payment. MEDPAR_OBSRVTN_TB MEDPAR Observation Switch Table Y = The claim involved treatment or observation in an observation room. N = The claim did not involve treatment or observation in an observation room. MEDPAR_OP_SRVC_IND_TB MEDPAR Outpatient Services Indicator Code Table 0 = No outpatient services/ambulatory surgical care (revenue code other than 049X, 050X) 1 = Outpatient services (revenue code 050X) 2 = Ambulatory surgical care (revenue code 049X) 3 = Outpatient services and ambulatory surgical care (revenue codes 049X and 050X) MEDPAR_ORGN_ACQSTN_IND_TB MEDPAR Organ Acquisition Indicator Code Table K1 = General classification (revenue code 0810) K2 = Living donor kidney (revenue code 0811) K3 = Cadaver donor kidney (revenue code 0812) K4 = Unknown donor kidney (revenue code 0813) K5 = Other kidney acquisition (revenue code 0814) H1 = Cadaver donor heart (revenue code 0815) H2 = Other heart acquisition (revenue code 0816) L1 = Donor liver (revenue code 0817) 01 = Other organ acquisition (revenue code 0819) 02 = General acquisition (revenue code 0890) B1 = Bone donor bank (revenue code 0891) 03 = Organ donor bank other than kidney (revenue code 0892) S1 = Skin donor bank (revenue code 0893) 04 = Other donor bank (revenue code 0899) BLANK = No organ acquisition indication MEDPAR_PHRMCY_IND_TB MEDPAR Pharmacy Indicator Code Table 0 = No drugs (revenue code other than those listed below) 1 = General drugs and/pr IV therapy (revenue code 025x, 026x) 2 = Erythropoietin (epoetin: revenue code 0630, 0635, 0637, 0639) 3 = Blood clotting drugs (revenue code 0636) 4 = General drugs and/or IV therapy; and epoetin (combination of values 1 and 2) 5 = General drugs and/or IV therapy; and blood clotting drugs (combination of values 1 and 3) MEDPAR_PPS_IND_TB MEDPAR PPS Indicator Code Table 0 = Non PPS 2 = PPS MEDPAR_PROD_RPLCMT_LIFECYC_TB MEDPAR Product Replacement within Lifecycle Switch Y = Claim involves the replacement of a product earlier than scheduled due to apparent malfunction. N = Claim does not involve the replacement of a product earlier than scheduled due to apparent malfunction. MEDPAR_PROD_RPLCMT_RCLL_TB MEDPAR Product Replacement for known Recall Switch Table Y = Claim involves the replacement of a product due to a recall of the product by the manufacturer or by the FDA. N = Claim does not involve the replacement of a product due to a recall of the product by the manufacturer or by the FDA. MEDPAR_PRVDR_NUM_SPCL_UNIT_TB MEDPAR Provider Number Special Unit Code M = PPS-exempt psychiatric unit in CAH R = PPS-exempt rehabilitation unit in CAH S = PPS-exempt psychiatric unit T = PPS-exempt rehabilitation unit U = Swing-bed short-term/acute care hospital W = Swing-bed long-term hospital Y = Swing-bed rehabilitation hospital Z = Swing-bed rural primary care hospital; eff 10/97 changed to critical access hospitals Blanks = Not PPS-exempt or swing-bed designation MEDPAR_RDLGY_CT_SCAN_IND_TB MEDPAR Radiology CT Scan Indicator Code Table 0 = No radiology CT scan (revenue code not 035X) 1 = Yes radiology CT scan (revenue code 035X) MEDPAR_RDLGY_DGNSTC_IND_TB MEDPAR Radiology Diagnostic Indicator Code Table 0 = No radiology-diagnostic (revenue code not 032x) 1 = Yes radiology-diagnostic (revenue code 032x) MEDPAR_RDLGY_NUCLR_MDCN_IND_TB MEDPAR Radiology Nuclear Medicine Indicator Code Table 0 = No nuclear medicine (revenue code not 034x) 1 = Yes nuclear medicine (revenue code 034x) MEDPAR_RDLGY_ONCLGY_IND_TB MEDPAR Radiology Oncology Indicator Code Table 0 = No radiology-oncology (revenue code not 028x) 1 = Yes radiology-oncology (revenue code 028x) MEDPAR_RDLGY_OTHR_IMGNG_IND_TB MEDPAR Radiology Other Imaging Indicator Code Table 0 = No other imaging services (revenue code not 040x) 1 = Yes other imaging services (revenue code 040x) MEDPAR_RDLGY_THRPTC_IND_TB MEDPAR Radiology Therapeutic Indicator Code Table 0 = No radiology-therapeutic (revenue code not 033X) 1 = Yes radiology-therapeutic (revenue code 033X) MEDPAR_SRGCL_PRCDR_IND_TB MEDPAR Surgical Procedure Indicator Code Table 0 = No surgery indicated 1 = Yes surgery indicated MEDPAR_SS_LS_SNF_IND_TB MEDPAR Short Stay/Long Stay/SNF Indicator Code Table N = SNF Stay (Prvdr3 = 5, 6, U, W, Y, or Z) S = Short-Stay (Prvdr3 = 0, M, R, S, T) L = Long-Stay (All Others) MEDPAR_TRNSPLNT_IND_TB MEDPAR Transplant Indicator Code Table 0 = No organ or kidney transplant (revenue code not 0362 or 0367) 2 = Organ transplant other than kidney (revenue code 0362) 7 = Kidney transplant (revenue code 0367) MEDPAR_WRNG_IND_TB MEDPAR Warning Indicators Code Table Warning indicator 1 ('adjustment indicator' derived from the presence of query code values noted below on any of the claim records included in the analysis): 0 = No adjustment (no query code = 0 or 5) 1 = Credit adjustment (query code = 0) 2 = Debit adjustment (query code = 5) 3 = Credit and debit adjustment (both query code = 0 and 5) Warning indicator 2 ('error condition' derived from checking the edit code trailer on the final action claims(s) that comprise the stay): 0 = No error 1 = Error condition Warning indicator 3 ('reimbursement/total charge indicator' derived after summing up fields on the final action claim(s) that comprise the stay; checks resulting Medicare payment amount (commonly called reimbursement), total charge amount, as well as beneificiary primary payer amount and utilization day count): 0 = Medicare payment amount and total charge amount > zeroes 1 = Medicare payment amount and total charge amount < zeroes 2 = Medicare payment amount is a credit 3 = Total charge amount is a credit 4 = Medicare payment amount, total charge amount, beneficiary primary payer claim payment amount, and utilization day count = zeroes Warning indicator 4 ('utilization day/los day indicator' derived after summing up fields on the final action claim(s) that comprise the stay; compares resulting utilization day count and length-of-stay count): 0 = Utilization day count = los day count 1 = Utilization day count < los day count 2 = Utilization day count > los day count warning indicator 5 ('single/multiple claim indicator' derived when the stay record is created by checking the number of final action claims that comprise the stay): 0 = Stay includes a single final action claim 1 = Stay includes multiple final action claims 2 = Stay includes multiple final action claims and beneficiary is still a patient (applicable to SNF stays only) Warning indicator 6 ('intermediary cancel indicator' derived from the presence of the values noted below for intermediary claim action code and intermediary- requested claim cancel reason code on any of the claims included in the analysis. If multiple claims contain these values, latest claim is used. If both specified action code and cancel reason code are present, cancel reason code takes priority.): 0 = No cancel action 1 = Cancel action by credit adjustment (action code = (2 or 6) 2 = Cancel action only (action code = 4) 3 = Coverage transfer (cancel reason code = C) 4 = Plan transfer (cancel reason code = P) 5 = Scramble (cancel reason code = S) 6 = Duplicate billing (cancel reason code = D) 7 = Other (cancel reason code = H) 8 = Combining 2 spells or 2 beneficiary records (cancel reason code = L) Warning indicator 7 ('state/county numeric indicator' derived from checking the format of the beneficiary residence SSA state code and beneficiary residence county code on the final action claim(s) that comprise the stay; determine if in numeric range): 0 = State and county codes are valid numeric values 1 = State and county codes are not in numeric range 2 = State code is not in numeric range 3 = County code is not in numeric range Warning indicator 8 ('duplicate indicator' derived from the presence of two claim records with the same claim number, admission date, provider number, claim from/ thru date, HCFA process date and query code; death/ admission date indicator derived by comparing the admission date on the final claim(s) that comprise the stay to the beneficiary death date): 0 = Do duplicate record 1 = Duplicate record 2 = Death date < admission date 3 = Death date < admission date and duplicate record Warning indicator 9 ('pass-thru indicator' derived from the presence of a pass thru per diem amount on the final action claim(s) that comprise the stay): 0 = No pass thru per diem present (Non-PPS) 1 = Pass thru per diem present on final action claim Warning indicator 10 (eff 3/96 update) (rugs indicator applicable to 'nhcmq rugs III SNF demo' stay records derived from the presence of 9,000 series revenue center codes.) 0 = No rugs 9,000 series revenue center codes 2 = Rugs 9,000 series revenue center code(s) with service date 1/1/96 or later 3 = Rugs 9,000 series revenue center code(s) with service date 7/1/96 or later 4 = Rugs 9,000 series revenue center code(s) with service date 1/1/97 or later Warning indicators 11 - 17 (not yet assigned; zeroes will be present) NCH_CLM_TYPE_TB NCH Claim Type Table 10 = HHA claim 20 = Non swing bed SNF claim 30 = Swing bed SNF claim 40 = Outpatient claim 50 = Hospice claim 60 = Inpatient claim 61 = Inpatient 'Full-Encounter' claim 62 = Medicare Advantage IME/GME Claims 63 = Medicare Advantage (no-pay) claims 64 = Medicare Advantage (paid as FFS) claims 71 = RIC O local carrier non-DMEPOS claim 72 = RIC O local carrier DMEPOS claim 81 = RIC M DMERC non-DMEPOS claim 82 = RIC M DMERC DMEPOS claim NOTE: In the data element NCH_CLM_TYPE_CD (derivation rules) the numbers for these claim types need to be changed - dictionary reflects 61 for all three. NG_ACO_IND_TB Next Generation (NG) Accountable Care Organization (ACO) Indicator Code Table 0 = Base record (no enhancements) 1 = Population Based Payments (PBP) 2 = Telehealth 3 = Post Discharge Home Health Visits 4 = 3-Day SNF Waiver 5 = Capitation 6 = CEC Telehealth 7 = Care Management Home Visits PTNT_DSCHRG_STUS_TB Patient Discharge Status Table 01 = Discharged to home/self care (routine charge). 02 = Discharged/transferred to other short term general hospital for inpatient care. 03 = Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care -- (For hospitals with an approved swing bed arrangement, use Code 61 - swing bed. For reporting discharges/ transfers to a non-certified SNF, the hospital must use Code 04 - ICF. 04 = Discharged/transferred to a facility that provides custodial or supportive care (includes intermediate care facilities (ICF). Also used to designate patients that are dischared/trans- ferred to a nursing facility with neither Medicare nor Medicaid certification and for discharges/transfers to Assisted Living Facilities. 05 = Discharged/transferred to a designated cancer center or children's hospital (eff. 10/09). Prior to 10/1/09, discharged/transferred to another type of institution for inpatient care (including distinct parts). NOTE: Effective 1/2005, psychiatric hospital or psychiatric distinct part unit of a hospital will no longer be identified by this code. New code is '65'. 06 = Discharged/transferred to home care of organized home health service organization in anticipation of covered skilled care. 07 = Left against medical advice or discontinued care. 08 = Discharged/transferred to home under care of a home IV drug therapy provider. (discontinued effective 10/1/05) 09 = Admitted as an inpatient to this hospital (effective 3/1/91). In situa- tions where a patient is admitted before midnight of the third day following the day of an outpatient service, the out- patient services are considered inpatient. 20 = Expired 21 = Discharged/transferred to Court/Law Enforcement. 30 = Still patient. 40 = Expired at home (Hospice claims only). 41 = Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only) 42 = Expired - place unknown (Hospice claims only) 43 = Discharged/transferred to a federal hospital (eff. 10/1/03). Discharges and transfers to a government operated health facility such as a Department of Defense hospital, a Veteran's Administration hospital or a Veteran's Administration nursing facility. To be used whenever the destination at discharge is a federal health care facility, whether the patient lives there or not. 50 = Hospice - home (eff. 10/96) 51 = Hospice - medical facility (certified) providing hospice level of care 61 = Discharged/transferred within this insti- tution to a hospital-based Medicare approved swing bed (eff. 9/01) 62 = Discharged/transferred to an inpatient rehabilitation facility including distinct parts units of a hospital. (eff. 1/2002) 63 = Discharged/transferred to a Medicare certified long term care hospital. (eff. 1/2002) 64 = Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare (eff. 10/2002) 65 = Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital (these types of hospitals were pulled from patient/discharge status code '05' and given their own code). (eff. 1/2005). 66 = Discharged/transferred to a Critical Access Hospital (CAH) (eff. 1/1/06) 69 = Discharge/transfers to a Designated Disaster Alternative Care site (eff. 10/2013) 70 = Discharged/transferred to another type of health care institution not defined elsewhere in code list. 71 = Discharged/transferred/referred to another institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05) 72 = Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05) 81 = Discharged to home or self-care with a planned acute care hospital inpatient (eff. 10/2013) 82 = Discharged/transferred to a short term general hospital for inpatient care readmission (eff. 10/2013) 83 = Discharged/transferred to a skilled nursing facility (SNF) with Medicare (eff. 10/2013) 84 = Discharged/transferred to a facility that provides custodial supportative care with a planned acute care hospital inpatient readmission certification with a planned acute care hospital inpatient readmission (eff. 10/2013) 85 = Discharged/transferred to a designated cancer center or children's hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 86 = Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (eff. 10/2013) 87 = Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (eff. 10/2013) 88 = Discharged/transferred to a Federal health care facility with a planned acute care hospital inpatient readmission (eff. 10/2013) 89 = Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hosptial inpatient readmission (eff. 10/2013) 90 = Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct units of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 91 = Discharged/transferred to a Medicare certified Long Term Care Hospital (LTCH) with a planned acute care hospital inpatient readmission (eff. 10/2013) 92 = Discharged/transferred to a nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (eff. 10/2013) 93 = Discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013) 94 = Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission (eff. 10/2013) 95 = Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission. (eff. 10/2013) RP_IND_TB Claim Representative Payee (RP) Indicator Code Table R = bypass representative payee Space RSDL_PMT_IND_TB Claim Residual Payment Indicator Code Table X = Residual Payment Space
