UB-04 Correspondence

REVISION to definition of Payer Code "N" - October 19th, 2009

We have been notified that some hospitals provide services to a large number of prisoners. If these services are provided through an agreement with a payer (i.e., a managed care payer/organization), it is appropriate to report the payer code that correctly identifies that payer. However, if the payer for these prisoners is not covered by an existing payer code, these records should be reported using payer code “N” from now on.

The definition for payer code “N” is changed effective October 19, 2009 as follows:

N = "Division of Health Services (Voc Rehab) and government payers not otherwise coded"

Use this payer code when services are provided to prisoners that are not covered by an appropriate payer code. Do not use payer code “O” for services provided to prisoners. The definition of payer code “N” is being revised to help hospitals prevent overuse of payer code “O” (more than 10%).

New Patient Discharge Status code 21 - October 6th, 2009

A new code, 21, has been added to Form Locator 17, Patient Discharge Status. This new code is effective with October 1, 2009 discharges and it is used to designate “discharged/transferred to court/law enforcement”. This code includes transfers to incarceration facilities such as jail, prison, or other detention facilities.

MODIFIED LIST of Fatal Edits for July 2009 discharges - September 22nd, 2009

This list of Warning edits will become FATAL edits with the processing of July-September 2009 discharges. These 3rd quarter 2009 discharges are due to be submitted no later than November 29, 2009. A few edits on the list have been DELAYED since this list was first sent out in April 2009 so please look at the updated list.

HIDI has been printing these edits in blue print on the error summary/error detail reports when the rate is more than 2%. This blue print indicates that these are conditions that will soon be FATAL errors and they need to be looked at by the hospitals and/or their data vendors BEFORE the 3rd quarter 2009 discharge data is submitted.

Some of these new fatal edits will become “Fatal but Verify” edits. This means that the record is considered to have a fatal error but if the hospital verifies that the data related to the error condition is correct as reported, the hospital will be able to indicate this on the HIDI online website. Based on this verification, the fatal flag due to this error condition will be removed. Some of these edit conditions are identified in the Medicare Code Edits as incorrect but in reality they may represent true conditions.

For example, the error message ‘Age is less than 15 and principal diagnosis is appropriate for adults only’ is flagged as a Fatal error. A review of the medical record verifies that the data of birth and principal diagnosis are reported correctly. The hospital will be able to verify that the data -- although it may look incorrect -- is correct as reported based on the information documented in the medical record.

If you have any questions about this information, please contact Jean Young.

Revenue unit and revenue charge edits - July 17th, 2009

Until further notice, all three of the following edits will remain as WARNINGS.

  • Edit 3801 - Revenue units are missing
  • Edit 3804 - Revenue units are zero
  • Edit 3901 - Revenue charge is missing

A delay had previously been announced for edit 3804 and edit 3901 to become fatal edits; however, due to comments from several hospitals, it was determined that edit 3801 could also be problematic. More research will be done before these edits move to the fatal edit list. 

Revenue unit and charge edits on UB discharge data - June 18th, 2009

The following 2 edits will remain as WARNINGs until further notice. These edits are currently WARNINGS and were scheduled to become FATAL errors with the submission of July-September 2009 discharge information. This delay will allow more time for further research on the impact of these edits on the data that is being submitted by hospitals.

  • Edit 3804 - Revenue units are zero
  • Edit 3901 - Revenue charge is missing

The following edit will become FATAL with the July-September 2009 discharge information. This edit is currently considered to be a WARNING:

  • Edit 3801 - Revenue units are missing

Please note that there are other edits that are currently WARNINGS that will become FATAL with the submission of July-September discharge information. This notice only refers to the 3 edits listed above. To see the other edits that will become fatal, scroll down to the April 8th entry entitled "Warning edits that will become FATAL edits with Q3 09 discharges".

EDITS that will remain as WARNINGS - April 15th, 2009

Recently a list of Warning edits that are scheduled to become FATAL edits with the reporting of 3rd quarter 2009 data was sent to the contacts in each hospital. There were 2 edits on that list that were indicated to become "Fatal but Verify" edits that will need to REMAIN AS WARNINGS until further notice. These 2 edits are #2505 and #2506 (see below). "Fatal but Verify" edits are flagged as fatal errors but if the hospital reviews and verifies the information to be correct as reported, the hospital can indicate this verification in the 'Enter Corrections' module on the HIDI website and the fatal error flag will be removed.

  • Edit #2505: Patient type is inpatient, but total charges are less than $150 or more than $30,000 per day.
  • Edit #2506: Patient type is outpatient, but total charges are less than $40 or more than $30,000.

Upon review of the Jan-Sept 2008 data, it was determined that if these 2 edits were made "Fatal but Verify" edits, too many records would have to be manually verified in order to remove the fatal error flags caused by the charge limits in these edits. THA will continue to work with the Department of Health to better define the upper and lower charge limits used in these edits. Until that time, these edits will remain as Warnings.

Please contact Jean Young at 615.401.7429 if you have any questions.

Warning edits that will become FATAL edits with Q3 09 discharges - April 8th, 2009

This list of Warning edits will become FATAL edits with the processing of July-September 2009 discharges. These 3rd quarter 2009 discharges are due to be submitted no later than November 29, 2009.

HIDI will begin printing these edits in blue print on the error summary/error detail reports if the rate is more than 2%. This blue print will indicate that these are conditions that will soon be FATAL errors and they need to be looked at by the hospitals and/or their data vendors BEFORE the 3rd quarter 2009 discharge data is submitted.

Some of these new fatal edits will become “Fatal but Verify” edits. This means that the record is considered to have a fatal error but if the hospital verifies that the data related to the error condition is correct as reported, the hospital will be able to indicate this on the HIDI online website. Based on this verification, the fatal flag due to this error condition will be removed. Some of these edit conditions are identified in the Medicare Code Edits as incorrect but in reality they may represent true conditions.

For example, the error message ‘Age is less than 15 and principal diagnosis is appropriate for adults only’ is flagged as a Fatal error. A review of the medical record verifies that the data of birth and principal diagnosis are reported correctly. The hospital will be able to verify that the data -- although it may look incorrect -- is correct as reported based on the information documented in the medical record.

If you have questions about this information, contact Jean Young at 615.401.7429

Unknown codes for Accident fields in UB discharge data - March 23rd, 2009

The Department of Health has added the following codes to allow for 'unknowns' to be reported in the ACCIDENT CODE, ACCIDENT STATE, and ACCIDENT DATE fields.

IF ACCIDENT CODE is 01-05 but ACCIDENT STATE and/or ACCIDENT DATE are unknown:

  • IF the ACCIDENT STATE is unknown, report Accident State as ‘XX’.
  • IF the complete ACCIDENT DATE is unknown, report Accident Date as ‘9999999999’.
  • IF only the accident day is unknown, report the month (01-12) and the 4-digit year and report the day as ‘99’ (i.e., 04992008).
  • IF the month and day are unknown, report month and day as ‘9999’ and provide the 4-digit year (i.e., 99992008).

IF there is an accident but the exact ACCIDENT CODE is unknown (i.e., can’t determine between Accident Code 01 and Accident Code 03), report Accident Code as ‘99’. In these rare cases, the Accident State and Accident Dates should be known.

Valid payer codes for 2009 UB discharge reporting - March 2nd, 2009

Due to the substantial changes in the TennCare MCOs and the Department's limit on the use of payer codes "T" (TennCare NOS) and payer code "O" (Other, unknown) in the 2009 data, click here for an updated list of valid payer codes to be used in the 2009 discharges submitted for state reporting. This list does not add any new payer codes; rather, it reflects several old payer codes that are no longer valid. Contact Jean Young if you have any questions concerning this information.

Changes in TennCare MCOs - January 2009 - December 18th, 2008

Please make those involved in UB reporting in your hospital aware of the following information as it relates to the use of payer codes in the UB data -- specifically the TennCare MCO payer codes. The State has reduced the number of TennCare MCOs that will operate in the 3 regions of the State.

The health plans will assume responsibility for physical health, mental health and substance abuse services for TennCare enrollees. Instead of having a health plan for physical health (MCO) and a different one for mental health and substance abuse services (BHO), enrollees will have one plan. The new, integrated health plans will help enrollees get both medical and behavioral healthcare through the MCO.

  • For residents in Middle TN as of April 1, 2007, only the following TennCare MCOs are in operation:
    • Amerigroup – UB payer code ‘10’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • For residents in West TN as of November 1, 2008, only the following TennCare MCOs are in operation:
    • Blue Care – UB payer code ‘J’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • For residents in East TN as of January 1, 2009, only the following TennCare MCOs are in operation:
    • Blue Care – UB payer code ‘J’
    • Americhoice – UB payer code ‘8’
    • TennCare Select* – UB payer code ‘Q’
  • The TennCare, NOS payer code ‘T’ will continue to be allowed but for no more than 10% of the records.
  • * TennCare Select only serves special enrollee populations as assigned by TennCare. Members cannot choose TennCare Select as their MCO.

Be aware that this does not limit where a TennCare patient can go to get healthcare services. In other words, a Middle TN resident with Amerigroup coverage can be treated in a Memphis hospital, or a Memphis resident with Blue Care coverage can be treated in a Nashville hospital even though those plans aren’t in operation in those areas. Also, a hospital in one region, particularly those close to the lines, may be contracted with MCOs in another region (i.e. not the one in which they are located).

Based on the information above, the following TennCare payer codes will NO LONGER BE VALID in the reported UB data effective with discharges January 1, 2009:

  • 5 = UAHC
  • 7 = Windsor Health Plan of TN, Inc.
  • 9 = Preferred Health Partnership
  • F = TLC Family Care
  • R = Unison Health Plan
  • E = BHO, not otherwise specified
  • U = Tennessee Behavioral Health
  • X = Premier Behavioral Systems of TN

HDDS Nov 18 letter & THA HIN info related to payer codes T and O - November 18th, 2008

This letter will be mailed to all hospitals from the Hospital Discharge Data System, Tennessee Department of Health (HDDS/TDH), Tuesday, November 18, 2008. This letter covers several issues related to the data that has been reported since hospitals have begun reporting in the UB-04 format. Please share this letter with your discharge data vendor or your IT staff -- whoever programs the file that creates the state discharge data each quarter for your hospital.

This second document provides some information from THA Health Information Network (THA HIN) to hospitals about how to determine the proportion of discharge records using payer codes ‘T’ and ‘O’. The use of these payer codes are two of the issues addressed in the November 18 letter from HDDS/TDH.

Warning edits becoming Fatal edits with Q3 08 discharges - October 30th, 2008

There were a lot of new fields added to the hospital discharge reporting requirement when hospitals moved to the new UB-04 format (with July 2007 discharges). The edits on these new fields were designated as Warnings for the first 12 months of submission. After the initial 12 months, these Warning edits were scheduled to become Fatal edits. The 12-month ‘delay’ was to allow hospitals time to work out problems they had in submitting the newly required fields.

Most of the new fields were implemented with July 2007 discharges. An exception to this, Present on Admission (POA) fields weren't required by the Dept of Health until January 2008 discharges. There will also be a 12-month delay on making the POA edits Fatal (POA edits become Fatal with January 2009 discharges). (THA requested the Dept to allow some of the POA edits to remain as Warnings even after January 2009 in the cases where the diagnosis/E-code doesn't require a POA but one is provided.)

Click Here for a list of all the edits on the new fields added to the hospital discharge reporting last year. Some of these edits will remain Warnings but most will become Fatal with the Q3 2008 discharges that are due to be reported no later than November 29, 2008. As indicated on the attached list, most of the POA edits become Fatal with Q1 2009 discharges. The 'Changes' column indicates the latest changes to the edits where the Dept was willing to leave some edits as Warnings or to make some edits "Fatal but Verify" edits (the condition will flag as a fatal error but the hospital may verify the information to be correct as reported). If there is no change indicated, the edit is scheduled to become Fatal soon.

Since April of this year, HIDI has been showing these “soon to become Fatal” edits in blue print on your error summary reports if the error rate was above 2% so hospitals could address reporting problems in these fields before they became Fatal errors. 

More information on new Accident fields - Accident Code_Accident Date_Accident State - October 27th, 2008

There are three (3) new fields in the UB discharge data that deal with accidents: Accident Code, Accident State, and Accident Date.

The reporting of these new fields depend on an occurrence code 01-05 being in the UB record. Occurrence codes (01-05) are not just related to motor vehicle accidents—they apply to all accidents. This information may be used by the Department of Health in linking the discharge data to the Crash Outcomes Data Evaluation System (CODES) but this is not the only reason the Department is requiring this information.

  • If Occurrence Code = 01-05, the code should be entered in positions 183-184 of the 2538 character record as the Accident Code.
  • If the Accident Code = 01-05, the date of the accident (MMDDYYYY) should be entered in positions 185-192 as the Accident Date.
  • If the Accident Code = 01-05, the state of the accident (2 character state code) should be entered in positions 181-182 as the Accident State. The State has recently agreed to allow a code ‘ZZ’ in the Accident State field if the accident state is unknown.

Unknown physician ID numbers on Outpatient discharges - October 22nd, 2008

If you have outpatient discharges that are flagging with Fatal errors because you are missing the ProfessionCode+License number and/or the UPIN/NPI, the information below may be helpful.

If providers in your community are sending patients to your hospital for outpatient tests, lab work, or diagnostic scans (i.e., CT, MRI, PET, etc.) you may not have the provider’s ProfessionCode+License number and/or UPIN/NPI if the provider is not credentialed by or does not work at the hospital. In these cases you should use the unknown codes in the Physician fields (especially in the Attending physician field).

  • Code for unknown ProfessionCode+License Number = UK9999999999
  • Code for unknown UPIN/NPI = OTH000 (alpha OTH followed by 3 zeroes)

Remember that for every physician field that is reported both portions of the provider ID (ProfessionCode+License Number and UPIN/NPI) must have something reported even if one or both portions are reported using unknown codes.

Be aware that at some point in time, the State may put a limit on the number of records that may show these unknown codes. THA will certainly urge the Department to allow a higher rate of records to be reported with unknown physician codes on the outpatient side than is allowed on the inpatient side because there are a lot of community providers that send their patients to the hospitals for these kinds of outpatient services.

REVISED - Warning edit 3709 - No accommodation revenue code for inpatients - REV CODE RANGE REVISED! - September 29th, 2008

Please notice if you have WARNING edit # 3709 on your INPATIENT error reports from HIDI! The error message presented with this edit is “No accommodation revenue code for inpatient”. This Warning may indicate that some outpatient discharges were submitted in your data with an inpatient bill type. Outpatients would not have accommodation revenue codes but all inpatients should have some variation of an accommodation revenue code (010X-021X).

If you see this error message, you should correct the error even though it is a Warning.

  • If the record is an outpatient that has been submitted in the inpatient data file, it should be deleted from the inpatient file and added to the outpatient file with the correct bill type.
  • If the record is truly an inpatient record, the accommodation revenue code needs to be added to the inpatient record so charges for all inpatients will be more reliable.
  • Corrections of this error may require resubmitting the data with corrected information if the number of records affected is too large.

The State may change this Warning to a Fatal error if problems continue to exist in the data being submitted by some hospitals. Please look at all edits carefully when you review your HIDI reports each time data is submitted. Normally Warnings do not require correction, but there are some Warning conditions that are more critical than others because they affect the overall validity of the data that is being submitted.

Importance of reporting correct NPI in UB discharge data! - September 8th, 2008

Because the Present on Admission (POA) edits are becoming Fatal errors soon (with the January 2009 discharges), hospitals need to be aware of the new information below:

CMS does not require POA indicators from hospitals that are not paid based on the inpatient prospective payment system (IPPS).

  • CMS is only requiring POA information to be reported for inpatient discharges from acute care hospitals. CMS does not require POA information to be reported by critical access hospitals, cancer hospitals, LTCH, pediatric hospitals, psychiatric hospitals or rehabilitation hospitals.
  • This requirement also excludes patients seen in rehabilitation and/or psych distinct part units within an acute care hospital.

The TN Dept of Health originally indicated that POA information would be required on all discharges from all hospitals. However, the State has recently decided to only require POA information on the discharges from acute care hospitals. Furthermore, if an acute care hospital has a psych or rehab distinct part unit, discharges from these distinct part units are also excluded from the POA reporting requirement.

THA will provide HIDI with a list of facilities that are critical access hospitals, cancer hospitals, long term care hospitals, pediatric hospitals, psychiatric hospitals and rehabilitation hospitals so the POA edits can be waived for them. However, for HIDI to be able to waive the POA edits for patients seen in your rehab and/or psych distinct part units, we must be able to identify these discharges within the discharge data you submit.

The new UB-04 format requires the hospital's NPI be reported in positions 1497-1511 in each 2538-character record submitted. It is very important that the NPI reported in these positions accurately reflect the NPI for the distinct part unit where the patient was treated. If your hospital has a psych or a rehab distinct part unit, the discharges from these units should report the NPI for that unit (i.e., records for patients seen in the psych unit would show the psych NPI in positions 1497-1511; records for patients seen in the rehab unit would show the rehab NPI in these positions, and all other records seen for acute care would show the acute care NPI for the hospital in these positions). Failure to do this may result in high fatal error rates when the POA errors become fatal errors and subsequent delays in being able to submit your discharge data to the TN Dept of Health.

Please work with your IT staff or your vendor to ensure that the NPI that is being reported in each of your discharge records is accurate for the type of discharge being submitted. THA staff will be contacting each hospital soon to verify the NPIs that may be submitted in your discharge data. We will provide this information to HIDI to use in editing the POA data.

Do Not Resuscitate - DNR - Clarification for UB-04 discharge reporting - July 21st, 2008

Information on new field, Do Not Resuscitate (DNR):

Do Not Resuscitate (DNR) is a new UB-04 field and it should be reported on ALL discharges (inpatient AND outpatient) reported to the Department of Health. This field is captured in position 180 of the 2538-character record.

The valid codes for this field are ‘Y’ or ‘N’. If any Condition Code field (Form Locators 18-28 on the UB-04 billing form) contains a “P1”, this field should be reported as ‘Y’ (yes). Otherwise, report this field as ‘N’ (no).

The current edit on this new field is a Warning however, it will become a Fatal edit with the submission of Q3 08 discharges.

New Field Information - Admit Hour - July 14th, 2008

Admit Hour is a new UB-04 field and it should be reported on all inpatient discharges reported to the Department of Health. This field is captured in positions 172-173 of the 2538-character record. The valid codes for Admit Hour are 00-23, 99, or blank. Use code 99 (unknown) if the discharge is an inpatient discharge and you do not know the Admit Hour. This field should be left blank only if the discharge is an outpatient record (these patients are not admitted for inpatient services so this field is not applicable).

The current edit on this new field is a Warning however, it will become a Fatal edit with the submission of Q3 08 discharges.

Code Definition
00 12 Midnight – 12:59 am
01 1:00 – 1:59 am
02 2:00 – 2:59 am
03 3:00 – 3:59 am
04 4:00 – 4:59 am
05 5:00 – 5:59 am
06 6:00 – 6:59 am
07 7:00 – 7:59 am
08 8:00 – 8:59 am
09 9:00 – 9:59 am
10 10:00 – 10:59 am
11 11:00 – 11:59 am
12 12 Noon – 12:59 pm
13 1:00 – 1:59 pm
14 2:00 – 2:59 pm
15 3:00 – 3:59 pm
16 4:00 – 4:59 pm
17 5:00 – 5:59 pm
18 6:00 – 6:59 pm
19 7:00 – 7:59 pm
20 8:00 – 8:59 pm
21 9:00 – 9:59 pm
22 10:00 – 10:59 pm
23 11:00 – 11:59 pm
99 Inpatient admission but admit hour unknown.
Blank Record is not an inpatient discharge.

New HIDI processing report - Verification Report - June 5th, 2008

Each THA member hospital submits discharge data quarterly through the Hospital Industry Data Institute (HIDI) secure website to meet the requirements of the state discharge reporting mandate. Once the data has been processed by HIDI, each hospital receives an email from HIDI indicating that the data has been processed and the processing reports are ready to be viewed. HIDI generates several reports each quarter for each hospital when the data are processed: Load Summary Reports, Edit Detail Reports (including edit summary information), and Validation Reports. These reports are made available to you by accessing the same website the hospital uses to submit the data (use the Download Reports feature). Each hospital should have someone reviewing these reports each quarter to make sure that the data submitted and processed for your hospital looks complete and, of even more importance, that the data looks reasonable for your hospital’s experience. Click here for a brief overview of each of these reports.

We have recently added a new report and this report should also be reviewed by each hospital each quarter. This Verification Report looks at four (4) key indicators of each hospital’s data to ensure that the data reported is complete and consistent over time.

  1. The 1st indicator is the Fatal Error Rate for inpatients and outpatients. The inpatient and outpatient fatal error rates must be no more than 2% each quarter to be accepted by the Tennessee Department of Health. (To identify specific records with fatal errors, hospitals would access the Edit Detail reports on the HIDI website.)
  2. The 2nd indicator is the Total Charges for inpatients and outpatients by quarter.
    Do these IP and OP charges look reasonable and consistent for each quarter when compared to previous quarters? If there are major increases or decreases in total charges over the year, can these increases/decreases be explained (i.e., opened a new service line or closed a service line, or updated charges in charge master)?
  3. The 3rd indicator shows the distribution of Patient Types for inpatients and outpatients by month for the current year and the previous year. Do the numbers reported by patient type look reasonable and consistent over time? If there are major increases or decreases over the year in any of the patient type categories, can these increases/decreases be explained? For example, if the ambulatory surgery numbers show a large increase from one month to the next, did the hospital add a new surgeon during that month that is bringing additional cases to the hospital?
  4. The 4th indicator shows the distribution by Payer Group for inpatients and outpatients by month for the current year and the previous year. Do the numbers reported by payer group look reasonable and consistent over time? If there are major increases or decreases in payer groups over the year, can these increases/decreases be explained? For example, if the Blue Cross numbers show a major decrease in one quarter, did your hospital’s contract with Blue Cross get changed at that time, reducing the number of Blue Cross patients you would see?

These are the types of data issues the Tennessee Department of Health will come back to THA to question if there are inconsistencies. We would prefer addressing (and documenting) these situations at the time the data is submitted rather than 6-24 months later when the Department finds them, but we need your help to do this. If we send you an email asking you to verify what may look to be inconsistent data, please let us hear back from you. If you look at the information and feel that it is accurate, tell us and we will document that you have verified the information and we will move on. Often these queries have accurately identified problems in a hospital's data submission that the hospital wanted to correct. Remember: this data will eventually be public so it is important that it be as accurate as possible.

HIDI change for Q1 08 discharge data submission - April 8, 2008

Effective with discharge data for January - March 2008 (Q1 08), when HIDI sends you an email notifying you that your quarterly data has been processed and your reports are ready to be viewed, they will attach a report that shows your inpatient and outpatient error summary pages (see this example). These pages are just the "summary" pages, so they do not include any PHI. These reports will also show any Fatal error messages with a rate above 2% in red print. You will need to address these errors to bring your Fatal error rate to no more than 2%.

I have also asked HIDI to use blue print to flag Warnings with a rate more than 2% IF the Warning error will become a Fatal error when the July 2008 or January 2009 discharges are submitted. These Warning errors that are becoming Fatal errors are the ones you need to address now before they cause problems for your data submission. (Warning errors that will remain as Warnings will be in black print if the rate is more than 2% -- only those that will become Fatal errors soon will be in blue.)

If you have any questions, feel free to contact Jean Young at 615.401.7429

Payer Codes added in 2007 - March 3, 2008

I would like to remind everyone that in 2007 we added some new payer codes that should be used (if appropriate) in reporting the hospital discharge data.

The payer codes added in 2007 are as follows:

10 = Amerigroup Community Care (new TennCare MCO effective Apr 1, 2007)
11 = Cover TN (also known as the Blue Cross InReach plan; Blue Cross Network V)
12 = Cover Kids
13 = Access TN

It is extremely important that hospitals use the new MCO code (code 10) and the new Cover Tennessee codes (11, 12, and 13 above) when reporting discharges that have these types of coverage. THA will use the data to carefully monitor the operations of the plans in order to identify issues with the coverage that are negatively impacting hospitals and to substantiate the need for plan changes.

Importance of reporting correct NPI in UB-04 discharge record - February 28, 2008

The Tennessee law and associated rules and regulations that require hospitals to submit discharge data to the TN Dept of Health require all inpatient discharges and selected outpatient discharges to be reported. Reporting on the inpatient side includes discharges from psych and rehab units within an acute care facility as well as the acute care inpatient discharges.

The new UB-04 format requires the hospital's NPI be reported in positions 1497-1511 in each 2538-character record that is submitted. It is very important that the NPI reported in each record accurately reflect the NPI for the unit where the patient was treated. If your hospital has a psych unit or a rehab unit and these units have an NPI that is different from the acute care NPI, the discharges from these units should report the appropriate NPI for the unit where the patient was treated (psych patients would report the psych NPI; rehab patients would report the rehab NPI, etc.). Most hospitals will have a NPI for the acute care setting and different NPIs for the psych and/or rehab units.

This correct NPI reporting by unit will allow the patients seen for psych and/or rehab services to be easily excluded from some data projects where only the acute care patients should be included. This will also allow for improved analysis for services provided in these specific units because the discharges can easily be identified by the NPI reported in the record.

Some hospitals will also have different NPIs for other units such as swing beds, SNF, hospice, and home health. These types of discharges are not included in the state’s hospital discharge reporting requirement.

Please work with your IT staff or your vendor to ensure that the NPI that is being reported in each of your discharge records is accurate for the type of discharge being submitted.

Patient Discharge Status Code Changes - February 5, 2008

Code 05 – code definition changed to “Discharged/transferred to a Designated Cancer Center or Children’s Hospital”

Usage Note: Transfers to non-designated cancer hospitals should use Code 02. A list of National Cancer Institute Designated Cancer Centers can be found at http://cancercenters.cancer.gov

Code 70 – new code added; definition “Discharged/transferred to another Type of Health Care Institution not Defined Elsewhere in this Code List”

The implementation of these codes was delayed from October 1, 2007 discharges until April 1, 2008 discharges.

Moving to MSDRGs - February 1, 2008

This document explains how THA plans to handle the move from DRGs to MS-DRGs effective with October 1, 2007 inpatient discharges. As you know the DRG and MS-DRG groupings are very different. Since THA MarketIQ provides some trend reports what will be affected by this change, THA needed to develop a process for handling the change in THA MarketIQ. This process can also be used for trend-type analysis using the THA HIN databases. This plan has been approved recently by the THA Data Policy Committee.

This change will not affect the data on THA MarketIQ or in the THA HIN inpatient database until the Oct-Dec 2007 discharges are added. The target date for adding these discharges is mid-late May 2008. Until that time, the DRGs and THA DRG product lines will continue to be used. The new MS-DRGs and MS-DRG product lines assignments available here.

DELAY on new fatal edit related to CPTs and ICD9 procedure codes - January 16, 2008

THA has asked the Department of Health and HIDI to DELAY the implementation of the new fatal edit related to CPTs and ICD9 procedure codes. This edit would require an ICD9 procedure code in principal procedure if there was one or more CPT codes reported in the range 10021-69990 (ambulatory surgery). The problem with this edit is that there are CPT codes within the CPT range that have no corresponding ICD9 procedure code, or the corresponding ICD9 procedure code is outside the ICD9 range used to define the ambulatory surgery records (00.01-86.99). Until further notice, this edit will NOT be used on the discharge data.

Reporting Clarification Letter from HDDS - January 11, 2008

This letter was mailed out by the Tennessee Department of Health today clarifying some additional UB-04 reporting issues. You should receive an official copy of this letter in the mail.

Penalty Enforcement Letter from HDDS - November 2, 2007

HDDS sent out this letter today with information regarding the commencement of penalty enforcement for excessive reporting errors.

UB-04 Clarification Letter from HDDS - October 31, 2007

HDDS sent out this letter today with some clarification regarding UB-04 Claims Data Reporting

Point of Origin Codes - October 18, 2007

Effective October 1, 2007, UB-04 field locator 15 has been renamed: Point of Origin for Admission or Visit.  Click here for information regarding the changes to the field previously known as Source of Admission. Field values 3 and A and Newborn values 1-4 have been discontinued.

Apparently these changes caught a lot of hospitals and payers unprepared but according to the latest information I have been able to gather, the new codes are in effect now.

Differences in CMS and TDH requirements for POA information - September 06, 2007

It is our understanding that there are differences in Present on Admission (POA) requirements between what CMS is requiring and what the Tennessee Department of Health (TDH) State Discharge Reporting System is requiring. These differences are itemized below:

1. EFFECTIVE DATE:

  • CMS is requiring POA information to be reported effective with October 1, 2007 discharges.
  • TDH is requiring POA information to be reported in the hospital discharge data effective with January 1, 2008 discharge information. TDH decided to allow an additional quarter for hospitals to become more familiar with the national guidelines before the POA data is edited in the hospital discharge information. Hospitals may submit POA information in the October -December 2007 data submission but the data will not be edited for absence/presence or validity of POA information until the January 1, 2008 discharge data is received.

2. HOSPITALS REQUIRED TO REPORT POA:

  • CMS is only requiring POA information to be reported for inpatient discharges from acute care hospitals. CMS does not require POA information to be reported by critical access hospitals, cancer hospitals, LTCH, pediatric hospitals, psychiatric hospitals or rehabilitation hospitals.
  • TDH is requiring POA information to be reported by ALL hospitals that are required to report discharge data to the Department. This includes hospitals excluded by the CMS requirement. The POA information will be used to help assess patient safety and address quality of care and performance measurement so this information is needed from all inpatient discharges from all Tennessee hospitals.

New UB-04 Edits - August 28, 2007

As you know there are several new fields being required when we move to the new UB-04 format for discharges occurring on or after July 1, 2007. Whenever new fields are added to the required dataset, new edits are also added to the processing to ensure that the data being captured is of highest quality.

Please download this file.

The document shows the new edits that were applied to the October 2006 discharges when the formats for the 3 provider fields (Attending physician, Other physician 1, and Other physician 2) were changed. The document also shows the new NPI validity edit that was added for the January 2007 discharge data.

This document also lists the new edits that will be applied to the July 1, 2007 discharges and to the January 1, 2008 discharges. THA recently met with the Department of Health staff and the Department has agreed to make most but not all of these new field edits Warnings for at least the first year. After the first year, some of these Warnings may become Fatal edits depending on the decisions made by the Department. Because of this, each hospital should be aware of the volume of the errors in these new fields and if the volume is high, the hospital should address the problem before these edits become Fatal errors.

UB-04 Discharge Data Issues to be Aware Of... - July 17, 2007

PRINCIPAL PROCEDURE on outpatient records.

The principal procedure and principal procedure date STILL MUST be provided as an ICD-9 procedure code on all outpatient records if there was a procedure provided. This principal procedure code should be provided in positions 1856-1862 and the corresponding procedure date should be provided in positions 1863-1870 of the new 2538 position record.

CPTs and HCPCS codes from Form Locator 44 should also be reported beginning with the data submitted in UB-04 format (discharges on or after July 2007).

TYPE ED VISIT and OUTCOME ED VISIT

If a hospital does not screen the patients coming through their ED (all patients who present to the ED are treated regardless of their medical condition or ability to pay), the correct response to Type of ED visit and Outcome of ED visit is '99' in positions 2070-2071. There are hospitals in Tennessee that are screening ED patients and these questions are to provide some information from those hospitals and to see how many patients are being referred to other sources of care because their medical condition does not warrant emergency room services.

Every ED record (records with revenue code 045X in any revenue code field) must have a code in positions 2070 and 2071. Position 2070 may be codes 1-3, or 9 and position 2071 may be codes 1-4, or 9. If there is no revenue code 045X in the record, positions 2070-2071 should be left blank.

Requirement to report Joint Annual Report (JAR) ID number on all discharge records - May 11, 2007

HDDS has sent out this letter regarding a new requirement to report Joint Annual Report (JAR) ID number on all discharge records.

Invalid TN License Numbers - May 07, 2007

1. Be aware that a new fatal edit has been added for the 1st quarter 2007 UB data. This edit checks the Attending physician, Other physician 1, and Other physician 2 NPI if reported. Using the Luhn algorithm, this edit indicates if the number reported is a valid NPI. If the NPI reported is not considered valid according to the Luhn algorithm, it will be considered a fatal error.

2. The Tennessee profession code indicator (MD, DO, NP, DS, etc.) and 10-digit Tennessee state license number should be provided for all provider fields if applicable. Facilities that overuse the unknown code for this information will eventually have fatal edit problems if these license numbers are not provided. This profession code-license number information will be used to supply the provider name since there is no crosswalk currently available for the NPI so it is very important that every facility report the profession code and license numbers for their providers.

3. Please DO NOT submit discharge data in the new UB-04 format for the Q1 07, January - March 2007, discharges. The new format may be used for submitting the Q2 07 discharges (since May 23 falls in Q2) but it is preferred that the new format not be used until you submit the Q3 07 data. The Q3 07 data is due to be submitted by November 29, 2007.

Fatal Error Rate - Dropped to 2% - April 30, 2007

The fatal error rates allowed for 2007 discharge data are dropping to no more than 2% for inpatient data and no more than 2% for outpatient data.

Prior to 2007 discharges, the fatal error rate was required to be no more than 3% for the inpatient and outpatient data.

UB-04 Layout Clarification - April 27, 2007

To clarify some information in the new UB-04 Hospital Discharge Data System Manual, Fields 259-265 should be left blank by hospitals. These fields occupy positions 2072-2298 in the new UB-04 record layout.

The patient street address, patient name, and insured's name fields, Fields 266-274, occupy positions 2299-2538 of the new UB-04 record layout. These fields should be reported by hospitals for all discharges when the data is submitted to HIDI. However, when HIDI creates the files that are provided to the TN Dept of Health (TDH), the street address and a small portion (initials) of the name fields will be provided to TDH only for selected records. For records that do not meet the selected record criteria, the street address and name fields will be deleted from the HIDI master files and not provided to any entity. The Dept is hoping they can use these fields to improve their ability to link discharge data with data in other public health related databases. They are willing to try the initials only for this linkage. If using initials only doesn't improve the linkage rate, the Dept will probably require HIDI to supply the entire names -- but only for these selected records (birth defects and crash outcomes records). Hospitals will be notified in advance if the data submitted to the Dept is expanded from the initials only to the full name fields.

Patient Relationship to Insured Code Changes - April 26, 2007

I recently became aware that the codes used by the “Patient Relationship to Insured” fields have changed again effective with March 1, 2007 discharges. The codes for these fields are established by a national billing committee and Tennessee adopts these national codes. The new Patient Relationship to Insured codes are a limited subset of the codes currently used for these fields.

The new codes to be used in the three (3) Patient Relationship to Insured fields (primary, secondary, and tertiary) are as follows:

01 = Spouse
18 = Self
19 = Child
20 = Employee
21 = Unknown
39 = Organ Donor
40 = Cadaver Donor
53 = Life Partner
G8 = Other Relationship

When HIDI edits the UB data submitted by each hospital, they edit these fields for valid codes. Even though these new codes are effective with March 1, 2007 discharges, HIDI will not flag records that contain the old codes that are no longer in use until the 2nd quarter 2007 discharge data (discharges occurring on or after April 1, 2007) is processed. Any records submitted for the 1st quarter 2007 will be accepted if one of the old Patient Relationship to Insured codes is reported.

POA Implementation Delay - April 19, 2007

IMPLEMENTATION OF POA IN THE TENNESSEE HOSPITAL DISCHARGE DATA (STATE REPORTING) WILL BE DELAYED UNTIL DISCHARGES ON OR AFTER JANUARY 1, 2008!

The State has decided to delay implementation of the Present on Admission (POA) indicators until January 1, 2008. This delay will be consistent with the CMS delay and allow for additional time to clarify the capture and coding of this very important information. You should receive a letter soon from George Wade, Tennessee Department of Health, to this effect.

Updated Payer Classification Codes - March 2007

Recently the payer classification codes to be used in reporting hospital discharge data were updated to include new codes for the three (3) programs under Cover Tennessee: CoverTN, CoverKids, and AccessTN. There is also a new payer code for the new MCO (Amerigroup) that will be effective April 1, 2007.  download >>>

PhysicanCode Reporting Changes - March 2007 Effective with October 2006 discharges hospitals are required to submit provider fields in the 1600-character UB-92 record differently... more info >>>