Current UB-04 Correspondence

Updated 2017 Ambulatory Surgery Definition

As you recall, in preparation for ICD-10 in Fall 2015 we notified you of the new ambulatory surgery definition.  The new definition relies on CPT/HCPCS codes reported.  With the new year comes a new set of  CPT/HCPCS codes.  After extensive review of the new codes by the Tennessee Hospital Association (THA) and the Tennessee Health Information Management Association (THIMA) professionals we have determined which codes should be included or excluded from the ambulatory surgery definition beginning with the Q1 - 2017 discharge data which are due May 30, 2017.  Please find the updated definition document attached.  As you review pages 2-10 you will see the changes highlighted in yellow.  Please know this update will be made each year with the release of new CPT/HCPCS codes.  

An ambulatory surgery definition document is being made available so you understand how the Remote Discharge Data System (RDDS) flags your outpatient records as an ambulatory surgery record.  Please continue to submit all of your outpatient records as you currently do and the system will continue to define and flag the ambulatory surgery records for you.  

You do not have to make any changes to the way you currently submit your data.  This is only an update to reflect the new 2017 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.

THA Ambulatory Surgery Definition

If you need assistance, please contact Larissa Lee


TDH Request for Information on UB-04 Data Reporting - November 4th, 2016

On November 4, 2016, the Tennessee Department of Health (TDH) emailed all licensed Tennessee Hospitals a letter requesting information on your quarterly UB-04 data submissions. A copy of the letter is attached. As you may recall, the TDH plans to send this data information request annually, each November. They are asking each hospital to submit the mandatory Reporting Method Sheet, PH-3925 (also attached) by November 20th via email to Nerissa Harvey at Nerissa.Harvey@tn.gov as stated in the attached letter.

When filling out the reporting method sheet, THA member hospitals should select, under section I, third quarter and use the date you submitted your data to THA via the Remote Discharge Data System (RDDS). If you have not yet submitted your Q3-2016 data, due by November 29th, still choose third quarter and indicate the anticipated submission date, not to exceed November 29th. As a gentle reminder, facilities failing to submit UB-04 discharged data to THA will be subjected to the penalties proscribed under T.C.A. 68-1-108.

Also, please be aware the attached reporting method sheet states all hospitals must complete and return the form signed and dated, each and every quarter. This is a misrepresentation as the form is only due on an annual basis. THA did clarify this with the TDH contact, Nerissa Harvey.

If you need assistance, please contact Larissa Lee


REVISED (again): Revenue Codes that Require CPT/HCPCS Codes on Outpatient Discharges - February 25th, 2016

The last revision to fatal edit #3506, revenue codes that require CPT/HCPCS codes on outpatient discharges, was sent to you on Tuesday, February 23rd. At that time revenue codes 251, 254, 255, 259, 278, 621 and 622 were excluded from the list. After further feedback and review, we are excluding more revenue codes. The revenue codes excluded for this revision are 252, 253, 256, and 257.

Click here for an updated listing of revenue codes that require CPT/HCPCS codes.

The deadline to submit your Q4-2015 data is March 1st. NOTE: If you submitted your hospitals Q4-2015 data on or before February 24, 2016, the above modifications have been applied to your data and new reports are available for you to review.

As always, be sure to complete a detailed review of your verification, edit summary and edit detail reports in RDDS. This is important with each data submission.

If you need assistance, please contact Larissa Lee


REVISED: Revenue Codes that Require CPT/HCPCS Codes on Outpatient Discharges - February 23rd, 2016

On February 2, 2016 you were notified of a revision to the list of revenue codes that require CPT/HCPCS codes on outpatient discharges (fatal edit # 3506). At that time revenue codes 258 and 637 were excluded from the list. After further feedback and review, we are excluding more revenue codes. The revenue codes excluded for this revision are 251, 254, 255, 259, 278, 621 and 622.

Click here for an updated listing of revenue codes that require CPT/HCPCS codes.

The deadline to submit your Q4-2015 data is March 1st. NOTE: If you submitted your hospital's Q4-2015 data on or before February 22, 2016, the above modifications have been applied to your data and new reports are available for you to review.

As always, be sure to complete a detailed review of your verification, edit summary and edit detail reports in RDDS. This is important with each data submission.

If you need assistance, please contact Larissa Lee


Update: Revenue Codes that Require CPT/HCPCS Codes on Outpatient Discharges - February 5th, 2016

In January 2014, an edit was added to the Tennessee Hospital Association Remote Discharge Data System (THA RDDS) to flag a record as a fatal error edit, # 3506, if an outpatient record contained one of the specified revenue codes but was missing a valid CPT/HCPCS code. On September 30, 2015, you were notified of additional revenue codes that were added as a warning edit, # 3511, and to become part of the fatal error edit, # 3506, with the submission of your Q4-2015 discharge data (discharges dated October 1, 2015 and beyond).

Many hospitals are beginning to submit their Q4-2015 data. After feedback and review, we found it necessary to remove two revenue codes from this list, revenue code 258 and 637. Please see this list of revenue codes that require a CPT/HCPCS code on outpatient discharges beginning with October 1, 2015 discharges (revised to exclude 258 and 637).

Now that the Tennessee Department of Health has dropped the ICD-9 principal procedure reporting requirement on outpatient discharges dated October 1, 2015 and beyond, it is more important than ever that hospitals report valid CPT/HCPCS on all outpatient records submitted. Fatal error edit, # 3506, was adjusted to include all appropriate revenue codes in an effort to improve the quality of the CPT/HCPCS reporting. This is vital in the new process of systematically identifying whether an outpatient record falls into the category of ambulatory surgery and also in the identification of the principal procedure.

After uploading your Q4-2015 data, please be sure to complete a detailed review of your verification, edit summary and edit detail reports in RDDS. This will provide you assurance that your data meets the above mentioned need as well as all other ICD-10 requirements. It is important to review these reports after each data submission.

Please contact Larissa Lee if she can be of further assistance as we continue to transition into ICD-10. 


Updated THA Data Release Policy - February 3rd, 2016

The THA Board of Directors met on December 11th, 2015 and approved changes to the THA Data Release Policy that were recommended by the THA Data Policy Committee. These changes were made to more accurately reference sections of the THA HIN Agreement, and to permit THA to release patient names to the Tennessee Department of Health, per the Department's formal request.

The changes to the content of the policy are highlighted in yellow in this version of the policy.

An un-highlighted version of the full policy is available here.

Please note, changes were made to the format of this document on 2/2/2016, but no other content changes were made.


Changes in Payer Codes - Effective with January 2016 Discharges - December 22, 2015

On June 29, 2015, we sent an email regarding changes in payer codes effective with January 1, 2016 discharge data. This notification serves as a reminder as the New Year is quickly approaching! More specifically, the changes are as follows:

  • Current payer codes “B-Blue Cross/Blue Shield (not managed care)” and “H-Blue Cross Managed Care – HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “B-Blue Cross/Blue Shield.”
    • There are two additions added to payer code B: (1) Blue Network E and (2) Blue Network M.
  • Current payer codes “I-Commercial Insurance (not managed care)” and “L-Commercial Managed Care-HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “L” and renamed to “Commercial – Other.”
  • The following payers have been removed from being grouped into payer code “L-Commercial-Other” and have been assigned new payer codes:
    • United Healthcare – payer code 14
    • Cigna – payer code 15
    • Aetna – payer code 16
  • A new payer code has been created for the Community Health Alliance (CHA). The payer code assigned is 17.
  • Payer code K has been renamed to Medicare Advantage and has three additions: (1) Windsor, (2) CrestPoint and (3) Sterling.
  • Payer code “13-Access TN” has been removed.

A few other minor changes were made which reflect updated health plan names, etc. Again, the changes outlined above are effective beginning with January 1, 2016 discharges. A reference document is available for download. The changes listed above and reflected in the Excel document should be applied to all three payer code fields (primary, secondary and tertiary payer codes).

Please share this information with each person in your facility who is involved in state required hospital discharge data reporting activities. Feel free to contact Larissa Lee, llee@tha.com, or Nora Sewell, nsewell@tha.com or 615-401-7426 with any questions. 


Additions to Outpatient Revenue Codes that Require CPT/HCPCS Code and Warning Edit #5702 to Become Fatal - September 30th, 2015

1. Additional Revenue Codes that Require a Valid CPT/HCPCS Code
In January 2014, an edit was added to the Tennessee Hospital Association Remote Discharge Data System (THA RDDS) to flag a record as a fatal error, edit # 3506, if a record contained one of the specified revenue codes but was missing a valid CPT/HCPCS code.

Now that the Tennessee Department of Health (TDH) has dropped the ICD-9 Principal Procedure reporting requirement on outpatient claims dated October 1, 2015 and beyond, it is more important than ever that hospitals report valid CPT/HCPCS on outpatient records. In an effort to improve the quality of CPT/HCPCS reporting, edit # 3506 will be updated to include all revenue codes that require a CPT/HCPCS code, according to the 2016 UB-04 manual. Hospitals should hear from TDH regarding this new edit soon.

As mentioned above, edit # 3506 is currently a fatal error. To allow these new revenue codes to be edited as a WARNING for 180 days, THA RDDS will be updated to include a new edit, # 3511.

Below is a link to an Excel spreadsheet list of revenue codes that require CPT/HCPCS codes to be reported according to the 2016 UB-04 manual. The first tab, titled “Rev Code List for Edit #3506,” lists all revenue codes that are currently part of the fatal error edit # 3506. The second tab, titled “Rev Code List for Edit #3511” lists all revenue codes that will be edited by edit # 3511. Initially, this edit will only generate a WARNING. However, beginning with discharges on or after October 1, 2015 (due to be submitted to the THA RDDS on March 1, 2016), the newly added revenue codes will become part of the FATAL edit #3506.

Click the following link to access the Excel spreadsheet list of revenue codes as mentioned above: http://www.tha-hin.com/files/Additional-Revenue-Codes-that-REQUIRE-CPT-HCPCS-Code.xlsx

Please review your “edit summary” reports when you submit your Q3-2015 data on or before November 29, 2015. Specifically, review the new warning, # 3511. This will allow you time to adjust your internal coding procedures to ensure that your outpatient records are being coded with valid CPT/HCPCS codes and avoid a potential high fatal error rate (>2%).

We would like to hear from you as soon as possible if you see any problems with the list of revenue codes requiring CPT/HCPCS so that we can work with TDH to modify the edit before it becomes a FATAL edit.

2. Warning Edit to Become Fatal with October 1, 2015 Discharges and Beyond
Currently the THA RDDS has a WARNING edit set into place, edit # 5702, ICD Version Qualifier is Missing. Per the Tennessee Department of Health (TDH), with Q4-2015 discharge data, hospitals have the option to submit either ICD-9 or ICD-10 diagnosis codes in your Q4-2015 data. Beginning with October 1, 2015 discharges (due to THA RDDS on March 1, 2016) this warning edit # 5702 will become FATAL error.

We have learned through the ICD-10 testing process that many hospitals are missing this information. It is important that you have the version qualifier field appropriately populated as follows:

Field # 182, UB-04 form locator 66, position 1654-1655, left justified. ICD-9 should be indicated as a 9 and ICD-10 indicated as a 0 (zero). Also note, this field is left justified with a two character width. It only requires one digit (9 or 0). Please do not place another zero or digit to fill in the second character. Leave the second character blank.

A reminder, while hospitals have the option to submit either ICD-9 or ICD-10 for Q4 2015 data, effective with January 1, 2016 discharges and beyond, all claims require ICD-10 diagnosis codes.

As always, please contact me if you have any questions related to the above information or other ICD-10 changes effective October 1, 2015. 


FOLLOW-UP: Changes to Outpatient Principal Procedure Reporting and Ambulatory Surgery Definition - September 16th, 2015

On August 25th, you received an email from Larissa Lee regarding the changes to the way outpatient records are reported with the transition to ICD-10 (see the content of the original email below). Per that email, the Tennessee Department of Health (TDH) tentatively approved the recommendation to drop the dual coding requirement effective on claims dated October 1, 2015 and beyond. This email is being sent as follow-up to let each of you know that the recommendation was officially approved by Commissioner Dr. John Dreyzehner. All Tennessee hospitals will receive this notification from the TDH in the coming days.

As stated in the original email below, THA’s analysis of the 2013 data revealed several hospitals that had coding issues. THA did further analysis of the 2014 data and found the same inconsistencies. We will be reaching out to the individual hospitals to assist you in resolving these issues. Again, we ask you to please convey to those who are responsible for coding your hospital’s outpatient records the importance of correctly coding them with valid CPT/HCPCS codes, when applicable.

Please contact Larissa Lee if you have any questions related to ICD-10 and the related changes effective October 1, 2015. 


Changes to Outpatient Principal Procedure Reporting and Ambulatory Surgery Definition - August 25th, 2015

Currently, hospitals are required to ‘dual code’ all outpatient records by reporting a principal procedure using ICD-9 procedure codes. In March 2014, you received notification from THA of the recommendation, support and approval from the THA Board of Directors and the THA Data Policy Committee to change the way outpatient records are reported with the transition to ICD-10. We are excited to announce that the Tennessee Department of Health (TDH) has tentatively approved the recommendation to drop the dual coding requirement effective on claims dated October 1, 2015 and beyond. Effective with October 1, 2015 claims, THA will rely on the CPT/HCPCS codes reported, when applicable, on outpatient records for the determination of principal procedures. Please see this letter from TDH with details on their tentative approval of this change.

The approved recommendation to rely on the CPT/HCPCS codes reported has required changing the current ambulatory surgery definition. The current definition used for identifying ambulatory surgery claims relies on the ‘dual coded’ ICD-9 procedure code in the range of 00.01-86.99. The new ambulatory surgery definition will be based on the outpatient bill types of 013X, 043X, 083X and 085X (all bill frequency types of XXX1 and XXX7). These bill types are already reported to the THA Remote Discharge Data System (RDDS). Once THA RDDS receives your discharge data upload, the RDDS system will then filter to the ambulatory surgery records, based on the bill types listed above, and apply the full methodology to identify and assign the principal procedure systematically. The full methodology will apply CMS’ ambulatory payment classification (APC) weight to each CPT/HCPCS in a single record. The CPT with the highest APC weight will be assigned as the principal procedure. THA HIN member hospitals will no longer be responsible for making this determination; hospitals will continue to be responsible for submitting the appropriate CPT/HCPCS on the outpatient records.

Our analyses of the 2013 data to test the new methodology revealed several facilities that had coding issues for this data set. We plan to do further analyses of the 2014 data to check for these inconsistencies and will reach out to the individual hospitals as appropriate. Please convey to those who are responsible for coding your hospitals’ outpatient records the importance of correctly coding them with valid CPT/HCPCS codes, when applicable.

Please contact Larissa Lee (llee@tha.com) if you have any questions related to the changes that will take effect with ICD-10, October 1, 2015. 


Notice – Penalty for Late Submission of UB Discharge Data – October 3rd, 2014

On October 3, 2014, the Tennessee Department of Health (TDH) mailed all licensed Tennessee hospitals a letter reinforcing penalty for failure to report. The TDH will begin enforcing the penalties associated with delinquent reports having a Statement Covers Period through Data on or after January 1, 2015. The implementation of this section of the T.C.A. at this date is in hopes to receive more complete and higher quality data. Hospitals that are currently delinquent on the date of implementation will not be charged for the previously delinquent records, but delinquencies after that date will be assessed the penalties. The letter sent by TDH can be viewed by clicking here.

THA has a process set in place to remind you of quarterly data submission deadlines. This process has not changed and will continue as it has in the past. Below are the quarterly reporting due dates for hospital UB discharge data submission:

  • January - March (Q1) discharge data are due to be submitted no later than May 30th.
  • April - June (Q2) discharge data are due to be submitted no later than August 29th.
  • July - September (Q3) discharge data are due to be submitted no later than November 29th.
  • October - December (Q4) discharge data are due to be submitted no later than March 1st of the following year.

Each quarter Nora Sewell, HIN Data Analyst, sends reporting reminders to hospitals, usually no less than a month before a reporting due date. Once the scheduled due date (as outlined above) has passed, Nora notifies the TDH of those hospitals who have not submitted their UB discharge data by the specified scheduled date. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to schedule.

There are three main characteristics every data system should strive for: timeliness, accuracy and completeness. Please help us keep the data quality and integrity high as it will only serve you, THA member hospitals, the most precise data possible.

Please contact Larissa Lee if you have any questions. 


Inpatient and Outpatient Replacement Bills – September 30, 2014

Inpatient Replacement Bill Type 0117
As you are aware, bill type 0117 indicates an inpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0117) will overlay the original record and the bill type will be changed from 0117 to 0111.

Please note: If a replacement bill (0117) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0111.

Outpatient Replacement Bill Type 0137
Similar to the above statement, bill type 0137 indicates an outpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0137) will overlay the original record and the bill type will be changed from 0137 to 0131.

Please note: If a replacement bill (0137) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0131.

Please contact Larissa Lee, llee@tha.com, or Nora Sewell, nsewell@tha.com, if you have any questions. 


How to submit TEST data through THA RDDS

The process to submit TEST data through THA RDDS is different from the process used in the past when test data was submitted through HIDI. Please be sure to follow the steps below when submitting TEST data through THA RDDS.

  1. Using RDDS, all TEST files should use discharge records that have not yet been submitted. TEST records should have discharge dates later than records already on RDDS for your hospital. In other words, if you have already submitted Q2 data for your hospital and it is within the fatal error threshold (no more than 2%), any TEST data should be for Q3 or later, or even a smaller submission that includes data for one month, (i.e., July data) would be acceptable to submit as a TEST file.
  2. Once the TEST file has processed and you have checked it to make sure the change you were making is working properly, you MUST DELETE the Batch (by number) that RDDS assigned to the TEST file when it was submitted.
  3. It is also recommended that THA HIN staff be notified in advance if you plan to submit TEST data so we can be aware and communicate this if necessary with the processing system. Notify Nora Sewell (nsewell@tha.com) or Larissa Lee (llee@tha.com).

If there are any questions, please contact Larissa or Nora to discuss.