MedPar 1987 - 1995 Unpacked

MEDICARE PROVIDER ANALYSIS REC 727 1 727 (1987 - 03/1995) CONTAINS SELECTED ITEMS OF AND REVIEW (MEDPAR) RECORD INFORMATION FROM THE HOSPITAL STAY RECORDS (INCLUDES ROLLED-UP INPATIENT CLAIMS DATA AND BENEFICIARY DEMOGRAPHICS).

THIS RECORD LAYOUT PROVIDES FOR MEDPAR NUMERIC FIELDS TO BE IN DISPLAY FORMAT (I.E., UNPACKED).

• SYSTEM ALIAS: MEDPARA

HEALTH INSURANCE CLAIM GROUP 11 1 11 THIS NUMBER UNIQUELY IDENTIFIES A MEDICARE NUMBER (HIC) BENEFICIARY.

• STANDARD ALIAS: BENE_CLM_NUM_GRP
• COMMON ALIAS: HIC

1. BENEFICIARY CLAIM ACCOUNT NUMBER

CHAR 9 1 9 THE NUMBER IDENTIFYING THE PRIMARY BENEFICIARY  UNDER THE SSA OR RRB PROGRAMS.

• STANDARD ALIAS: BENE_CLM_ACNT_NUM
• COMMON ALIAS: CAN
• SAS ALIAS: CAN
• SOURCE: SSA,RRB
• LIMITATIONS: RRB-ISSUED NUMBERS CONTAIN AN OVERPUNCH IN THE FIRST POSITION THAT MAY APPEAR AS A PLUS ZERO OR A-G. RRB-FORMATTED NUMBERS MAY CAUSE MATCHING PROBLEMS ON NON-IBM MACHINES.

2. EQUATED BENEFICIARY

CHAR 2 10 11 THIS CODE SPECIFIES THE TYPE OF BENEFICIARY IDENTIFICATION CODE (BIC) FOR CASH PAYMENT PROGRAMS AND IDENTIFIES THE TYPE OF RELATIONSHIP BETWEEN THE INDIVIDUAL AND PRIMARY BENEFICIARY WHEN THE INDIVIDUAL IS QUALIFIED UNDER ANOTHER'S ACCOUNT. THE CODE IS EQUATED TO A COMMON BIC.

FOR EXAMPLE, THE RECORDS FOR A WIFE (BIC B) WHO BECOMES A WIDOW (BIC D) IN THE FILE YEAR WOULD HAVE ALL RECORDS CODED TO THE FIRST BIC.

• COMMON ALIAS: BIC
• CODES:

3. AGE

CHAR 3 12 14 THIS FIELD SPECIFIES THE BENEFICIARY'S AGE AS OF THE LAST BIRTHDAY BASED ON DATE OF ADMISSION. IT IS CALCULATED FROM THE DATE OF BIRTH.

• EDIT-RULES: NUMERIC  FIELD ENTRIES RANGE FROM 001 THROUGH 124.
• SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS

4. SEX

CHAR 1 15 15 THIS FIELD INDICATES THE SEX OF THE BENEFICIARY.

• STANDARD ALIAS: BENE_SEX_IDENT_CD
• CODES: 0 = UNKNOWN; 1 = MALE; 2 = FEMALE
• SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS
• LIMITATIONS: UNKNOWN IS USUALLY AN RRB DEFICIENCY IN REPORTING. IF THE SEX IS NOT INDICATED ON THE BILL, THE SEX IS CODED AS UNKNOWN.

5. BENEFICIARY RACE CODE

CHAR 1 16 16 THE RACE OF A BENEFICIARY.

• STANDARD ALIAS: BENE_RACE_CD
• SAS ALIAS: RACE_CD
• CODES:
• SOURCE: SSA

6. MEDICARE STATUS CODE

CHAR 2 17 18 THIS FIELD SPECIFIES THE REASON FOR THE BENEFICIARY'S ENTITLEMENT.

• STANDARD ALIAS: BENE_MDCR_STUS_CD
• COMMON ALIAS: MSC
• CODES:
• SOURCE: THIS FIELD IS CODED FROM AGE, ORIGINAL REASON FOR ENTITLEMENT, CURRENT REASON FOR ENTITLEMENT AND ESRD INDICATOR CONTAINED IN THE ENROLLMENT DATA BASE AT THE CENTRAL OFFICE AT THE DATE OF PROCESSING.

BENEFICIARY STATE AND GROUP 5 19 23 COUNTY OF RESIDENCE

7. STATE CODE

CHAR 2 19 20 THIS FIELD SPECIFIES THE STATE OF RESIDENCE OF THE BENEFICIARY AND IS BASED ON THE MAILING ADDRESS USED FOR CASH BENEFITS OR THE MAILING ADDRESS USED FOR OTHER PURPOSES (FOR EXAMPLE, PREMIUM BILLING). THIS INFORMATION IS MAINTAINED FROM CHANGE OF ADDRESS NOTICES SENT IN BY THE BENEFICIARIES, AND IS APPENDED TO THE RECORD AT TIME OF PROCESSING IN CENTRAL OFFICE. THE CODING SYSTEM IS THE SSA SYSTEM, NOT THE FEDERAL INFORMATION PROCESSING STANDARD (FIPS).

• STANDARD ALIAS: BENE_RSDNC_SSA_STD_STATE_CD
• CODES:
• SOURCE: SSA AND RRB BENEFICIARY RECORD SYSTEMS. FOR RRB BENEFICIARIES, THE STATE IS CODED IN SSA BASED ON MAILING ADDRESS.
• LIMITATIONS: IN SOME CASES, THE CODE MAY NOT BE THE ACTUAL STATE OF RESIDENCE. (FOR EXAMPLE, IF THE BENEFICIARY HAS A REPRESENTATIVE PAYEE).

8. COUNTY CODE

CHAR 3 21 23 THIS CODE SPECIFIES THE SSA CODE FOR THE COUNTY OF RESIDENCE OF THE BENEFICIARY. EACH STATE HAS A SERIES OF CODES BEGINNING WITH '000' FOR EACH COUNTY WITHIN THAT STATE. CERTAIN CITIES WITHIN THAT STATE HAVE THEIR OWN CODE. COUNTY CODES MUST BE COMBINED WITH STATE CODES IN ORDER TO LOCATE THE SPECIFIC COUNTY. THE CODING SYSTEM IS THE SSA SYSTEM, NOT THE FEDERAL INFORMATION PROCESSING SYSTEM (FIPS).

• STANDARD ALIAS: BENE_RSDNC_SSA_STD_CNTY_CD
• EDIT-RULES: NUMERIC
• SOURCE: 'GEOGRAPHIC CODE MANUAL FOR STATE AND COUNTY OF RESIDENCE' PRODUCED BY THE SSA.
• LIMITATIONS: SOME CODES MAY BE INVALID, UNKNOWN, OR '999'. (DIFFERENT FROM FIPS)

9. ZIP CODE OF RESIDENCE

CHAR 5 24 28 THIS FIELD SPECIFIES THE ZIP CODE AND IS BASED UPON THE MAILING ADDRESS USED FOR CASH BENEFITS TO THE BENEFICIARY OR FOR OTHER PURPOSES (E.G., PREMIUM BILLING).

• STANDARD ALIAS: BENE_MLG_CNTCT_ZIP_CD
• COMMENT: CODES IDENTIFY POSTAL SERVICE AREAS WITHIN THE U.S.A. BUT DO NOT NECESSARILY ADHERE TO BOUNDARIES OF CITIES, COUNTIES, STATES, OR OTHER JURISDICTIONS. THE CODE IS APPENDED TO THE RECORD AT TIME OF PROCESSING IN CENTRAL OFFICE. THE FIRST THREE POSITIONS OF THE ZIP CODE REPRESENT A PARTICULAR SECTIONAL POSTAL CENTER OR A METROPOLITAN CITY. THE LAST TWO DIGITS REPRESENT THE ASSOCIATED POST POST OFFICE SERVED BY THE POSTAL CENTER OR THE DELIVERY AREA SERVED BY THE POSTAL STATION.
• SOURCE:  SSA AND RRB BENEFICIARY RECORD SYSTEMS
• LIMITATIONS: ZIP CODE MAY NOT CORRESPOND WITH STATE OF RESIDENCE.

10. FILLER

CHAR 4 29 32

11. DAY OF ADMISSION

NUM 1 33 33 THIS FIELD SPECIFIES THE DAY OF THE WEEK THE ADMISSION OCCURRED.

• 1 DIGIT
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 15 (DATE OF ADMISSION)

12. DISCHARGE STATUS

CHAR 1 34 34 THIS FIELD SPECIFIES THE BENEFICIARY'S CONDITION ON THE DATE OF DISCHARGE FROM THE HOSPITAL.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM (DISCHARGE DESTINATION)'

13. HMO/READMISSION INDICATOR

CHAR 1 35 35 THIS FIELD SPECIFIES (A) WHETHER AN HMO IS PAYING FOR SERVICES PROVIDED, (B) WHETHER THE PATIENT HAS BEEN READMITTED WITHIN SEVEN DAYS OF AN EARLIER DISCHARGE, OR (C) BOTH.

• CODES:
• SOURCE: CODED AT CENTRAL OFFICE.

14. PPS INDICATOR

CHAR 1 36 36 THIS FIELD SPECIFIES WHETHER A HOSPITAL IS BEING PAID UNDER THE PROSPECTIVE PAYMENT SYSTEM (PPS).

• CODES:
• SOURCE: THE PPS INDICATOR IS SET AT THE CENTRAL OFFICE AND IS CODED BY THE INTERMEDIARY. A CODE OTHER THAN '65' IN THE UNIBILL CONDITION CODE FIELD INDICATES THAT THIS IS A PPS PROVIDER.
• LIMITATIONS: EXPERIENCE WITH THE INDICATOR SHOWS THAT IT WAS UNRELIABLE IN 1983, 1984, AND 1985.

15. MEDICARE PROVIDER NUMBER

CHAR 6 37 42 THIS FIELD SPECIFIES THE INSTITUTION THAT RENDERED SERVICES TO A BENEFICIARY. THIS IS THE UNIQUE NUMBER ISSUED BY THE CMS REGIONAL OFFICE TO A PROVIDER OF SERVICES UPON INITIAL CERTIFICATION FOR PARTICIPATION IN THE MEDICARE PROGRAM.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 7 (MEDICARE PROVIDER NUMBER).
• LIMITATIONS: THE MEDPAR FILE CONTAINS ONLY INPATIENT HOSPITAL RECORDS. PROVIDER NUMBERS ARE VALIDATED AGAINST A FILE OF MEDICARE-CERTIFIED PROVIDERS BY THE INTERMEDIARY. HOWEVER, THIS PROCESS IS NOT REPEATED WHEN THE MEDPAR FILE IS CONSTRUCTED.

16. PROVIDER CODE (SPECIAL UNIT CODE)

CHAR 1 43 43 THIS FIELD SPECIFIES THE PPS-EXEMPT SPECIAL  CARE UNITS OF INPATIENT HOSPITALS.

• CODES:
• SOURCE: THIS IS A UNIQUE IDENTIFIER ISSUED BY THE CMS REGIONAL OFFICE TO A PROVIDER OF SERVICE. THE NON-BLANK CODE REPLACES THE THIRD DIGIT OF THE PROVIDER NUMBER ON INCOMING BILLS.

17. FACILITY TYPE

CHAR 1 44 44 THIS FIELD SPECIFIES THE TYPE OF HOSPITAL

• CODES: S = SHORT STAY; L = LONG STAY; N = SNF
• SOURCE: DERIVED FROM UNIFORM BILL 82, FORM HCFA-1450, ITEM 8

18. NUMBER OF BILLS

NUM 3 45 47 THIS FIELD SPECIFIES THE NUMBER OF BILLS FOR A STAY.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: GENERATED FROM THE STAY RECORD AT CENTRAL OFFICE

19. ACCRETION DATE

NUM 5 48 52 THIS FIELD SPECIFIES THE MOST RECENT DATE THE STAY RECORD WAS MODIFIED BECAUSE OF RECEIPT OF A BILLING ACTION.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

20. EXHAUSTED DATE OF BENEFITS

NUM 5 53 57 THIS FIELD SPECIFIES THE DATE THE BENEFITS FOR THE BENEFICIARY WERE EXHAUSTED, I.E., ALL AVAILABLE FULL AND COINSURANCE DAYS FOR THAT SPELL OF ILLNESS HAVE BEEN USED.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: FROM THE FISCAL INTERMEDIARY

21. SNF QUALIFICATION FROM DATE

NUM 5 58 62 THIS FIELD SPECIFIES THE DATE THE BENEFICIARY WAS ADMITTED TO A GENERAL CARE HOSPITAL FOR AT LEAST THREE DAYS TO QUALIFY FOR MEDICARE COVERAGE IN A SNF-ONLY FACILITY.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: FROM THE FISCAL INTERMEDIARY

22. SNF QUALIFICATION THROUGH DATE

NUM 5 63 67 THIS FIELD SPECIFIES THE DATE THE BENEFICIARY  WAS DISCHARGED FROM A GENERAL CARE HOSPITAL AFTER QUALIFYING (AT LEAST A THREE DAY STAY) FOR MEDICARE IN A SNF-ONLY FACILITY.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: FROM THE FISCAL INTERMEDIARY

23. DATE OF ADMISSION

NUM 5 68 72 THIS FIELD SPECIFIES THE DATE ON WHICH THE BENEFICIARY WAS ADMITTED FOR INPATIENT CARE TO THE INSTITUTION.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 15

24. DATE OF DISCHARGE

NUM 5 73 77 THIS FIELD SPECIFIES THE DATE ON WHICH THE BENEFICIARY WAS DISCHARGED.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

25. ACTIVE CARE ENDED DATE

NUM 5 78 82 THIS FIELD SPECIFIES THE DATE ACTIVE INPATIENT HOSPITAL CARE ENDED, IF IT WAS PRIOR TO THE DATE OF DISCHARGE, AND IS USED FOR A SKILLED NURSING FACILITY (SNF) ONLY.

• 5 DIGITS
• EDIT-RULES: YYDDD, WHERE OCCURRENCE CODE ON BILL = 22
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

26. HIMASTER DATE OF DEATH

NUM 5 83 87 THIS FIELD SPECIFIES THE DATE THE BENEFICIARY DIED.

• 5 DIGITS
• EDIT-RULES: YYDDD
• SOURCE: DERIVED FROM THE HIMASTER OR UNIFORM BILL 82, FORM HCFA-1450

27. HIMASTER INDICATOR

CHAR 1 88 88 THIS FIELD SPECIFIES WHETHER THE DATE OF DEATH WAS VERIFIED. IF THE DATE OF DEATH IS VERIFIED, IT HAS BEEN REPORTED THROUGH THE SSA.

• CODES: V = DATE OF DEATH VERIFIED; B = DATE OF DEATH TAKEN FROM BILL
• SOURCE: HIMASTER

28. SSI DATA

CHAR 4 89 92 COMMENT: THIS FIELD SPECIFIES INFORMATION THAT MAY BE USED TO DETERMINE THE DISPROPORTUNATE SHARE PAID TO A HOSPITAL. SENSITIVE DATA; LIMITED AVAILABILITY

SOURCE: FROM SSA

29. LENGTH OF STAY

NUM 5 93 97 THIS FIELD SPECIFIES THE TOTAL LENGTH OF A PATIENT'S HOSPITAL STAY FROM THE DATE OF ADMISSION TO THE DATE OF DISCHARGE (OR THROUGH DATE IF STILL A PATIENT.)

• 5 DIGITS
• EDIT-RULES: NUMERIC     THE ENTRY 999 MAY BE EITHER A VALID ENTRY OR AN INDICATION OF FIELD OVERFLOW RESULTING FROM A DIFFERENCE LARGER THAN THREE CHARACTERS.
• DERIVATION: THE DIFFERENCE OBTAINED BY SUBTRACTING THE DATE OF ADMISSION FROM THE DATE OF DISCHARGE. IF DIFFERENCE WAS 0, IT WAS MADE 1.
• SOURCE: UNIFORM BILL HCFA-1450, ITEM 22 (STATEMENT COVERS PERIOD THROUGH DATE) MINUS ITEM 15 (ADMISSION DATE)

30. OUTLIER DAYS

NUM 3 98 100 THIS FIELD SPECIFIES THE NUMBER OF DAYS PAID AS OUTLIERS UNDER PPS AND THE DAYS OVER THE THRESHOLD FOR THE DRG. THE NUMBER CAN BE A DAY OR COST OUTLIER.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: FISCAL INTERMEDIARY

31. COVERED DAYS

NUM 3 101 103 THIS FIELD SPECIFIES THE NUMBER OF DAYS OF CARE REPORTED ON THE UNIFORM BILL THAT ARE COVERED BY MEDICARE.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• DERIVATION: THIS IS THE TOTAL OF ACCOMMODATIONS UNITS ENTERED IN ITEM 52 MINUS THE NON-COVERED DAYS IN ITEM 24 OF THE UNIFORM BILL, MINUS THE LEAVE OF ABSENCE DAYS, PLUS THE DAY OF DISCHARGE OR DEATH.
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 23

32. COINSURANCE DAYS

NUM 3 104 106 THIS FIELD SPECIFIES THE NUMBER OF INPATIENT HOSPITAL DAYS OCCURRING AFTER THE 60TH DAY AND BEFORE THE 91ST DAY OF THE SPELL OF ILLNESS, WHICH, UNDER COVERAGE, ARE THE DAYS THE BENEFICIARY IS LIABLE FOR A DAILY COINSURANCE AMOUNT.

• 3 DIGITS
• CODES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 25

33. LIFETIME RESERVE DAYS USED

NUM 3 107 109 THIS FIELD SPECIFIES THE NUMBER OF LIFETIME RESERVE DAYS USED BY A BENEFICIARY DURING THIS STAY. EACH BENEFICIARY HAS A LIFETIME RESERVE OF 60 ADDITIONAL DAYS OF MEDICARE COVERAGE FOR INPATIENT HOSPITAL SERVICES AFTER USING 90 DAYS OF INPATIENT HOSPITAL SERVICES DURING A SPELL OF ILLNESS.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 26

34. FILLER

CHAR 21 110 130

35. COINSURANCE AMOUNT

NUM 7 131 137 THIS FIELD SPECIFIES THE COINSURANCE AMOUNT, WHICH IS THE THE NUMBER OF COINSURANCE DAYS MULTIPLIED BY THE APPLICABLE COINSURANCE RATE PAID BY THE PATIENT.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 61A, B, OR C

36. INPATIENT DEDUCTIBLE

NUM 7 138 144 THIS FIELD SPECIFIES THE AMOUNT IDENTIFIED BY THE HOSPITAL AS THE PATIENT'S LIABILITY FOR INPATIENT DEDUCTIBLE.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 60

37. BLOOD DEDUCTIBLE

NUM 7 145 151 THIS FIELD SPECIFIES THE AMOUNT IDENTIFIED BY THE HOSPITAL AS THE PATIENT'S LIABILITY FOR BLOOD USED.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

38. PRIMARY PAYER AMOUNT

NUM 7 152 158 THIS FIELD SPECIFIES THE AMOUNT PAID THE PRIMARY INSURER FOR THE BENEFICIARY STAY IN A HOSPITAL.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: FROM THE FISCAL INTERMEDIARY

39. OUTLIER AMOUNT

NUM 7 159 165 THIS FIELD SPECIFIES THE AMOUNT PAID OVER THE DRG ALLOWANCE.

• 7 DIGITS
• CODES: $$$$$$$
• SOURCE: FROM THE FISCAL INTERMEDIARY

40. DISPROPORTIONATE SHARE AMOUNT

NUM 7 166 172 THIS FIELD SPECIFIES THE AMOUNT PAID OVER THE  DRG FOR THE DISPROPORTIONATE SHARE HOSPITAL.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: FROM THE FISCAL INTERMEDIARY

41. INDIRECT MEDICAL EDUCATION

NUM 7 173 179 THIS FIELD SPECIFIES THE ADDITIONAL AMOUNT (IME) AMOUNT PAID TO TEACHING HOSPITALS FOR IME. AFTER OCTOBER, 1989, THIS IS INCLUDED IN THE AMOUNT REIMBURSED.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: FROM THE FISCAL INTERMEDIARY

42. DRG PRICE

NUM 7 180 186 THIS FIELD SPECIFIES THE DRG PRICE, WHICH IS IS THE SUM OF THE REIMBURSEMENT, PRIMARY PAYOR REIMBURSEMENT, PRIMARY PAYOR AMOUNT, COINSURANCE AMOUNT, INPATIENT DEDUCTIBLE, AND BLOOD DEDUCTIBLE NON-COVERED CHARGES, LESS THE OUTLIER AMOUNT.   (R + P + C + I + B) - O = DRG PRICE

• 7 DIGITS UNSIGNED
• EDIT-RULES: $$$$$$$
• SOURCE: COMPUTED BY THE FISCAL INTERMEDIARY FOR ALL DISCHARGES

43. BILL TOTAL PER DIEM

NUM 7 187 193 THIS FIELD SPECIFIES THE TOTAL PER DIEM AMOUNT DERIVED BY MULTIPLYING THE PER DIEM FROM THE BILL BY THE NUMBER OF COVERED DAYS.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: FROM THE FISCAL INTERMEDIARY

44. PPS CAPITAL TOTAL AMOUNT

NUM 7 194 200 THIS FIELD SPECIFIES THE TOTAL REIMBURSEMENT FOR DEPRECIATION, RENT, CERTAIN INTEREST, AND RENT, CERTAIN INTEREST, AND REAL ESTATE TAXES FOR HOSPITAL BUILDINGS AND EQUIPMENT SUBJECT TO THE PPS. EFFECTIVE WITH HOSPITAL COST REPORTING PERIODS ON OR AFTER OCTOBER 1991.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE:  FROM THE FISCAL INTERMEDIARY

45. TOTAL PER DIEM

NUM 7 201 207 THIS FIELD SPECIFIES THE TOTAL PER DIEM AMOUNT.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• DERIVATION: AMOUNT DERIVED BY MULTIPLYING THE HOSPITAL COST REPORT PER DIEM BY COVERED DAYS.
• SOURCE: FISCAL INTERMEDIARY

46. IME

NUM 7 208 214 THIS FIELD SPECIFIES THE AMOUNT PAID TO TEACHING HOSPITALS FOR IME AND IS DERIVED FROM HOSPITAL COST REPORTS.

• 7 DIGITS
• EDIT-RULES: AMOUNT IS ROUNDED TO WHOLE DOLLARS
• SOURCE: FROM THE HOSPITAL COST REPORTS

47. ACQUISITION CHARGES

NUM 7 215 221 THIS FIELD SPECIFIES THE TOTAL AMOUNT OF ALL ACQUISITION CHARGES, I.E., ORGAN ACQUISITION, MEDICAL EQUIPMENT.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

48. TOTAL CHARGES

NUM 7 222 228 THIS FIELD SPECIFIES THE TOTAL CHARGES, INCLUDING NON-COVERED CHARGES, FOR THE BENEFICIARY REPORTED FOR THIS HOSPITAL STAY.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, REPORTED IN ITEM 53 (TOTAL CHARGES) IDENTIFIED BY ITEM 51 (REVENUE CODE 001)
• LIMITATIONS: AN ANOMALY HAS BEEN DISCOVERED WHEN DISCHARGES CONTAIN ZEROS IN THE TOTAL CHARGES FIELD. AT THIS TIME, THE CAUSE IS UNKNOWN. SINCE THESE RECORDS REPRESENT 0.002 PERCENT OF THE FILE, USERS ARE ASKED TO DELETE THEM AS ERRORS.

49. COVERED CHARGES

NUM 7 229 235 THIS FIELD SPECIFIES THE PORTION OF TOTAL CHARGES COVERED BY MEDICARE.

• 7 DIGITS
• DERIVATION: THIS FIELD IS DERIVED AT CENTRAL OFFICE BY SUBTRACTING NON-COVERED CHARGES FROM TOTAL CHARGES.
• CODES: $$$$$$$
• SOURCE: CENTRAL OFFICE

50. AMOUNT REIMBURSED

NUM 7 236 242 THE AMOUNT PAID TO THE PROVIDER AND/OR PATIENT BY MEDICARE FOR THE SERVICES REPORTED ON THE BILL. THIS AMOUNT DOES NOT INCLUDE CAPITAL CAPITAL PASS-THRU AMOUNT, INDIRECT MEDICAL EDUCATION AMOUNT (IME), OR KIDNEY ACQUISITION AMOUNT. IN ADDITION, IT EXCLUDES AMOUNTS PAID BY OR ON BEHALF OF THE PATIENT. (IME WAS INCLUDED EFFECTIVE OCTOBER, 1989.)

• 7 DIGITS
• CODES: $$$$$$$
• COMMENT: IME WAS EXCLUDED BEFORE OCTOBER 1989. THIS FIELD MAY BE ZERO IF MEDICARE IS NOT THE PRIMARY PAYER.
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, 'FOR INTERMEDIARY USE ONLY' SECTION, ITEM F

51. TOTAL ACCOMMODATION CHARGES

NUM 7 243 249 THIS FIELD SPECIFIES THE WHOLE DOLLAR AMOUNT OF THE TOTAL CHARGES FIELDS FOR ALL ROUTINE ACCOMMODATIONS REPORTED FOR THE BENEFICIARY DURING THIS HOSPITAL STAY. IT EXCLUDES SPECIAL ACCOMMODATION CHARGES (FOR EXAMPLE, INTENSIVE CARE AND CORONARY CARE UNITS).

• 7 DIGITS
• CODES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, SUMMATION OF ITEM 53 (TOTAL CHARGES) AND IDENTIFIED BY ITEM 51 (REVENUE CODES 10X THROUGH 18X)

52. TOTAL DEPARTMENTAL CHARGES

NUM 7 250 256 THIS FIELD SPECIFIES THE TOTAL OF THE SEPARATE DEPARTMENTAL CHARGES FOR THE BENEFICIARY REPORTED DURING THIS HOSPITAL STAY.

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, REPORTED IN ITEM 53 (TOTAL CHARGES) AND IDENTIFIED BY ITEM ITEM 51 (REVENUE CODES 22X THROUGH 99X)

ACCOMMODATION DAYS GROUP 15 257 271 THESE FIELDS SPECIFY THE NUMBER OF DAYS FOR ALL ROUTINE ACCOMMODATIONS.

53. PRIVATE ROOM DAYS

NUM 3 257 259

• 3 DIGITS
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

54. SEMI-PRIVATE ROOM

DAYS NUM 3 260 262

• 3 DIGITS
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

55. WARD DAYS

NUM 3 263 265

• 3 DIGITS
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

56. INTENSIVE CARE DAYS

NUM 3 266 268 THIS FIELD SPECIFIES THE NUMBER OF DAYS THE BENEFICIARY SPENT IN INTENSIVE/SPECIAL CARE DURING THIS HOSPITAL STAY.

• 3 DIGITS
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CODE 20X

57. CORONARY CARE DAYS

NUM 3 269 271 THIS FIELD SPECIFIES THE NUMBER OF DAYS THE BENEFICIARY SPENT IN A CORONARY CARE UNIT DURING THIS HOSPITAL STAY.

• 3 DIGITS
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 21X

ACCOMMODATION CHARGES GROUP 35 272 306 THESE FIELDS SPECIFY THE CHARGES FOR ALL ROUTINE ACCOMMODATIONS.

58. PRIVATE ROOM CHARGES

NUM 7 272 278

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

59. SEMI-PRIVATE ROOM CHARGES

NUM 7 279 285

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

60. WARD CHARGES

NUM 7 286 292

• 7 DIGITS
• EDIT-RULES:$$$$$$$
• SOURCE:UNIFORM BILL 82, FORM HCFA-1450

61. INTENSIVE CARE CHARGES

NUM 7 293 299

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

62. CORONARY CARE CHARGES

NUM 7 300 306

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

SERVICE CHARGES GROUP 175 307 481 THESE FIELDS SPECIFY THE CHARGES FOR VARIOUS SERVICES.

63. OTHER CHARGES

NUM 7 307 313

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 002 THROUGH 099, 22X, 23X, 24X, 52X, 53X, 55X, 56X, 57X, 58X, 59X, 60X, 64X, 65X, 66X, 67X, 68X, 69X, 70X, 76X, 77X, 78X, 90X, 91X, 92X, 93X, 94X, 95X, 99X.

64. PHARMACY CHARGES

NUM 7 314 320

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 25X, 26X, 63X.

65. MEDICAL/SURGICAL SUPPLIES CHARGES

NUM 7 321 327

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 27X, 62X.

66. DURABLE MEDICAL EQUIPMENT CHARGES

NUM 7 328 334

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 290, 291, 292.

67. USED DURABLE MEDICAL EQUIPMENT CHARGES

NUM 7 335 341

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 293.

68. PHYSICAL THERAPY CHARGES

NUM 7 342 348 7 DIGITS

• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 42X.

69. OCCUPATIONAL THERAPY CHARGES

NUM 7 349 355 7 DIGITS

• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 43X.

70. SPEECH PATHOLOGY CHARGES

NUM 7 356 362 7 DIGITS

• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 44X, 47X.

71. INHALATION THERAPY CHARGES

NUM 7 363 369 7 DIGITS

• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 41X, 46X.

72. BLOOD CHARGES

NUM 7 370 376

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 38X.

73. BLOOD ADMINISTRATION CHARGES

NUM 7 377 383

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 39X.

74. OPERATING ROOM CHARGES

NUM 7 384 390

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 36X, 71X, 72X.

75. LITHOTRIPSY CHARGES

NUM 7 391 397

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 79X.

76. CARDIOLOGY CHARGES

NUM 7 398 404

• 7 DIGITS
• EDIT-RULES:$$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 48X, 73X.

77. ANESTHESIA CHARGES

NUM 7 405 411

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE:
• UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 37X.

78. LABORATORY CHARGES

NUM 7 412 418

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 30X, 31X, 74X, 75X.

79. RADIOLOGY CHARGES

NUM 7 419 425

• 7 DIGITS
• EDIT-RULES:$$$$$$$
• SOURCE:UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 28X, 32X, 33X, 34X, 35X, 40X.

80. MRI CHARGES

NUM 7 426 432

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 61X.

81. OUTPATIENT SERVICES CHARGES

NUM 7 433 439

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 49X, 50X.

82. EMERGENCY ROOM CHARGES

NUM 7 440 446

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 45X.

83. AMBULANCE CHARGES

NUM 7 447 453

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 54X.

84. PROFESSIONAL FEES

NUM 7 454 460

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 96X, 97X, 98X.

85. ORGAN ACQUISITION CHARGES

NUM 7 461 467

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 81X, 89X.

86. ESRD REVENUE SETTING

NUM 7 468 474

• 7 DIGITS
• CHARGES
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 80X, 82X, 83X, 84X, 85X, 86X, 87X, 88X.

87. CLINIC VISIT CHARGES

NUM 7 475 481

• 7 DIGITS
• EDIT-RULES: $$$$$$$
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450 REVENUE CENTER 51X.

88. INTENSIVE CARE INDICATOR

CHAR 1 482 482

THIS FIELD SPECIFIES THAT THE BENEFICIARY HAS SPENT TIME UNDER INTENSIVE CARE AND INDICATES THE TYPE OF ICU.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

89. CORONARY CARE INDICATOR

CHAR 1 483 483 THIS FIELD SPECIFIES THAT THE BENEFICIARY HAS SPENT TIME UNDER CORONARY CARE AND INDICATES TYPE OF CORONARY CARE UNIT.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

90. PHARMACY INDICATOR

NUM 1 484 484 THIS FIELD SPECIFIES THAT THE BENEFICIARY HAS RECEIVED DRUGS DURING A STAY.

• 1 DIGIT
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

91. TRANSPLANT INDICATOR

NUM 1 485 485 THIS FIELD SPECIFIES WHETHER THE BENEFICIARY HAS HAD A TRANSPLANT.

• 1 DIGIT
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

RADIOLOGY INDICATORS GROUP 6 486 491 THESE FIELDS SPECIFY THE TYPE(S) OF RADIOLOGIC TREATMENT A BENEFICIARY HAS RECEIVED.

92. ONCOLOGY INDICATOR

NUM 1 486 486

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

93. RADIOLOGY-DIAGNOSTIC INDICATOR

NUM 1 487 487

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

94. RADIOLOGY-THERAPEUTIC INDICATOR

NUM 1 488 488

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

95. NUCLEAR MEDICINE INDICATOR

NUM 1 489 489

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

96. CT SCAN INDICATOR

NUM 1 490 490

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

97. OTHER IMAGING SERVICES INDICATOR

NUM 1 491 491

• 1 DIGIT
• CODES: 1 = YES; 0 = NO
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

98. OUTPATIENT SERVICES INDICATOR

NUM 1 492 492 THIS FIELD SPECIFIES WHETHER THE BENEFICIARY  HAS RECEIVED OUTPATIENT SERVICES, AMBULATORY SURGICAL CARE, OR BOTH.

• 1 DIGIT
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

99. ORGAN INDICATOR

CHAR 2 493 494 THIS FIELD SPECIFIES THE TYPE OF ORGAN TRANSPLANT.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

100. ESRD SETTING

CHAR 2 495 496 THIS FIELD SPECIFIES THE TYPE OF DIALYSIS USED ON THE BENEFICIARY.

• OCCURS: 5 TIMES
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

101. NUMBER OF DIAGNOSIS CODES

NUM 2 505 506 THIS FIELD INDICATES THE NUMBER OF DIAGNOSIS CODES PRESENT IN THE STAY RECORD, I.E., THE NUMBER OF FIELDS THAT ARE NOT BLANK.

• 2 DIGITS
• EDIT-RULES: RANGE 0 THRU 10
• SOURCE: UNIFORM BILL HCFA-1450, ITEMS 77 THROUGH 81

DIAGNOSTIC CODES GROUP 50 507 556 THESE FIELDS SPECIFY THE PRINCIPAL AND OTHER DIAGNOSIS CODES THAT ARE OBTAINED FROM THE PATIENT'S DISCHARGE BILL. PRINCIPAL IS DEFINED AS THE CONDITION ESTABLISHED, AFTER STUDY, TO BE CHIEFLY RESPONSIBLE FOR OCCASIONING THE ADMISSION OF THE PATIENT. CODING IS BASED ON INTERNATIONAL CLASSIFICATION OF DISEASES 9TH REVISION, CLINICAL MODIFICATION (ICD-9-CM). PROVIDERS KEY THE ICD-9-CM CODE FROM THE BILLS AND REPORT THE INFORMATION TO CMS AS PART OF THE CLAIMS TAPE RECORD. EACH CODE CAN BE UP TO FIVE CHARACTERS, LEFT JUSTIFIED. A MAXIMUM OF TEN CODES IS CARRIED IN THE RECORD.

102. DIAGNOSIS CODE

CHAR 5 507 511 THE ICD-9-CM BASED CODE IDENTIFYING THE BENEFICIARY'S DIAGNOSIS.

• OCCURS: 10 TIMES
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEMS 77 THROUGH 81
• LIMITATIONS: MAY CONTAIN INVALID CODES

103. SURGERY INDICATOR

CHAR 1 557 557 THIS FIELD SPECIFIES WHETHER THERE IS A SURGERY PROCEDURE ON THE BILL.

• CODES: 0 = NO; 1 = YES
• SOURCE: THIS FIELD IS DERIVED AT CENTRAL OFFICE.

104. NUMBER OF SURGICAL CODES

NUM 2 558 559 THIS FIELD SPECIFIES THE NUMBER OF SURGICAL CODES IN THE RECORD.

• 2 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

105. NUMBER OF SURGICAL DATES

NUM 2 560 561 THIS FIELD SPECIFIES THE NUMBER OF SURGICAL DATES IN THE RECORD.

• 2 DIGITS
• CODES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

SURGICAL CODES GROUP 40 562 601 THESE FIELDS SPECIFY THE CODES THAT CORRESPOND TO THE SURGICAL PROCEDURES PERFORMED ON THE BENEFICIARY. UP TO TEN OCCURRENCES MAY BE PRESENT.

106. SURGICAL PROCEDURE CODE

CHAR 4 562 565 CODE CORRESPONDING TO A SURGICAL PROCEDURE PERFORMED ON THE BENEFICIARY.

• OCCURS: 10 TIMES
• EDIT-RULES: ICD-9-CM
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

SURGICAL DATES GROUP 50 602 651 THESE FIELDS SPECIFY THE DATES THAT SURGERY WAS PERFORMED ON THE BENEFICIARY. UP TO TEN OCCURRENCES MAY BE PRESENT.

107. SURGICAL DATE

NUM 5 602 606 DATE SURGERY WAS PERFORMED ON THE BENEFICIARY.

• 5 DIGITS
• OCCURS: 10 TIMES
• EDIT-RULES: YYDDD
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

108. BLOOD FURNISHED (PINTS)

NUM 3 652 654 THIS FIELD SPECIFIES THE TOTAL NUMBER OF PINTS OF WHOLE BLOOD OR UNITS OF PACKED RED CELLS FURNISHED, REGARDLESS OF WHETHER THEY WERE REPLACED. BLOOD IS REPORTED IN COMPLETE UNITS ROUNDED UPWARDS. THIS ENTRY SERVES AS THE BASIS FOR COUNTING PINTS TOWARD THE BLOOD DEDUCTIBLE AND MUST, THEREFORE, INCLUDE BOTH REPLACED AND UNREPLACED BLOOD.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 40
• LIMITATIONS: BASED ON AN ANALYSIS OF AGGREGATED RECORDS, THERE APPEARS TO BE A MISINTERPRETATION BY SOME PROVIDERS OF THE FORMAT, I.E., THE FIELD IS TO CONTAIN WHOLE UNITS BUT APPEARS IN SOME CASES TO BE REPORTED WITH TENTHS OF UNITS.

109. FILLER

CHAR 2 655 656

110. DIAGNOSIS RELATED GROUP

NUM 3 657 659 EACH DRG REPRESENTS BROAD CLINICAL CATEGORIES (DRG) CODE THAT ARE BASED ON BODY SYSTEM INVOLVEMENT AND DISEASE ETIOLOGY. EACH CATEGORY IS SIMILAR IN ITS USE OF DIAGNOSTIC RESOURCES AND IS USING SPECIFIC GUIDELINES. EACH CATEGORY MUST HAVE BEEN CLINICALLY CONSISTENT, HAD A SUFFICIENT NUMBER OF PATIENTS, AND COVERED THE COMPLETE RANGE OF DIAGNOSES REPRESENTED IN THE ICD-9-CM WITHOUT OVERLAP. THE CATEGORIES WERE DEVELOPED BY A YALE UNIVERSITY RESEARCH TEAM AND REVISED BY HEALTH SERVICES INTERNATIONAL, INC.

• 3 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: ADDED TO THE RECORD BY THE INTERMEDIARY'S GROUPER SOFTWARE WHICH TRANSLATES VARIABLES SUCH AS AGE, SEX, DIAGNOSIS AND SURGICAL CODES INTO THE SINGLE APPLICABLE DRG. THE GROUPER SOFTWARE IS UPDATED PERIODICALLY AS SHOWN.
• CODE
• LIMITATIONS: DRG 467 AND DRG 470 ARE CATEGORIES WHICH COULD NOT BE ACCURATELY CLASSIFIED INTO VALID DRG'S.

111. DISCHARGE DESTINATION

NUM 2 660 661 THIS FIELD SPECIFIES THE DESTINATION OF THE PATIENT UPON DISCHARGE FROM THE HOSPITAL.

• 2 DIGITS
• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 21
• LIMITATIONS: THIS FIELD HAS NOT BEEN VALIDATED. THERE IS SOME QUESTION OF ITS RELIABLILTY.

112. OUTLIER CODE/DRG SOURCE

NUM 1 662 662 THIS FIELD IDENTIFIES TWO MUTUALLY EXCLUSIVE CONDITIONS. THE FIRST, FOR PPS PROVIDERS (CODES 0, 1, AND 2), CLASSIFIES STAYS OF EXCEPTIONAL COST OR LENGTH (OUTLIERS). THE SECOND, FOR NON-PPS PROVIDERS (CODES 6, 7, 8, AND 9), DENOTES THE SOURCE FOR DEVELOPING THE DRG.

• 1 DIGIT
• CODES:
• SOURCE: THIS FIELD IS CODED AT CENTRAL OFFICE.

113. PRIMARY PAYER CODE

CHAR 1 663 663 THIS FIELD INDICATES WHO IS PRIMARILY RESPONSIBLE FOR PAYMENT.

• CODES:
• SOURCE: FROM THE FISCAL INTERMEDIARY

114. ESRD CONDITION CODE

NUM 2 664 665 THIS FIELD SPECIFIES THE ESRD CONDITION CODES FOUND ON THE BENEFICIARY'S BILL.

• 2 DIGITS
• CODES:
• SOURCE: FROM THE FISCAL INTERMEDIARY

115. SOURCE OF ADMISSION

CHAR 1 666 666 THIS FIELD SPECIFIES THE TYPE OF ADMISSION FOR INPATIENT HOSPITAL STAYS.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 18

116. TYPE OF ADMISSION

CHAR 1 465 465 THIS FIELD SPECIFIES THE BASIC TYPES OF ADMISSION FOR INPATIENT HOSPITAL STAYS.

• CODES:
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450, ITEM 17

117. INTERMEDIARY NUMBER

CHAR 5 466 470 THIS FIELD SPECIFIES THE IDENTIFYING NUMBER OF THE INTERMEDIARY PROCESSING THE BILL.

• EDIT-RULES: FOR THE FIRST TWO POSITIONS: 00 = BLUE CROSS; NN = COMMERCIAL PLAN
• SOURCE: FROM THE FISCAL INTERMEDIARY

118. ADMISSION DIAGNOSIS CODE

CHAR 5 673 677 THIS FIELD SPECIFIES THE ICD-9 DIAGNOSIS CODE AT THE TIME OF ADMISSION.

• EDIT-RULES: NUMERIC
• SOURCE: UNIFORM BILL 82, FORM HCFA-1450

119. HMO NUMBER

NUM 5 678 682 THIS FIELD SPECIFIES THE NUMBER OF THE HMO PLAN IN WHICH THE BENEFICIARY IS ENROLLED.

• 5 DIGITS
• STANDARD ALIAS: HMO_NUM
• EDIT-RULES: NUMERIC
• SOURCE: FROM THE FISCAL INTERMEDIARY

120. HMO OPTION CODE

CHAR 1 683 683 THIS FIELD SPECIFIES THE TYPE OF PLAN THE BENEFICIARY HAS CHOSEN.

• STANDARD ALIAS: HMO_OPTN_CD
• CODES:
• SOURCE: FROM THE FISCAL INTERMEDIARY

121. ADMISSION TO DATE OF DEATH

NUM 5 684 688 THIS FIELD SPECIFIES THE NUMBER OF DAYS FROM INTERVAL THE BENEFICIARY'S ADMISSION TO THE DATE OF DEATH.

• 5 DIGITS
• EDIT-RULES: NUMERIC
• SOURCE: MEDPAR

122. FILLER

CHAR 4 689 692

123. IMCAB INFORMATION

NUM 3 693 695 FOR FUTURE USE

• 3 DIGITS

124. DATE OF DATA

NUM 1 696 696 FOR INTERNAL USE ONLY

• 1 DIGIT

125. SAMPLE SIZE

NUM 1 697 697 FOR INTERNAL USE ONLY

• 1 DIGIT

126. WARNING INDICATORS

NUM 17 698 714 THESE FIELDS SPECIFY THE DETAILED BILLING INFORMATION THAT ENABLE THE USER TO DESIGNATE THE TYPE OF BILL, I.E., SINGLE, MULTIPLE, CREDIT ADJUSTMENT.

• 17 DIGITS
• CODES:
• SOURCE: MEDPAR

127. ORIGINAL HIC

CHAR 11 715 725 THIS FIELD SPECIFIES THE ORIGINAL HIC PROVIDED BY THE REQUESTOR.

SOURCE: REQUESTOR

128. ACTIVE CROSS-REFERENCE

CHAR 1 726 726 THIS FIELD SPECIFIES WHETHER THE HI CLAIM INDICATOR NUMBER ORIGINATED FROM A CROSS-REFERENCE.

• CODES: X = CROSS-REFERENCE; A = ACTIVE
• SOURCE: HI CLAIM NUMBER CROSS-REFERENCE INFORMATION

129. REASON FOR SELECTION

CHAR 1 727 727 THIS FIELD SPECIFIES WHETHER THIS RECORD IS A CASE OR CONTROL RECORD.

• CODES: