| MEDPAR 'R2K' Limited Dataset Record Layout |
| FIELD |
POSITION |
|
Length |
DESCRIPTION |
DERIVATIONS |
CODE TABLE |
| NCH Claim Type Code |
1 |
2 |
2 |
The code used to identify the type of claim record being processed in NCH. |
FFS CLAIM TYPE CODES DERIVED FROM: NCH CLM_NEAR_LINE_RIC_CD NCH PMT_EDIT_RIC_CD NCH CLM_TRANS_CD NCH PRVDR_NUM INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (Pre-HDC processing — AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD MCO_PRD_EFCTV_DT MCO_PRD_TRMNTN_DT |
NCH_CLM_TYPE_TB |
| Beneficiary Age Count |
14 |
16 |
3 |
The beneficiary's age as of date of admission. |
This field is derived by subtracting the bene date of birth from the admission date, present on the first claim record included in the stay. Exception: If the resulting age is 64, and the MSC = 10 or 11, the age is changed to 65. |
MEDPAR Beneficiary Age |
| Beneficiary Sex Code |
17 |
17 |
1 |
The sex of a beneficiary. |
|
BENE_SEX_IDENT_TB |
| Beneficiary Race Code |
18 |
18 |
1 |
The race of a beneficiary. |
|
BENE_RACE_TB |
| Beneficiary Medicare Status Code |
19 |
20 |
2 |
The CWF-derived reason for a beneficiary's entitlement to Medicare benefits, as of the reference date (CLM_THRU_DT). |
CWF derives MSC from the following: 1. Date of birth 2. Claim through date 3. Original/Current reasons for entitlement 4. ESRD indicator 5. Beneficiary claim number Items 1,3,4,5 come from the CWF beneficiary master record; Item 2 comes from the FI/Carrier claim record. |
BENE_MDCR_STUS_TB |
| Beneficiary Residence SSA Standard State Code |
21 |
22 |
2 |
The SSA standard state code of a beneficiary's residence. |
|
GEO_SSA_STATE_TB |
| Admission Day Code |
35 |
35 |
1 |
The code indicating the day of the week on which the beneficiary was admitted to a facility. |
This field is derived from the admission date that is present on the first claim record included in the stay. |
MEDPAR_ADMSN_DAY_TB |
| Beneficiary Discharge Status Code |
36 |
36 |
1 |
The code used to identify the status of the patient as of the CLM_THRU_DT. |
This field is derived from the claim status code that is present on the last claim record included in the stay. |
MEDPAR_BENE_DSCHRG_STUS_TB |
| GHO Paid Code |
37 |
37 |
1 |
The code indicating whether or not a GHO has paid the provider for the claim(s). |
|
MEDPAR_GHO_PD_TB |
| PPS Indicator Code |
38 |
38 |
1 |
The code indicating whether or not the facility is being paid under the prospective payment system (PPS). |
If the condition code not equal 65 on all of the claims included in the stay and the third position of the provider number is numeric set MEDPAR_PPS_IND_CD to 2 (PPS). Otherwise set it to 0 (Non PPS.) |
MEDPAR_PPS_IND_TB |
| Organization NPI Number |
39 |
48 |
10 |
ON AN INSTITUTIONAL CLAIM, THE NATIONAL PROVIDER IDENTIFIER (NPI) NUMBER ASSIGNED TO UNIQUELY IDENTIFY THE INSTITUTIONAL PROVIDER CERTIFIED BY MEDICARE TO PROVIDE SERVICES TO THE BENEFICIARY. |
|
|
| Provider Number Group |
49 |
54 |
6 |
|
|
|
| Provider State Code |
49 |
50 |
2 |
The first two positions of the provider number, identifying the state of the institutional provider that furnished services to the beneficiary during the stay. |
This field comes from positions 1 & 2 of the provider number that is present on the first claim record included in the stay. |
GEO_SSA_STATE_TB |
| Provider Number Third Position Code |
51 |
51 |
1 |
The third position of the provider number, identifying the category of institutional provider that furnished services to the beneficiary during the stay. |
This field is position 3 of the provider number from the first claim record included in the stay modified as follows: Where position 3 is an alpha character (S, T, U, W or Y) move to the MEDPAR provider special unit code and replace with a '0'. Where position 3 is an alpha character (M or R) move to the MEDPAR provider special unit code and replace with a '1'. |
|
| Provider Number Serial Code |
52 |
54 |
3 |
The last three positions of the provider number, identifying the specific serial numbers of the institutional provider that furnished services to the beneficiary during the stay. |
This field comes from positions 4 – 6 of the provider number on the first claim record included in the stay. |
|
| Provider Number Special Unit Code |
55 |
55 |
1 |
The code identifying the special numbering system for units of hospitals that are excluded from PPS or hospitals with SNF swing-bed designation. |
If the third position of the provider number from the first claim record included in the stay equals 'M', 'R', 'S', 'T', 'U', 'W', 'Y' OR 'Z', it is moved to this field, otherwise it is blank. |
|
| Short Stay/Long Stay/SNF Indicator Code |
56 |
56 |
1 |
The code indicating whether the stay is a short stay, long stay, or SNF. |
This field is derived from the third position of the provider number that is present on the first claim record included in the stay. |
|
| Stay Final Action Claims Count |
57 |
59 |
3 |
The count of the number of claim records (final action) included in the stay. |
This field is derived by counting the number of final action claims used to create the stay. |
|
| Admission Date |
88 |
94 |
7 |
The date the beneficiary was admitted for Inpatient care or the date that care started. |
This field specifies the date of the beneficiary's admission to the institution translated into the quarter of the year in which the admission occurred. Coding Scheme: QYY where: 1YY = First quarter of year; 2YY = Second quarter of yea; 3YY = Third quarter of year; 4YY = Fourth quarter of year |
|
| Discharge Date |
95 |
101 |
7 |
The date on which the beneficiary was discharged or died. |
This field specifies the date of the beneficiary's death or discharge from the institution translated into the quarter of the year in which the admission occurred. Coding Scheme: QYY where: 1YY = First quarter of year; 2YY = Second quarter of yea; 3YY = Third quarter of year; 4YY = Fourth quarter of year |
|
| Length of Stay Day Count |
124 |
128 |
5 |
The count in days of the total length of a beneficiary's stay in a hospital or SNF. |
This field is derived by subtracting the date of discharge (or thru date in SNF cases where beneficiary is still a patient) from the date of admission. If difference is '0,' the value becomes a '1.' |
|
| Outlier Day Count |
129 |
131 |
3 |
The count of the number of days paid as outliers (either a day or cost outlier) under PPS beyond the DRG threshold. |
This field is derived by checking the MEDPAR utilization day count against the DRG threshold table (DRG weights file). |
|
| Utilization Day Count |
132 |
136 |
5 |
The count of the number of covered days of care that are chargeable to Medicare utilization for the stay. |
This field is derived by accumulating the utilization day count that is present on any of the claim records included in the stay (i.e., the sum of utilization days reported on the claims that comprise the stay). |
|
| Beneficiary Total Coinsurance Day Count |
137 |
139 |
3 |
The count of the total number of coinsurance days involved with the beneficiary's stay in a facility. For Inpatient services, the beneficiary is liable for a daily coinsurance amount after the 60th day and before the 91st day in a single spell of illness; for SNF services, the beneficiary is liable for a daily coinsurance amount after the 20th day and before the 101st day in a single spell of illness. |
This field is derived by accumulating the coinsurance day count that is present on any of the claim records included in the stay (i.e., the sum of coinsurance days reported on the claims that comprise the stay). |
|
| Beneficiary LRD Used Count |
140 |
142 |
3 |
The count of the number of lifetime reserve days (LRD) used by the beneficiary for this stay. |
This field is derived by accumulating the lifetime reserve days used count that is present on any of the claim records included in the stay (i.e., the sum of LRD reported on the claims that comprise the stay). |
|
| Beneficiary Part A Coinsurance Liability Amount |
143 |
151 |
9 |
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for part A coinsurance for the stay. |
|
|
| Beneficiary Inpatient Deductible Liability Amount |
152 |
160 |
9 |
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the Inpatient deductible for the stay. |
|
|
| Beneficiary Blood Deductible Liability Amount |
161 |
169 |
9 |
The amount of money (rounded to whole dollars) identified as the beneficiary's liability for the blood deductible for the stay. |
This field is derived by accumulating the beneficiary blood deductible liability amount that is present on any of the claim records included in the stay (i.e., the sum of the blood deductibles reported on the claims that comprise the stay). |
|
| Beneficiary Primary Payer Amount |
170 |
178 |
9 |
The amount of payment (rounded to whole dollars) made on behalf of the beneficiary by a primary payer other than Medicare, which has been applied to the covered Medicare charges for the stay. |
This field is derived by accumulating the beneficiary primary payer payment amount that is present on any of the claim records included in the stay (i.e., the sum of the primary payer amounts reported on the claims that comprise the stay). |
|
| DRG Outlier Approved Payment Amount |
179 |
187 |
9 |
The amount of additional payment (rounded to whole dollars) approved due to an outlier situation over the DRG allowance for the stay. |
This field is derived by accumulating the DRG outlier approved payment amount (value code = 17 amount) that is present on any of the claim records included in the stay (i.e., the sum of outlier amounts reported on the claims that comprise the stay). |
|
| Inpatient Disproportionate Share Amount |
188 |
196 |
9 |
The amount paid over the DRG amount (rounded to whole dollars) for the disproportionate share hospital for the stay. |
This field is derived by accumulating the value amount associated with value code = 18 that is present on any o the claim records included in the stay (i.e., the sum of value code 18 amounts reported on the claims that comprise the stay). |
|
| Indirect Medical Education (IME) Amount |
197 |
205 |
9 |
The amount of additional payment (rounded to whole dollars) made to teaching hospitals for IME for the stay. |
This field is derived by accumulating the value amount associated with value code = 19 that is present on any of the claim records included in the stay (i.e., the sum of IME amounts – value code 19 amounts – reported on the claims that comprise the stay). |
|
| DRG Price Amount |
206 |
214 |
9 |
The amount (called the 'DRG price' for purposes of MEDPAR analysis) that would have been paid if no deductibles, coinsurance, primary payers, or outliers were involved (rounded to whole dollars). |
This field is derived by accumulating the following amounts: MEDPAR Medicare payment amount, MEDPAR beneficiary primary payer payment amount, MEDPAR beneficiary coinsurance liability amount, MEDPAR beneficiary Inpatient deductible liability amount, MEDPAR beneficiary blood deductible amount; and then subtracting from the sum the MEDPAR DRG outlier approved payment amount. |
|
| Total Pass Through Amount |
215 |
223 |
9 |
The total of all claim pass through amounts (rounded to whole dollars) for the stay. |
This field is derived by multiplying the pass thru per diem amount that is present on the last claim record included in the stay times the MEDPAR utilization day count (the sum of the utilization (covered) days reported on the claims that comprise the stay). |
|
| Total PPS Capital Amount |
224 |
232 |
9 |
The total amount (rounded to whole dollars) that is payable for capital PPS (e.g., reimbursement for depreciation, rent, certain interest, real estate taxes for hospital buildings/equipment subject to PPS). |
This field is derived by accumulating the total PPS capital amount that is present on any of the claim records included in the stay (i.e., the sum of total PPS capital amounts reported on the claims that comprise the stay). |
|
| Inpatient Low Volume Payment Amount |
233 |
241 |
9 |
The amount field used to identify a payment adjustment given to hospitals to account for the higher costs per discharge for low income hospitals under the Inpatient Prospective Payment System (IPPS). |
This field is derived by accumulating the IP Low Volume Amount that is present on any of the claim records included in the stay (i.e. the sum of the low volume amounts re- ported on the claims that comprise the stay). |
|
| Total Charge Amount |
242 |
250 |
9 |
The total amount (rounded to whole dollars) of all charges (covered and noncovered) for all services provided to the beneficiary for the stay. |
This field is derived by accumulating the total charge amount from all claim records included in the stay (i.e. the sum of total charges reported on the claims that comprise the stay). |
|
| Total Covered Charge Amount |
251 |
259 |
9 |
The portion of the total charges amount (rounded to whole dollars) that is covered by Medicare for the stay. |
This field is derived by calculating the covered charges from all claim records included in the stay (i.e., subtract the revenue center noncovered charge amount from the revenue center total charge amount for revenue center code = 0001 that is reported on the claims that comprise the stay; sum the results). Exception: if there exists an erroneous condition relative to revenue center code 0001, the calculation will be made for each revenue center code included on the claims that comprise the stay with the results summed to create the total. |
|
| Medicare Payment Amount |
260 |
268 |
9 |
Amount of payment made from the Medicare trust fund for the services covered by the claim record. Generally, the amount is calculated by the fi; and represents what was paid to the institutional provider, with the exceptions noted below. **Note: in some situations, a negative claim payment amount May be present; e.g., (1) when a beneficiary is charged the full deductible during a short stay and the deductible exceeded the amount Medicare pays; or (2) when a beneficiary is charged a coinsurance amount during a long stay and the coinsurance amount exceeds the amount Medicare pays (most prevalent situation involves psych hospitals who are paid a daily per diem rate no matter what the charges are.) Under ip PPS, Inpatient hospital services are paid based on a predetermined rate per discharge, using the DRG patient classification system and the pricer program. On the ip PPS claim, the payment amount includes the DRG outlier approved payment amount, disproportionate share (since 5/1/86), in- direct medical education (since 10/1/88), total PPS capital (since 10/1/91). It does not include the pass thru amounts (i.e., capital-related costs, direct medical education costs, kidney acquisition costs, bad debts); or any beneficiary-paid amounts (i.e., deductibles and coinsurance); or any other payer reimbursement. Under SNF PPS, SNFs will classify beneficiaries using the patient classification system known as rugs III. For the SNF PPS claim, the SNF pricer will calculate/return the rate for each revenue center line item with revenue center code = '0022'; multiply the rate times the units count; and then sum the amount payable for all lines with revenue center code '0022' to determine the total claim payment amount. Exceptions: For claims involving demos and bba encounter data, the amount reported in this field May not just represent the actual provider payment. For demo ids '01','02','03','04' — claims contain amount paid to the provider, except that special 'differentials' paid outside the normal payment system are not included. For demo ids '05','15' — encounter data 'claims' contain amount Medicare would have paid under ffs, instead of the actual pay- ment to the MCO. For demo ids '06','07','08' — claims contain actual provider payment but represent a special negotiated bundled payment for both part a and part B services. To identify what the conventional provider part a payment would have been, check value code = 'y4'. For bba encounter data (non-demo) — 'claims' contain amount Medicare would have paid under ffs, instead of the actual payment to the bba plan. |
This field is derived by accumulating the payment amount that is present on all of the claim records included in the stay (i.e, the sum of payment (reimbursement) reported on the claims that comprise the stay). |
|
| All Accommodations Total Charge Amount |
269 |
277 |
9 |
The total charge amount (rounded to whole dollars) for all accommodations (routine hospital room and board charges for general care, coronary care and/or intensive care units) related to a beneficiary's stay. |
This field is the sum of MEDPAR private room charge amount, MEDPAR semiprivate room charge amount, MEDPAR ward charge amount, MEDPAR intensive care charge amount, and MEDPAR coronary care charge amount (i.e., the accumulation of the revenue center total charge amount associated with revenue center codes 0100 – 0219 from all claim records included in the stay). |
|
| Departmental Total Charge Amount |
278 |
286 |
9 |
The total charge amount (rounded to whole dollars) for all ancillary departments (other than routine room and board, CCU, and ICU) related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 0220 – 0999 from all claim records included in the stay (i.e, the sum of charges for all revenue centers other than accommodations 0100 – 0219). |
|
| Private Room Day Count |
287 |
289 |
3 |
The count of the number of private room days used by the beneficiary for the stay. |
This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 011x and 014x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9033-9044 series. |
|
| Semiprivate Room Day Count |
290 |
292 |
3 |
The count of the number of semi-private room days used by the beneficiary for the stay. |
This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 010X, 012X, 013X, 016X – 019X from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9019-9032 series. |
|
| Ward Day Count |
293 |
295 |
3 |
The count of the number of ward days used by the beneficiary for the stay. |
This field is derived by accumulating the revenue center unit count associated with accommodation revenue center code 015x from all claim records included in the stay. Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9000-9018 series. |
|
| Intensive Care Day Count |
296 |
298 |
3 |
The count of the number of intensive care days used by the beneficiary for the stay. |
This field is derived by accumulating the revenue center unit count associated with accommodation revenue center codes 020X (all 9 subcategories) from all claims included in the stay. LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0206 due to coders misunderstanding the term 'post ICU' as including any day after an ICU stay rather than just days in a step-down/lower case version of an ICU. 'Post' was removed from the revenue center code 0206 description, effective 10/1/96 (12/96 MEDPAR update). 0206 Is now defined as 'intermediate ICU'. |
|
| Coronary Care Day Count |
299 |
301 |
3 |
The count of the number of coronary care days used by the beneficiary for the stay. |
This field is derived by accumulating the revenue center unit count associated with accommodation revenue center code 021x (all six subcategories) from all claim records included in the stay. LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0214 due to coders misunderstanding the term 'post ccu' as including any day after a ccu stay rather than just days in a step-down/lower case version of a ccu. 'Post' was removed from the revenue center code 0214 description, effective 10/1/96 (12/96 MEDPAR update). 0214 Is now defined as 'intermediate ccu'. |
|
| Private Room Charge Amount |
302 |
310 |
9 |
The charge amount (rounded to whole dollars) for private room accommodations related to a beneficiary's stay. |
THIS FIELD IS DERIVED BY ACCUMULATING THE REVENUE CENTER TOTAL CHARGE AMOUNT ASSOCIATED WITH REVENUE CENTER CODES 011X AND 014X FROM ALL CLAIM RECORDS INCLUDED IN THE STAY. EXCEPTION FOR SNF RUGS DEMO EFF 3/96 SNF UPDATE: FIELD IS DERIVED FROM REVENUE CENTER CODES IN THE 9033-9044 SERIES. |
|
| Semi-Private Room Charge Amount |
311 |
319 |
9 |
The charge amount (rounded to whole dollars) for semi- private room accommodations related to a beneficiary's stay. |
THIS FIELD IS DERIVED BY ACCUMULATING THE REVENUE CENTER TOTAL CHARGE AMOUNT ASSOCIATED WITH REVENUE CENTER CODES 010X, 012X, 013X, AND 016X – 019X FROM ALL CLAIM RECORDS INCLUDED IN THE STAY. EXCEPTION FOR SNF RUGS DEMO EFF 3/96 SNF UPDATE: FIELD IS DERIVED FROM REVENUE CENTER CODES IN THE 9019-9032 SERIES. |
|
| Ward Charge Amount |
320 |
328 |
9 |
The charge amount (rounded to whole dollars) for ward accommodations related to a beneficiary's stay. |
This field is derived by accumulating the revenue total charge amount associated with revenue cente r code 015x from all claim records included in the Exception for SNF rugs demo eff 3/96 SNF update: field is derived from revenue center codes in the 9000-9018 series. |
|
| Intensive Care Charge Amount |
329 |
337 |
9 |
The charge amount (rounded to whole dollars) for intensive care accommodations related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with accommodation revenue center code 020x from all claim records included in the stay. |
|
| Coronary Care Charge Amount |
338 |
346 |
9 |
The charge amount (rounded to whole dollars) for coronary care accommodations related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with accommodation revenue center code 021X from all claim records included in the stay. |
|
| Other Service Charge Amount |
347 |
355 |
9 |
The charge amount (rounded to whole dollars) for other services (revenue centers that do not fit into other categories) related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with the 'other' revenue center codes from all claim records included in the stay the 'other' codes include 0002-0099, 022x, 023x, 024x, 052x, 053x, 055x – 060x, 064x – 070x, 076x – 078x, 090x 095x, and 099x. (Some of these codes are not yet assigned.) |
|
| Pharmacy Charge Amount |
356 |
364 |
9 |
The charge amount (rounded to whole dollars) for pharmaceutical costs related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 025x, 026x, and 063x from all claims records included in the stay. |
|
| Medical/Surgical Supply Charge Amount |
365 |
373 |
9 |
The charge amount (rounded to whole dollars) for medical/surgical supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 027x and 062x from all claim records included in the stay. |
|
| DME Charge Amount |
374 |
382 |
9 |
The charge amount (rounded to whole dollars) for DME (purchase of new DME and rentals) related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 0290, 0291, 0292, and 0294 – 0299 from all claim records included in the stay. |
|
| Used DME Charge Amount |
383 |
391 |
9 |
The charge amount (rounded to whole dollars) for used DME (purchase of used DME) related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 0293 from all claim records included in the stay. |
|
| Physical Therapy Charge Amount |
392 |
400 |
9 |
The charge amount (rounded to whole dollars) for physical therapy services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 042x from all claims records included in the stay. |
|
| Occupational Therapy Charge Amount |
401 |
409 |
9 |
The charge amount (rounded to whole dollars) for occupational therapy services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 043x from all claims records included in the stay. |
|
| Speech Pathology Charge Amount |
410 |
418 |
9 |
The charge amount (rounded to whole dollars) for speech pathology services (speech, language, audiology) provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 044x and 047x from all claim records included in the stay. |
|
| Inhalation Therapy Charge Amount |
419 |
427 |
9 |
The charge amount (rounded to whole dollars) for inhalation therapy services (respiratory and pulmonary function) provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 041x and 046x from all claim records included in the stay. |
|
| Blood Charge Amount |
428 |
436 |
9 |
The charge amount (rounded to whole dollars) for blood provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 038x from all claim records included in the stay. |
|
| Blood Administration Charge Amount |
437 |
445 |
9 |
The charge amount (rounded to whole dollars) for blood storage and processing related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 039x from all claim records included in the stay. |
|
| Operating Room Charge Amount |
446 |
454 |
9 |
The charge amount (rounded to whole dollars) for the operating room, recovery room, and labor room delivery used by the beneficiary during the stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 036X, 071X, and 072X from all claim records included in the stay. |
|
| Lithotripsy Charge Amount |
455 |
463 |
9 |
The charge amount (rounded to whole dollars) for lithotripsy services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 079X from all claim records included in the stay. |
|
| Cardiology Charge Amount |
464 |
472 |
9 |
The charge amount (rounded to whole dollars) for cardiology services and electrocardiogram(s) provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 048X and 073X from all claim records included in the stay. |
|
| Anesthesia Charge Amount |
473 |
481 |
9 |
The charge amount (rounded to whole dollars) for anesthesia services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 037X from all claim records included in the stay. |
|
| Laboratory Charge Amount |
482 |
490 |
9 |
The charge amount (rounded to whole dollars) for laboratory costs related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 030x, 031x, 074x, and 075x from all claim records included in the stay. |
|
| Radiology Charge Amount |
491 |
499 |
9 |
The charge amount (rounded to whole dollars) for radiology costs (including oncology, excluding MRI) related to a beneficiary's stay. |
This field is derived by accumulating revenue center total charge amount associated with revenue center codes 028x, 032x, 033x, 034x, 035x, and 040x from all claim records included in the stay. |
|
| MRI Charge Amount |
500 |
508 |
9 |
The charge amount (rounded to whole dollars) for MRI services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center 061x from all claim records included in the stay. |
|
| Outpatient Service Charge Amount |
509 |
517 |
9 |
The charge amount (rounded to whole dollars) for outpatient services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 049x and 050x from all claim records included in the stay. |
|
| Emergency Room Charge Amount |
518 |
526 |
9 |
The charge amount (rounded to whole dollars) for emergency room services provided during the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 045X from all claim records included in the stay. |
|
| Ambulance Charge Amount |
527 |
535 |
9 |
The charge amount (rounded to whole dollars) for ambulance services related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 054x from all claim records included in the stay. |
|
| Professional Fees Charge Amount |
536 |
544 |
9 |
The charge amount (rounded to whole dollars) for professional fees related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 096x, 097x, and 098x from all claims records included in the stay. |
|
| Organ Acquisition Charge Amount |
545 |
553 |
9 |
The charge amount (rounded to whole dollars) for organ acquisition or other donor bank services related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 081x and 089x from all claim records included in the stay. |
| ESRD Revenue Setting Charge Amount |
554 |
562 |
9 |
The charge amount (rounded to whole dollars) for ESRD services (other than organ acquisition and other donor bank) related to a beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center codes 080x, 082x – 088x from all claim records included in the stay. |
|
| Clinic Visit Charge Amount |
563 |
571 |
9 |
The charge amount (rounded to whole dollars) for clinic visits (e.g., visits to chronic pain or dental centers or to clinics providing psychiatric, ob-gyn, pediatric services) related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount associated with revenue center code 051x from all claim records included in the stay. |
|
| Intensive Care Unit (ICU) Indicator Code |
572 |
572 |
1 |
The code indicating that the beneficiary has spent time under intensive care during the stay. It also specifies the type of ICU. |
This field is derived by checking for the presence of icu revenue center codes (listed below) on any of the claim records included in the stay. If more than one of the revenue center codes listed below are included on these claims, the code with the highest revenue center total charge amount is used. LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0206 due to coders misunderstanding the term 'post ICU' as including any day after an ICU stay rather than just days in a step-down/lower case version of an ICU. 'Post' was removed from the revenue center code 0206 description, effective 10/1/96 (12/96 MEDPAR update). 0206 Is now defined as 'intermediate ICU'. |
MEDPAR_ICU_IND_TB |
| Coronary Care Indicator Code |
573 |
573 |
1 |
The code indicating that the beneficiary has spent time under coronary care during the stay. It also specifies the type of coronary care unit. |
This field is derived by checking for the presence of coronary care revenue center codes (listed below) on any of the claim records included in the stay. If more than one of the revenue center codes listed below are included on these claims, the code with the highest revenue center total charge amount is used. LIMITATIONS: There is approximately a 20% error rate in the revenue center code category 0214 due to coders misunderstanding the term 'post CCU' as including any day after a CCU stay rather than just days in a step-down/lower case version of a CCU. 'Post' was removed from the revenue center code 0214 description, effective 10/1/96 (12/96 MEDPAR update). 0214 Is now defined as 'intermediate CCU'. |
MEDPAR_CRNRY_CARE_IND_TB |
| Pharmacy Indicator Code |
574 |
574 |
1 |
The code indicating whether or not the beneficiary received drugs during the stay. It also specifies the type of drugs. |
This field is derived by checking for the presence of drug-specific revenue center codes (listed below) on any of the claim records included in the stay. |
MEDPAR_PHRMCY_IND_TB |
| Transplant Indicator Code |
575 |
575 |
1 |
The code indicating whether or not the beneficiary received a organ transplant during the stay. |
This field is derived by checking for the presence of the transplant revenue center code (listed below) on any of the claim records included in the stay. |
MEDPAR_TRNSPLNT_IND_TB |
| Radiology Oncology Indicator Switch |
576 |
576 |
1 |
The switch indicating whether or not the beneficiary received radiology oncology services during the stay. |
This field is derived by checking for revenue center code 028X on any of the claim records included in the stay. |
MEDPAR_RDLGY_ONCLGY_IND_TB |
| Radiology Diagnostic Indicator Switch |
577 |
577 |
1 |
The switch indicating whether or not the beneficiary received radiology diagnostic services during the stay. |
This field is derived by checking for revenue center code 032x on any of the claim records included in the stay. |
MEDPAR_RDLGY_DGNSTC_IND_TB |
| Radiology Therapeutic Indicator Switch |
578 |
578 |
1 |
The switch indicating whether or not the beneficiary received radiology therapeutic services during the stay. |
This field is derived by checking for revenue center code 033X on any of the claim records included in the stay. |
MEDPAR_RDLGY_THRPTC_IND_TB |
| Radiology Nuclear Medicine Indicator Switch |
579 |
579 |
1 |
The switch indicating whether or not the beneficiary received radiology nuclear medicine services during the stay. |
This field is derived by checking for revenue center code 034x on any of the claim records included in the stay. |
MEDPAR_RDLGY_NUCLR_MDCN_IND_TB |
| Radiology CT Scan Indicator Switch |
580 |
580 |
1 |
The switch indicating whether or not the beneficiary received radiology computed tomographic (CT) scan services during the stay. |
This field is derived by checking for revenue center code 035X on any of the claim records included in the stay. |
MEDPAR_RDLGY_CT_SCAN_IND_TB |
| Radiology Other Imaging Indicator Switch |
581 |
581 |
1 |
The switch indicating whether or not the beneficiary received radiology other imaging services during the stay. |
This field is derived by checking for revenue center code 040X on any of the claim records included in the stay. |
MEDPAR_RDLGY_OTHR_IMGNG_IND_TB |
| Outpatient Services Indicator Code |
582 |
582 |
1 |
The code indicating whether or not the beneficiary has received outpatient services, ambulatory surgical care, or both. |
This field is derived by checking for the presence of the outpatient services revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_OP_SRVC_IND_TB |
| Organ Acquisition Indicator Code |
583 |
584 |
2 |
The code indicating the type of organ acquisition received by the beneficiary during the stay. |
This field is derived by checking for the presence of the organ acquisition indicator revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ORGN_ACQSTN_IND_TB |
| ESRD Setting Indicator Code |
585 |
586 |
2 |
The code indicating the type of dialysis received by the beneficiary during the stay. Up to 5 2-position codes may be present. |
This field is derived from the presence of the dialysis revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ESRD_SETG_IND_TB |
| ESRD Setting Indicator Code 2 |
587 |
588 |
2 |
The code indicating the type of dialysis received by the beneficiary during the stay. Up to 5 2-position codes may be present. |
This field is derived from the presence of the dialysis revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ESRD_SETG_IND_TB |
| ESRD Setting Indicator Code 3 |
589 |
590 |
2 |
The code indicating the type of dialysis received by the beneficiary during the stay. Up to 5 2-position codes may be present. |
This field is derived from the presence of the dialysis revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ESRD_SETG_IND_TB |
| ESRD Setting Indicator Code 4 |
591 |
592 |
2 |
The code indicating the type of dialysis received by the beneficiary during the stay. Up to 5 2-position codes may be present. |
This field is derived from the presence of the dialysis revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ESRD_SETG_IND_TB |
| ESRD Setting Indicator Code 5 |
593 |
594 |
2 |
The code indicating the type of dialysis received by the beneficiary during the stay. Up to 5 2-position codes may be present. |
This field is derived from the presence of the dialysis revenue center codes listed below on any of the claim records included in the stay. |
MEDPAR_ESRD_SETG_IND_TB |
| Claim Present on Admission Diagnosis Code Count |
595 |
596 |
2 |
Effective with Version 'J', the count of the number of Present on Admission (POA) codes reported on the Inpatient/SNF claim. The purpose of this count is to indicate how many claim POA diagnosis trailers are present. |
|
|
| Claim Present on Admission Diagnosis Indicator Code |
597 |
597 |
1 |
Effective with Version 'J', the code used to identify the present on admission(POA) indicator code associated with the diagnosis codes (principal and secondary). The present on admission indicators for the diagnosis E codes are stored in the present on admission diagnosis E trailer. |
|
CLM_POA_IND_TB |
| Claim Present on Admission Diagnosis Indicator Code 2 |
598 |
598 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 3 |
599 |
599 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 4 |
600 |
600 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 5 |
601 |
601 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 6 |
602 |
602 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 7 |
603 |
603 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 8 |
604 |
604 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 9 |
605 |
605 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 10 |
606 |
606 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 11 |
607 |
607 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 12 |
608 |
608 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 13 |
609 |
609 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 14 |
610 |
610 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 15 |
611 |
611 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 16 |
612 |
612 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 17 |
613 |
613 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 18 |
614 |
614 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 19 |
615 |
615 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 20 |
616 |
616 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 21 |
617 |
617 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 22 |
618 |
618 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 23 |
619 |
619 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 24 |
620 |
620 |
1 |
|
|
|
| Claim Present on Admission Diagnosis Indicator Code 25 |
621 |
621 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Code Count |
672 |
673 |
2 |
Effective with Version 'J', the count of the number of Present on Admission (POA) codes associated with the diagnosis E codes reported on the Inpatient/SNF claim. The purpose of this count is to indicate how many claim POA diagnosis E trailers are present. |
|
|
| Claim Present on Admission Diagnosis E Indicator Code |
674 |
674 |
1 |
Effective with Version 'J', the code used to identify the present on admission(POA) indicator code associated with the diagnosis E codes. |
|
|
| Claim Present on Admission Diagnosis E Indicator Code 2 |
675 |
675 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 3 |
676 |
676 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 4 |
677 |
677 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 5 |
678 |
678 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 6 |
679 |
679 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 7 |
680 |
680 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 8 |
681 |
681 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 9 |
682 |
682 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 10 |
683 |
683 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 11 |
684 |
684 |
1 |
|
|
|
| Claim Present on Admission Diagnosis E Indicator Code 12 |
685 |
685 |
1 |
|
|
|
| Diagnosis Code Count |
736 |
737 |
2 |
The count of the number of diagnosis codes included in the stay. |
This field is derived by adding '1' to the count of the other diagnosis codes reported on the last claim record included in the stay. The '1' represents the principal diagnosis code, which is reported separately from the other diagnosis. |
|
| Diagnosis Version Code |
738 |
738 |
1 |
Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10. |
|
CLM_DGNS_VRSN_TB |
| Diagnosis Version Code 2 |
739 |
739 |
1 |
|
|
|
| Diagnosis Version Code 3 |
740 |
740 |
1 |
|
|
|
| Diagnosis Version Code 4 |
741 |
741 |
1 |
|
|
|
| Diagnosis Version Code 5 |
742 |
742 |
1 |
|
|
|
| Diagnosis Version Code 6 |
743 |
743 |
1 |
|
|
|
| Diagnosis Version Code 7 |
744 |
744 |
1 |
|
|
|
| Diagnosis Version Code 8 |
745 |
745 |
1 |
|
|
|
| Diagnosis Version Code 9 |
746 |
746 |
1 |
|
|
|
| Diagnosis Version Code 10 |
747 |
747 |
1 |
|
|
|
| Diagnosis Version Code 11 |
748 |
748 |
1 |
|
|
|
| Diagnosis Version Code 12 |
749 |
749 |
1 |
|
|
|
| Diagnosis Version Code 13 |
750 |
750 |
1 |
|
|
|
| Diagnosis Version Code 14 |
751 |
751 |
1 |
|
|
|
| Diagnosis Version Code 15 |
752 |
752 |
1 |
|
|
|
| Diagnosis Version Code 16 |
753 |
753 |
1 |
|
|
|
| Diagnosis Version Code 17 |
754 |
754 |
1 |
|
|
|
| Diagnosis Version Code 18 |
755 |
755 |
1 |
|
|
|
| Diagnosis Version Code 19 |
756 |
756 |
1 |
|
|
|
| Diagnosis Version Code 20 |
757 |
757 |
1 |
|
|
|
| Diagnosis Version Code 21 |
758 |
758 |
1 |
|
|
|
| Diagnosis Version Code 22 |
759 |
759 |
1 |
|
|
|
| Diagnosis Version Code 23 |
760 |
760 |
1 |
|
|
|
| Diagnosis Version Code 24 |
761 |
761 |
1 |
|
|
|
| Diagnosis Version Code 25 |
762 |
762 |
1 |
|
|
|
| Diagnosis Code |
763 |
769 |
7 |
The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). |
|
|
| Diagnosis Code 2 |
770 |
776 |
7 |
|
|
|
| Diagnosis Code 3 |
777 |
783 |
7 |
|
|
|
| Diagnosis Code 4 |
784 |
790 |
7 |
|
|
|
| Diagnosis Code 5 |
791 |
797 |
7 |
|
|
|
| Diagnosis Code 6 |
798 |
804 |
7 |
|
|
|
| Diagnosis Code 7 |
805 |
811 |
7 |
|
|
|
| Diagnosis Code 8 |
812 |
818 |
7 |
|
|
|
| Diagnosis Code 9 |
819 |
825 |
7 |
|
|
|
| Diagnosis Code 10 |
826 |
832 |
7 |
|
|
|
| Diagnosis Code 11 |
833 |
839 |
7 |
|
|
|
| Diagnosis Code 12 |
840 |
846 |
7 |
|
|
|
| Diagnosis Code 13 |
847 |
853 |
7 |
|
|
|
| Diagnosis Code 14 |
854 |
860 |
7 |
|
|
|
| Diagnosis Code 15 |
861 |
867 |
7 |
|
|
|
| Diagnosis Code 16 |
868 |
874 |
7 |
|
|
|
| Diagnosis Code 17 |
875 |
881 |
7 |
|
|
|
| Diagnosis Code 18 |
882 |
888 |
7 |
|
|
|
| Diagnosis Code 19 |
889 |
895 |
7 |
|
|
|
| Diagnosis Code 20 |
896 |
902 |
7 |
|
|
|
| Diagnosis Code 21 |
903 |
909 |
7 |
|
|
|
| Diagnosis Code 22 |
910 |
916 |
7 |
|
|
|
| Diagnosis Code 23 |
917 |
923 |
7 |
|
|
|
| Diagnosis Code 24 |
924 |
930 |
7 |
|
|
|
| Diagnosis Code 25 |
931 |
937 |
7 |
|
|
|
| Diagnosis E Code Count |
988 |
989 |
2 |
Effective with Version 'J', the count of the number of diagnosis E codes reported on the Inpatient/SNF claim. The purpose of this count is to indicate how many diagnosis E trailers are present. |
|
|
| Diagnosis E Version Code |
990 |
990 |
1 |
Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10. |
|
CLM_DGNS_VRSN_TB |
| Diagnosis E Version Code 2 |
991 |
991 |
1 |
|
|
|
| Diagnosis E Version Code 3 |
992 |
992 |
1 |
|
|
|
| Diagnosis E Version Code 4 |
993 |
993 |
1 |
|
|
|
| Diagnosis E Version Code 5 |
994 |
994 |
1 |
|
|
|
| Diagnosis E Version Code 6 |
995 |
995 |
1 |
|
|
|
| Diagnosis E Version Code 7 |
996 |
996 |
1 |
|
|
|
| Diagnosis E Version Code 8 |
997 |
997 |
1 |
|
|
|
| Diagnosis E Version Code 9 |
998 |
998 |
1 |
|
|
|
| Diagnosis E Version Code 10 |
999 |
999 |
1 |
|
|
|
| Diagnosis E Version Code 11 |
1000 |
1000 |
1 |
|
|
|
| Diagnosis E Version Code 12 |
1001 |
1001 |
1 |
|
|
|
| Diagnosis E Code |
1002 |
1008 |
7 |
Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect. |
|
|
| Diagnosis E Code 2 |
1009 |
1015 |
7 |
|
|
|
| Diagnosis E Code 3 |
1016 |
1022 |
7 |
|
|
|
| Diagnosis E Code 4 |
1023 |
1029 |
7 |
|
|
|
| Diagnosis E Code 5 |
1030 |
1036 |
7 |
|
|
|
| Diagnosis E Code 6 |
1037 |
1043 |
7 |
|
|
|
| Diagnosis E Code 7 |
1044 |
1050 |
7 |
|
|
|
| Diagnosis E Code 8 |
1051 |
1057 |
7 |
|
|
|
| Diagnosis E Code 9 |
1058 |
1064 |
7 |
|
|
|
| Diagnosis E Code 10 |
1065 |
1071 |
7 |
|
|
|
| Diagnosis E Code 11 |
1072 |
1078 |
7 |
|
|
|
| Diagnosis E Code 12 |
1079 |
1085 |
7 |
|
|
|
| Surgical Procedure Indicator Switch |
1136 |
1136 |
1 |
The switch indicating whether or not there were any surgical procedures performed during the beneficiary's stay. |
This field is derived by checking for the presence of procedure codes on the last claim record included in the stay. |
MEDPAR_SRGCL_PRCDR_IND_TB |
| Surgical Procedure Code Count |
1137 |
1138 |
2 |
The count of the number of surgical procedure codes included in the stay. |
This field is derived by counting the procedure codes that are reported on the last claim record included in the stay. |
|
| Surgical Procedure Performed Day Count |
1139 |
1140 |
2 |
The count of the number of dates associated with the surgical procedures included in the stay. |
This field is derived by counting the surgical procedures dates that are reported on the last claim record included in the stay. |
|
| Surgical Procedure Version Code |
1141 |
1141 |
1 |
Effective with Version 'J', the code used to indicate if the surgical procedure code is ICD-9 or ICD-10. |
|
CLM_PRCDR_VRSN_TB |
| Surgical Procedure Version Code 2 |
1142 |
1142 |
1 |
|
|
|
| Surgical Procedure Version Code 3 |
1143 |
1143 |
1 |
|
|
|
| Surgical Procedure Version Code 4 |
1144 |
1144 |
1 |
|
|
|
| Surgical Procedure Version Code 5 |
1145 |
1145 |
1 |
|
|
|
| Surgical Procedure Version Code 6 |
1146 |
1146 |
1 |
|
|
|
| Surgical Procedure Version Code 7 |
1147 |
1147 |
1 |
|
|
|
| Surgical Procedure Version Code 8 |
1148 |
1148 |
1 |
|
|
|
| Surgical Procedure Version Code 9 |
1149 |
1149 |
1 |
|
|
|
| Surgical Procedure Version Code 10 |
1150 |
1150 |
1 |
|
|
|
| Surgical Procedure Version Code 11 |
1151 |
1151 |
1 |
|
|
|
| Surgical Procedure Version Code 12 |
1152 |
1152 |
1 |
|
|
|
| Surgical Procedure Version Code 13 |
1153 |
1153 |
1 |
|
|
|
| Surgical Procedure Version Code 14 |
1154 |
1154 |
1 |
|
|
|
| Surgical Procedure Version Code 15 |
1155 |
1155 |
1 |
|
|
|
| Surgical Procedure Version Code 16 |
1156 |
1156 |
1 |
|
|
|
| Surgical Procedure Version Code 17 |
1157 |
1157 |
1 |
|
|
|
| Surgical Procedure Version Code 18 |
1158 |
1158 |
1 |
|
|
|
| Surgical Procedure Version Code 19 |
1159 |
1159 |
1 |
|
|
|
| Surgical Procedure Version Code 20 |
1160 |
1160 |
1 |
|
|
|
| Surgical Procedure Version Code 21 |
1161 |
1161 |
1 |
|
|
|
| Surgical Procedure Version Code 22 |
1162 |
1162 |
1 |
|
|
|
| Surgical Procedure Version Code 23 |
1163 |
1163 |
1 |
|
|
|
| Surgical Procedure Version Code 24 |
1164 |
1164 |
1 |
|
|
|
| Surgical Procedure Version Code 25 |
1165 |
1165 |
1 |
|
|
|
| Surgical Procedure Code |
1166 |
1172 |
7 |
The ICD-9-CM code identifying the principal or other surgical procedure performed during the beneficiary's stay. This element is part of the MEDPAR surgical procedure group. It may occur up to 6 times. |
This field is the actual principal surgical procedure code (1st occurrence) or one of up to 5 other surgical procedure codes that may be present on the last claim record included in the stay. |
|
| Surgical Procedure Code 2 |
1173 |
1179 |
7 |
|
|
|
| Surgical Procedure Code 3 |
1180 |
1186 |
7 |
|
|
|
| Surgical Procedure Code 4 |
1187 |
1193 |
7 |
|
|
|
| Surgical Procedure Code 5 |
1194 |
1200 |
7 |
|
|
|
| Surgical Procedure Code 6 |
1201 |
1207 |
7 |
|
|
|
| Surgical Procedure Code 7 |
1208 |
1214 |
7 |
|
|
|
| Surgical Procedure Code 8 |
1215 |
1221 |
7 |
|
|
|
| Surgical Procedure Code 9 |
1222 |
1228 |
7 |
|
|
|
| Surgical Procedure Code 10 |
1229 |
1235 |
7 |
|
|
|
| Surgical Procedure Code 11 |
1236 |
1242 |
7 |
|
|
|
| Surgical Procedure Code 12 |
1243 |
1249 |
7 |
|
|
|
| Surgical Procedure Code 13 |
1250 |
1256 |
7 |
|
|
|
| Surgical Procedure Code 14 |
1257 |
1263 |
7 |
|
|
|
| Surgical Procedure Code 15 |
1264 |
1270 |
7 |
|
|
|
| Surgical Procedure Code 16 |
1271 |
1277 |
7 |
|
|
|
| Surgical Procedure Code 17 |
1278 |
1284 |
7 |
|
|
|
| Surgical Procedure Code 18 |
1285 |
1291 |
7 |
|
|
|
| Surgical Procedure Code 19 |
1292 |
1298 |
7 |
|
|
|
| Surgical Procedure Code 20 |
1299 |
1305 |
7 |
|
|
|
| Surgical Procedure Code 21 |
1306 |
1312 |
7 |
|
|
|
| Surgical Procedure Code 22 |
1313 |
1319 |
7 |
|
|
|
| Surgical Procedure Code 23 |
1320 |
1326 |
7 |
|
|
|
| Surgical Procedure Code 24 |
1327 |
1333 |
7 |
|
|
|
| Surgical Procedure Code 25 |
1334 |
1340 |
7 |
|
|
|
| Blood Pints Furnished Quantity |
1566 |
1568 |
3 |
The quantity of blood (number of whole pints) furnished to the beneficiary during the stay. Note: this includes blood pints replaced as well as not replaced. |
This field is derived by accumulating the blood pints furnished quantity from all claim records included in the stay. |
|
| DRG Code |
1571 |
1573 |
3 |
The code indicating the DRG to which the claims that comprise the stay belong for payment purposes. |
This field comes from the actual DRG code that is present on the last claim record included in the stay. exception: if the DRG code is not present (e.g., claims from Maryland and PPS-exempt hospital units do not have a DRG), a valid DRG is obtained using the grouper software and is moved to this field. |
|
| Discharge Destination Code |
1574 |
1575 |
2 |
The code primarily indicating the destination of the beneficiary upon discharge from a facility; also denotes death or SNF/still patient situations. |
This field comes from the claim status code that is present on the last claim record included in the stay. |
PTNT_DSCHRG_STUS_TB |
| DRG/Outlier Stay Code |
1576 |
1576 |
1 |
The code identifying (1) for PPS providers if the stay has an unusually long length (day outlier) or high cost (cost outlier); or (2) for non-PPS providers the source for developing the DRG. |
This field is the actual DRG outlier stay code that is present on the last claim record included in the stay. Applicable to PPS providers: 0 = No Outlier 1 = Day Outlier 2 = Cost Outlier Applicable to Non-PPS Providers: 6 = Valid DRG Received From Intermediary 7 = HCFA-Developed DRG 8 = HCFA-Developed DRG Using Claim Status Code 9 = Not Groupable |
|
| Beneficiary Primary Payer Code |
1577 |
1577 |
1 |
The code indicating the type of payer who has primary responsibility for the payment of the Medicare beneficiary's claims related to the stay. |
This field comes from the primary payer code that is present on the first claim record included in the stay. |
MEDPAR_BENE_PRMRY_PYR_TB |
| ESRD Condition Code |
1578 |
1579 |
2 |
The code indicating if the beneficiary had an ESRD condition reported during the stay. |
This field is derived by checking for condition codes 70 – 76 on any of the claim records included in the stay. |
MEDPAR_ESRD_COND_TB |
| Source Inpatient Admission Code |
1580 |
1580 |
1 |
The code indicating the source of the beneficiary's admission to an Inpatient facility or, for newborn admission, the type of delivery. |
This field comes from the source Inpatient admission code that is present on the last claim record included in the stay. |
CLM_SRC_IP_ADMSN_TB |
| Inpatient Admission Type Code |
1581 |
1581 |
1 |
The code indicating the type and priority of the beneficiary's admission to a facility for the Inpatient hospital stay. |
This field comes from the Inpatient admission type code that is present on the last claim record included in the stay. |
|
| Fiscal Intermediary/Carrier Identification Number |
1582 |
1586 |
5 |
The identification of the intermediary processing the beneficiary's claims related to the stay. |
|
|
| Admitting Diagnosis Version Code |
1587 |
1587 |
1 |
Effective with Version 'J', the code used to indicate if the diagnosis code is ICD-9 or ICD-10. |
|
CLM_ADMTG_DGNS_VRSN_TB |
| Admitting Diagnosis Code |
1588 |
1594 |
7 |
The ICD code indicating the beneficiary's initial diagnosis at the time of admission. |
|
|
| Admission Death Day Count |
1595 |
1599 |
5 |
The count of the number of days from the date the beneficiary was admitted to a facility to the beneficiary's date of death (DOD). |
This field is derived by counting the number of days between the MEDPAR admission date (the admission date present on the first claim record included in the stay) and MEDPAR beneficiary death date (the death date present on the enrollment database, which is accessed prior to creation of the quarterly MEDPAR file). |
|
| Care Improvement Model 1 Code |
1624 |
1625 |
2 |
Effective with CR#7, the code used to identify that the care improvement model 1 is being used for bundling payments. The valid value for care improvement model 1 is '61'. This value is also reflected in the demonstration trailer. |
This field comes from the Claim Care Improvement Model (CLM- CARE-IMPRVMT-MODEL-1-CD) code that is present on the first claim record included in the stay. If there is no Claim Care Improve Model code on the 1st claim then take the first found code on a the other claims that make up the stay. |
CLM_CARE_IMPRVMT_MODEL_TB |
| Care Improvement Model 2 Code |
1626 |
1627 |
2 |
Effective with CR#7, the code used to identify that the care improvement model 2 is being used for bundling payments. The valid value for care improvement model 2 is '62'. This value is also reflected in the demonstration trailer. |
This field comes from the Claim Care Improvement Model (CLM- CARE-IMPRVMT-MODEL-2-CD) code that is present on the first claim record included in the stay. If there is no Claim Care Improvement Model code on the 1st claim then take the first found code on any of the other claims that make up the stay. |
CLM_CARE_IMPRVMT_MODEL_TB |
| Care Improvement Model 3 Code |
1628 |
1629 |
2 |
Effective with CR#7, the code used to identify that the care improvement model 3 is being used for bundling payments. The valid value for care improvement model 3 is '63'. This value is also reflected in the demonstration trailer. |
This field comes from the Claim Care Improvement Model (CLM- CARE-IMPRVMT-MODEL-3-CD) code that is present on the first claim record included in the stay. If there is no Claim Care Improvement Model code on the 1st claim then take the first found code on any of the other claims that make up the stay. |
CLM_CARE_IMPRVMT_MODEL_TB |
| Care Improvement Model 4 Code |
1630 |
1631 |
2 |
Effective with CR#7, the code used to identify that the care improvement model 4 is being used for bundling payments. The valid value for care improvement model 4 is '64'. This value is also reflected in the demonstration trailer. |
This field comes from the Claim Care Improvement Model (CLM- CARE-IMPRVMT-MODEL-4-CD) code that is present on the first claim record included in the stay. If there is no Claim Care Improvement Model code on the 1st claim then take the first found code on any of the other claims that make up the stay. |
CLM_CARE_IMPRVMT_MODEL_TB |
| VBP Participant Indicator Code |
1632 |
1632 |
1 |
The code used to identify a reason a hospital is excluded from the Hospital Value Based Purchasing (HVBP) progam. The ACA (Section 3001) excludes from HVBP program hospitals that meet certain conditions. |
This field comes from the Claim VBP Participant Indicator code (CLM-VBP-PRTCPNT- IND-CD) that is present on the first claim record included in the stay. If there is no Claim VBP Participant Indicator code on the first claim then take the first found code on any of the other claims that make up the stay. |
CLM_VBP_PRTCPNT_IND_TB |
| HRR Participant Indicator Code |
1633 |
1633 |
1 |
The code used to identify whetherthe facility is participating in the Hospital Readmission Reduction Program. |
This field comes from the Claim HRR Participant Indicator code (CLM-HRR- PRTCPNT-IND-CD) that is present on the first claim record included in the stay. If there is no Claim HRR Participant Indicator code on the first claim then take the first found code on any of the other claims that make up the stay. |
CLM_HRR_PRTCPNT_IND_TB |
| Bundled Model Discount Percent |
1634 |
1636 |
3 |
The field used to identify the discount percentage that will be applied to the payment for all of the hospitals' DRG over the lifetime of the initiative. The hospital must be participating in the Model 1 Bundled Payments for Care Improvement initiative. |
This field comes from the Claim Bundled Model Discount (CLM-BNDLD-MODEL-1-DSCNT-PCT) that is present on the last record included in the stay. |
|
| VBP Adjustment Percent |
1637 |
1648 |
12 |
Under the Hospital Value Based Purchasing (HVBP) program, the percent used to identify an adjustment made to certain subsection (d) IPPS hospitals base operating DRG amount, in accordance with their Total Performance Score (TPS) as required by the Affordable Care Act (ACA). This is the Value Based Purchasing Score. |
This field comes from the Claim VBP Adjustment Percent (CLM-VBP-CLM- ADJSTMT-PCT) that is present on the last claim record included in the stay. |
|
| HRR Adjustment Percent |
1649 |
1653 |
5 |
Under the Hospital Readmission Reduction (HRR) Program, the percent used to identify the readmission adjustment factor that will be applied in determining a 'subsection (d) hospital's operating IPPS payment amount in accordance with Section 3025 of the Affordable Care Act (ACA). |
This field comes from the Claim HRR Adjustment Percent (CLM-HRR-ADJSTMT-PCT) that is present on the last claim record included in the stay. |
|
| Informational Encounter Indicator Switch |
1654 |
1654 |
1 |
The switch used to identify if a beneficiary is enrolled in a Managed Care Organization. |
If any claim that comprises the Stay has has a condition code (CLM RLT COND CD) equal to '04' populate the MEDPAR Informational Encounter Switch with a 'Y'. If no '04' condition code, populate field with an 'N'. |
MEDPAR_INFRMTL_ENCTR_IND_TB |
| MA Teaching Indicator Switch |
1655 |
1655 |
1 |
The code used to identify whether the claim contains any request for supplemental IME/DGME/N&AH payment. |
If any claim that comprises the Stay has has a condition code (CLM-RLT-COND-CD) equal to '69' populate the MEDPAR MA Teaching Indicator Switch with a 'Y'. If no '69' condition code, populate field with an 'N'. |
MEDPAR_MA_TCHNG_IND_TB |
| Product Replacement within Product Lifecycle Switch |
1656 |
1656 |
1 |
The switch used to identify whether a claim involves the replacement of a product earlier than the anticipated lifecycle due to an indication the product is not functioning properly. |
If any claim that comprises the Stay has has a condition code (CLM-RLT-COND-CD) equal to '49' populate the MEDPAR Product Replacement within Product Lifecycle Switch with a 'Y'. If no '49' condition code, populate field with an 'N'. |
MEDPAR_PROD_RPLCMT_LIFECYC_TB |
| Product Replacement for known Recall of Product Switch |
1657 |
1657 |
1 |
The switch used to identify whether a claim involves the replacement of a product as a result of the Manufacturer or FDA having identified the product for recall and therefore a replacement. |
If any claim that comprises the Stay has a Condition code CLM-RLT-COND-CD) equal to '50' populate the MEDPAR Product Replacement Recall Switch with a 'Y'. If no '50' condition code |
MEDPAR_PROD_RPLCMT_RCLL_TB |
| Credit Received from Manufacturer for Replaced Medical Device Switch |
1658 |
1658 |
1 |
The switch used to identify whether the provider received a credit from the Manufacturer for a replaced medical device. |
If any claim that comprises the Stay has a value code (CLM-VAL-CD) equal to 'FD' populate the MEDPAR Credit Received from Manufacturer for Replaced Medical Device Switch with a 'Y'. If no 'FD' value code, populate field with an 'N'. |
MEDPAR_CRED_RCVD_RPLCD_DVC_TB |
| Observation Switch |
1659 |
1659 |
1 |
The switch used to identify whether the claim involves treatment or observation in an observation room. |
If any claim that comprises the Stay has a revenue center code (REV-CNTR-CD) equal to '0762' populate the MEDPAR Observation Switch with a 'Y'. If no '0762' revenue center code populate field with an 'N'. |
MEDPAR_OBSRVTN_TB |
| New Technology Add On Amount |
1660 |
1668 |
9 |
The amount of payments made for discharges involving approved new technologies. If the total covered costs of the discharge exceeds the DRG payment for the case (including adjustments for IME and disproportionate share hospitals (DSH) but excluding outlier payments) an add-on amount is made indicating a new technology was used in the treatment of the beneficiary. |
This field is derived by accumulating the amount field (CLM-VAL-AMT) found in the value code trailer for value code (CLM-VAL-CD) equal to '77' for any claim records included in the stay. |
|
| Base Operating DRG Amount |
1669 |
1677 |
9 |
The sum of the claim base operating DRG amounts reported on the claims that comprise the stay. The base operating DRG amount used to identify the wage-adjusted DRG operating payment plus the new technology add-on payment. |
This field is derived by accumulating the Claim Base Operating DRG amount (CLM-BASE-OPRTG-DRG-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim base operating DRG amounts reported on the claims that comprise the stay). |
|
| Operating HSP Amount |
1678 |
1686 |
9 |
The sum of the claim operating HSP amounts reported on the claims that comprise the stay. The operating HSP amount is used to identify the difference between the HSP rate payment (updated HSP x DRG weight) and the federal rate payment (includes DSH, IME, outliers, etc. as applicable) when HSP rate payment exceeds Federal rate payment (otherwise $0). |
This field is derived by accumulating the Claim Operating HSP Amount (CLM_OPRTG_HSP_AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim operating HSP amounts reported on the claims that comprise the stay). |
|
| Medical/Surgical General Amount |
1687 |
1695 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical general supplies related to the beneficiary's stay. |
This field is dervived by accumulating the revenue center total charge amount (REV-CNTR- TOT-CHRG-AMT) associated with revenue center code (REV CNTR CD) '0270' from all claim records included in the stay. |
|
| Medical/Surgical Non-Sterile Supplies Amount |
1696 |
1704 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical nonsterile supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0271' from all claim records included in the stay. |
|
| Medical/Surgical Sterile Supplies Amount |
1705 |
1713 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical sterile supplies related to the beneficiary's stay. |
This field is derived by accumulalting the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0272' from all claim records included in the stay. |
|
| Medical/Surgical Take Home Amount |
1714 |
1722 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical take home supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0273' from all claim records included in the stay. |
|
| Medical/Surgical Prosthetic/Orthotic Device Amount |
1723 |
1731 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical prosthetic/orthotic supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0274' from all claim records included in the stay. |
|
| Medical/Surgical Pacemaker Amount |
1732 |
1740 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical pacemaker supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG- AMT) associated with revenue center code (REV- CNTR-CD) '0275' from all claim records included in the stay. |
|
| Medical/Surgical Intraocular Lens Amount |
1741 |
1749 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical intraocular lens supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0276' from all claim records included in the stay. |
|
| Medical/Surgical Oxygen Take Home Amount |
1750 |
1758 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical oxygen take home supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0277' from all claim records included in the stay. |
|
| Medical/Surgical Other Implants Amount |
1759 |
1767 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical other implant supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0278' from all claim records included in the stay |
|
| Medical/Surgical Other Supplies/Devices Amount |
1768 |
1776 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical other devices supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0279' from all claim records included in the stay. |
|
| Medical/Surgical Supplies Incident to Radiology Amount |
1777 |
1785 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical supplies incident to radiology related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0621' from all claim records included in the stay. |
|
| Medical/Surgical Supplies Incident to Other Diagnostic Service Amount |
1786 |
1794 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical supplies incident to other diagnostic services related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0622' from all claim records included in the stay. |
|
| Medical/Surgical Dressings Amount |
1795 |
1803 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical dressing supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV CNTR CD) '0623' from all claim records included in the stay. |
|
| Medical/Surgical Investigational Device Amount |
1804 |
1812 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical investigational devices supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0624' from all claim records included in the stay. |
|
| Medical/Surgical Miscellaneous Amount |
1813 |
1821 |
9 |
The charge amount (rounded to whole dollars) for the medical/surgical miscellaneous supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD_ '0620', '0625', '0626', '0627', '0628' & '0629' from all claim records included in the stay. |
|
| Radiology Oncology Amount |
1822 |
1830 |
9 |
The charge amount (rounded to whole dollars) for the oncology services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0280', '0281', '0282', '0283', '0284', '0285', '0286', '0287', '0288' & '0289' from all claim records included in the stay. |
|
| Radiology Diagnostic Amount |
1831 |
1839 |
9 |
The charge amount (rounded to whole dollars) for the radiology diagnositic services related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0320', '0321', '0322','0323', '0324', '0325', '0326', '0327', '0328' & '0329' from all claim records included in the stay. |
|
| Radiology Therapeutic Amount |
1840 |
1848 |
9 |
The charge amount (rounded to whole dollars) for the radiology therapeutic services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0330', '0331', '0332', '0333', '0334', '0335', '0336', '0337', '0338' & '0339' from all claim records included in the stay. |
|
| Radiology Nuclear Medicine Amount |
1849 |
1857 |
9 |
The charge amount (rounded to whole dollars) for the nuclear medicine services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0340', '0341', '0342', '0343', '0344', '0345', '0346' '0347', '0348' & '0349' from all claim records included in the stay. |
|
| Radiology Computed Tomographic (CT) Amount |
1858 |
1866 |
9 |
The charge amount (rounded to whole dollars) for the Computed Tomographic (CT) services related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0350', '0351', '0352', '0353', '0354', '0355', '0356', '0357', '0358' & '0359' from all claim records records included in the stay. |
|
| Radiology Other Imaging Services Amount |
1867 |
1875 |
9 |
The charge amount (rounded to whole dollars) for the radiology other imaging services related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0400', '0401', '0402', '0403', '0404', '0405', '0406', '0407', '0408' & '0409' from all claim records included in the stay. |
|
| Operating Room Amount |
1876 |
1884 |
9 |
The charge amount (rounded to whole dollars) for the operating room services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0360', '0361', '0362', '0363', '0364', '0365', '0366', '0367', '0368', '0369', '0710', '0711', '0712', '0713', '0714', '0715', '0717', '0718' & '0719' from all claim records included in the stay. |
|
| Operating Room Labor and Delivery Amount |
1885 |
1893 |
9 |
The charge amount (rounded to whole dollars) for the labor room/delivery services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR- TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0720', '0721', '0722', '0723', '0724', '0725', '0726', '0727', '0728' & '0729' from all claim records included in the stay. |
|
| Cardiac Catheterization Amount |
1894 |
1902 |
9 |
The charge amount (rounded to whole dollars) for the cardiac catherization services/supplies related to the beneficiary's stay. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR- TOT-CHRG-AMT) associated with revenue center codes (REV-CNTR-CD) '0481' from all claim records included in the stay. |
|
| Sequestration Reduction Amount |
1903 |
1911 |
9 |
This field represents the sequestration reduction amount (rounded to whole dollars). |
This field is derived by accumulating the amount field (CLM-VAL-AMT) found in the value code trailer for value code (CLM-VAL-CD) equal to '73' for any claim records included in the stay. |
| Uncompensated Care Payment Amount |
1912 |
1920 |
9 |
The field represents the uncompensated care amount (rounded to whole dollars) of the payment for DSH hospitals. Uncompensated care payments are effective for claims with discharge dates on or after 10/1/2013. For payment policies, see the Affordable Care Act section 3133 and the FY 2014 IPPS final rule. |
This field is derived by accumulating the Claim IPPS Flexible Payment 1 Amount (CLM-IPPS-FLEX-PMT-1-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim IPPS flexible payment 1 amounts reported on the claims that comprise the stay). |
| Bundled Adjustment Amount |
1921 |
1929 |
9 |
This field represents the amount (rounded to whole dollars) the claim was reduced by. This field only applies to providers participating in the CMMI model 1 bundled payment program and the adjustment is calculated off the base operating DRG amount field. See CMMI webpage for details on the Model 1 bundled payment program: http://innovation.cms.gov/initiatives/bundled-payments/ |
This field is derived by accumulating the Claim IPPS Flexible Payment 2 Amount (CLM-IPPS-FLEX-PMT-2-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim IPPS flexible payment 2 amounts reported on the claims that comprise the stay). |
| VBP Adjustment Amount |
1930 |
1938 |
9 |
This field represents the amount (rounded to whole dollars) of the Hospital Value Based Purchasing (VBP) amount. This could be an additional payment on the claim or a reduction, depending on the hospital's score. For details on the VBP program, see the website: http://www.cms.gov/Medicare/Quality-Initiatives-Patient-assessment-Instruments/hospital-value-based-purchasing/index.html?rediret=/hospital-value-based-purchasing |
This field is derived by accumulating the Claim IPPS Flexible Payment 3 Amount (CLM-IPPS-FLEX-PMT-3-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim IPPS flexible payment 3 amounts reported on the claims that comprise the stay). |
| HRR Adjustment Amount |
1939 |
1947 |
9 |
The amount field (rounded to whole dollars) that represents the Hospital Readmission Reduction (HRR) Program amount. This is a reduction to the claim for readmissions. This field holds a negative amount. For details on the readmission program, see website: http://www.cms.gov/Medicare/Medicare-Fee-For-Service-Payment/AcuteInpatientPPS/Readmissions-Reduction-Program.html |
This field is derived by accumulating the Claim IPPS Flexible Payment 4 Amount (CLM-IPPS-FLEX-PMT-4-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim IPPS flexible payment 4 amounts reported on the claims that comprise the stay). |
| EHR Payment Adjustment Amount |
1948 |
1956 |
9 |
This field indicates the dollar amount of the Electronic Health Record (EHR) reduction for eligible hospitals that are not meaningful EHR users. |
This field is derived by accumulating the Claim EHR Payment Adjustment Amount field (CLM-EHR-ADJSTMT-AMT) that is present on any of the claims records included in the stay (i.e. sum of the CLM-EHR-ADJSTMT-AMT reported on the claims that comprise the stay). |
| PPS Standard Value Payment Amount |
1957 |
1965 |
9 |
This amount field identifies the PRICER output standardized amount. This amount is never used for payments. It is used for comparisons across different regions of the country for the value-based purchasing initiatives and for research. It is a standard amount, without the geographical payment adjustments and some of the other add-on payments that actually go the hospitals. |
This field is derived by accumulating the Claim PSS Standard Value Payment Amount field (CLM-PPS-STD-VAL-PMT-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-PPS-STD-VAL-PMT-AMT reported on the claims that comprise the stay). |
| Final Standard Amount |
1966 |
1974 |
9 |
This amount field identifies the result of application of additional standardization requirements (e.g. sequestration) to the PPS Standardized Payment Amount. This amount is never used for payments. It is used for comparisons across different regions of the country for the value-based purchasing initiatives and for research. It is a standard amount, without the geographical payment adjustments and some of the other add-on payments that actually go the hospitals. |
This field is derived by accumulating the Claim Final Amount field (CLM-FINL-STD-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-FINL-STD-AMT reported on the claims that comprise the stay). |
| HAC Reduction Payment Amount |
1975 |
1983 |
9 |
This field identifies the reduction amount from the IPPS payment for hospitals that rank in the lowest-performing quartile of selected Hospital Acquired Conditions. |
This field is derived by accumulating the HAC Reduction Payment Amount (HAC-RDCTN-PMT-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim HAC reduction payment amounts reported on the claims that comprise the stay). |
| IPPS Flex Payment 7 Amount |
1984 |
1992 |
9 |
This field is a placeholder for a dollar amount to be used for a future policy. |
This field is derived by accumulating the Claim IPPS Flexible Payment 7 Amount (CLM-IPPS-FLEX-PMT-7-AMT) that is present on any of the claim records included in the stay (i.e. the sum of the claim IPPS flexible payment 7 amounts reported on the claims that comprise the stay). |
| Patient Add-On Payment Amount |
1993 |
2001 |
9 |
This field represents a based rate increase factor for 1.3516 for new patient initial preventive physical examination (IPPE) and annual wellness visit. |
This field is derived by accumulating the Revenue Center Patient Add On Payment Amount field (REV-CNTY-PTNT-ADD-ON-PMT-AMT) that is present on any of the claim records included in the stay (i.e. REV-CNTR-PTNT-ADD-ON-PMT-AMT reported on the claims that comprise the stay). |
| HAC Program Reduction Indicator Switch |
2002 |
2002 |
1 |
This field identifies hospitals subject to a Hospital Acquired Condition (HAC) reduction of what they would otherwise be paid under the IPPS. |
This field comes from the HAC Program Reduction Indicator Switch (CLM-HAC-PGM-RDCTN-IND-SW) that is present on the first claim record included in the stay. If there is no HAC Program Reduction Indicator switch on the 1st claim, then take the first found code on any of the other claims that make up the stay. |
| EHR Program Reduction Indicator Switch |
2003 |
2003 |
1 |
This field identifies which hospitals are Electronic Health Records meaningful users. |
This field comes from the EHR Program Reduction Indicator Switch (CLM-EHR-PGM-RDCTN-IND-SW) that is present on the first claim record included in the stay. If there is no EHR Program Reduction Indicator switch on the 1st claim, then take the first found code on any of the other claims that make up the stay. |
| Prior Authorization Indicator Code |
2004 |
2007 |
4 |
The indicator assigned by CMS for each prior authorization program to define the applicable line of business i.e. Part A, Part B, DME, Home Health & Hospice. |
This field comes from the Prior Authorization Indicator Code (CLM-PRIOR-AUTHRZTN-IND-CD) that is present on the first claim record included in the stay. If there is no Prior Authorization Indicator code on the 1st claim, then take the first found code on any of the other claims that make up the stay. |
| Unique Tracking Number |
2008 |
2021 |
14 |
The number assigned to each prior authorization request. |
This field comes from the Unique Tracking Number (CLM-UNIQ-TRKNG-NUM) that is present on the first claim record included in the stay. If there is no unique tracking number on the 1st claim, then take the first found number on any of the other claims that make up the stay. |
| 2 Midnight Stay Indicator Switch |
2022 |
2022 |
1 |
|
This field comes from the Claim Occurrence Span Code = 72 that is present on any claim included in the stay. If an occurrence span code = 72 is found, set the indicator to 'Y'. If no occurrence span code of 72 is found on any of the claims set the indicator to 'N'. |
| Site Neutral Payment Based on Cost Amount |
2023 |
2031 |
9 |
Under the Long Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on estimated cost of the case. |
This field is derived by accumulating the Claim Site Neutral Payment Based on Cost Amount field (CLM-SITE-NTRL-PMT-CST-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-SITE-NTRL-PMT-CST-AMT reported on the claims that comprise the LTCH stay). |
| Site Neutral Payment Based on IPPS Amount |
2032 |
2040 |
9 |
Under the Long Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the Inpatient Prospective Payment System (IPPS) comparable amount. This amount does not include any applicable outlier payment amount. |
This field is derived by accumulating the Claim Site Neutral Payment Based on IPPS Amount field (CLM-SITE-NTRL-PMT-IPPS-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-SITE-NTRL-PMT-IPPS-AMT reported on the claims that comprise the LTCH stay). |
| Full Standard Payment Amount |
2041 |
2049 |
9 |
Under the Long Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the MS-LTC-DRG. This amount does not include any applicable outlier payment amount. |
This field is derived by accumulating the Claim Full Standard Payment Amount field (CLM-FULL-STD-PMT-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-FULL-STD-PMT-AMT reported on the claims that comprise the LTCH stay). |
| Short Stay Outlier (SSO) Payment Amount |
2050 |
2058 |
9 |
Under the Long Term Care Hospital (LTCH) Prospective Payment System (PPS), the payment amount based on the MS-LTC-DRG payment with short stay outlier (SSO) adjustment. This amount does not include any applicable outlier payment amount. |
This field is derived by accumulating the Claim SSO Standard Payment Amount field (CLM-SSO-STD-PMT-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-SSO-STD-PMT-AMT reported on the claims that comprise the LTCH stay). |
| Next Generation (NG) Accountable Care Organization (ACO) Indicator 1 Code |
2059 |
2059 |
1 |
This field represents the benefit enhancement indicator that identifies claims that qualify for specific claims processing edits. |
This field comes from the CLM-NG-ACO Indicator 1 Code (CLM-NG-ACO-IND-1-CD) that is present on the first claim record included in the stay. If there is no CLM-NG-ACO-IND-1-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Next Generation (NG) Accountable Care Organization (ACO) Indicator 2 Code |
2060 |
2060 |
1 |
This field represents the benefit enhancement indicator that identifies claims that qualify for specific claims processing edits. |
This field comes from the CLM-NG-ACO Indicator 2 Code (CLM-NG-ACO-IND-2-CD) that is present on the first claim record included in the stay. If there is no CLM-NG-ACO-IND-2-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Next Generation (NG) Accountable Care Organization (ACO) Indicator 3 Code |
2061 |
2061 |
1 |
This field represents the benefit enhancement indicator that identifies claims that qualify for specific claims processing edits. |
This field comes from the CLM-NG-ACO Indicator 3 Code (CLM-NG-ACO-IND-3-CD) that is present on the first claim record included in the stay. If there is no CLM-NG-ACO-IND-3-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Next Generation (NG) Accountable Care Organization (ACO) Indicator 4 Code |
2062 |
2062 |
1 |
This field represents the benefit enhancement indicator that identifies claims that qualify for specific claims processing edits. |
This field comes from the CLM-NG-ACO Indicator 4 Code (CLM-NG-ACO-IND-4-CD) that is present on the first claim record included in the stay. If there is no CLM-NG-ACO-IND-4-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Next Generation (NG) Accountable Care Organization (ACO) Indicator 5 Code |
2063 |
2063 |
1 |
This field represents the benefit enhancement indicator that identifies claims that qualify for specific claims processing edits. |
This field comes from the CLM-NG-ACO Indicator 5 Code (CLM-NG-ACO-IND-5-CD) that is present on the first claim record included in the stay. If there is no CLM-NG-ACO-IND-5-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Residual Payment Indicator Code |
2064 |
2064 |
1 |
The residual payment indicator is used by CWF claims processing for the purpose of bypassing its normal MSP editing that would otherwise apply for ongoing responsibility for medicals (ORM) or worker's compensation Medicare Set-Aside Arrangements (WCMSA). Normally, CWF does not allow a secondary payment on MSP involving ORM or WCMSA, so the RPI will be used to allow CWF to make an exception to its normal routine. |
This field comes from the CLM Residual Payment Indicator Code (CLM-RSDL-PMT-IND-CD) that is present on the first claim record included in the stay. If there is no CLM-RSDL-PMT-IND-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Claim Representative Payee (RP) Indicator Code |
2065 |
2065 |
1 |
The field at the claim level to designate bypassing of the prior authorization processing for claims with a rep payee when an ‘R’ is present in the field. |
This field comes from the CLM Representative Payee Indicator Code (CLM-RP-IND-CD) that is present on the first claim record included in the stay. If there is no CLM-RP-IND-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Revenue Center Representative Payee (RP) Indicator Code |
2066 |
2066 |
1 |
The field at the line level to designate bypassing of the prior authorization processing for claims with a rep payee when an ‘R’ is present in the field. |
This field comes from the Revenue Center Representative Payee Indicator Code (REV-CNTR-RP-IND-CD) field. If an 'R' is present on any occurrence of revenue center trailer, in any claim included in the stay, move to MEDPAR-REV-CNTR-RP-IND-CD. |
| Accountable Care Organization (ACO) Identification Number |
2067 |
2076 |
10 |
The field identifies the unique identification number assigned to the Accountable Care Organization (ACO). |
This field comes from the Claim ACO Identification Number (CLM-ACO-ID-NUM) that is present on the first claim record included in the stay. If there is no CLM-ACO-ID-NUM on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Revenue Center Allogeneic Stem Cell Acquisition/Donor Services |
2089 |
2097 |
9 |
The field used to identify revenue center allogenic stem cell acquisition/donor services. |
This field is derived by accumulating the revenue center total charge amount (REV-CNTR-TOT-CHRG-AMT) associated with revenue center code (REV-CNTR-CD) '0815' from all claim records included in the stay. |
| Islet Add-On Payment Amount |
2098 |
2106 |
9 |
This field is used to identify the Islet add-on payment amount found in the value code/amount trailer. |
This field is derived by accumulating the amount field (CLM_VAL_AMT) found in the value code (CLM_VAL_CD) equal to 'Q7' from all claim records included in the stay. |
| Claim Inpatient Initial MS-DRG Code |
2107 |
2110 |
4 |
This field identifies the initial MS-DRG code assigned by MS-DRG Grouper prior to application of Hospital Acquired Conditions (HAC) logic. |
This field comes from the Claim Inpatient Initial MS DRG Code field (CLM-IP-INITL-MS-DRG-CD) that is present on the first NCH claim record included in the stay. If there is no CLM-IP-INITL-MS-DRG-CD on the 1st claim then take the first found code on any of the other claims that make up the stay. |
| Value Code Q1 Payment (ACO) Reduction Amount |
2111 |
2119 |
9 |
This field identifies the ACO Payment Reduction Amount (the actual amount of the Pioneer reduction) identified by Value Code = Q1. |
This field is derived by accumulating the amount field (CLM‑VAL‑AMT) found in the value code trailer for value code (CLM‑VAL‑CD) equal to ‘Q1’ for any claim records included in the stay. |
| MedPAR Claim Model Reimbursement Amount |
2120 |
2128 |
9 |
This Claim Level Field will be used to identify the “Net Reimbursement Amount” of what Medicare would have paid for Global Budget Services from a hospital participating in the particular model. If the claim only includes global services, the reimbursement amount (CLM_PMT_AMT) will reflect $0 (zero). If the claim includes global services and non-global services, the reimbursement amount will reflect the amount Medicare actually paid for the non-global services. |
This field is derived by accumulating the Claim Model Reimbursement Amount (CLM-MODEL-REIMBRSMT-AMT) that is present on any of the claim records included in the stay (i.e. sum of the CLM-MODEL-REIMBRSMT-AMT reported on the claims that comprised the stay). |
| MedPAR Revenue Center Model Reimbursement Amount |
2129 |
2137 |
9 |
This field identifies the “Net Reimbursement Amount” of what Medicare would have paid for the Global Budget Service reflected at the line level, from a hospital participating in the particular model. |
This field is derived by accumulating the Revenue Center Model Reimbursement Amount (REV-CNTR-MODEL-AMT) that is present on any line item on all claim records included in the stay (i.e. sum of the REV-CNTR-MODEL-AMT reported on the claims that comprised the stay). |
| MedPAR Value Code QB OCM+ Payment Adjustment Amount |
2138 |
2146 |
9 |
This field identifies the OCM+ Payment Adjustment Amount. |
This field is derived by accumulating the amount field (CLM‑VAL‑AMT) found in the value code trailer for value code (CLM‑VAL‑CD) equal to ‘QB’ for any claim records included in the stay. |
| DRG Version 36 |
2147 |
2149 |
3 |
The DRG version assigned to this stay. |
|
|
| DRG Version 37 |
2150 |
2152 |
3 |
The DRG version assigned to this stay. |
|
|
| DRG Version 38 |
2153 |
2155 |
3 |
The DRG version assigned to this stay. |
|
|
| DRG Version 39 |
2156 |
2158 |
3 |
The DRG version assigned to this stay. |
|
|
| LTCH Standard Pay Case* |
2159 |
2159 |
1 |
If LTCH_STND_PAY_CASE = 1, identifies a LTCH discharge that meets the proposed statutory criteria for exclusion from the site neutral payment rate in accordance with section 1206(a)(1) of Pub. L. 113-67. |
| Previous ICU Days* |
2160 |
2162 |
3 |
The total number of intensive care unit (ICU) or coronary care unit days during the IPPS acute-care hospital stay that immediately preceded the admission to the LTCH. |
