

Variable Definitions¶

Note

These definitions are scraped from ResDAC. Click on the header of a variable description to see the ResDAC page.

Beneficiary Total Coinsurance Days Count ¶

Short SAS Name: COIN_DAY
Long SAS Name: BENE_TOT_COINSRNC_DAYS_CNT

Contained in

The count of the total number of coinsurance days involved with the beneficiary's stay in a facility.

Claim Accountable Care Organization (ACO) Identification Number ¶

Short SAS Name: ACO_ID_NUM
Long SAS Name: ACO_ID_NUM

Contained in

The field identifies the Accountable Care Organization (ACO) Identification Number.

Claim Admission Date ¶

Short SAS Name: ADMSN_DT
Long SAS Name: CLM_ADMSN_DT

Contained in

On an institutional claim, the date the beneficiary was admitted to the hospital, skilled nursing facility, or christian science sanitorium.

Claim Admitting Diagnosis Code ¶

Short SAS Name: ADMTG_DGNS_CD
Long SAS Name: ADMTG_DGNS_CD

Contained in

A diagnosis code on the institutional claim indicating the beneficiary's initial diagnosis at admission.

NOTE1: Effective 1/1/2004 with the implementa- tion of NCH/NMUD CR#1, the admitting diagnosis (also known as reason for patient visit) was added to the Outpatient claim. This data was stored in positions 572-576 (FILLER) until the implementation of NCH/NMUD CR#2. Prior to 1/1/2004, this field was only present on inpatient claims.

Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services.

Claim Attending Physician NPI Number ¶

Short SAS Name: AT_NPI
Long SAS Name: AT_PHYSN_NPI

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`
Outpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`

Dataset	2008	2007	2006	2005	2004
Inpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`
Outpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`

Dataset	2003	2002	2001	2000	1999
Inpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`
Outpatient	`at_npi`	`at_npi`	`at_npi`	`at_npi`	`at_npi`

Contained in

On an institutional claim, the national provider identifier (NPI) number assigned to uniquely identify the physician who has overall responsibility for the beneficiary's care and treatment.

NOTE: Effective May 2007, the NPI will be- come the national standard identifier for covered health care providers. NPIs will replace current OSCAR provider number, UPINs, NSC numbers, and local contractor provider identification numbers (PINs) on standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, PIN, OSCAR provider number, etc.)).

NOTE1: CMS has determined that dual provider identifiers (old legacy numbers and new NPI) must be available in the NCH. After the 5/07 NPI implementation, the standard system main- tainers will add the legacy number to the claim when it is adjudicated. We will continue to receive the OSCAR provider number and any currently issued UPINs. Effective May 2007, no NEW UPINs (legacy number) will be generated for NEW physicians (Part B and Outpatient claims), so there will only be NPIs sent in to the NCH for those physicians.

Claim Attending Physician Specialty Code ¶

Short SAS Name: AT_PHYSN_SPCLTY_CD
Long SAS Name: AT_PHYSN_SPCLTY_CD

Contained in

This variable is the code used to identify the CMS specialty code corresponding to the attending physician.

Values

Code	Code Value
00	Carrier wide
01	General practice
02	General Surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family Practice
09	Interventional Pain Management (IPM) (eff. 4/1/03)
10	Gastroenterology
11	Internal Medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech/language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Psychiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants (eff. 4/1/03 - previously grouped with Certified Registered Nurse Anesthetists (CRNA))
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics) e
53	Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthotist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing indepedently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
66	Rheumatology
67	Occupational therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
68	Clinical psychologist
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional (eff. 1/1/02)
72	Pain Management (eff. 1/1/02)
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers (prior to 4/2003 this included independent Diagnostic Testing Facilities (IDTF)
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs -- eff. 4/1/03)
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventative medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/01/06, known as Independent physiological laboratory
96	Optician
97	Physician assistant
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A4	Home Health Agency (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)
B1	Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)
B2	Pedorthic Personnel (eff. 10/2/07)
B3	Medical Supply Company with pedorthic personnel (eff. 10/2/07)
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist (off. 7/2016)

Claim Attending Physician UPIN Number ¶

Short SAS Name: AT_UPIN
Long SAS Name: AT_PHYSN_UPIN

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`
Outpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`

Dataset	2008	2007	2006	2005	2004
Inpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`
Outpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`

Dataset	2003	2002	2001	2000	1999
Inpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`
Outpatient	`at_upin`	`at_upin`	`at_upin`	`at_upin`	`at_upin`

Contained in

On an institutional claim, the unique physician identification number (UPIN) of the physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the beneficiary's medical care and treatment (attending physician).

NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.

Claim Diagnosis Code I ¶

Short SAS Name: ICD_DGNS_CD1
Long SAS Name: ICD_DGNS_CD1

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd1`	`icd_dgns_cd1`	`icd_dgns_cd1`	`dgns_cd1`
Inpatient	`icd_dgns_cd1`	`icd_dgns_cd1`	`icd_dgns_cd1`	`icd_dgns_cd1`	`dgnscd1`
Outpatient	`icd_dgns_cd1`	`icd_dgns_cd1`	`icd_dgns_cd1`	`icd_dgns_cd1`	`dgnscd1`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`
Inpatient	`dgnscd1`	`dgnscd1`	`dgnscd1`	`dgns_cd1`	`dgns_cd1`
Outpatient	`dgnscd1`	`dgnscd1`	`dgnscd1`	`dgns_cd1`	`dgns_cd1`

Dataset	2003	2002	2001	2000	1999
Carrier	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`	`bdx1`
Inpatient	`dgns_cd1`	`dgns_cd1`	`dgnscd1`	`dgnscd1`	`dgnscd1`
Outpatient	`dgns_cd1`	`dgns_cd1`	`dgns_cd1`	`dgnscd1`	`dgnscd1`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code II ¶

Short SAS Name: ICD_DGNS_CD2
Long SAS Name: ICD_DGNS_CD2

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd2`	`icd_dgns_cd2`	`icd_dgns_cd2`	`dgns_cd2`
Inpatient	`icd_dgns_cd2`	`icd_dgns_cd2`	`icd_dgns_cd2`	`icd_dgns_cd2`	`dgnscd2`
Outpatient	`icd_dgns_cd2`	`icd_dgns_cd2`	`icd_dgns_cd2`	`icd_dgns_cd2`	`dgnscd2`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`
Inpatient	`dgnscd2`	`dgnscd2`	`dgnscd2`	`dgns_cd2`	`dgns_cd2`
Outpatient	`dgnscd2`	`dgnscd2`	`dgnscd2`	`dgns_cd2`	`dgns_cd2`

Dataset	2003	2002	2001	2000	1999
Carrier	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`	`bdx2`
Inpatient	`dgns_cd2`	`dgns_cd2`	`dgnscd2`	`dgnscd2`	`dgnscd2`
Outpatient	`dgns_cd2`	`dgns_cd2`	`dgns_cd2`	`dgnscd2`	`dgnscd2`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code III ¶

Short SAS Name: ICD_DGNS_CD3
Long SAS Name: ICD_DGNS_CD3

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd3`	`icd_dgns_cd3`	`icd_dgns_cd3`	`dgns_cd3`
Inpatient	`icd_dgns_cd3`	`icd_dgns_cd3`	`icd_dgns_cd3`	`icd_dgns_cd3`	`dgnscd3`
Outpatient	`icd_dgns_cd3`	`icd_dgns_cd3`	`icd_dgns_cd3`	`icd_dgns_cd3`	`dgnscd3`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`
Inpatient	`dgnscd3`	`dgnscd3`	`dgnscd3`	`dgns_cd3`	`dgns_cd3`
Outpatient	`dgnscd3`	`dgnscd3`	`dgnscd3`	`dgns_cd3`	`dgns_cd3`

Dataset	2003	2002	2001	2000	1999
Carrier	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`	`bdx3`
Inpatient	`dgns_cd3`	`dgns_cd3`	`dgnscd3`	`dgnscd3`	`dgnscd3`
Outpatient	`dgns_cd3`	`dgns_cd3`	`dgns_cd3`	`dgnscd3`	`dgnscd3`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code IV ¶

Short SAS Name: ICD_DGNS_CD4
Long SAS Name: ICD_DGNS_CD4

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd4`	`icd_dgns_cd4`	`icd_dgns_cd4`	`dgns_cd4`
Inpatient	`icd_dgns_cd4`	`icd_dgns_cd4`	`icd_dgns_cd4`	`icd_dgns_cd4`	`dgnscd4`
Outpatient	`icd_dgns_cd4`	`icd_dgns_cd4`	`icd_dgns_cd4`	`icd_dgns_cd4`	`dgnscd4`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`
Inpatient	`dgnscd4`	`dgnscd4`	`dgnscd4`	`dgns_cd4`	`dgns_cd4`
Outpatient	`dgnscd4`	`dgnscd4`	`dgnscd4`	`dgns_cd4`	`dgns_cd4`

Dataset	2003	2002	2001	2000	1999
Carrier	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`	`bdx4`
Inpatient	`dgns_cd4`	`dgns_cd4`	`dgnscd4`	`dgnscd4`	`dgnscd4`
Outpatient	`dgns_cd4`	`dgns_cd4`	`dgns_cd4`	`dgnscd4`	`dgnscd4`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code). NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code IX ¶

Short SAS Name: ICD_DGNS_CD9
Long SAS Name: ICD_DGNS_CD9

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd9`	`icd_dgns_cd9`	`icd_dgns_cd9`
Inpatient	`icd_dgns_cd9`	`icd_dgns_cd9`	`icd_dgns_cd9`	`icd_dgns_cd9`	`dgnscd9`
Outpatient	`icd_dgns_cd9`	`icd_dgns_cd9`	`icd_dgns_cd9`	`icd_dgns_cd9`	`dgnscd9`

Dataset	2008	2007	2006	2005	2004
Carrier
Inpatient	`dgnscd9`	`dgnscd9`	`dgnscd9`	`dgns_cd9`	`dgns_cd9`
Outpatient	`dgnscd9`	`dgnscd9`	`dgnscd9`	`dgns_cd9`	`dgns_cd9`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd9`	`dgns_cd9`	`dgnscd9`	`dgnscd9`	`dgnscd9`
Outpatient	`dgns_cd9`	`dgns_cd9`	`dgns_cd9`	`dgnscd9`	`dgnscd9`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code V ¶

Short SAS Name: ICD_DGNS_CD5
Long SAS Name: ICD_DGNS_CD5

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd5`	`icd_dgns_cd5`	`icd_dgns_cd5`	`dgns_cd5`
Inpatient	`icd_dgns_cd5`	`icd_dgns_cd5`	`icd_dgns_cd5`	`icd_dgns_cd5`	`dgnscd5`
Outpatient	`icd_dgns_cd5`	`icd_dgns_cd5`	`icd_dgns_cd5`	`icd_dgns_cd5`	`dgnscd5`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd5`	`dgns_cd5`	`dgns_cd5`
Inpatient	`dgnscd5`	`dgnscd5`	`dgnscd5`	`dgns_cd5`	`dgns_cd5`
Outpatient	`dgnscd5`	`dgnscd5`	`dgnscd5`	`dgns_cd5`	`dgns_cd5`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd5`	`dgns_cd5`	`dgnscd5`	`dgnscd5`	`dgnscd5`
Outpatient	`dgns_cd5`	`dgns_cd5`	`dgns_cd5`	`dgnscd5`	`dgnscd5`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VI ¶

Short SAS Name: ICD_DGNS_CD6
Long SAS Name: ICD_DGNS_CD6

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd6`	`icd_dgns_cd6`	`icd_dgns_cd6`	`dgns_cd6`
Inpatient	`icd_dgns_cd6`	`icd_dgns_cd6`	`icd_dgns_cd6`	`icd_dgns_cd6`	`dgnscd6`
Outpatient	`icd_dgns_cd6`	`icd_dgns_cd6`	`icd_dgns_cd6`	`icd_dgns_cd6`	`dgnscd6`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd6`	`dgns_cd6`	`dgns_cd6`
Inpatient	`dgnscd6`	`dgnscd6`	`dgnscd6`	`dgns_cd6`	`dgns_cd6`
Outpatient	`dgnscd6`	`dgnscd6`	`dgnscd6`	`dgns_cd6`	`dgns_cd6`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd6`	`dgns_cd6`	`dgnscd6`	`dgnscd6`	`dgnscd6`
Outpatient	`dgns_cd6`	`dgns_cd6`	`dgns_cd6`	`dgnscd6`	`dgnscd6`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VII ¶

Short SAS Name: ICD_DGNS_CD7
Long SAS Name: ICD_DGNS_CD7

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd7`	`icd_dgns_cd7`	`icd_dgns_cd7`	`dgns_cd7`
Inpatient	`icd_dgns_cd7`	`icd_dgns_cd7`	`icd_dgns_cd7`	`icd_dgns_cd7`	`dgnscd7`
Outpatient	`icd_dgns_cd7`	`icd_dgns_cd7`	`icd_dgns_cd7`	`icd_dgns_cd7`	`dgnscd7`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd7`	`dgns_cd7`	`dgns_cd7`
Inpatient	`dgnscd7`	`dgnscd7`	`dgnscd7`	`dgns_cd7`	`dgns_cd7`
Outpatient	`dgnscd7`	`dgnscd7`	`dgnscd7`	`dgns_cd7`	`dgns_cd7`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd7`	`dgns_cd7`	`dgnscd7`	`dgnscd7`	`dgnscd7`
Outpatient	`dgns_cd7`	`dgns_cd7`	`dgns_cd7`	`dgnscd7`	`dgnscd7`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code VIII ¶

Short SAS Name: ICD_DGNS_CD8
Long SAS Name: ICD_DGNS_CD8

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd8`	`icd_dgns_cd8`	`icd_dgns_cd8`	`dgns_cd8`
Inpatient	`icd_dgns_cd8`	`icd_dgns_cd8`	`icd_dgns_cd8`	`icd_dgns_cd8`	`dgnscd8`
Outpatient	`icd_dgns_cd8`	`icd_dgns_cd8`	`icd_dgns_cd8`	`icd_dgns_cd8`	`dgnscd8`

Dataset	2008	2007	2006	2005	2004
Carrier	`dgns_cd8`	`dgns_cd8`	`dgns_cd8`
Inpatient	`dgnscd8`	`dgnscd8`	`dgnscd8`	`dgns_cd8`	`dgns_cd8`
Outpatient	`dgnscd8`	`dgnscd8`	`dgnscd8`	`dgns_cd8`	`dgns_cd8`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd8`	`dgns_cd8`	`dgnscd8`	`dgnscd8`	`dgnscd8`
Outpatient	`dgns_cd8`	`dgns_cd8`	`dgns_cd8`	`dgnscd8`	`dgnscd8`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code X ¶

Short SAS Name: ICD_DGNS_CD10
Long SAS Name: ICD_DGNS_CD10

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`icd_dgns_cd10`	`icd_dgns_cd10`	`icd_dgns_cd10`
Inpatient	`icd_dgns_cd10`	`icd_dgns_cd10`	`icd_dgns_cd10`	`icd_dgns_cd10`	`dgnscd10`
Outpatient	`icd_dgns_cd10`	`icd_dgns_cd10`	`icd_dgns_cd10`	`icd_dgns_cd10`	`dgnscd10`

Dataset	2008	2007	2006	2005	2004
Carrier
Inpatient	`dgnscd10`	`dgnscd10`	`dgnscd10`	`dgns_cd10`	`dgns_cd10`
Outpatient	`dgnscd10`	`dgnscd10`	`dgnscd10`	`dgns_cd10`	`dgns_cd10`

Dataset	2003	2002	2001	2000	1999
Carrier
Inpatient	`dgns_cd10`	`dgns_cd10`	`dgnscd10`	`dgnscd10`	`dgnscd10`
Outpatient	`dgns_cd10`	`dgns_cd10`	`dgns_cd10`	`dgnscd10`	`dgnscd10`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XI ¶

Short SAS Name: ICD_DGNS_CD11
Long SAS Name: ICD_DGNS_CD11

Variable Names

Dataset	2013	2012	2011	2010
Carrier		`icd_dgns_cd11`	`icd_dgns_cd11`	`icd_dgns_cd11`
Inpatient	`icd_dgns_cd11`	`icd_dgns_cd11`	`icd_dgns_cd11`	`icd_dgns_cd11`
Outpatient	`icd_dgns_cd11`	`icd_dgns_cd11`	`icd_dgns_cd11`	`icd_dgns_cd11`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XII ¶

Short SAS Name: ICD_DGNS_CD12
Long SAS Name: ICD_DGNS_CD12

Variable Names

Dataset	2013	2012	2011	2010
Carrier		`icd_dgns_cd12`	`icd_dgns_cd12`	`icd_dgns_cd12`
Inpatient	`icd_dgns_cd12`	`icd_dgns_cd12`	`icd_dgns_cd12`	`icd_dgns_cd12`
Outpatient	`icd_dgns_cd12`	`icd_dgns_cd12`	`icd_dgns_cd12`	`icd_dgns_cd12`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10. NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XIII ¶

Short SAS Name: ICD_DGNS_CD13
Long SAS Name: ICD_DGNS_CD13

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd13`	`icd_dgns_cd13`	`icd_dgns_cd13`	`icd_dgns_cd13`
Outpatient	`icd_dgns_cd13`	`icd_dgns_cd13`	`icd_dgns_cd13`	`icd_dgns_cd13`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XIV ¶

Short SAS Name: ICD_DGNS_CD14
Long SAS Name: ICD_DGNS_CD14

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd14`	`icd_dgns_cd14`	`icd_dgns_cd14`	`icd_dgns_cd14`
Outpatient	`icd_dgns_cd14`	`icd_dgns_cd14`	`icd_dgns_cd14`	`icd_dgns_cd14`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XIX ¶

Short SAS Name: ICD_DGNS_CD19
Long SAS Name: ICD_DGNS_CD19

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd19`	`icd_dgns_cd19`	`icd_dgns_cd19`	`icd_dgns_cd19`
Outpatient	`icd_dgns_cd19`	`icd_dgns_cd19`	`icd_dgns_cd19`	`icd_dgns_cd19`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XV ¶

Short SAS Name: ICD_DGNS_CD15
Long SAS Name: ICD_DGNS_CD15

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd15`	`icd_dgns_cd15`	`icd_dgns_cd15`	`icd_dgns_cd15`
Outpatient	`icd_dgns_cd15`	`icd_dgns_cd15`	`icd_dgns_cd15`	`icd_dgns_cd15`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XVI ¶

Short SAS Name: ICD_DGNS_CD16
Long SAS Name: ICD_DGNS_CD16

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd16`	`icd_dgns_cd16`	`icd_dgns_cd16`	`icd_dgns_cd16`
Outpatient	`icd_dgns_cd16`	`icd_dgns_cd16`	`icd_dgns_cd16`	`icd_dgns_cd16`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XVII ¶

Short SAS Name: ICD_DGNS_CD17
Long SAS Name: ICD_DGNS_CD17

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd17`	`icd_dgns_cd17`	`icd_dgns_cd17`	`icd_dgns_cd17`
Outpatient	`icd_dgns_cd17`	`icd_dgns_cd17`	`icd_dgns_cd17`	`icd_dgns_cd17`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XVIII ¶

Short SAS Name: ICD_DGNS_CD18
Long SAS Name: ICD_DGNS_CD18

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd18`	`icd_dgns_cd18`	`icd_dgns_cd18`	`icd_dgns_cd18`
Outpatient	`icd_dgns_cd18`	`icd_dgns_cd18`	`icd_dgns_cd18`	`icd_dgns_cd18`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XX ¶

Short SAS Name: ICD_DGNS_CD20
Long SAS Name: ICD_DGNS_CD20

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd20`	`icd_dgns_cd20`	`icd_dgns_cd20`	`icd_dgns_cd20`
Outpatient	`icd_dgns_cd20`	`icd_dgns_cd20`	`icd_dgns_cd20`	`icd_dgns_cd20`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XXI ¶

Short SAS Name: ICD_DGNS_CD21
Long SAS Name: ICD_DGNS_CD21

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd21`	`icd_dgns_cd21`	`icd_dgns_cd21`	`icd_dgns_cd21`
Outpatient	`icd_dgns_cd21`	`icd_dgns_cd21`	`icd_dgns_cd21`	`icd_dgns_cd21`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XXII ¶

Short SAS Name: ICD_DGNS_CD22
Long SAS Name: ICD_DGNS_CD22

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd22`	`icd_dgns_cd22`	`icd_dgns_cd22`	`icd_dgns_cd22`
Outpatient	`icd_dgns_cd22`	`icd_dgns_cd22`	`icd_dgns_cd22`	`icd_dgns_cd22`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XXIII ¶

Short SAS Name: ICD_DGNS_CD23
Long SAS Name: ICD_DGNS_CD23

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd23`	`icd_dgns_cd23`	`icd_dgns_cd23`	`icd_dgns_cd23`
Outpatient	`icd_dgns_cd23`	`icd_dgns_cd23`	`icd_dgns_cd23`	`icd_dgns_cd23`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XXIV ¶

Short SAS Name: ICD_DGNS_CD24
Long SAS Name: ICD_DGNS_CD24

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd24`	`icd_dgns_cd24`	`icd_dgns_cd24`	`icd_dgns_cd24`
Outpatient	`icd_dgns_cd24`	`icd_dgns_cd24`	`icd_dgns_cd24`	`icd_dgns_cd24`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis Code XXV ¶

Short SAS Name: ICD_DGNS_CD25
Long SAS Name: ICD_DGNS_CD25

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_dgns_cd25`	`icd_dgns_cd25`	`icd_dgns_cd25`	`icd_dgns_cd25`
Outpatient	`icd_dgns_cd25`	`icd_dgns_cd25`	`icd_dgns_cd25`	`icd_dgns_cd25`

Contained in

The diagnosis code identifying the beneficiary's principal or other diagnosis (including E code).

NOTE: Prior to Version H, the principal diagnosis code was not stored with the 'OTHER' diagnosis codes. During the Version H conversion the CLM_PRNCPAL_DGNS_CD was added as the first occurrence.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

NOTE2: Effective with Version 'J', the diagnosis E codes are stored in a separate trailer (CLM_DGNS_E_GRP).

Claim Diagnosis E Code I ¶

Short SAS Name: ICD_DGNS_E_CD1
Long SAS Name: ICD_DGNS_E_CD1

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse effect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code II ¶

Short SAS Name: ICD_DGNS_E_CD2
Long SAS Name: ICD_DGNS_E_CD2

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code III ¶

Short SAS Name: ICD_DGNS_E_CD3
Long SAS Name: ICD_DGNS_E_CD3

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code IV ¶

Short SAS Name: ICD_DGNS_E_CD4
Long SAS Name: ICD_DGNS_E_CD4

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code IX ¶

Short SAS Name: ICD_DGNS_E_CD9
Long SAS Name: ICD_DGNS_E_CD9

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code V ¶

Short SAS Name: ICD_DGNS_E_CD5
Long SAS Name: ICD_DGNS_E_CD5

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code VI ¶

Short SAS Name: ICD_DGNS_E_CD6
Long SAS Name: ICD_DGNS_E_CD6

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code VII ¶

Short SAS Name: ICD_DGNS_E_CD7
Long SAS Name: ICD_DGNS_E_CD7

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code VIII ¶

Short SAS Name: ICD_DGNS_E_CD8
Long SAS Name: ICD_DGNS_E_CD8

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code X ¶

Short SAS Name: ICD_DGNS_E_CD10
Long SAS Name: ICD_DGNS_E_CD10

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code XI ¶

Short SAS Name: ICD_DGNS_E_CD11
Long SAS Name: ICD_DGNS_E_CD11

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Claim Diagnosis E Code XII ¶

Short SAS Name: ICD_DGNS_E_CD12
Long SAS Name: ICD_DGNS_E_CD12

Contained in

Effective with Version J, the code used to identify the external cause of injury, poisoning, or other adverse affect.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accomodate the future implementation of ICD-10. During the Version 'J' conversion this field was populated throughout history.

Short SAS Name: DRG_CD
Long SAS Name: CLM_DRG_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`
MedPAR	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`

Dataset	2008	2007	2006	2005	2004
Inpatient	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`
MedPAR	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`

Dataset	2003	2002	2001	2000	1999
Inpatient	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`	`drg_cd`
MedPAR	`drg_cd`	`drg_cd`	`mdrg`	`mdrg`	`mdrg`

Contained in

The diagnostic related group to which a hospital claim belongs for prospective payment purposes.

Claim Facility Type Code ¶

Short SAS Name: FAC_TYPE
Long SAS Name: CLM_FAC_TYPE_CD

Contained in

The first digit of the type of bill (TOB1) submitted on an institutional claim used to identify the type of facility that provided care to the beneficiary.

Values

Code	Code Value
1	Hospital
2	Skilled nursing facility (SNF)
3	Home health agency (HHA)
4	Religious Nonmedical (Hospital) (eff. 8/1/00); prior to 8/00 referenced Christian Science (CS)
5	Religious Nonmedical (Extended Care) (eff. 8/1/00); prior to 8/00 referenced CS (discontinued effective 10/1/05)
6	Intermediate care
7	Clinic or hospital-based renal dialysis facility
8	Special facility or ASC surgery
9	Reserved

Claim Frequency Code ¶

Short SAS Name: FREQ_CD
Long SAS Name: CLM_FREQ_CD

Contained in

The third digit of the type of bill (TOB3) submitted on an institutional claim record to indicate the sequence of a claim in the beneficiary's current episode of care.

Values

Code	Code Value
0	Non-payment/zero claims
1	Admit thru discharge claim
2	Interim - first claim
3	Interim - continuing claim (not valid for PPS claims)
4	Interim - last claim (not valid for PPS claims)
5	Late charge(s) only claim
6	Adjustment of prior claim
7	Replacement of prior claim (eff 10/93) provider debit
8	Void/cancel prior claim (eff 10/93) provider cancel
9	Final claim -- used in an HH PPS episode to indicate the claim should be processed like debit/credit adjustment to RAP (initial claim) (eff. 10/00)
A	Admission election notice - used when hospice or Religious Nonmedical Health Care Institution is submitting the HCFA-1450 as an admission notice - hospice NOE only
B	Hospice/Medicare Coordinated Care Demonstration/RNCHI - Termination/Revocation Notice - hospice NOE only (eff 9/93)
C	Hospice change of provider notice - hospice NOE only (eff 9/93)
D	Hospice/Medicare Coordinated Care Demonstration/RNHCI - void/cancel - hospice NOE only (eff 9/93)
E	Hospice change of ownership - hospice NOE only (eff 1/97)
F	Beneficiary initiated adjustment claim (eff 10/93)
G	CWF generated adjustment claim (eff 10/93)
H	CMS generated adjustment claim (eff 10/93)
I	Misc adjustment claim (other than PRO or provider) - used to identify a debit adjustment initiated by CMS or an intermediary (other than QIO or Provider) - eff 10/93, used to identify intermediary initiated adjustment only
J	Other adjustment request (eff 10/93)
K	OIG initiated adjustment (eff 10/93)
M	MSP adjustment (eff 10/93)
P	Adjustment required by Quality Improvement Organization (QIO) -- formerly Peer Review Organization (PRO)
X	Special adjustment processing - used for QA editing (eff 8/92)
Z	Hospital Encounter Data alternate submission (TOB '11Z') used for MCO enrollee hospital discharges 7/1/97-12/31/98; not stored in NCH. Exception: Problem in startup months may have resulted in this abbreviated UB-92 being erroneously stored in NCH.

Claim From Date ¶

Short SAS Name: FROM_DT
Long SAS Name: CLM_FROM_DT

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`from_dt`	`from_dt`	`from_dt`	`from_dt`
Inpatient	`from_dt`	`from_dt`	`from_dt`	`from_dt`	`from_dt`
Outpatient	`from_dt`	`from_dt`	`from_dt`	`from_dt`	`from_dt`

Dataset	2008	2007	2006	2005	2004
Carrier	`from_dt`	`from_dt`	`from_dt`	`sfromdt`	`sfromdt`
Inpatient	`from_dt`	`from_dt`	`from_dt`	`sfromdt`	`sfromdt`
Outpatient	`from_dt`	`from_dt`	`from_dt`	`sfromdt`	`sfromdt`

Dataset	2003	2002	2001	2000	1999
Carrier	`sfromdt`	`sfromdt`	`from_dt`	`from_dt`	`bfromdt`
Inpatient	`sfromdt`	`sfromdt`	`from_dt`	`from_dt`	`from_dt`
Outpatient	`sfromdt`	`sfromdt`	`sfromdt`	`from_dt`	`from_dt`

Contained in

The first day on the billing statement covering services rendered to the bene- ficiary (a.k.a. 'Statement Covers From Date').

NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match.

Claim ID ¶

Short SAS Name: CLM_ID
Long SAS Name: CLM_ID

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`clm_id`	`clm_id`	`clm_id`	`clm_id`
Inpatient	`clm_id`	`clm_id`	`clm_id`	`clm_id`	`clm_id`
Outpatient	`clm_id`	`clm_id`	`clm_id`	`clm_id`	`clm_id`

Dataset	2008	2007	2006	2005	2004
Carrier	`clm_id`	`clm_id`	`clm_id`	`claimindex`	`claimindex`
Inpatient	`clm_id`	`clm_id`	`clm_id`	`claimindex`	`claimindex`
Outpatient	`clm_id`	`clm_id`	`clm_id`	`claimindex`	`claimindex`

Dataset	2003	2002	2001	2000	1999
Carrier	`claimindex`	`claimindex`	`carrcntl`	`carrcntl`	`bccn`
Inpatient	`claimindex`	`claimindex`	`link_num`	`link_num`	`clm_cntl`
Outpatient	`claimindex`	`claimindex`	`claimindex`	`link_num`	`link_num`

Contained in

The Unique CCW indentifier for a base claim. Simple encryption applied for extracts. Non-encrypted if pulled directly from CCW Oracle.

Limitation

When pulled directly from CCW, this is a numeric column.

Claim Inpatient Admission Type Code ¶

Short SAS Name: TYPE_ADM
Long SAS Name: CLM_IP_ADMSN_TYPE_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`type_adm`	`type_adm`	`type_adm`	`type_adm`	`type_adm`

Dataset	2008	2007	2006	2005	2004
MedPAR	`type_adm`	`type_adm`	`type_adm`	`type_adm`	`type_adm`

Dataset	2003	2002	2001	2000	1999
MedPAR	`type_adm`	`type_adm`	`madmtype`	`madmtype`	`madmtype`

Contained in

The code indicating the type and priority of an inpatient admission associated with the service on an intermediary submitted claim.

Values

Code	Code Value
0	Blank
1	Emergency - The patient required immediate medical intervention as a result of severe, life threatening, or potentially disabling conditions. Generally, the patient was admitted through the emergency room.
2	Urgent - The patient required immediate attention for the care and treatment of a physical or mental disorder. Generally, the patient was admitted to the first available and suitable accommodation.
3	Elective - The patient's condition permitted adequate time to schedule the availability of suitable accommodations.
4	Newborn - Necessitates the use of special source of admission codes.
5	Trauma Center - visits to a trauma center/hospital as licensed or designated by the State or local government authority authorized to do so, or as verified by the American College of Surgeons and involving a trauma activation.
6 THRU 8	Reserved
9	Unknown - Information not available.

Claim Line Number ¶

Short SAS Name: CLM_LN
Long SAS Name: CLM_LINE_NUM

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`clm_ln`	`clm_ln`	`clm_ln`	`clm_ln`	`clm_ln`

Dataset	2008	2007	2006	2005	2004
Outpatient	`clm_ln`	`clm_ln`	`clm_ln`	`cntrindex`	`cntrindex`

Dataset	2003	2002	2001
Outpatient	`cntrindex`	`cntrindex`	`cntrindex`

Contained in

The claim line number for detail revenue or part B line.

Claim MCO Paid Switch ¶

Short SAS Name: MCOPDSW
Long SAS Name: CLM_MCO_PD_SW

Contained in

A switch indicating whether or not a Managed Care Organization (MCO) has paid the provider for an institutional claim.

Limitation

DESCRIPTION : The MCO paid switch made consistent with criteria used to identify an inpatient encounter claim.

BACKGROUND : During the NCH Version 'I' conversion, history was populated with an NCH Claim Type Code that will identify the record as an inpatient encounter claim. When applying the CWF logic to identify an inpatient encounter claim, it was discovered that when all the criteria was met the MCO paid switch was sometimes a blank or '0' (reflecting that the MCO did not pay the provider).

CORRECTIVE ACTION : With the inception of the Version 'I' processing (7/00), if all the criteria for identifying an inpatient encounter claim is met but the MCO paid switch is a blank or '0' it is changed to a '1'. A patch code = '13' was applied to all claims back to 7/1/97 service year thru date.

Values

Code	Code Value
1	MCO has paid the provider for a claim
BLANK or 0	MCO has not paid the provider for a claim

Claim Medical Record Number ¶

Short SAS Name: CLM_MDCL_REC
Long SAS Name: CLM_MDCL_REC

Contained in

The number assigned by the provider to the beneficiary's medical record to assist in record retrieval.

Claim Medicare Non Payment Reason Code ¶

Short SAS Name: NOPAY_CD
Long SAS Name: CLM_MDCR_NON_PMT_RSN_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`nopay_cd`	`nopay_cd`	`nopay_cd`	`nopay_cd`	`nopay_cd`

Dataset	2008	2007	2006	2005	2004
Outpatient	`nopay_cd`	`nopay_cd`	`nopay_cd`	`nopay_cd`	`nopay_cd`

Dataset	2003	2002	2001	2000	1999
Outpatient	`nopay_cd`	`nopay_cd`	`nopay_cd`	`nopay_cd`	`cancelcd`

Contained in

The reason that no Medicare payment is made for services on an institutional claim.

NOTE1: This field was put on all institutional claim types but data did not start coming in on OP/HHA/Hospice until 4/1/02. Prior to 4/1/02, data only came in Inpatient/SNF claims.

NOTE2: Effective 4/1/02, this field was also expanded to two bytes to accommodate new values. The NCH Nearline file did not expand the current 1-byte field but instituted a crosswalk of the 2-byte field to the 1-byte character value. See table of code for the crosswalk.

NOTE3: Effective with Version 'J', the field has been expanded on the NCH claim to 2 bytes. With this expansion the NCH will no longer use the character values to represent the official two byte values being sent in by CWF since 4/2002.

During the Version 'J' conversion, all character values were converted to the two byte values.

NOTE4: These code values were not identified as part of the original CMS data documentation. ResDAC has identified the values and has provided them for convenience.

Values

Valid Values effective 1/2011 (2-byte values are replacing the character values)

Code	Code Value
A	Covered worker's compensation (Obsolete)
B	Benefit exhausted
C	Custodial care - noncovered care (includes all 'beneficiary at fault'waiver cases) (Obsolete)
E	HMO out-of-plan services not emergency or urgently needed (Obsolete)
E	MSP cost avoided - IRS/SSA/HCFA Data Match (eff. 7/00)
F	MSP cost avoid HMO Rate Cell (eff. 7/00)
G	MSP cost avoided Litigation Settlement (eff. 7/00)
H	MSP cost avoided Employer Voluntary Reporting (eff. 7/00)
J	MSP cost avoid Insurer Voluntary Reporting (eff. 7/00)
K	MSP cost avoid Initial Enrollment Questionnaire (eff. 7/00)
N	All other reasons for nonpayment
P	Payment requested
Q	MSP cost avoided Voluntary Agreement (eff. 7/00)
R	Benefits refused, or evidence not submitted
T	MSP cost avoided - IEQ contractor (eff. 9/76) (obsolete 6/30/00)
U	MSP cost avoided - HMO rate cell adjustment (eff. 9/76) (Obsolete 6/30/00)
V	MSP cost avoided - litigation settlement (eff. 9/76) (Obsolete 6/30/00)
W	Worker's compensation (Obsolete)
X	MSP cost avoided - generic
Y	MSP cost avoided - IRS/SSA data match project (obsolete 6/30/00)
Z	Zero reimbursement RAPs -- zero reimbursement made due to medical review intervention or where provider specific zero payment has been determined. (effective with HHPPS - 10/00)
00	MSP cost avoided - COB Contractor
12	MSP cost avoided - BCBS Voluntary Agreements
13	MSP cost avoided - Office of Personnel Management
14	MSP cost avoided - Workman's Compensation (WC) Datamatch
15	MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) (eff. 4/2006)
16	MSP cost avoided - Liability Insurer VDSA (eff. 4/2006)
17	MSP cost avoided - No-Fault Insurer VDSA (eff. 4/2006)
18	MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement (eff. 4/2006)
19	SEE NOTE4: Coordination of Benefits Contractor 11119 (see CMS Change Request 7906 for identification of the contractor.)
21	MSP cost avoided - MIR Group Heqalth Plan (eff. 1/2009)
22	MSP cost avoided - MIR non-Group Health Plan (eff. 1/2009)
25	MSP cost avoided - Recovery Audit Contractor - California (eff. 10/2005)
26	MSP cost avoided - Recovery Audit Contractor - Florida (eff. 10/2005)
42	SEE NOTE4: Coordination of Benefits Contractor 11142 (see CMS Change Request 7906 for identification of the contractor.)
43	SEE NOTE4: Coordination of Benefits Contractor 11143 (see CMS Change Request 7906 for identification of the contractor.)

Effective 4/1/02, the Medicare nonpayment reason code was expanded to a 2-byte field. The NCH instituted a crosswalk from the 2-byte code to a 1-byte character code. Below are the character codes (found in NCH & NMUD). At some point, NMUD will carry the 2-byte code but NCH will continue to have the 1-byte character code.

Code	Code Value
!	MSP cost avoided - COB Contractor ('00' 2-byte code)
@	MSP cost avoided - BC/BS Voluntary Agreements ('12' 2-byte code)
#	MSP cost avoided - Office of Personnel Management ('13' 2-byte code)
$	MSP cost avoided - Workman's Compensation (WC) Datamatch ('14' 2-byte code)
*	MSP cost avoided - Workman's Compensation Insurer Voluntary Data Sharing Agreements (WC VDSA) ('15' 2-byte code) (eff. 4/2006)
(	MSP cost avoided - Liability Insurer VDSA ('16' 2-byte code) (eff. 4/2006)
)	MSP cost avoided - No-Fault Insurer VDSA ('17' 2-byte code) (eff. 4/2006)
+	MSP cost avoided - Pharmacy Benefit Manager Data Sharing Agreement ('18' 2-byte code) (eff. 4/2006)
<	MSP cost avoided - MIR Group Health Plan ('21' 2-byte code) (eff. 1/2009)
>	MSP cost avoided - MIR non-Group Health Plan ('22' 2-byte code) (eff. 1/2009)
%	MSP cost avoided - Recovery Audit Contractor - California ('25' 2-byte code) (eff. 10/2005)
&	MSP cost avoided - Recovery Audit Contractor - Florida ('26' 2-byte code) (eff. 10/2005)

Claim Non Utilization Days Count ¶

Short SAS Name: NUTILDAY
Long SAS Name: CLM_NON_UTLZTN_DAYS_CNT

Contained in

On an institutional claim, the number of days of care that are not chargeable to Medicare facility utilization.

Claim Occurrence Span Code ¶

Short SAS Name: SPAN_CD
Long SAS Name: CLM_SPAN_CD

Contained in

The code that identifies a significant event relating to an institutional claim that may affect payer processing. These codes are claim-related occurrences that are related to a time period (span of dates).

Values

Code	Code Value
70	Eff 10/93, payer use only, the nonutilization from/thru dates for PPS-inlier stay where bene had exhausted all full/coinsurance days, but covered on cost report. SNF qualifying hospital stay from/thru dates
71	Hospital prior stay dates - the from/thru dates of any hospital stay that ended within 60 days of this hospital or SNF admission.
72	First/last visit - the dates of the first and last visits occurring in this billing period if the dates are different from those in the statement covers period.
73	Benefit eligibility period - the inclusive dates during which CHAMPUS medical benefits are available to a sponsor's bene as shown on the bene's ID card.
74	Non-covered level of care - the from/thru dates of a period at a noncovered level of care in an otherwise covered stay, excluding any period reported with occurrence span code 76, 77, or 79.
75	The from/thru dates of SNF level of care during IP hospital stay. Shows PRO approval of patient remaining in hospital because SNF bed not available. Not applicable to swing bed cases. PPS hospitals use in day outlier cases only.
76	Patient liability - From/thru dates of period of noncovered care for which hospital may charge bene. The FI or PRO must have approved such charges in advance. Patient must be notified in writing 3 days prior to noncovered period
77	Provider liability (utilization charged) - The from/thru dates of period of noncovered care for which the provider is liable. Eff 3/92, applies to provider liability where bene is charged with utilization and is liable for deductible/coinsurance
78	SNF prior stay dates - The from/thru dates of any SNF stay that ended within 60 days of this hospital or SNF admission.
79	Provider Liability (non-utilization) (Payer code) - Eff 3/92, from/thru dates of period of non-covered care where bene is not charged with utilization, deductible, or coinsurance and provider is liable. Eff 9/93, non-covered period of care due to lack of medical necessity.
80	Prior Same-SNF Stay Dates for Payment Ban Purposes - the from/thru dates of a prior same-SNF stay indicating a patient resided in the SNF prior to, and if applicable, during a payment ban period up until their discharge to a hospital.
81-99	Reserved for state assignment
M0	QIO/UR approved stay dates - Eff 10/93, the first and last days that were approved where not all of the stay was approved.
M1	Provider Liability-No Utilization - from/thru dates of a period of non-covered care that is denied due to lack of medical necessity or custodial care for which the provider is liable. (eff. 10/01)
M2	Dates of Inpatient Respite Care - from/thru dates of a period of inpatient respite care for hospice patients. (eff. 10/00)
M3	ICF Level of Care - the from/thru dates of a period of intermediate level of care during an inpatient hospital stay.
M4	Residential Level of Care - the from/thru dates of a period of residential level of care during an inpatient hospital stay.

Claim Occurrence Span From Date ¶

Short SAS Name: SPANFROM
Long SAS Name: CLM_SPAN_FROM_DT

Contained in

The from date of a period associated with an occurrence of a specific event relating to an institutional claim that may affect payer processing.

Claim Occurrence Span Through Date ¶

Short SAS Name: SPANTHRU
Long SAS Name: CLM_SPAN_THRU_DT

Contained in

The thru date of a period associated with an occurrence of a specific event relating to an institutional claim that may affect payer processing.

Claim Operating Physician NPI Number ¶

Short SAS Name: OP_NPI
Long SAS Name: OP_PHYSN_NPI

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`
Outpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`

Dataset	2008	2007	2006	2005	2004
Inpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`
Outpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`

Dataset	2003	2002	2001	2000	1999
Inpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`
Outpatient	`op_npi`	`op_npi`	`op_npi`	`op_npi`	`op_npi`

Contained in

On an institutional claim, the National Provider Identifier (NPI) number assigned to uniquely identify the physician with the primary responsibility for performing the surgical procedure(s).

NOTE: Effective May 2007, the NPI will become the national standard identifier for covered health care providers. NPIs will replace the current OSCAR provider number, UPINs, NSC numbers, and local contractor provider identi- fication numbers (PINs) on standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, PIN, OSCAR provider number, etc.)).

NOTE1: CMS has determined that dual provider identifiers (old legacy number and new NPI) must be available in the NCH. After the 5/07 NPI implementation, the standard system maint- tainers will add the legacy number to the claim when its adjudicated. We will continue to re- ceive the OSCAR provider number and any currently issued UPINs. Effective May 2007, no NEW UPINs (legacy numbers) will be generated for NEW physicians (Part B and outpatient claims), so there will only be NPIs sent in to the NCH for those physicians.

Claim Operating Physician Specialty Code ¶

Short SAS Name: OP_PHYSN_SPCLTY_CD
Long SAS Name: OP_PHYSN_SPCLTY_CD

Contained in

The code used to identify the CMS specialty code corresponding to the operating physician. The Affordable Care Act (ACA) provides for incentive payments for physicians and non-physician practitioners with specific primary specialty designations. In order to determine if the physician or non-physicians is eligible for the incentive payment, the specialty code, NPI and name must be carried on the claims.

Values

Code	Code Value
00	Carrier wide
01	General practice
02	General surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family practice
09	Interventional Pain Management (IPM) (eff. 4/1/03)
10	Gastroenterology
11	Internal medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech/language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Psychiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants (eff. 4/1/03--previously grouped with Certified Registered Nurse Anesthetists (CRNA))
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)
53	Medical supply company with certified prosthetics-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthoptist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing independently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
66	Rheumatology
67	Occupational therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
68	Clinical laboratory (billing independently)
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional (eff. 1/1/02)
72	Pain Management (eff. 1/1/02)
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers (prior to 4/2003 this included independent Diagnostic Testing Facilities (IDTF))
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs--eff. 4/1/03))
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventive medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/10/06, known as Independent physiological laboratory
96	Optician
97	Physician assistant
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A4	Home Health Agency (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)
B1	Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)
B2	Pedorthic Personnel (eff. 10/2/07)
B3	Medical Supply Company with pedorthic personnel (eff. 10/2/07)
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist (eff. 7/2016)

Claim Operating Physician UPIN Number ¶

Short SAS Name: OP_UPIN
Long SAS Name: OP_PHYSN_UPIN

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`
Outpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`

Dataset	2008	2007	2006	2005	2004
Inpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`
Outpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`

Dataset	2003	2002	2001	2000	1999
Inpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`
Outpatient	`op_upin`	`op_upin`	`op_upin`	`op_upin`	`op_upin`

Contained in

On an institutional claim, the unique physician identification number (UPIN) of the physician who performed the principal procedure. This element is used by the provider to identify the operating physician who performed the surgi- cal procedure.

Claim Other Physician NPI Number ¶

Short SAS Name: OT_NPI
Long SAS Name: OT_PHYSN_NPI

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`
Outpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`

Dataset	2008	2007	2006	2005	2004
Inpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`
Outpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`

Dataset	2003	2002	2001	2000	1999
Inpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`
Outpatient	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`	`ot_npi`

Contained in

On an institutional claim, the National Provider Identifier (NPI) number assigned to uniquely identify the other physician associated with the institutiohal claim.

NOTE: Effective May 2007, the NPI will be- come the national standard identifier for covered health care providers. NPIs will replace current OSCAR provider number, UPINs, NSC numbers, and local contractor provider identification numbers (PINs) on standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, PIN, OSCAR provider number, etc.)).

NOTE1: CMS has determined that dual provider identifiers (old legacy numbers and new NPI) must be available in the NCH. After the 5/07 NPI implementation, the standard system main- tainers will add the legacy number to the claim when it is adjudicated. We will continue to receive the OSCAR provider number and any currently issued UPINs. Effective May 2007, no NEW UPINs (legacy number) will be generated for NEW physicians (Part B AND outpatient claims), so there will only be NPIs sent in to the NCH for those physicians.

Claim Other Physician Specialty Code ¶

Short SAS Name: OT_PHYSN_SPCLTY_CD
Long SAS Name: OT_PHYSN_SPCLTY_CD

Contained in

The code used to identify the CMS specialty code corresponding to the other physician.

The Affordable Care Act (ACA) provides for incentive payments for physicians and non-physician practitioners with specific primary specialty designations. In order to determine if the physician or non-physician is eligible for the incentive payment, the specialty code, NPI and name must be carried on the claims.

Values

Code	Code Value
00	Carrier wide
01	General practice
02	General surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family Practice
09	Interventional Pain Management (IPM) (eff. 4/1/03)
10	Gastroenterology
11	Internal medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech/language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Psychiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants (eff. 4/1/03--previously grouped with Certified Registered Nurse Anesthetists (CRNA))
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)
53	Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthotist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing independently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
66	Rheumatology
67	Occupational therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
68	Clinical psychologist
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional (eff. 1/1/02)
72	Pain Management (eff. 1/1/02)
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers (prior to 4/2003 this included Independent Diagnostic Testing Facilities (IDTF))
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs -- eff. 4/1/03))
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventive medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/01/06, known as Independent physiological laboratory
96	Optician
97	Physician assistnat
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)
B1	Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)
B2	Pedorthic Personnel (eff. 10/2/07)
B3	Medical Supply Company with pedorthic personnel (eff. 10/2/07)
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist (eff. 7/2016)

Claim Other Physician UPIN Number ¶

Short SAS Name: OT_UPIN
Long SAS Name: OT_PHYSN_UPIN

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`
Outpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`

Dataset	2008	2007	2006	2005	2004
Inpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`
Outpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`

Dataset	2003	2002	2001	2000	1999
Inpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`
Outpatient	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`	`ot_upin`

Contained in

On an institutional claim, the unique physician identification number (UPIN) of the other physician associated with the institutional claim.

Short SAS Name: DISP_SHR
Long SAS Name: CLM_PPS_CPTL_DSPRPRTNT_SHR_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`disp_shr`	`disp_shr`	`disp_shr`	`disp_shr`	`disp_shr`

Dataset	2008	2007	2006	2005	2004
MedPAR	`disp_shr`	`disp_shr`	`disp_shr`	`disp_shr`	`disp_shr`

Dataset	2003	2002	2001	2000	1999
MedPAR	`disp_shr`	`disp_shr`	`mdprpamt`	`mdprpamt`	`mdprpamt`

Contained in

Effective 3/2/92, the amount of disproportionate share (rate reflecting indigent population served) portion of the PPS payment for capital.

Claim PPS Capital Exception Amount ¶

Short SAS Name: CPTL_EXP
Long SAS Name: CLM_PPS_CPTL_EXCPTN_AMT

Contained in

Effective 3/2/92, the capital PPS amount of exception payments provided for hospitals with inordinately high levels of capital obligations. Exception payments expire at the end of the 10-year transition period.

Values

Code
XXX.XX

Claim PPS Capital FSP Amount ¶

Short SAS Name: CPTL_FSP
Long SAS Name: CLM_PPS_CPTL_FSP_AMT

Contained in

Effective 3/2/92, the amount of the federal specific portion of the PPS payment for capital.

Values

Code
XXX.XX

Claim PPS Capital IME Amount ¶

Short SAS Name: IME_AMT
Long SAS Name: CLM_PPS_CPTL_IME_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`ime_amt`	`ime_amt`	`ime_amt`	`ime_amt`	`ime_amt`

Dataset	2008	2007	2006	2005	2004
MedPAR	`ime_amt`	`ime_amt`	`ime_amt`	`ime_amt`	`ime_amt`

Dataset	2003	2002	2001	2000	1999
MedPAR	`ime_amt`	`ime_amt`	`mtotime`	`mtotime`	`mtotime`

Contained in

Effective 3/2/92, the amount of the indirect medical education (IME) (reimbursable amount for teaching hospitals only; an added amount passed by Congress to augment normal PPS payments for teaching hospitals to compensate them for higher patient costs resulting from medical education programs for interns and residents) portion of the PPS payment for capital.

Claim PPS Capital Outlier Amount ¶

Short SAS Name: CPTLOUTL
Long SAS Name: CLM_PPS_CPTL_OUTLIER_AMT

Contained in

Effective 3/2/92, the amount of the outlier portion of the PPS payment for capital.

Values

Code
XXX.XX

Claim PPS Indicator Code ¶

Short SAS Name: PPS_IND
Long SAS Name: CLM_PPS_IND_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`pps_ind`	`pps_ind`	`pps_ind`	`pps_ind`	`pps_ind`

Dataset	2008	2007	2006	2005	2004
MedPAR	`pps_ind`	`pps_ind`	`pps_ind`	`pps_ind`	`pps_ind`

Dataset	2003	2002	2001	2000	1999
MedPAR	`pps_ind`	`pps_ind`	`mpps`	`mpps`	`mpps`

Contained in

Effective with Version H, the code indicating whether or not the (1) claim is PPS and/or (2) the beneficiary is a deemed insured Medicare Qualified Government Employee (MQGE).

NOTE: Beginning with NCH weekly process date 10/3/97 through 5/29/98, this field was pop- ulated with only the PPS indicator. Beginning with NCH weekly process date 6/5/98, this field was additionally populated with the deemed MQGE indicator. Claims processed prior to 10/3/97 will contain spaces.

Values

Effective NCH weekly process date 10/3/97 - 5/29/98

Code	Code Value
0	not PPS bill (claim contains no PPS indicator)
2	PPS bill ( claim contains PPS indicator)

Effective NCH weekly process date 6/5/98

Code	Code Value
0	not applicable (claim contains neither PPS nor deemed insured MQGE status indicators)
1	Deemed insured MQGE (claim contains deemed insured MQGE indicator but not PPS indicator)
2	PPS bill ( claim contains PPS indicator but no deemed insured MQGE status indicator)
3	Both PPS and deemed insured MQGE (contains both PPS and deemed insured MQGE indicators)

Claim PPS Old Capital Hold Harmless Amount ¶

Short SAS Name: HLDHRMLS
Long SAS Name: CLM_PPS_OLD_CPTL_HLD_HRMLS_AMT

Contained in

Effective 3/2/92, this amount is the hold harmless amount payable for old capital as computed by PRICER for providers with a payment code equal to 'A'. The hold harmless amount-old capital is 100 percent of the reasonable costs of old capital for sole community sole community hospitals, or 85 percent of the reasonable costs associated with old capital for all other hospitals, plus a payment for new capital.

Claim Principal Diagnosis Code ¶

Short SAS Name: PRNCPAL_DGNS_CD
Long SAS Name: PRNCPAL_DGNS_CD

Variable Names

Dataset	2012	2011	2010	2009	2008
Carrier	`prncpal_dgns_cd`	`prncpal_dgns_cd`	`prncpal_dgns_cd`	`dgns_cd1`	`dgns_cd1`

Dataset	2007	2006	2005	2004	2003
Carrier	`dgns_cd1`	`dgns_cd1`	`pdgns_cd`	`pdgns_cd`	`pdgns_cd`

Dataset	2002	2001	2000	1999
Carrier	`pdgns_cd`	`pdgns_cd`	`pdgns_cd`	`pdgns_cd`

Contained in

The diagnosis code identifying the diagnosis, condition, problem or other reason for the admission/encounter/visit shown in the medical record to be chiefly responsible for the services provided.

NOTE: Effective with Version H, this data is also redundantly stored as the first occurrence of the diagnosis trailer.

NOTE1: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

Claim Procedure Code I ¶

Short SAS Name: ICD_PRCDR_CD1
Long SAS Name: ICD_PRCDR_CD1

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`prcdrcd1`
Outpatient	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`icd_prcdr_cd1`	`prcdrcd1`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd1`	`prcdrcd1`	`prcdrcd1`	`prcdr_cd1`	`prcdr_cd1`
Outpatient	`prcdrcd1`	`prcdrcd1`	`prcdrcd1`	`prcdr_cd1`	`prcdr_cd1`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd1`	`prcdr_cd1`	`prcdrcd1`	`prcdrcd1`	`prcdrcd1`
Outpatient	`prcdr_cd1`	`prcdr_cd1`	`prcdr_cd1`	`prcdrcd1`	`prcdrcd1`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code I Date ¶

Short SAS Name: PRCDR_DT1
Long SAS Name: PRCDR_DT1

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt1`	`prcdr_dt1`	`prcdr_dt1`	`prcdr_dt1`	`prcdrdt1`
Outpatient	`prcdr_dt1`	`prcdr_dt1`	`prcdr_dt1`	`prcdr_dt1`	`prcdrdt1`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt1`	`prcdrdt1`	`prcdrdt1`	`prcdr_dt1`	`prcdr_dt1`
Outpatient	`prcdrdt1`	`prcdrdt1`	`prcdrdt1`	`prcdr_dt1`	`prcdr_dt1`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt1`	`prcdr_dt1`	`prcdrdt1`	`prcdr_dt1`	`prcdrdt1`
Outpatient	`prcdr_dt1`	`prcdr_dt1`	`prcdr_dt1`	`prcdrdt1`	`prcdrdt1`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code II ¶

Short SAS Name: ICD_PRCDR_CD2
Long SAS Name: ICD_PRCDR_CD2

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`prcdrcd2`
Outpatient	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`icd_prcdr_cd2`	`prcdrcd2`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd2`	`prcdrcd2`	`prcdrcd2`	`prcdr_cd2`	`prcdr_cd2`
Outpatient	`prcdrcd2`	`prcdrcd2`	`prcdrcd2`	`prcdr_cd2`	`prcdr_cd2`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd2`	`prcdr_cd2`	`prcdrcd2`	`prcdrcd2`	`prcdrcd2`
Outpatient	`prcdr_cd2`	`prcdr_cd2`	`prcdr_cd2`	`prcdrcd2`	`prcdrcd2`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code II Date ¶

Short SAS Name: PRCDR_DT2
Long SAS Name: PRCDR_DT2

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt2`	`prcdr_dt2`	`prcdr_dt2`	`prcdr_dt2`	`prcdrdt2`
Outpatient	`prcdr_dt2`	`prcdr_dt2`	`prcdr_dt2`	`prcdr_dt2`	`prcdrdt2`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt2`	`prcdrdt2`	`prcdrdt2`	`prcdr_dt2`	`prcdr_dt2`
Outpatient	`prcdrdt2`	`prcdrdt2`	`prcdrdt2`	`prcdr_dt2`	`prcdr_dt2`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt2`	`prcdr_dt2`	`prcdrdt2`	`prcdr_dt2`	`prcdrdt2`
Outpatient	`prcdr_dt2`	`prcdr_dt2`	`prcdr_dt2`	`prcdrdt2`	`prcdrdt2`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code III ¶

Short SAS Name: ICD_PRCDR_CD3
Long SAS Name: ICD_PRCDR_CD3

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`prcdrcd3`
Outpatient	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`icd_prcdr_cd3`	`prcdrcd3`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd3`	`prcdrcd3`	`prcdrcd3`	`prcdr_cd3`	`prcdr_cd3`
Outpatient	`prcdrcd3`	`prcdrcd3`	`prcdrcd3`	`prcdr_cd3`	`prcdr_cd3`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd3`	`prcdr_cd3`	`prcdrcd3`	`prcdrcd3`	`prcdrcd3`
Outpatient	`prcdr_cd3`	`prcdr_cd3`	`prcdr_cd3`	`prcdrcd3`	`prcdrcd3`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code III Date ¶

Short SAS Name: PRCDR_DT3
Long SAS Name: PRCDR_DT3

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt3`	`prcdr_dt3`	`prcdr_dt3`	`prcdr_dt3`	`prcdrdt3`
Outpatient	`prcdr_dt3`	`prcdr_dt3`	`prcdr_dt3`	`prcdr_dt3`	`prcdrdt3`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt3`	`prcdrdt3`	`prcdrdt3`	`prcdr_dt3`	`prcdr_dt3`
Outpatient	`prcdrdt3`	`prcdrdt3`	`prcdrdt3`	`prcdr_dt3`	`prcdr_dt3`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt3`	`prcdr_dt3`	`prcdrdt3`	`prcdr_dt3`	`prcdrdt3`
Outpatient	`prcdr_dt3`	`prcdr_dt3`	`prcdr_dt3`	`prcdrdt3`	`prcdrdt3`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code IV ¶

Short SAS Name: ICD_PRCDR_CD4
Long SAS Name: ICD_PRCDR_CD4

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`prcdrcd4`
Outpatient	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`icd_prcdr_cd4`	`prcdrcd4`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd4`	`prcdrcd4`	`prcdrcd4`	`prcdr_cd4`	`prcdr_cd4`
Outpatient	`prcdrcd4`	`prcdrcd4`	`prcdrcd4`	`prcdr_cd4`	`prcdr_cd4`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd4`	`prcdr_cd4`	`prcdrcd4`	`prcdrcd4`	`prcdrcd4`
Outpatient	`prcdr_cd4`	`prcdr_cd4`	`prcdr_cd4`	`prcdrcd4`	`prcdrcd4`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code IV Date ¶

Short SAS Name: PRCDR_DT4
Long SAS Name: PRCDR_DT4

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt4`	`prcdr_dt4`	`prcdr_dt4`	`prcdr_dt4`	`prcdrdt4`
Outpatient	`prcdr_dt4`	`prcdr_dt4`	`prcdr_dt4`	`prcdr_dt4`	`prcdrdt4`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt4`	`prcdrdt4`	`prcdrdt4`	`prcdr_dt4`	`prcdr_dt4`
Outpatient	`prcdrdt4`	`prcdrdt4`	`prcdrdt4`	`prcdr_dt4`	`prcdr_dt4`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt4`	`prcdr_dt4`	`prcdrdt4`	`prcdr_dt4`	`prcdrdt4`
Outpatient	`prcdr_dt4`	`prcdr_dt4`	`prcdr_dt4`	`prcdrdt4`	`prcdrdt4`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code IX ¶

Short SAS Name: ICD_PRCDR_CD9
Long SAS Name: ICD_PRCDR_CD9

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd9`	`icd_prcdr_cd9`	`icd_prcdr_cd9`	`icd_prcdr_cd9`
Outpatient	`icd_prcdr_cd9`	`icd_prcdr_cd9`	`icd_prcdr_cd9`	`icd_prcdr_cd9`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code IX Date ¶

Short SAS Name: PRCDR_DT9
Long SAS Name: PRCDR_DT9

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt9`	`prcdr_dt9`	`prcdr_dt9`	`prcdr_dt9`
Outpatient	`prcdr_dt9`	`prcdr_dt9`	`prcdr_dt9`	`prcdr_dt9`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code V ¶

Short SAS Name: ICD_PRCDR_CD5
Long SAS Name: ICD_PRCDR_CD5

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`prcdrcd5`
Outpatient	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`icd_prcdr_cd5`	`prcdrcd5`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd5`	`prcdrcd5`	`prcdrcd5`	`prcdr_cd5`	`prcdr_cd5`
Outpatient	`prcdrcd5`	`prcdrcd5`	`prcdrcd5`	`prcdr_cd5`	`prcdr_cd5`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd5`	`prcdr_cd5`	`prcdrcd5`	`prcdrcd5`	`prcdrcd5`
Outpatient	`prcdr_cd5`	`prcdr_cd5`	`prcdr_cd5`	`prcdrcd5`	`prcdrcd5`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code V Date ¶

Short SAS Name: PRCDR_DT5
Long SAS Name: PRCDR_DT5

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt5`	`prcdr_dt5`	`prcdr_dt5`	`prcdr_dt5`	`prcdrdt5`
Outpatient	`prcdr_dt5`	`prcdr_dt5`	`prcdr_dt5`	`prcdr_dt5`	`prcdrdt5`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt5`	`prcdrdt5`	`prcdrdt5`	`prcdr_dt5`	`prcdr_dt5`
Outpatient	`prcdrdt5`	`prcdrdt5`	`prcdrdt5`	`prcdr_dt5`	`prcdr_dt5`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt5`	`prcdr_dt5`	`prcdrdt5`	`prcdr_dt5`	`prcdrdt5`
Outpatient	`prcdr_dt5`	`prcdr_dt5`	`prcdr_dt5`	`prcdrdt5`	`prcdrdt5`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code VI ¶

Short SAS Name: ICD_PRCDR_CD6
Long SAS Name: ICD_PRCDR_CD6

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`prcdrcd6`
Outpatient	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`icd_prcdr_cd6`	`prcdrcd6`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrcd6`	`prcdrcd6`	`prcdrcd6`	`prcdr_cd6`	`prcdr_cd6`
Outpatient	`prcdrcd6`	`prcdrcd6`	`prcdrcd6`	`prcdr_cd6`	`prcdr_cd6`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_cd6`	`prcdr_cd6`	`prcdrcd6`	`prcdrcd6`	`prcdrcd6`
Outpatient	`prcdr_cd6`	`prcdr_cd6`	`prcdr_cd6`	`prcdrcd6`	`prcdrcd6`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code VI Date ¶

Short SAS Name: PRCDR_DT6
Long SAS Name: PRCDR_DT6

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prcdr_dt6`	`prcdr_dt6`	`prcdr_dt6`	`prcdr_dt6`	`prcdrdt6`
Outpatient	`prcdr_dt6`	`prcdr_dt6`	`prcdr_dt6`	`prcdr_dt6`	`prcdrdt6`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prcdrdt6`	`prcdrdt6`	`prcdrdt6`	`prcdr_dt6`	`prcdr_dt6`
Outpatient	`prcdrdt6`	`prcdrdt6`	`prcdrdt6`	`prcdr_dt6`	`prcdr_dt6`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prcdr_dt6`	`prcdr_dt6`	`prcdrdt6`	`prcdr_dt6`	`prcdrdt6`
Outpatient	`prcdr_dt6`	`prcdr_dt6`	`prcdr_dt6`	`prcdrdt6`	`prcdrdt6`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code VII ¶

Short SAS Name: ICD_PRCDR_CD7
Long SAS Name: ICD_PRCDR_CD7

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd7`	`icd_prcdr_cd7`	`icd_prcdr_cd7`	`icd_prcdr_cd7`
Outpatient	`icd_prcdr_cd7`	`icd_prcdr_cd7`	`icd_prcdr_cd7`	`icd_prcdr_cd7`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code VII Date ¶

Short SAS Name: PRCDR_DT7
Long SAS Name: PRCDR_DT7

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt7`	`prcdr_dt7`	`prcdr_dt7`	`prcdr_dt7`
Outpatient	`prcdr_dt7`	`prcdr_dt7`	`prcdr_dt7`	`prcdr_dt7`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code VIII ¶

Short SAS Name: ICD_PRCDR_CD8
Long SAS Name: ICD_PRCDR_CD8

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd8`	`icd_prcdr_cd8`	`icd_prcdr_cd8`	`icd_prcdr_cd8`
Outpatient	`icd_prcdr_cd8`	`icd_prcdr_cd8`	`icd_prcdr_cd8`	`icd_prcdr_cd8`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code VIII Date ¶

Short SAS Name: PRCDR_DT8
Long SAS Name: PRCDR_DT8

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt8`	`prcdr_dt8`	`prcdr_dt8`	`prcdr_dt8`
Outpatient	`prcdr_dt8`	`prcdr_dt8`	`prcdr_dt8`	`prcdr_dt8`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code X ¶

Short SAS Name: ICD_PRCDR_CD10
Long SAS Name: ICD_PRCDR_CD10

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd10`	`icd_prcdr_cd10`	`icd_prcdr_cd10`	`icd_prcdr_cd10`
Outpatient	`icd_prcdr_cd10`	`icd_prcdr_cd10`	`icd_prcdr_cd10`	`icd_prcdr_cd10`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code X Date ¶

Short SAS Name: PRCDR_DT10
Long SAS Name: PRCDR_DT10

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt10`	`prcdr_dt10`	`prcdr_dt10`	`prcdr_dt10`
Outpatient	`prcdr_dt10`	`prcdr_dt10`	`prcdr_dt10`	`prcdr_dt10`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XI ¶

Short SAS Name: ICD_PRCDR_CD11
Long SAS Name: ICD_PRCDR_CD11

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd11`	`icd_prcdr_cd11`	`icd_prcdr_cd11`	`icd_prcdr_cd11`
Outpatient	`icd_prcdr_cd11`	`icd_prcdr_cd11`	`icd_prcdr_cd11`	`icd_prcdr_cd11`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XI Date ¶

Short SAS Name: PRCDR_DT11
Long SAS Name: PRCDR_DT11

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt11`	`prcdr_dt11`	`prcdr_dt11`	`prcdr_dt11`
Outpatient	`prcdr_dt11`	`prcdr_dt11`	`prcdr_dt11`	`prcdr_dt11`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XII ¶

Short SAS Name: ICD_PRCDR_CD12
Long SAS Name: ICD_PRCDR_CD12

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd12`	`icd_prcdr_cd12`	`icd_prcdr_cd12`	`icd_prcdr_cd12`
Outpatient	`icd_prcdr_cd12`	`icd_prcdr_cd12`	`icd_prcdr_cd12`	`icd_prcdr_cd12`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XII Date ¶

Short SAS Name: PRCDR_DT12
Long SAS Name: PRCDR_DT12

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt12`	`prcdr_dt12`	`prcdr_dt12`	`prcdr_dt12`
Outpatient	`prcdr_dt12`	`prcdr_dt12`	`prcdr_dt12`	`prcdr_dt12`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XIII ¶

Short SAS Name: ICD_PRCDR_CD13
Long SAS Name: ICD_PRCDR_CD13

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd13`	`icd_prcdr_cd13`	`icd_prcdr_cd13`	`icd_prcdr_cd13`
Outpatient	`icd_prcdr_cd13`	`icd_prcdr_cd13`	`icd_prcdr_cd13`	`icd_prcdr_cd13`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XIII Date ¶

Short SAS Name: PRCDR_DT13
Long SAS Name: PRCDR_DT13

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt13`	`prcdr_dt13`	`prcdr_dt13`	`prcdr_dt13`
Outpatient	`prcdr_dt13`	`prcdr_dt13`	`prcdr_dt13`	`prcdr_dt13`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XIV ¶

Short SAS Name: ICD_PRCDR_CD14
Long SAS Name: ICD_PRCDR_CD14

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd14`	`icd_prcdr_cd14`	`icd_prcdr_cd14`	`icd_prcdr_cd14`
Outpatient	`icd_prcdr_cd14`	`icd_prcdr_cd14`	`icd_prcdr_cd14`	`icd_prcdr_cd14`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XIV Date ¶

Short SAS Name: PRCDR_DT14
Long SAS Name: PRCDR_DT14

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt14`	`prcdr_dt14`	`prcdr_dt14`	`prcdr_dt14`
Outpatient	`prcdr_dt14`	`prcdr_dt14`	`prcdr_dt14`	`prcdr_dt14`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XIX ¶

Short SAS Name: ICD_PRCDR_CD19
Long SAS Name: ICD_PRCDR_CD19

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd19`	`icd_prcdr_cd19`	`icd_prcdr_cd19`	`icd_prcdr_cd19`
Outpatient	`icd_prcdr_cd19`	`icd_prcdr_cd19`	`icd_prcdr_cd19`	`icd_prcdr_cd19`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XIX Date ¶

Short SAS Name: PRCDR_DT19
Long SAS Name: PRCDR_DT19

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt19`	`prcdr_dt19`	`prcdr_dt19`	`prcdr_dt19`
Outpatient	`prcdr_dt19`	`prcdr_dt19`	`prcdr_dt19`	`prcdr_dt19`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XV ¶

Short SAS Name: ICD_PRCDR_CD15
Long SAS Name: ICD_PRCDR_CD15

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd15`	`icd_prcdr_cd15`	`icd_prcdr_cd15`	`icd_prcdr_cd15`
Outpatient	`icd_prcdr_cd15`	`icd_prcdr_cd15`	`icd_prcdr_cd15`	`icd_prcdr_cd15`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XV Date ¶

Short SAS Name: PRCDR_DT15
Long SAS Name: PRCDR_DT15

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt15`	`prcdr_dt15`	`prcdr_dt15`	`prcdr_dt15`
Outpatient	`prcdr_dt15`	`prcdr_dt15`	`prcdr_dt15`	`prcdr_dt15`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XVI ¶

Short SAS Name: ICD_PRCDR_CD16
Long SAS Name: ICD_PRCDR_CD16

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd16`	`icd_prcdr_cd16`	`icd_prcdr_cd16`	`icd_prcdr_cd16`
Outpatient	`icd_prcdr_cd16`	`icd_prcdr_cd16`	`icd_prcdr_cd16`	`icd_prcdr_cd16`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XVI Date ¶

Short SAS Name: PRCDR_DT16
Long SAS Name: PRCDR_DT16

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt16`	`prcdr_dt16`	`prcdr_dt16`	`prcdr_dt16`
Outpatient	`prcdr_dt16`	`prcdr_dt16`	`prcdr_dt16`	`prcdr_dt16`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XVII ¶

Short SAS Name: ICD_PRCDR_CD17
Long SAS Name: ICD_PRCDR_CD17

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd17`	`icd_prcdr_cd17`	`icd_prcdr_cd17`	`icd_prcdr_cd17`
Outpatient	`icd_prcdr_cd17`	`icd_prcdr_cd17`	`icd_prcdr_cd17`	`icd_prcdr_cd17`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XVII Date ¶

Short SAS Name: PRCDR_DT17
Long SAS Name: PRCDR_DT17

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt17`	`prcdr_dt17`	`prcdr_dt17`	`prcdr_dt17`
Outpatient	`prcdr_dt17`	`prcdr_dt17`	`prcdr_dt17`	`prcdr_dt17`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XVIII ¶

Short SAS Name: ICD_PRCDR_CD18
Long SAS Name: ICD_PRCDR_CD18

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd18`	`icd_prcdr_cd18`	`icd_prcdr_cd18`	`icd_prcdr_cd18`
Outpatient	`icd_prcdr_cd18`	`icd_prcdr_cd18`	`icd_prcdr_cd18`	`icd_prcdr_cd18`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XVIII Date ¶

Short SAS Name: PRCDR_DT18
Long SAS Name: PRCDR_DT18

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt18`	`prcdr_dt18`	`prcdr_dt18`	`prcdr_dt18`
Outpatient	`prcdr_dt18`	`prcdr_dt18`	`prcdr_dt18`	`prcdr_dt18`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XX ¶

Short SAS Name: ICD_PRCDR_CD20
Long SAS Name: ICD_PRCDR_CD20

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd20`	`icd_prcdr_cd20`	`icd_prcdr_cd20`	`icd_prcdr_cd20`
Outpatient	`icd_prcdr_cd20`	`icd_prcdr_cd20`	`icd_prcdr_cd20`	`icd_prcdr_cd20`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XX Date ¶

Short SAS Name: PRCDR_DT20
Long SAS Name: PRCDR_DT20

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt20`	`prcdr_dt20`	`prcdr_dt20`	`prcdr_dt20`
Outpatient	`prcdr_dt20`	`prcdr_dt20`	`prcdr_dt20`	`prcdr_dt20`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XXI ¶

Short SAS Name: ICD_PRCDR_CD21
Long SAS Name: ICD_PRCDR_CD21

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd21`	`icd_prcdr_cd21`	`icd_prcdr_cd21`	`icd_prcdr_cd21`
Outpatient	`icd_prcdr_cd21`	`icd_prcdr_cd21`	`icd_prcdr_cd21`	`icd_prcdr_cd21`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XXI Date ¶

Short SAS Name: PRCDR_DT21
Long SAS Name: PRCDR_DT21

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt21`	`prcdr_dt21`	`prcdr_dt21`	`prcdr_dt21`
Outpatient	`prcdr_dt21`	`prcdr_dt21`	`prcdr_dt21`	`prcdr_dt21`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XXII ¶

Short SAS Name: ICD_PRCDR_CD22
Long SAS Name: ICD_PRCDR_CD22

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd22`	`icd_prcdr_cd22`	`icd_prcdr_cd22`	`icd_prcdr_cd22`
Outpatient	`icd_prcdr_cd22`	`icd_prcdr_cd22`	`icd_prcdr_cd22`	`icd_prcdr_cd22`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XXII Date ¶

Short SAS Name: PRCDR_DT22
Long SAS Name: PRCDR_DT22

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt22`	`prcdr_dt22`	`prcdr_dt22`	`prcdr_dt22`
Outpatient	`prcdr_dt22`	`prcdr_dt22`	`prcdr_dt22`	`prcdr_dt22`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XXIII ¶

Short SAS Name: ICD_PRCDR_CD23
Long SAS Name: ICD_PRCDR_CD23

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd23`	`icd_prcdr_cd23`	`icd_prcdr_cd23`	`icd_prcdr_cd23`
Outpatient	`icd_prcdr_cd23`	`icd_prcdr_cd23`	`icd_prcdr_cd23`	`icd_prcdr_cd23`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XXIII Date ¶

Short SAS Name: PRCDR_DT23
Long SAS Name: PRCDR_DT23

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt23`	`prcdr_dt23`	`prcdr_dt23`	`prcdr_dt23`
Outpatient	`prcdr_dt23`	`prcdr_dt23`	`prcdr_dt23`	`prcdr_dt23`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XXIV ¶

Short SAS Name: ICD_PRCDR_CD24
Long SAS Name: ICD_PRCDR_CD24

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd24`	`icd_prcdr_cd24`	`icd_prcdr_cd24`	`icd_prcdr_cd24`
Outpatient	`icd_prcdr_cd24`	`icd_prcdr_cd24`	`icd_prcdr_cd24`	`icd_prcdr_cd24`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XXIV Date ¶

Short SAS Name: PRCDR_DT24
Long SAS Name: PRCDR_DT24

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt24`	`prcdr_dt24`	`prcdr_dt24`	`prcdr_dt24`
Outpatient	`prcdr_dt24`	`prcdr_dt24`	`prcdr_dt24`	`prcdr_dt24`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Procedure Code XXV ¶

Short SAS Name: ICD_PRCDR_CD25
Long SAS Name: ICD_PRCDR_CD25

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`icd_prcdr_cd25`	`icd_prcdr_cd25`	`icd_prcdr_cd25`	`icd_prcdr_cd25`
Outpatient	`icd_prcdr_cd25`	`icd_prcdr_cd25`	`icd_prcdr_cd25`	`icd_prcdr_cd25`

Contained in

The code that indicates the principal or other procedure performed during the period covered by the institutional claim.

NOTE: Effective July 2004, ICD-9-CM procedure codes are no longer being accepted on Outpatient claims. The ICD-9-CM codes were named as the HIPPA standard code set for inpatient hospital procedures. HCPCS/CPT codes were named as the standard code set for physician services and other health care services.

Claim Procedure Code XXV Date ¶

Short SAS Name: PRCDR_DT25
Long SAS Name: PRCDR_DT25

Variable Names

Dataset	2013	2012	2011	2010
Inpatient	`prcdr_dt25`	`prcdr_dt25`	`prcdr_dt25`	`prcdr_dt25`
Outpatient	`prcdr_dt25`	`prcdr_dt25`	`prcdr_dt25`	`prcdr_dt25`

Contained in

On an institutional claim, the date on which the principal or other procedure was performed.

Claim Query Code ¶

Short SAS Name: QUERY_CD
Long SAS Name: CLAIM_QUERY_CODE

Contained in

Code indicating the type of claim record being processed with respect to payment (debit/credit indicator; interim/final indicator).

Values

Code	Code Value
1	Interim bill
3	Final bill
5	Debit adjustment

Short SAS Name: RLT_COND
Long SAS Name: CLM_RLT_COND_CD

Contained in

The code that indicates a condition relating to an institutional claim that may affect payer processing.

Values

For codes C1 THRU C7, NOTE: Beginning July 2005, this code is relevant to types of bill other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).

Code	Code Value
01 THRU 16	Insurance related
17 THRU 30	Special condition
31 THRU 35	Student status codes which are required when a patient is a dependent child over 18 years old
36 THRU 45	Accommodation
46 THRU 54	CHAMPUS information
55 THRU 59	Skilled nursing facility
60 THRU 70	Prospective payment
71 THRU 99	Renal dialysis setting
A0 THRU B9	Special program codes
C0 THRU C9	QIO approval services
D0 THRU W0	Change conditions

Code	Code Value
01	Military service related - Medical condition incurred during military service.
02	Employment related - Patient alleged that the medical condition causing this episode of care was due to environment/events resulting from employment.
03	Patient covered by insurance not reflected here - Indicates that patient or patient representative has stated that coverage may exist beyond that reflected on this bill.
04	Health Maintenance Organization (HMO) enrollee - Medicare beneficiary is enrolled in an HMO. Eff 9/93, hospital must also expect to receive payment from HMO.
05	Lien has been filed - Provider has filed legal claim for recovery of funds potentially due a patient as a result of legal action initiated by or on behalf of the patient.
06	ESRD patient in 1^st 18 months of entitlement covered by employer group health insurance - indicates Medicare may be secondary insurer. Eff 3/1/96, ESRD patient in 1^st 30 months of entitlement covered by employer group health insurance.
07	Treatment of nonterminal condition for hospice patient - The patient is a hospice enrollee, but the provider is not treating a terminal condition and is requesting Medicare reimbursement.
08	Beneficiary would not provide information concerning other insurance coverage.
09	Neither patient nor spouse is employed - Code indicates that in response to development questions, the patient and spouse have denied employment.
10	Patient and/or spouse is employed but no EGHP coverage exists or (eff 9/93) other employer sponsored/provided health insurance covering patient.
11	The disabled beneficiary and/or family member has no group coverage from a LGHP or (eff 9/93) other employer sponsored/provided health insurance covering patient.
12	Payer code - Reserved for internal use only by third party payers. HCFA will assign as needed. Providers will not report them.
13	Payer code - Reserved for internal use only by third party payers. HCFA will assign as needed. Providers will not report them.
14	Payer code - Reserved for internal use only by third party payers. HCFA will assign as needed. Providers will not report them.
15	Clean claim (eff 10/92)
16	SNF transition exemption - An exemption from the post-hospital requirement applies for this SNF stay or the qualifying stay dates are more than 30 days prior to the admission date
17	Patient is over 100 years old - Code indicates that the patient was over 100 years old at the date of admission.
18	Maiden name retained - A dependent spouse entitled to benefits who does not use her husband's last name.
19	Child retains mother's name - A patient who is a dependent child entitled to CHAMPVA benefits that does not have father's last name.
20	Bene requested billing - Provider realizes the services on this bill are at a noncovered level of care or otherwise excluded from coverage, but the bene has requested formal determination
21	Billing for denial notice - The SNF or HHA realizes services are at a noncovered level of care or excluded, but requests a Medicare denial in order to bill medicaid or other insurer
22	Patient on multiple drug regimen - A patient who is receiving multiple intravenous drugs while on home IV therapy
23	Homecaregiver available - The patient has a caregiver available to assist him or her during self-administration of an intravenous drug
24	Home IV patient also receiving HHA services - the patient is under care of HHA while receiving home IV drug therapy services
25	Reserved for national assignment
26	VA eligible patient chooses to receive services in Medicare certified facility rather than a VA facility (eff 3/92)
27	Patient referred to a sole community hospital for a diagnostic laborator test - (sole community hospital only) (eff 9/93)
28	Patient and/or spouse's EGHP is secondary to Medicare - Qualifying EGHP for employers who have fewer than 20 employees (eff 9/93)
29	Disabled beneficiary and/or family member's LGHP is secondary to Medicare - Qualifying LGHP for employer having fewer than 100 full and part-time employees
30	Qualifying Clinical Trials - Non-research services provided to all patients, including managed care enrollees, enrolled in a Qualified Clinical Trial.
31	Patient is student (full time - day) - Patient declares that he or she is enrolled as a full time day student.
32	Patient is student (cooperative/work study program)
33	Patient is student (full time - night) - Patient declares that he or she is enrolled as a full time night student.
34	Patient is student (part time) - Patient declares that he or she is enrolled as a part time student.
36	General care patient in a special unit - Patient is temporarily placed in special care unit bed because no general care beds were available.
37	Ward accommodation is patient's request - Patient is assigned to ward accommodations at patient's request.
38	Semi-private room not available - Indicates that either private or ward accommodations were assigned because semi-private accomodations were not available.
39	Private room medically necessary - Patient needed a private room for medical reasons.
40	Same day transfer - Patient transferred to another facility before midnight of the day of admission.
41	Partial hospitalization - Eff 3/92, indicates claim is for partial hospitalization services. For OP services, this includes a variety of psych programs.
42	Continuing Care Not Related to Inpatient Admission - continuing care not related to the condition or diagnosis for which the beneficiary received inpatient hospital services (eff. 10/01)
43	Continuing Care Not Provided Within Prescribed Postdischarge Window - continuing care was related to the inpatient admission but the prescribed care was not provided within the post-discharge window (eff. 10/01)
44	Inpatient Admission Changed to Outpatient - For use on outpatient claims only, when the physician ordered inpatient services, but upon internal review performed before the claim was initially submitted, the hospital determined the services did not meet its inpatient criteria (eff. 4/1/04)
45	Reserved for national assignment.
46	Nonavailability statement on file for CHAMPUS claim for nonemergency IP care for CHAMPUS bene residing within the catchment area (usually a 40 mile radius) of a uniform services hospital.
47	Reserved for CHAMPUS.
48	Reserved for national assignment.
49	Product Replacement within Product Lifecycle-replacement of a product earlier than the anticipated lifecycle due to an indication that the product is not functioning properly (eff. 4/2006)
50	Product Replacement for Known Recall of a Product - Manufacturer or FDA has identified the product for recall and therefore replacement (eff. 4/2006)
51	Reserved for national assignment.
52	Reserved for national assignment.
53	Reserved for national assignment.
54	Reserved for national assignment.
55	SNF bed not available - The patient's SNF admission was delayed more than 30 days after hospital discharge because a SNF bed was not available.
56	Medical appropriateness - Patient's SNF admission was delayed more than 30 days after hospital discharge because physical condition made it inappropriate to begin active care within that period
57	SNF readmission - Patient previously received Medicare covered SNF care within 30 days of the current SNF admission.
58	Payment of SNF claims for beneficiaries disenrolling from terminating M+C plans plans who have not met the 3-day hospital stay requirement (eff. 10/1/00)
59	Reserved for national assignment.
60	Operating cost day outlier - PRICER indicates this bill is length of stay outlier (PPS)
61	Operating cost cost outlier - PRICER indicates this bill is a cost outlier (PPS)
62	PIP bill - This bill is a periodic interim payment bill.
63	PRO denial received before batch clearance report - The HCSSACL receipt date is used on PRO adjustment if the PRO's notification is before orig bill's acceptance report (Payer only code eff 9/93)
64	Other than clean claim - The claim is not a 'clean claim'
65	Non-PPS code - The bill is not a prospective payment system bill.
66	Outlier not claimed - Bill may meet the criteria for cost outlier, but the hospital did not claim the cost outlier (PPS)
67	Beneficiary elects not to use LTR days
68	Beneficiary elects to use LTR days
69	Operating IME Payment Only - providers request for IME payment for each discharge of MCO enrollee, beginning 1/1/98, from teaching hospitals (facilities with approved medical residency training program); not stored in NCH. Exception: problem in startup year may have resulted in this special IME payment request being erroneously stored in NCH. If present, disregard claim as condition code '69' is not valid NCH claim.
70	Self-administered EPO - Billing is for a home dialysis patient who self administers EPO.
71	Full care in unit - Billing is for a patient who received staff assisted dialysis services in a hospital or renal dialysis facility.
72	Self care in unit - Billing is for a patient who managed his own dialysis services without staff assistance in a hospital or renal dialysis facility.
73	Self care training - Billing is for special dialysis services where the patient and helper (if necessary) were learning to perform dialysis.
74	Home - Billing is for a patient who received dialysis services at home.
75	Home 100% reimbursement - (not to be used for services after 4/15/90) The billing is for home dialsis patient using a dialysis machine that was purchased under the 100% program.
76	Back-up facility - Billing is for a patient who received dialysis services in a back-up facility.
77	Provider accepts or is obligated/required due to contractual agreement or law to accept payment by a primary payer as payment in full - Medicare pays nothing.
78	New coverage not implemented by HMO - eff 3/92, indicates newly covered service under Medicare for which HMO does not pay.
79	CORF services provided off site - Code indicates that physical therapy, occupational therapy, or speech pathology services were provided off site.
80	Home Dialysis - Nursing Facility - Home dialysis furnished in a SNF or nursing facility. (eff. 4/4/05)
81-99	Reserved for state assignment.
A0	Special Zip Code Reporting - five digit zip code of the location from which the beneficiary is initially placed on board the ambulance (eff. 9/01)
A0	CHAMPUS external partnership program special program indicator code (eff 10/93) (obsolete)
A1	EPSDT/CHAP - Early and periodic screening diagnosis and treatment special program indicator code (eff 10/93)
A2	Physically handicapped children's program - Services provided receive special funding through Title 8 of the Social Security Act or the CHAMPUS program for the handicapped. (eff 10/93)
A3	Special federal funding - Designed for uniform use by state uniform billing committees. Special program indicator code (eff 10/93)
A4	Family planning - Designed for uniform use by state uniform billing committees. Special program indicator code (eff 10/93)
A5	Disability - Designed for uniform use by state uniform billing committees. Special program indicator code (eff 10/93)
A6	PPV/Medicare - Identifies that pneumococcal pneumonia 100% payment vaccine (PPV) services should be reimbursed under a special Medicare program provision. Special program indicator code (eff 10/93)
A7	Induced abortion to avoid danger to woman's life. Special program indicator code (eff 10/93)
A8	Induced abortion - Victim of rape/incest. Special program indicator code (eff 10/93)
A9	Second opinion surgery - Service requested to support second opinion on surgery. Part B deductible and coinsurance do not apply. Special program indicator code (eff 10/93)
AA	Abortion Performed due to Rape (eff. 10/1/02)
AB	Abortion Performed due to Incest (eff. 10/1/02)
AC	Abortion Performed due to Serious Fetal Genetic Defect, Deformity or Abnormality (eff. 10/1/02)
AD	Abortion Performed due to a Life Endangering Physical Condition Caused by, arising from or exacerbated by the Pregnancy itself (eff. 10/1/02)
AE	Abortion Performed due to physical health of mother that is not life endangering (eff. 10/1/02)
AF	Abortion Performed due to emotional/psychological health of mother (eff. 10/1/02)
AG	Abortion performed due to social economic reasons (eff. 10/1/02)
AH	Elective Abortion (eff. 10/1/02)
AI	Sterilization (eff. 10/1/02)
AJ	Payer Responsible for copayment (4/1/03)
AK	Air Ambulance Required - For ambulance claims. Time needed to transport poses a threat. (eff. 10/16/03)
AL	Specialized Treatment/bed Unavailable - For ambulance claims. Specialized treatment bed unavailable. Transported to alternate facility. (eff. 10/16/03)
AM	Non-emergency Medically Necessary Stretcher Transport Required - For ambulance claims. Non-emergency medically necessary stretcher transport required. (eff. 10/16/03)
AN	Preadmission Screening Not Required - person meets the criteria for an exemption from preadmission screening. (eff. 1/1/04)
B0	Medicare Coordinated Care Demonstration Program - patient is a participant in a Medicare Coordinated Care Demonstration (eff. 10/01)
B1	Beneficiary ineligible for demonstration program (eff. 1/02).
B2	Critical Access Hospital Ambulance Attestation - Attestation by CAH that it meets the criteria for exemption from the Ambulance Fee Schedule
B3	Pregnancy Indicator - Indicates the patient is pregnant. Required when mandated by law. (eff. 10/16/03)
B4	Admission Unrelated to Discharge - Admission unrelated to discharge on same day. This code is for discharges starting on January 1, 2004.
B5	Special program indicator Reserved for national assignment.
B6	Special program indicator Reserved for national assignment.
B7	Special program indicator Reserved for national assignment.
B8	Special program indicator Reserved for national assignment.
B9	Special program indicator Reserved for national assignment.
C0	Reserved for national assignment.
C1	Approved as billed - The services provided for this billing period have been reviewed by the QIO/UR or intermediary and are fully approved including any day or cost outlier. (eff 10/93) NOTE: Beginning July 2005, this code is relevant to type of bills other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C2	Automatic approval as billed based on focused review. (No longer used for Medicare) QIO approval indicator services (eff 10/93) NOTE: Beginning July 2005, this code is relevant to type of bills other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C3	Partial approval - The services provided for this billing period have been reviewed by the QIO/UR or intermediary and some portion has been denied (days or services). (eff 10/93) NOTE: Beginning July 2005, this code is relevant to type of bills other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C4	Admission/services denied - Indicates that all of the services were denied by the QIO/UR. QIO approval indicator services (eff 10/93) NOTE: Beginning July 2005, this code is relevant to types of bill other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C5	Postpayment review applicable - QIO/UR review to take place after payment. QIO approval indicator services (eff 10/93) NOTE: Beginning July 2005, this code is relevant to types of bill other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C6	Admission preauthorization - The QIO/UR authorized this admission/service but has not reviewed the services provided. QIO approval indicator services (eff 10/93) NOTE: Beginning July 2005, this code is relevant to types of bill other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C7	Extended authorization - the QIO has authorized these services for an extended length of time but has not reviewed the services provided. QIO approval indicator services (eff 10/93) NOTE: Beginning July 2005, this code is relevant to types of bill other than inpatient (18X, 21X, 22X, 32X, 33X, 34X, 75X, 81X, 82X).
C8	Reserved for national assignment. QIO approval indicator services (eff 10/93)
C9	Reserved for national assignment. QIO approval indicator services (eff 10/93)
D0	Changes to service dates. Change condition (eff 10/93)
D1	Changes in charges. Change condition (eff 10/93)
D2	Changes in revenue codes/HCPCS/HIPPS Rate Code Change condition (eff 10/93)
D3	Second or subsequent interim PPS bill. Change condition (eff 10/93)
D4	Change in ICD-9-CM diagnosis and/or procedure code Change condition (eff 10/93)
D5	Cancel only to correct a beneficiary claim account number or provider identification number. change condition (eff 10/93)
D6	Cancel only to repay a duplicate payment or OIG overpayment (includes cancellation of an OP bill containing services required to be included on the IP bill). Change condition eff 10/93.
D7	Change to make Medicare the secondary payer. Change condition (eff 10/93)
D8	Change to make Medicare the primary payer. Change condition (eff 10/93)
D9	Any other change. Change condition (eff 10/93)
DR	Disaster Relief (eff. 10/2005) - Code used to facilitate claims processing and track services and items provided to victims of Hurricane Katrina and any future disasters.
E0	Change in patient status. Change condition (eff 10/93)
EY	National Emphysema Treatment Trial (NETT) or Lung Volume Reduction Surgery (LVRS) clinical study (eff. 11/97)
G0	Multiple medical visits occur on the same day in the same revenue center but visits are distinct and constitute independent visits (allows for payment under outpatient PPS -- eff. 7/3/00).
H0	Delayed Filing, Statement of Intent Submitted -- statement of intent was submitted within the qualifying period to specifically identify the existence of another third party liability situation. (eff. 9/01)
M0	All inclusive rate for outpatient services. (payer only code)
M1	Roster billed influenza virus vaccine. (payer only code) Eff 10/96, also includes pneumoccocal pneumonia vaccine (PPV)
M2	HH override code - home health total reimbursement exceeds the $150,000 cap or the number of total visits exceeds the 150 limitation. (eff 4/3/95) (payer only code)
W0	United Mine Workers of America (UMWA) SNF demonstration indicator (eff 1/97); but no claims transmitted until 2/98)
XX	Transgender/Hermaphrodite Beneficiaries (eff. ½/07)

Short SAS Name: RLTCNDSQ
Long SAS Name: RLT_COND_CD_SEQ

Contained in

The sequence number of the related institutional condition code for normal forms layout used in CCW.

Short SAS Name: OCRNC_CD
Long SAS Name: CLM_RLT_OCRNC_CD

Contained in

The code that identifies a significant event relating to an institutional claim that may affect payer processing. These codes are claim-related occurrences that are related to a specific date.

Values

Code	Code Value
01 THRU 09	Accident
10 THRU 19	Medical condition
20 THRU 39	Insurance related
40 THRU 69	Service related
A1-A3	Miscellaneous

Code	Code Value
01	Auto accident - The date of an auto accident.
02	No-fault insurance involved, including auto accident/other - The date of an accident where the state has applicable no-fault liability laws, (i.e., legal basis for settlement without admission or proof of guilt).
03	Accident/tort liability - The date of an accident resulting from a third party's action that may involve a civil court process in an attempt to require payment by the third party, other than no-fault liability.
04	Accident/employment related - The date of an accident relating to the patient's employment.
05	Other accident - The date of an accident not described by the codes 01 thru 04.
06	Crime victim - Code indicating the date on which a medical condition resulted from alleged criminal action committed by one or more parties.
07	Reserved for national assignment.
08	Reserved for national assignment.
11	Onset of symptoms/illness - The date the patient first became aware of symptoms/illness.
12	Date of onset for a chronically dependent individual - Code indicates the date the patient/bene became a chronically dependent individual.
13	Reserved for national assignment.
14	Reserved for national assignment.
15	Reserved for national assignment.
16	Reserved for national assignment.
17	Date outpatient occupational therapy plan established or last reviewed - Code indicating the date an occupational therapy plan was established or last reviewed (eff 3/93)
18	Date of retirement (patient/bene) - Code indicates the date of retirement for the patient/bene.
19	Date of retirement spouse - Code indicates the date of retirement for the patient's spouse.
20	Guarantee of payment began - The date on which the provider began claiming Medicare payment under the guarantee of payment provision.
21	UR notice received - Code indicating the date of receipt by the hospital & SNF of the UR committee's finding that the admission or future stay was not medically necessary.
22	Active care ended - The date on which a covered level of care ended in a SNF or general hospital, or date active care ended in a psychiatric or tuberculosis hospital or date on which patient was released on a trial basis from a residential facility. Code is not required if code "21" is used.
23	Cancellation of Hospice benefits - The date the RHHI cancelled the hospice benefit. (eff. 10/00). NOTE: this will be different than the revocation of the hospice benefit by beneficiaries. Benefits exhausted - The last date for which benefits can be paid. (term 9/30/93; replaced by code A3)
24	Date insurance denied - The date the insurer's denial of coverage was received by a higher priority payer.
25	Date benefits terminated by primary payer - The date on which coverage (including worker's compensation benefits or no-fault coverage) is no longer available to the patient.
26	Date skilled nursing facility (SNF) bed available - The date on which a SNF bed became available to a hospital inpatient who required only SNF level of care.
27	Date of Hospice Certification or Re-Certification -- code indicates the date of certification or recertification of the hospice benefit period, beginning with the first two initial benefit periods of 90 days each and the subsequent 60-day benefit periods. (eff. 9/01)
27	Date home health plan established or last reviewed - Code indicating the date a home health plan of treatment was established or last reviewed. (Obsolete) not used by hospital unless owner of facility
28	Date comprehensive outpatient rehabilitation plan established or last reviewed - Code indicating the date a comprehensive outpatient rehabilitation plan was established or last reviewed. not used by hospital unless owner of facility
29	Date OPT plan established or last reviewed - the date a plan of treatment was established for outpatient physical therapy. Not used by hospital unless owner of facility
30	Date speech pathology plan treatment established or last reviewed - The date a speech pathology plan of treatment was established or last reviewed. Not used by hospital unless owner of facility
31	Date bene notified of intent to bill (accommodations) - The date of the notice provided to the patient by the hospital stating that he no longer required a covered level of IP care.
32	Date bene notified of intent to bill (procedures or treatment) - The date of the notice provided to the patient by the hospital stating requested care (diagnostic procedures or treatments) is not considered reasonable or necessary.
33	First day of the Medicare coordination period for ESRD bene - During which Medicare benefits are secondary to benefits payable under an EGHP. Required only for ESRD beneficiaries.
34	Date of election of extended care facilities - The date the guest elected to receive extended care services (used by Religious Nonmedical Health Care Institutions only).
35	Date treatment started for physical therapy - Code indicates the date services were initiated by the billing provider for physical therapy.
36	Date of discharge for the IP hospital stay when patient received a transplant procedure - Hospital is billing for immunosuppressive drugs.
37	The date of discharge for the IP hospital stay when patient received a noncovered transplant procedure - Hospital is billing for immunosuppresive drugs.
38	Date treatment started for home IV therapy - Date the patient was first treated in his home for IV therapy.
39	Date discharged on a continuous course of IV therapy - Date the patient was discharged from the hospital on a continuous course of IV therapy.
40	Scheduled date of admission - The date on which a patient will be admitted as an inpatient to the hospital. (This code may only be used on an outpatient claim.)
41	Date of First Test for Pre-admission Testing - The date on which the first outpatient diagnostic test was performed as part of a pre-admission testing (PAT) program. This code may only be used if a date of admission was scheduled prior to the administration of the test(s). (eff. 10/01)
42	Date of discharge/termination of hospice care - for the final bill for hospice care. Eff 5/93, definition revised to apply only to date patient revoked hospice election.
43	Scheduled Date of Canceled Surgery - date which ambulatory surgery was scheduled. (eff. 9/01)
44	Date treatment started for occupational therapy - Code indicates the date services were initiated by the billing provider for occupational therapy.
45	Date treatment started for speech therapy - Code indicates the date services were initiated by the billing provider for speech therapy.
46	Date treatment started for cardiac rehabilitation - Code indicates the date services were initiated by the billing provider for cardiac rehabilitation.
47	Date Cost Outlier Status Begins - code indicates that this is the first day the cost outlier threshold is reached. For Medicare purposes, a bene must have regular coinsurance and/or lifetime reserve days available beginning on this date to allow coverage of additional daily charges for the purpose of making cost outlier payments. (eff. 9/01)
48	Payer code - Code reserved for internal use only by third party payers. HCFA assigns as needed for your use. Providers will not report it.
49	Payer code - Code reserved for internal use only by third party payers. HCFA assigns as needed for your use. Providers will not report it.
50 - 69	Reserved for state assignment
A1	Birthdate, Insured A - The birthdate of the individual in whose name the insurance is carried. (Eff 10/93)
A2	Effective date, Insured A policy - A code indicating the first date insurance is in force. (eff 10/93)
A3	Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer A. (eff 10/93)
B1	Birthdate, Insured B - The birthdate of the individual in whose name the insurance is carried. (eff 10/93)
B2	Effective date, Insured B policy - A code indicating the first date insurance is in force. (eff 10/93)
B3	Benefits exhausted - code indicating the last date for which benefits are available and after which no payment can be made to payer B. (eff 10/93)
C1	Birthdate, Insured C - The birthdate of the individual in whose name the insurance is carried. (eff 10/93)
C2	Effective date, Insured C policy - A code indicating the first date insurance is in force. (eff 10/93)
C3	Benefits exhausted - Code indicating the last date for which benefits are available and after which no payment can be made to payer C. (eff 10/93)

Short SAS Name: RLTOCRSQ
Long SAS Name: RLT_OCRNC_CD_SEQ

Contained in

The sequence number of the related institutional occurrence code for normal forms layout used in CCW.

Short SAS Name: OCRNCDT
Long SAS Name: CLM_RLT_OCRNC_DT

Contained in

The date associated with a significant event related to an institutional claim that may affect payer processing.

Short SAS Name: RLTSPNSQ
Long SAS Name: RLT_SPAN_CD_SEQ

Contained in

The sequence number of the related institutional span code for normal forms layout used in CCW.

Short SAS Name: RLTVALSQ
Long SAS Name: RLT_VAL_CD_SEQ

Contained in

The sequence number of the related institutional value code for normal forms layout used in CCW.

Claim Rendering Physician NPI Number ¶

Short SAS Name: RNDRNG_PHYSN_NPI
Long SAS Name: CLM_RNDRNG_PHYSN_NPI_NUM

Variable Names

Dataset	2013	2012	2011	2010
Outpatient	`rndrng_physn_npi`	`rndrng_physn_npi`	`rndrng_physn_npi`	`rndrng_physn_npi`

Contained in

This variable is the National Provider Identifier (NPI) for the physician who rendered the services. NPIs replaced UPINs as the standard provider identifiers beginning in 2007. The UPIN is almost never populated after 2009.

CMS has determined that dual provider identifiers (old legacy numbers and new NPI) must be available in the NCH. After the 5/07 NPI implementation, the standard system maintainers will add the legacy number to the claim when it is adjudicated. We will continue to receive the OSCAR provider number and any currently issued UPINs. Effective May 2007, no new UPINs (legacy numbers) will be generated for new physicians (Part B and outpatient claims), so there will only be NPIs sent in to the NCH for those physicians.

Claim Rendering Physician Specialty Code ¶

Short SAS Name: RNDRNG_PHYSN_SPCLTY_CD
Long SAS Name: CLM_RNDRNG_PHYSN_SPCLTY_CD

Contained in

The code used to identify the CMS specilty code of the rendering physician/practitioner.

Values

Code	Code Value
00	Carrier wide
01	General practice
02	General surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family practice
09	Interventional Pain Management (IPM) (eff. 4/1/03)
10	Gastroenterology
11	Internal medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech/language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Physchiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants (eff. 4/1/03--previously grouped with Certified Registered Nurse Anesthetists (CRNA))
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)
53	Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthotist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public Health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing independently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
66	Rheumatology
67	Occupational therapist (private practice added 4/103) (independently practicing removed 4/1/03)
68	Clinical psychologist
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional (eff.1/1/02)
72	Pain Management (eff. 1/1/02)
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers (prior to 4/2003 this included Independent Diagnostic Testing Facilities (IDFT))
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs--eff. 4//1/03))
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventive medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/01/06, known as Independent physiological laboratory
96	Optician
97	Physician assistant
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A4	Home Health Agency (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)
B1	Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)
B2	Pedorthic Personnel (eff. 10/2/07)
B3	Medical Supply Company with pedorthic personnel (eff. 10/2/07)
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist (eff. 7/2016)

Claim Service Classification Type Code ¶

Short SAS Name: TYPESRVC
Long SAS Name: CLM_SRVC_CLSFCTN_TYPE_CD

Contained in

The second digit of the type of bill (TOB2) submitted on an institutional claim record to indicate the classification of the type of service provided to the beneficiary.

Values

For facility type code 1 thru 6, and 9

Code	Code Value
1	Inpatient (including Part A)
2	Hospital based or Inpatient (Part B only) or home health visits under Part B
3	Outpatient (HHA-A also)
4	Other (Part B) -- (Includes HHA medical and other health services not under a plan of treatment, hospital or SNF for diagnostic clinical laboratory services for "nonpatients," and referenced diagnostic services. For HHAs under PPS, indicates an osteoporo
5	Intermediate care - level I
6	Intermediate care - level II
7	Subacute Inpatient (revenue code 019X required) (formerly Intermediate care - level III) NOTE: 17X & 27X are discontinued effective 10/1/05.
8	Swing beds (used to indicate billing for SNF level of care in a hospital with an approved swing bed agreement)
9	Reserved for national assignment

For facility type code 7

Code	Code Value
1	Rural Health Clinic (RHC)
2	Hospital based or independent renal dialysis facility
3	Free-standing provider based federally qualified health center (FQHC) (eff 10/91)
4	Other Rehabilitation Facility (ORF) and Community Mental Health Center (CMHC) (eff 10/91 - 3/97); ORF only (eff. 4/97)
5	Comprehensive Rehabilitation Center (CORF)
6	Community Mental Health Center (CMHC) (eff 4/97)
7-8	Reserved for national assignment
9	Other

For facility type code 8

Code	Code Value
1	Hospice (non-hospital based)
2	Hospice (hospital based)
3	Ambulatory surgical center in hospital outpatient department
4	Freestanding birthing center
5	Critical Access Hospital (eff. 10/99) formerly Rural primary care hospital (eff. 10/94)
6-8	Reserved for national use
9	Other

Claim Source Inpatient Admission Code ¶

Short SAS Name: SRC_ADMS
Long SAS Name: CLM_SRC_IP_ADMSN_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`src_adms`	`src_adms`	`src_adms`	`src_adms`	`src_adms`

Dataset	2008	2007	2006	2005	2004
MedPAR	`src_adms`	`src_adms`	`src_adms`	`src_adms`	`src_adms`

Dataset	2003	2002	2001	2000	1999
MedPAR	`src_adms`	`src_adms`	`madmsrce`	`madmsrce`	`madmsrce`

Contained in

The code indicating the source of the referral for the admission or visit.

Values

For Inpatient/SNF Claims:

Code	Code Value
0	ANOMALY: invalid value, if present, translate to '9'
1	Non-Health Care Facility Point of Origin (Physician Referral) - The patient was admitted to this facility upon an order of a physician.
2	Clinic referral - The patient was admitted upon the recommendation of this facility's clinic physician.
3	HMO referral - Reserved for national assignment. (eff. 3/08) Prior to 3/08, HMO referral - The patient was admitted upon the recommendation of a health maintenance organization (HMO) physician.
4	Transfer from hospital (Different Facility) - The patient was admitted to this facility as a hospital transfer from an acute care facility where he or she was an inpatient.
5	Transfer from a skilled nursing facility (SNF) or Intermediate Care Facility (ICF) - The patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident.
6	Transfer from another health care facility - The patient was admitted to this facility as a transfer from another type of health care facility not defined elsewhere in this code list where he or she was an inpatient.
7	Emergency room - The patient was admitted to this facility after receiving services in this facility's emergency room department. (Obsolete - eff. 7/1/10)
8	Court/law enforcement - The patient was admitted upon the direction of a court of law or upon the request of a law enforcement agency's representative.
9	Information not available - The means by which the patient was admitted is not known.
A	Reserved for National Assignment. (eff. 3/08) Prior to 3/08 defined as: Transfer from a Critical Access Hospital - patient was admitted/referred to this facility as a transfer from a Critical Access Hospital.
B	Transfer from Another Home Health Agency - The patient was admitted to this home health agency as a transfer from another home health agency. (Discontinued July 1, 2010- See Condition Code 47)
C	Readmission to Same Home Health Agency - The patient was readmitted to this home health agency within the same home health episode period. (Discontinued July 1, 2010)
D	Transfer from hospital inpatient in the same facility resulting in a separate claim to the payer - The patient was admitted to this facility as a transfer from hospital inpatient within this facility resulting in a separate claim to the payer.
E	Transfer from Ambulatory Surgical Center - The patient was admitted to this facility as a transfer from an ambulatory surgery center. (eff. 10/1/2007)
F	Transfer from Hospice and is under a Hospice Plan of Care or Enrolled in a Hospice Program - The patient was admitted to this facility as a transfer from a hospice. (eff. 10/1/2007)

For Newborn Type of Admission:

Code	Code Value
1	Normal delivery - A baby delivered without complications. (Obsolete eff. 10/1/07)
2	Premature delivery - A baby delivered with time and/or weight factors qualifying it for premature status. (Obsolete eff. 10/1/07)
3	Sick baby - A baby delivered with medical complications, other than those relating to premature status. (Obsolete eff. 10/1/07)
4	Extramural birth - A baby delivered in a non-sterile environment. (Obsolete eff. 10/1/07)
5	Born Inside this Hospital (eff. 10/1/07)
6	Born Outside of This Hospital (eff. 10/1/07)
7-9	Reserved for national assignment.

Claim Through Date ¶

Short SAS Name: THRU_DT
Long SAS Name: CLM_THRU_DT

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`
Inpatient	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`
Inpatient	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`
Outpatient	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`	`thru_dt`

Dataset	2008	2007	2006	2005	2004
Carrier	`thru_dt`	`thru_dt`	`thru_dt`	`sthrudt`	`sthrudt`
Inpatient	`thru_dt`	`thru_dt`	`thru_dt`	`sthrudt`	`sthrudt`
Inpatient	`thru_dt`	`thru_dt`	`thru_dt`	`srev_dt`	`srev_dt`
Outpatient	`thru_dt`	`thru_dt`	`thru_dt`	`sthrudt`	`sthrudt`

Dataset	2003	2002	2001	2000	1999
Carrier	`sthrudt`	`sthrudt`	`thru_dt`	`thru_dt`	`bthrudt`
Inpatient	`sthrudt`	`sthrudt`	`thru_dt`	`thru_dt`	`thru_dt`
Inpatient	`srev_dt`	`srev_dt`	`rev_dt`	`rev_dt`	`rev_dt`
Outpatient	`sthrudt`	`sthrudt`	`sthrudt`	`thru_dt`	`thru_dt`

Contained in

The last day on the billing statement covering services rendered to the beneficiary (a.k.a 'Statement Covers Thru Date').

NOTE: For Home Health PPS claims, the 'from' date and the 'thru' date on the RAP (initial claim) must always match.

Claim Total Charge Amount ¶

Short SAS Name: TOT_CHRG
Long SAS Name: CLM_TOT_CHRG_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`
Outpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`

Dataset	2008	2007	2006	2005	2004
Inpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`
Outpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`

Dataset	2003	2002	2001	2000	1999
Inpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`
Outpatient	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`	`tot_chrg`

Contained in

Effective with Version G, the total charges for all services included on the institutional claim. This field is redundant with revenue center code 0001/total charges.

Limitation

DESCRIPTION : The total charge amount field in the fixed portion was truncated on outpatient, hospice and home health claims. BACKGROUND : For outpatient, hospice and home health claims, the total charge amount field in the fixed portion was truncated (the cents were dropped off; the decimal point was moved, making cents out of dollars) in the CWFMQA process beginning with data received from CWF ¼/99 through 5/14/99. The problem occurred when CWF increased the size of the field. CORRECTIVE ACTION : The CWFMQA front-end was fixed. The Nearline was patched during the quarterly merge in 7/99 for service years 1998 and 1999. The NCH_PACTCH_CD field will be populated with a value '11'. The 1998 and 1999 SAFs were corrected when finalized in 7/99. The patch involved moving the total charge amount in the revenue center trailer to the total charge amount field in the fixed portion, for records with NCH Daily Process Date ¼/99 - 5/14/99.

Values

Code
XXX.XX

Claim Treatment Authorization Number ¶

Short SAS Name: CLM_TRTMT_AUTHRZTN_NUM
Long SAS Name: CLM_TRTMT_AUTHRZTN_NUM

Contained in

The number assigned by the medical reviewer and reported by the provider to identify the medical review (treatment authorization) action taken after review of the beneficiary's case. It designates that treatment covered by the bill has been authorized by the payer.

This number is used by the fiscal intermediary and the Peer Review Organization.

Values

Code
XXXXXXX

Claim Utilization Day Count ¶

Short SAS Name: UTIL_DAY
Long SAS Name: CLM_UTLZTN_DAY_CNT

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`util_day`	`util_day`	`util_day`	`util_day`	`util_day`

Dataset	2008	2007	2006	2005	2004
Inpatient	`util_day`	`util_day`	`util_day`	`util_day`	`util_day`

Dataset	2003	2002	2001	2000	1999
Inpatient	`util_day`	`util_day`	`util_day`	`util_day`	`util_day`

Contained in

On an institutional claim, the number of covered days of care that are chargeable to Medicare facility utilization that includes full days, coinsurance days, and lifetime reserve days. It excludes any days classified as non-covered, leave of absence days, and the day of discharge or death.

Claim Value Amount ¶

Short SAS Name: VAL_AMT
Long SAS Name: CLM_VAL_AMT

Contained in

The amount related to the condition identified in the CLM_VAL_CD which was used by the intermediary to process the institutional claim.

Values

Code
XXX.XX

Claim Value Code ¶

Short SAS Name: VAL_CD
Long SAS Name: CLM_VAL_CD

Contained in

The code indicating the value of a monetary condition which was used by the intermediary to process an institutional claim.

Values

Claim Value Table.txt

County Code from Claim (SSA)¶

Short SAS Name: CNTY_CD
Long SAS Name: BENE_CNTY_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`
Inpatient	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`
MedPAR	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`
Outpatient	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`	`cnty_cd`

Dataset	2008	2007	2006	2005	2004
Carrier	`cnty_cd`	`cnty_cd`	`cnty_cd`	`county`	`county`
Inpatient	`cnty_cd`	`cnty_cd`	`cnty_cd`	`county`	`county`
MedPAR	`cnty_cd`	`cnty_cd`	`cnty_cd`	`county`	`county`
Outpatient	`cnty_cd`	`cnty_cd`	`cnty_cd`	`county`	`county`

Dataset	2003	2002	2001	2000	1999
Carrier	`county`	`county`	`cnty_cd`	`cnty_cd`	`bcounty`
Inpatient	`county`	`county`	`cnty_cd`	`cnty_cd`	`cnty_cd`
MedPAR	`county`	`county`	`mcounty`	`mcounty`	`mcounty`
Outpatient	`county`	`county`	`county`	`cnty_cd`	`cnty_cd`

Contained in

The SSA standard county code of a beneficiary's residence.

Date of Birth from Claim (Date)¶

Short SAS Name: DOB_DT
Long SAS Name: DOB_DT

Contained in

The beneficiary's date of birth.

Demo information text ¶

Short SAS Name: DEMO_INFO_TXT
Long SAS Name: DEMO_INFO_TXT

Contained in

This is a text field that contains information related to the demonstration.For example, a claim involving a CHOICES demo id 05 would contain the MCO plan contract number in the first five positions of this text field.

When the Demo ID = 01 (RUGS) -- the text field will contain a 2, 3 or 4 to denote the RUGS phase. If RUGS phase is blank or not one of the above the text field will reflect 'INVALID'. NOTE: In Version 'G', RUGS phase was stored in redefined Claim Edit Group, 3^rd occurrence, 4^th position. Demo ID = 02 (Home Health demo) -- the text field will contain PROV#. When demo number not equal to 02 then text will reflect 'INVALID'. Demo ID = 03 (Telemedicine demo) -- text field will contain the HCPCS code. If the required HCPCS is not shown then the text field will reflect 'INVALID'. Demo ID = 04 (UMWA) -- text field will contain W0 denoting that condition code W0 was present. If condition code W0 not present then the text field will reflect 'INVALID'. Demo ID = 05 (CHOICES) -- the text field will contain the CHOICES plan number, if both of the following conditions are met: (1) CHOICES plan number present and PPS or Inpatient claim shows that 1^st 3 positions of provider number as 210 and the admission date is within HMO effective/termination date; or non-PPS claim and the from date is within HMO effective/termination date and (2) CHOICES plan number matches the HMO plan number. If either condition is not met the text field will reflect 'INVALID CHOICES PLAN NUMBER'. When CHOICES plan number not present, text will reflect 'INVALID'. Demo ID = 15 (ESRD Managed Care) -- text field will contain the ESRD/MCO plan number. If ESRD/MCO plan number not present the field will reflect 'INVALID'. Demo ID = 38 (Physician Encounter Claims) -- text field will contain the MCO plan number. When MCO plan number not present the field will reflect 'INVALID'.

Demonstration number ¶

Short SAS Name: DEMO_ID_NUM
Long SAS Name: DEMO_ID_NUM

Contained in

The number assigned to identify a CMS demonstration project.This field is also used to denote special processing (a.k.a. Special Processing Number, SPN).

Values

Code	Code Value
1	Nursing Home Case-Mix and Quality: NHCMQ (RUGS) Demo – testing PPS for SNFs in 6 states, using a case-mix classification system based on resident characteristics and actual resources used. The claims carry a RUGS indicator and one or more revenue center codes in the 9,000 series.
2	National HHA Prospective Payment Demo -- testing PPS for HHAs in 5 states, using two alternate methods of paying HHAs: per visit by type of HHA visit and per episode of HH care.
3	Telemedicine Demo -- testing covering traditionally non-covered physician services for medical consultation furnished via two-way, interactive video systems (i.e. teleconsultation)in 4 states. The claims contain line items with 'QQ' HCPCS code.
4	United Mine Workers of America (UMWA) Managed Care Demo -- testing risk sharing for Part A services, paying special capitation rates for all UMWA beneficiaries residing in 13 designated counties in 3 states. Under the demo, UMWA will waive the 3-day qualifying hospital stay for a SNF admission. The claims contain TOB '18X','21X','28X' and '51X'; condition code = W0; claim MCO paid switch = not '0'; and MCO contract # = '90091'.
5	Medicare Choices (MCO encounter data) demo --testing expanding the type of Managed Care plans available and different payment methods at 16 MCOs in 9 states. The claims contain one of the specific MCO Plan Contract # assigned to the Choices Demo site. NOTE - this demonstration was terminated 12/31/2000.
6	Coronary Artery Bypass Graft (CABG) Demo --testing bundled payment (all-inclusive global pricing) for hospital + physician services related to CABG surgery in 7 hospitals in 7 states. The inpatient claims contain a DRG '106' or '107'. NOTE - this demonstration was terminated in 1998.
7	Virginia Cardiac Surgery Initiative (VCSI) (formerly referred to as Medicare Quality Partnerships Demo) -- this is a voluntary consortium of the cardiac surgery Medicare FFS Claims (Version K) Codebook 166 May 2017 physician groups and the non-Veterans Administration hospitals providing open heart surgical services in the Commonwealth of Virginia. The goal of the demo is to share data on quality and process innovations in an attempt to improve the care for all cardiac patients. The demonstration only affects those FIs that process claims from hospitals in Virginia and the carriers that process claims from physicians providing inpatient services at those hospitals. The hospitals will be reimbursed on a global payment basis for selected cardiac surgical diagnosis related groups (DRGs). The inpatient claims will contain a DRG '104', '105', '106', '107', '109'; the related physician/supplier claims will contain the claim payment denial reason code = 'D'. NOTE - The implementation date for this demonstration is 4/1/03.
8	Provider Partnership Demo -- testing per-case payment approaches for acute inpatient hospitalizations, making a lump-sum payment (combining the normal Part A PPS payment with the Part B allowed charges into a single fee schedule) to a Physician/Hospital Organization for all Part A and Part B services associated with a hospital admission. From 3 to 6 hospitals in the Northeast and Mid-Atlantic regions may participate in the demo.
15	ESRD Managed Care (MCO encounter data) -- testing open enrollment of ESRD beneficiaries and capitation rates adjusted for patient treatment needs at 3 MCOs in 3 States. The claims contain one of the specific MCO Plan Contract # assigned to the ESRD demo site.
30	Lung Volume Reduction Surgery (LVRS) or National Emphysema Treatment Trial (NETT) Clinical Study -- evaluating the effectiveness of LVRS and maximum medical therapy (including pulmonary rehab) for Medicare beneficiaries in last stages of emphysema at 18 hospitals nationally, in collaboration with NIH.
31	VA Pricing Special Processing (SPN) -- not really a demo but special request from VA due to court settlement; not Medicare services but VA inpatient and physician services submitted to FI 00400 and Carrier 00900 to obtain Medicare pricing -- NCH WILL PROCESS VA CLAIMS ANNOTATED WITH DEMO ID '31', BUT WILL NOT TRANSMIT TO HCFA (CMS) (not in Nearline File).
37	Medicare Coordinated Care Demonstration -- to test whether coordinated care services furnished to certain beneficiaries improves outcome of care and reduces Medicare expenditures under Part A and Part B. There will be at least 14 Coordinated Care Entities (CCEs). The selected entities will be assigned a provider number specifically for the demonstration services.
37	Medicare Disease Management (DMD) -- the purpose of this demonstration is to study the impact on costs and health outcomes of applying disease management services supplemented with coverage for prescription drugs for certain Medicare diagnosed, beneficiaries with advanced-stage congestive heart failure, diabetes, or coronary heart disease. Three demonstration sites will be used for this demonstration and it will last for 3 years. (Effective 4/1/2003).
38	Physician Encounter Claims - the purpose of this demo id is to identify the physician encounter claims being processed at the HCFA Data Center (HDC). This number will help EDS in making the claim go through the appropriate processing logic, which differs from that for fee-for-service. NOT IN NCH. NOTE - Effective October, 2000. Demo ids will not be assigned to Inpatient and Outpatient encounter claims.
39	Centralized Billing of Flu and PPV Claims -- The purpose of this demo is to facilitate the processing carrier, Trailblazers, paying flu and PPV claims based on payment localities. Providers will be giving the shots throughout the country and transmitting the claims to Trailblazers for processing. NOTE - Effective October, 2000 for carrier claims.
40	Payment of Physician and Non-physician Services in certain Indian Providers -- the purpose of this demo is to extend payment for services of physician and non-physician practitioners furnished in hospitals and ambulatory care clinics. Prior to the legislation change in BIPA, reimbursement for Medicare services provided in IHS facilities was limited to services provided in hospitals and skilled nursing facilities. This change will allow payment for IHS, Tribe and Tribal Organization providers under the Medicare physician fee schedule. NOTE - Effective July 1, 2001 for institutional and carrier claims.
48	Medical Adult Day-Care Services -- the purpose of this demonstration is to provide, as part of the episode of care for home health services, medical adult day care services to Medicare beneficiaries as a substitute for a portion of home health services that would otherwise be provided in the beneficiaries home. This demo would last approx. 3 years in not more than 5 sites. Payment for each home health service episode of care will be set at 95% of the amount that would otherwise be paid for home health services provided entirely in the home. NOTE - Effective July 5, 2005 for HHA claims.
49	Hemodialysis
53	Extended Stay
54	ACE Demo
58	used to identify the Multi-payer Advanced Primary Care Practice (MAPCP) demonstration. (eff. 7/2/12)
59	ACO Pioneer Demonstration (eff. 1/2014)
61	CLM-CARE-IMPRVMT-MODEL-1
62	CLM-CARE-IMPRVMT-MODEL-2
63	CLM-CARE-IMPRVMT-MODEL-3
64	CLM-CARE-IMPRVMT-MODEL-4
65	rebilled claims due to auditor denials -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
66	rebilled claims due to provider self-audit after claim submission/payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
67	rebilled claims due to provider self-audit after the patient has been discharged, but prior to payment -- code being implemented for a demonstration to determine the efficiency of allowing providers to rebill for all outpatient services, minus a penalty, when an inpatient claim is denied in full because of medical review because the beneficiary did not require inpatient services. (eff. 7/2/12)
68	NCH will not apply the 3-day hospital stay requirement when processing a SNF claim. (eff. 1/2014)
70	used for Electrical Workers Insurance Fund claims. (eff. 7/2/12)
74	unknown value
77	Shared Savings Program (eff. 10/2016)
78	Comprehensive Primary Care Plus (CPC+) (eff. 4/2017)

Demonstration sequence number ¶

Short SAS Name: DEMO_ID_SQNC_NUM
Long SAS Name: DEMO_ID_SQNC_NUM

Contained in

The number of demonstration identification trailers present on the claim.

The demonstration sequence number is a sequential line number to distinguish distinct demonstration projects that affect the same claim.

Encrypted CCW Beneficiary ID ¶

Short SAS Name: BENE_ID
Long SAS Name: BENE_ID

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`bene_id`	`bene_id`	`bene_id`	`bene_id`
Inpatient	`bene_id`	`bene_id`	`bene_id`	`bene_id`	`bene_id`
MedPAR	`bene_id`	`bene_id`	`bene_id`	`bene_id`	`bene_id`
Outpatient	`bene_id`	`bene_id`	`bene_id`	`bene_id`	`bene_id`

Dataset	2008	2007	2006
Carrier	`bene_id`	`bene_id`	`bene_id`
Inpatient	`bene_id`	`bene_id`	`bene_id`
MedPAR	`bene_id`	`bene_id`	`bene_id`
Outpatient	`bene_id`	`bene_id`	`bene_id`

Contained in

The unique CCW indentifier for a beneficiary. The CCW assigns a unique beneficiary identification number to each individual who receives Medicare and/or Medicaid, and uses that number to identify an individual’s records in all CCW data files (e.g., Medicare claims, MAX claims, MDS assessment data). This number does not change during a beneficiary’s lifetime and each number is used only once. The BENE_ID is specific to the CCW and is not applicable to any other identification system or data source.

FI Claim Process Date ¶

Short SAS Name: FI_CLM_PROC_DT
Long SAS Name: FI_CLM_PROC_DT

Contained in

The date the fiscal intermediary completes processing and releases the institutional claim to the CWF host.

FI Number ¶

Short SAS Name: FI_NUM
Long SAS Name: FI_NUM

Contained in

The identification number assigned by CMS to a fiscal intermediary authorized to process institutional claim records. Effective October 2006, the Medicare Administrative Contractors (MACs) began replacing the existing fiscal intermediaries and started processing institu- tional claim records for states assigned to its jurisdiction. NOTE: The 5-position MAC number will be housed in the existing FI_NUM field. During the transition from an FI to a MAC the FI_NUM field could contain either a FI number or a MAC number. See the FI_NUM table of codes to identify the new MAC numbers and their effective dates.

Values

JURISDICTION 3 - Part A MACs

Code	Code Value
10	Alabama BC - Alabama
11	Alabama BC - Iowa (replaced by MAC # 03401 -- see below)
20	Arkansas BC - Arkansas
21	Arkansas BC - Rhode Island
30	Arizona BC (replaced by MAC #03101 -- see below)
40	California BC (term. 12/00)
50	New Mexico BC/CO (term. 06/89)
60	Connecticut BC (term. 06/99)
70	Delaware BC - terminated 2/98
80	Florida BC (term. 03/88)
90	Florida BC
101	Georgia BC
121	Illinois - HCSC (term. 08/98)
123	Michigan - HCSC (term. 08/98)
130	Indiana BC/Administar Federal
131	Illinois - Administar
140	Iowa - Wellmark (term. 6/2000)
150	Kansas BC (term. 2008) (replaced with MAC # 05201 --see below)
160	Kentucky/Administar
180	Maine BC
181	Maine BC - Massachusetts
190	Maryland BC (term. 9/2005)
200	Massachusetts BC (term. 7/97)
210	Michigan BC (term. 9/94)
220	Minnesota BC (term. 07/99)
230	Mississippi BC
231	Mississippi BC/LA (term. 09/92)
232	Mississippi BC
241	Missouri BC (term. 9/92)
250	Montana BC (replaced by MAC #03201 -- see below)
260	Nebraska BC (term. 2007) (replaced with MAC # 05401 --see below)
270	New Hampshire BC
280	New Jersey BC (term. 8/2000)
290	New Mexico BC - terminated 11/95
308	New York - Empire BC
310	North Carolina BC (term. 01/02)
320	North Dakota BC - North Dakota (replaced with MAC # 03301 -- see below)
322	North Dakota BC - Washington & Alaska
323	North Dakota BC - Idaho, Oregon & Utah (replaced with MAC # 03501 --see below)
332	Ohio-Administar
340	Oklahoma BC (term. 2008) (replaced with MAC # 04301 --see below)
350	Oregon BC
351	Oregon BC/ID. (term. 09/88)
355	Oregon-CWF
362	Independence BC - terminated 8/97
363	Pennsylvania/Highmark - Veritus
366	Highmark (MD & DC) - Part A (eff. 10/2005)
370	Rhode Island BC
380	South Carolina BC - South Carolina
382	South Carolina BC - North Carolina
390	Tennessee BC
400	Texas BC
410	Utah BC (term. 09/00)
423	Virginia BC; Trigon (term. 08/99)
430	Washington/Alaska BC
450	Wisconsin BC - Wisconsin
452	Wisconsin BC - Michigan
453	Wisconsin BC - Virginia & West Virginia
454	Wisconsin BC - California
460	Wyoming BC (replaced by MAC # 03601 -- see below)
468	N Carolina BC/CPRTIVA
993	BC/BS Assoc.
17120	Hawaii Medical Service (term. 06/99)
50333	Travelers; Connecticut United Healthcare (terminated - date unknown)
51051	Aetna California - terminated 6/97
51070	Aetna Connecticut - terminated 6/97
51100	Aetna Florida - terminated 6/97
51140	Aetna Illinois - terminated 6/97
51390	Aetna Pennsylvania - terminated 6/97
52280	NE - Mutual of Omaha
57400	Puerto Rico - Cooperativa
61000	Aetna (term. 06/97)
80883	Contractor ID for Inpatient & Outpatient Risk Adjustment Data (data not sent through CWF; but through Palmetto)

JURISDICTION 4 - Part A MACs

Code	Code Value
3101	Arizona (eff. 10/1/2006) (replaces FI #00030)
3201	Montana (eff. 12/1/2006) (replaces FI #00250)
3301	N. Dakota (eff. 12/1/2006) (replaces FI #00320)
3401	S. Dakota (eff. 3/1/2007) (replaces FI #00011)
3501	Utah (eff. 12/1/2006) (replaces FI #00323)
3601	Wyoming (eff. 11/1/2006) (replaces FI #00460)

JURISDICTION 5 - Part A MACs

Code	Code Value
4301	Oklahoma (eff. 3/1/2008) (replaces FI #00340)

Code	Code Value
5201	Oklahoma (eff. 3/1/2008) (replaces FI #00150)
5401	Oklahoma (eff. 12/1/2007)(replaces FI #00260)

FI or MAC Claim Action Code ¶

Short SAS Name: ACTIONCD
Long SAS Name: FI_CLM_ACTN_CD

Contained in

The type of action requested by the intermediary to be taken on an institutional claim.

Values

ResDAC note: the only values that are actually found in the CCW data are 1, 5, 8. The CMS value for code 3, referred to in code 5 is "Secondary debit adjustment - used only in credit/debit pairs (under HHPPS, would be the final claim or an adjustment on a LUPA)."

Code	Code Value
1	Original debit action (includes non-adjustment RTI correction items) - it will always be a 1 in regular bills.
5	Force action code 3
8	Benefits refused (for inpatient bills, an 'R' nonpayment code must also be present

First Claim Diagnosis E Code ¶

Short SAS Name: FST_DGNS_E_CD
Long SAS Name: FST_DGNS_E_CD

Contained in

The code used to identify the 1^st external cause of injury, poisoning, or other adverse effect This diagnosis E code is also stored as the 1^st occurrence of the diagnosis E code trailer.

NOTE: Effective with Version 'J', this field has been expanded from 5 bytes to 7 bytes to accommodate the future implementation of ICD-10.

Gender Code from Claim ¶

Short SAS Name: GNDR_CD
Long SAS Name: GNDR_CD

Contained in

The sex of a beneficiary.

Values

Code	Code Value
1	Male
2	Female
0	Unknown

HCPCS Initial Modifier Code ¶

Short SAS Name: MDFR_CD1

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`
Outpatient	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`

Dataset	2008	2007	2006	2005	2004
Carrier	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`
Outpatient	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`

Dataset	2003	2002	2001	2000	1999
Carrier	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`bhmod1`
Outpatient	`mdfr_cd1`	`mdfr_cd1`	`mdfr_cd1`	`mdfcd1_`	`mdfcd1_`

Contained in

Skilled Nursing Facility RIF

A first modifier to the Healthcare Common Procedure Coding System (HCPCS) procedure code to enable a more specific procedure identification for the revenue center or line item service for the claim.

HCPCS Second Modifier Code ¶

Short SAS Name: MDFR_CD2

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`
Outpatient	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`

Dataset	2008	2007	2006	2005	2004
Carrier	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`
Outpatient	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`

Dataset	2003	2002	2001	2000	1999
Carrier	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`bhmod2`
Outpatient	`mdfr_cd2`	`mdfr_cd2`	`mdfr_cd2`	`mdfcd2_`	`mdfcd2_`

Contained in

Skilled Nursing Facility RIF

A second modifier to the Healthcare Common Procedure Coding System (HCPCS) procedure code to make it more specific than the first modifier code to identify the revenue center or line item service for the claim.

HCPCS Third Modifier Code ¶

Short SAS Name: MDFR_CD3
Long SAS Name: HCPCS_3RD_MDFR_CD

Contained in

A third modifier to the Healthcare Common Procedure Coding System (HCPCS) procedure code to make it more specific than the first or second modifier codes to identify the revenue center or line item services for the claim.

NCH Active or Covered Level Care Thru Date ¶

Short SAS Name: CARETHRU
Long SAS Name: NCH_ACTV_OR_CVRD_LVL_CARE_THRU

Contained in

The date on a claim for which the covered level of care ended in a general hospital or the active care ended in a psychiatric/TB hospital.

Derivation

DERIVED FROM: CLM_RLT_OCRNC_CD CLM_RLT_OCRNC_DT

DERIVATION RULES: Based on the presence of occurrence code 22 move the related occurrence date to NCH_ACTV_CVR_LVL_CARE_THRU_DT.

NCH Beneficiary Blood Deductible Liability Amount ¶

Short SAS Name: BLDDEDAM
Long SAS Name: NCH_BENE_BLOOD_DDCTBL_LBLTY_AM

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`
MedPAR	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`
Outpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`

Dataset	2008	2007	2006	2005	2004
Inpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`
MedPAR	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`
Outpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`

Dataset	2003	2002	2001	2000	1999
Inpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`
MedPAR	`blddedam`	`blddedam`	`mbldded`	`mbldded`	`mbldded`
Outpatient	`blddedam`	`blddedam`	`blddedam`	`blddedam`	`blddedam`

Contained in

The amount of money for which the intermediary determined the beneficiary is liable for the blood deductible.

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT DERIVATION RULES: Based on the presence of value code equal to '06' move the corresponding value amount to NCH_BENE_BLOOD_DDCTBL_AMT.

Values

Code
XXX.XX

NCH Beneficiary Discharge Date ¶

Short SAS Name: DSCHRGDT

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`dschrgdt`	`dschrgdt`	`dschrgdt`	`dschrgdt`	`dschrgdt`

Dataset	2008	2007	2006	2005	2004
MedPAR	`dschrgdt`	`dschrgdt`	`dschrgdt`	`sdschrgdt`	`sdschrgdt`

Dataset	2003	2002	2001	2000	1999
MedPAR	`sdschrgdt`	`sdschrgdt`	`mdisdte`	`mdisdte`	`mdisdte`

Contained in

On an inpatient or Home Health claim, the date the beneficiary was discharged from the facility, or died.

Date matches the "thru" date on the claim (CLM_THRU_DT). When there is a discharge date, the discharge status code (PTNT_DSCHRG_STUS_CD) indicates the final disposition of the patient after discharge.

Derivation

DERIVED FROM: NCH_PTNT_STUS_IND_CD CLM_THRU_DT

DERIVATION RULES: Based on the presence of patient discharge status code not equal to 30 (still patient), move the claim thru date to the NCH_BENE_DSCHRG_DT.

NCH Beneficiary Inpatient Deductible Amount ¶

Short SAS Name: DED_AMT
Long SAS Name: NCH_BENE_IP_DDCTBL_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`
MedPAR	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`

Dataset	2008	2007	2006	2005	2004
Inpatient	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`
MedPAR	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`

Dataset	2003	2002	2001	2000	1999
Inpatient	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`	`ded_amt`
MedPAR	`ded_amt`	`ded_amt`	`mpded`	`mpded`	`mpded`

Contained in

The amount of the deductible the beneficiary paid for inpatient services, as originally submitted on the institutional claim.

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT DERIVATION RULES: Based on the presence of value code equal to A1, B1, or C1 move the corresponding value amount to the NCH_BENE_IP_DDCTBL_AMT.

Values

Code
XXX.XX

NCH Beneficiary Medicare Benefits Exhausted Date ¶

Short SAS Name: EXHST_DT
Long SAS Name: NCH_BENE_MDCR_BNFTS_EXHTD_DT_I

Contained in

The last date for which the beneficiary has Medicare coverage. This is completed only where where benefits were exhausted before the date of discharge and during the billing period covered by this institutional claim.

Derivation

DERIVED FROM: CLM_RLT_OCRNC_CD CLM_RLT_OCRNC_DT

DERIVATION RULES (Effective 10/93): Based on the presence of occurrence code A3, B3 or C3 move the related occurrence date to NCH_MDCR_BNFT_EXHST_DT. *NOTE: Prior to 10/93, the date associated with occurrence code 23 was moved to this field.

NCH Beneficiary Part A Coinsurance Liability Amount ¶

Short SAS Name: COIN_AMT
Long SAS Name: NCH_BENE_PTA_COINSRNC_LBLTY_AM

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`
MedPAR	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`

Dataset	2008	2007	2006	2005	2004
Inpatient	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`
MedPAR	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`

Dataset	2003	2002	2001	2000	1999
Inpatient	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`	`coin_amt`
MedPAR	`coin_amt`	`coin_amt`	`mcoinamt`	`mcoinamt`	`mcoinamt`

Contained in

The amount of money for which the intermediary has determined that the beneficiary is liable for Part A coinsurance on the institutional claim.

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT DERIVATION RULES: Based on the presence of value code equal to 8, 9, 10 or 11 move the corresponding value amount to the NCH_BENE_IP_PTA_COINSRC_AMT.

Values

Code
XXX.XX

NCH Blood Pints Furnished Quantity ¶

Short SAS Name: BLDFRNSH
Long SAS Name: NCH_BLOOD_PNTS_FRNSHD_QTY

Contained in

Number of whole pints of blood furnished to the beneficiary, as reported on the carrier claim (non-DMERC).

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT

DERIVATION RULES: Based on the presence of value code equal to 37 move the related value amount to the NCH_BLOOD_PT_FRNSH_QTY.

NCH Claim Type Code ¶

Short SAS Name: CLM_TYPE
Long SAS Name: NCH_CLM_TYPE_CD

Variable Names

Dataset	2012	2011	2010	2009	2008
Carrier	`clm_type`	`clm_type`	`clm_type`	`clm_type`	`clm_type`

Dataset	2007	2006	2005	2004	2003
Carrier	`clm_type`	`clm_type`	`clm_type`	`clm_type`	`clm_type`

Dataset	2002	2001	2000	1999
Carrier	`clm_type`	`clm_type`	`clm_type`	`clm_type`

Contained in

The code used to identify the type of claim record being processed in NCH.

NOTE1: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

NOTE2: During the Version I conversion this field was expanded to include inpatient 'full' encounter claims (for service dates after 6/30/97).

NOTE3: Effective with Version 'J', 3 new code values have been added to include a type code for the Medicare Advantage claims (IME/GME, no-pay and paid as FFS). During the Version 'J' conversion, these type codes were populated throughout history.

Derivation

FFS CLAIM TYPE CODES DERIVED FROM: NCH CLM_NEAR_LINE_RIC_CD NCH PMT_EDIT_RIC_CD NCH CLM_TRANS_CD NCH PRVDR_NUM INPATIENT 'FULL' ENCOUNTER TYPE CODE DERIVED FROM: (Pre-HDC processing -- AVAILABLE IN NCH) CLM_MCO_PD_SW CLM_RLT_COND_CD MCO_CNTRCT_NUM MCO_OPTN_CD MCO_PRD_EFCTV_DT MCO_PRD_TRMNTN_DT DERIVATION RULES: SET CLM_TYPE_CD TO 10 (HHA CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V','W' OR 'U' 2. PMT_EDIT_RIC_CD EQUAL 'F' 3. CLM_TRANS_CD EQUAL '5' SET CLM_TYPE_CD TO 20 (SNF NON-SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM IS NOT 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 30 (SNF SWING BED CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '0' OR '4' 4. POSITION 3 OF PRVDR_NUM EQUAL 'U', 'W', 'Y' OR 'Z' SET CLM_TYPE_CD TO 40 (OUTPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'W' 2. PMT_EDIT_RIC_CD EQUAL 'D' 3. CLM_TRANS_CD EQUAL '6' SET CLM_TYPE_CD TO 50 (HOSPICE CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'I' 3. CLM_TRANS_CD EQUAL 'H' SET CLM_TYPE_CD TO 60 (INPATIENT CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' SET CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM - PRIOR TO HDC PROCESSING - AFTER 6/30/97 - 12/4/00) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_MCO_PD_SW = '1' 2. CLM_RLT_COND_CD = '04' 3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET_CLM_TYPE_CD TO 61 (INPATIENT 'FULL' ENCOUNTER CLAIM -- EFFECTIVE WITH HDC PROCESSING) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'V' 2. PMT_EDIT_RIC_CD EQUAL 'C' OR 'E' 3. CLM_TRANS_CD EQUAL '1' '2' OR '3' 4. FI_NUM = 80881 SET CLM_TYPE_CD TO 62 (Medicare Advantage IME/GME CLAIMS - 10/1/05 - FORWARD) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_MCO_PD_SW = '0' 2. CLM_RLT_COND_CD = '04' & '69' 3. MCO_CNTRCT_NUM MCO_OPTN_CD = 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED ON OR AFTER 10/6/08 1. CLM_THRU_DT ON OR AFTER 10/1/06 2. CLM_MCO_PD_SW = '1' 3. CLM_RLT_COND_CD = '04' 4. MCO_CNTRCT_NUM MCO_OPTN_CD = 'A', 'B' OR 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS 5. ZERO REIMBURSEMENT (CLM_PMT_AMT) SET CLM_TYPE_CD TO 63 (HMO NO-PAY CLAIMS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED PRIOR to 10/6/08 1. MCO_CNTRCT_NUM MCO_OPTN_CD = 'A', 'B' OR 'C' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS 2. ZERO REIMBURSEMENT (CLM_PMT_AMT) SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED PRIOR to 10/6/08 1. MCO_CNTRCT_NUM MCO_OPTN_CD = '1', '2' OR '4' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 64 (HMO CLAIMS PAID AS FFS) WHERE THE FOLLOWING CONDITIONS ARE MET: CLAIMS PROCESSED on or after 10/6/08 1. CLM_RLT_COND_CD = '04' 2. MCO_CNTRCT_NUM MCO_OPTN_CD = '1', '2' OR '4' CLM_FROM_DT & CLM_THRU_DT ARE WITHIN THE MCO_PRD_EFCTV_DT & MCO_PRD_TRMNTN_DT ENROLLMENT PERIODS SET CLM_TYPE_CD TO 71 (RIC O non-DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 72 (RIC O DMEPOS CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'O' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table). SET CLM_TYPE_CD TO 81 (RIC M non-DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD not on DMEPOS table SET CLM_TYPE_CD TO 82 (RIC M DMEPOS DMERC CLAIM) WHERE THE FOLLOWING CONDITIONS ARE MET: 1. CLM_NEAR_LINE_RIC_CD EQUAL 'M' 2. HCPCS_CD on DMEPOS table (NOTE: if one or more line item(s) match the HCPCS on the DMEPOS table).

Values

Code	Code Value
10	HHA claim
20	Non swing bed SNF claim
30	Swing bed SNF claim
40	Outpatient claim
50	Hospice claim
60	Inpatient claim
61	Inpatient 'Full-Encounter' claim
62	Medicare Advantage IME/GME claims
63	Medicare Advantage (no-pay) claims
64	Medicare Advantage (paid as FFS) claim
71	RIC O local carrier non-DMEPOS claim
72	RIC O local carrier DMEPOS claim
81	RIC M DMERC non-DMEPOS claim
82	RIC M DMERC DMEPOS claim

NCH Inpatient Noncovered Charge Amount ¶

Short SAS Name: NCCHGAMT
Long SAS Name: NCH_IP_NCVRD_CHRG_AMT

Contained in

Effective with Version H, the noncovered charges for all accommodations and services, reported on an inpatient claim (used for internal CWFMQA editing purposes).

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: REV_CNTR_CD REV_CNTR_NCVR_CHRG_AMT

DERVIATION RULES: Based on the presence of revenue center code equal to 0001 move the related noncovered charge amount to NCH_IP_NCOV_CHRG_AMT.

Values

Code
XXX.XX

NCH Inpatient Total Deduction Amount ¶

Short SAS Name: TDEDAMT
Long SAS Name: NCH_IP_TOT_DDCTN_AMT

Contained in

Effective with Version H, the total Part A deductions reported on the Inpatient claim (used for internal CWFMQA editing purposes).

NOTE: During the Version H conversion this field was populated with data throughout history (back to 1991), but the derivation rule applied was in- complete for claims processed prior to 10/93. Disregard any data present in this field on claims with NCH weekly process date earlier than 10/93.

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT

DERIVATION RULES (Effective 10/93): Accumulate the value amounts associated with value codes equal to 06, 08 thru 11 and A1, B1 or C1 and move to IP_TOT_DDCTN_AMT. NOTE: Value codes 08-11 did not exist in the NCH prior to 2/93; values codes A1, B1, C1 did not exist prior to 10/93.

Values

Code
XXX.XX

NCH Near Line Record Identification Code ¶

Short SAS Name: RIC_CD
Long SAS Name: NCH_NEAR_LINE_REC_IDENT_CD

Contained in

A code defining the type of claim record being processed.

Values

Code	Code Value
O	Part B physician/supplier claim record (processed by local carriers; can include DMEPOS services)
V	Part A institutional claim record (inpatient (IP), skilled nursing facility (SNF), christian science (CS), home health agency (HHA), or hospice)
W	Part B institutional claim record (outpatient (OP), HHA)
U	Both Part A and B institutional home health agency (HHA) claim records -- due to HHPPS and HHA A/B split. (effective 10/00)
M	Part B DMEPOS claim record (processed by DME Regional Carrier) (effective 10/93)

NCH Patient Status Indicator Code ¶

Short SAS Name: PTNTSTUS
Long SAS Name: NCH_PTNT_STATUS_IND_CD

Contained in

Effective with Version H, the code on an inpatient/SNF and Hospice claim, indicating whether the beneficiary was discharged, died or still a patient (used for internal CWFMQA editing purposes.)

NOTE: During the Version H conversion this field was populated throughout history (back to service year 1991).

Derivation

DERIVED FROM: NCH PTNT_DSCHRG_STUS_CD DERIVATION RULES: SET NCH_PTNT_STUS_IND_CD TO 'A' WHERE THE PTNT_DSCHRG_STUS_CD NOT EQUAL TO '20'- '30' OR '40' - '42'. SET NCH_PTNT_STUS_IND_CD TO 'B' WHERE THE PTNT_DSCHRG_STUS_CD EQUAL TO '20'- '29' OR '40' - '42'. SET NCH_PTNT_STUS_IND_CD TO 'C' WHERE THE PTNT_DSCHRG_STUS_CD EQUAL TO '30'

Values

Code	Code Value
A	Discharged
B	Died
C	Still patient

NCH Primary Payer Claim Paid Amount*¶

Short SAS Name: PRPAYAMT
Long SAS Name: NCH_PRMRY_PYR_CLM_PD_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`
MedPAR	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`
Outpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`
MedPAR	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`
Outpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`
MedPAR	`prpayamt`	`prpayamt`	`mppamt`	`mppamt`	`mppamt`
Outpatient	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`	`prpayamt`

Contained in

Effective with Version H, the amount of a payment made on behalf of a Medicare bene- ficiary by a primary payer other than Medicare, that the provider is applying to covered Medicare charges on a non-institutional claim.

NOTE: During the Version H conversion, this field was populated with data throughout history (back to service year 1991) by summing up the line item primary payer amounts.

NCH Primary Payer Code ¶

Short SAS Name: PRPAY_CD
Long SAS Name: NCH_PRMRY_PYR_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
MedPAR	`prpay_cd`	`prpay_cd`	`prpay_cd`	`prpay_cd`	`prpay_cd`

Dataset	2008	2007	2006	2005	2004
MedPAR	`prpay_cd`	`prpay_cd`	`prpay_cd`	`prpay_cd`	`prpay_cd`

Dataset	2003	2002	2001	2000	1999
MedPAR	`prpay_cd`	`prpay_cd`	`mppcde`	`mppcde`	`mppcde`

Contained in

The code, on an institutional claim, specifying a federal non-Medicare program or other source that has primary responsibility for the payment of the Medicare beneficiary's health insurance bills.

Derivation

DERIVED FROM: CLM_VAL_CD CLM_VAL_AMT DERIVATION RULES SET NCH_PRMRY_PYR_CD TO 'A' WHERE THE CLM_VAL_CD = '12' SET NCH_PRMRY_PYR_CD TO 'B' WHERE THE CLM_VAL_CD = '13' SET NCH_PRMRY_PYR_CD TO 'C' WHERE THE CLM_VAL_CD = '16' and CLM_VAL_AMT is zeroes SET NCH_PRMRY_PYR_CD TO 'D' WHERE THE CLM_VAL_CD = '14' SET NCH_PRMRY_PYR_CD TO 'E' WHERE THE CLM_VAL_CD = '15' SET NCH_PRMRY_PYR_CD TO 'F' WHERE THE CLM_VAL_CD = '16' (CLM_VAL_AMT not equal to zeroes) SET NCH_PRMRY_PYR_CD TO 'G' WHERE THE CLM_VAL_CD = '43' SET NCH_PRMRY_PYR_CD TO 'H' WHERE THE CLM_VAL_CD = '41' SET NCH_PRMRY_PYR_CD TO 'I' WHERE THE CLM_VAL_CD = '42' SET NCH_PRMRY_PYR_CD TO 'L' (or prior to 4/97 set code to 'J') WHERE THE CLM_VAL_CD = '47'

Values

Values C, M, N, Y, Z and BLANK indicate Medicare is primary payer. (values Z and Y were used prior to 12/90. BLANK was supposed to be effective after 12/90, but may have been used prior to that date.)

Code	Code Value
A	Working aged bene/spouse with employer group health plan (EGHP)
B	End stage renal disease (ESRD) beneficiary in the 18 month coordination period with an employer group health plan
C	Conditional payment by Medicare; future reimbursement expected
D	Automobile no-fault (eff. 4/97; Prior to 3/94, also included any liability insurance)
E	Workers' compensation
F	Public Health Service or other federal agency (other than Dept. of Veterans Affairs)
G	Working disabled bene (under age 65 with LGHP)
H	Black Lung
I	Dept. of Veterans Affairs
J	Any liability insurance (eff. 3/94 - 3/97)
L	Any liability insurance (eff. 4/97) (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
M	Override code: EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
N	Override code: non-EGHP services involved (eff. 12/90 for carrier claims and 10/93 for FI claims; obsoleted for all claim types 7/1/96)
BLANK	Medicare is primary payer (not sure of effective date: in use 1/91, if not earlier)
Y	Other secondary payer investigation shows Medicare as primary payer
Z	Medicare is primary payer

NCH Provider State Code ¶

Short SAS Name: PRSTATE
Long SAS Name: PRVDR_STATE_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`
Outpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`

Dataset	2008	2007	2006	2005	2004
Inpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`
Outpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`

Dataset	2003	2002	2001	2000	1999
Inpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`
Outpatient	`prstate`	`prstate`	`prstate`	`prstate`	`prstate`

Contained in

Effective with Version H, the two position SSA state code where provider facility is located.

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: NCH PRVDR_NUM DERIVATION RULES: SET NCH_PRVDR_STATE_CD TO PRVDR_NUM POS1-2. FOR PRVDR_NUM POS1-2 EQUAL '55' OR '75' SET NCH_PRVDR_STATE_CD TO '05'. FOR PRVDR_NUM POS1-2 EQUAL '67' OR '74' SET NCH_PRVDR_STATE_CD TO '45'. FOR PRVDR_NUM POS1-2 EQUAL '68' OR '69' SET NCH_PRVDR_STATE_CD TO '10'. FOR PRVDR_NUM POS1-2 EQUAL '78' SET NCH_PRVDR_STATE_CD TO '14' FOR PRVDR_NUM POS1-2 EQUAL TO '76' SET NCH_PRVDR_STATE_CD TO '16' FOR PRVDR_NUM POS1-2 EQUAL '70' SET NCH_PRVDR_STATE_CD TO '17' FOR PRVDR_NUM POS1-2 EQUAL '71' SET NCH_PRVDR_STATE_CD TO '19' FOR PRVDR_NUMBER POS1-2 EQUAL '77' SET NCH_PRVDR_STATE_CD TO '24' FOR PRVDR_NUM POS1-2 EQUAL TO '72' SET NCH_PRVDR_STATE_CD TO '36' FOR PRVDR_NUM POS1-2 EQUAL TO '73' SET NCH_PRVDR_STATE_CD TO '39'

Values

Code	Code Value
1	Alabama
2	Alaska
3	Arizona
4	Arkansas
5	California
6	Colorado
7	Connecticut
8	Delaware
9	District of Columbia
10	Florida
11	Georgia
12	Hawaii
13	Idaho
14	Illinois
15	Indiana
16	Iowa
17	Kansas
18	Kentucky
19	Louisiana
20	Maine
21	Maryland
22	Massachusetts
23	Michigan
24	Minnesota
25	Mississippi
26	Missouri
27	Montana
28	Nebraska
29	Nevada
30	New Hampshire
31	New Jersey
32	New Mexico
33	New York
34	North Carolina
35	North Dakota
36	Ohio
37	Oklahoma
38	Oregon
39	Pennsylvania
40	Puerto Rico
41	Rhode Island
42	South Carolina
43	South Dakota
44	Tennessee
45	Texas
46	Utah
47	Vermont
48	Virgin Islands
49	Virginia
50	Washington
51	West Virginia
52	Wisconsin
53	Wyoming
54	Africa
55	California
56	Canada & Islands
57	Central America and West Indies
58	Europe
59	Mexico
60	Oceania
61	Philippines
62	South America
63	U.S. Possessions
64	American Samoa
65	Guam
66	Commonwealth of the Northern Marianas Islands
67	Texas
68	Florida (eff. 10/2005)
69	Florida (eff. 10/2005)
70	Kansas (eff. 10/2005)
71	Louisiana (eff. 10/2005)
72	Ohio (eff. 10/2005)
73	Pennsylvania (eff. 10/2005)
74	Texas (eff. 10/2005)
80	Maryland (eff. 8/2000)
97	Northern Marianas
98	Guam
99	With 000 county code is American Samoa; otherwise unknown

NCH Qualified Stay From Date ¶

Short SAS Name: QLFYFROM

Contained in

Skilled Nursing Facility RIF

Effective with Version H, the beginning date of the beneficiary's qualifying stay (used for internal CWFMQA editing purposes). For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization to benefits. For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A', or at least three days in a row if the source of admission is other than 'A'.

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: CLM_OCRNC_SPAN_CD CLM_OCRNC_SPAN_FROM_DT

DERIVATION RULES: Based on the presence of occurrence code 70 move the related occurrence from date to NCH_QLFY_STAY_FROM_DT.

NCH Qualify Stay Through Date ¶

Short SAS Name: QLFYTHRU

Contained in

Skilled Nursing Facility RIF

Effective with Version H, the ending date of the beneficiary's qualifying stay (used for internal CWFMQA editing purposes.) For inpatient claims, the date relates to the PPS portion of the inlier for which there is no utilization to benefits. For SNF claims, the date relates to a qualifying stay from a hospital that is at least two days in a row if the source of admission is an 'A', or at least three days in a row if the source of admission is other than 'A'.

NOTE: During the Version H, conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: CLM_OCRNC_SPAN_CD CLM_OCRNC_SPAN_THRU_DT

DERIVATION RULES: Based on the presence of occurrence code 70 move the related occurrence thru date to NCH_QLFY_STAY_THRU_DT.

NCH Verified Noncovered Stay From Date ¶

Short SAS Name: NCOVFROM
Long SAS Name: NCH_VRFD_NCVRD_STAY_FROM_DT

Contained in

Effective with Version H, the beginning date of the beneficiary's noncovered stay (used for internal CWFMQA editing purposes.)

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: CLM_OCRNC_SPAN_CD CLM_OCRNC_SPAN_FROM_DT

DERIVATION RULES: Based on the presence of occurrence code 74, 76, 77 or 79 move the related occurrence from date to NCH_VRFY_NCOV_STAY_FROM_DT.

NCH Verified Noncovered Stay Through Date ¶

Short SAS Name: NCOVTHRU
Long SAS Name: NCH_VRFD_NCVRD_STAY_THRU_DT

Contained in

Effective with Version H, the ending date of the beneficiary's noncovered stay (used for internal CWFMQA editing purposes.)

NOTE: During the Version H conversion this field was populated with data throughout history (back to service year 1991).

Derivation

DERIVED FROM: CLM_OCRNC_SPAN_CD CLM_OCRNC_SPAN_THRU_DT

DERIVATION RULES: Based on the presence of occurrence code 74, 76, 77 or 79 move the related occurrence thru date to NCH_VRFY_NCOV_STAY_THRU_DT.

NCH Weekly Claim Processing Date ¶

Short SAS Name: WKLY_DT
Long SAS Name: NCH_WKLY_PROC_DT

Contained in

The date the weekly NCH database load process cycle begins, during which the claim records are loaded into the Nearline file. This date will always be a Friday, although the claims will actually be appended to the database subsequent to the date.

Organization NPI Number ¶

Short SAS Name: ORGNPINM
Long SAS Name: ORG_NPI_NUM

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`
Outpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`

Dataset	2008	2007	2006	2005	2004
Inpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`
Outpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`

Dataset	2003	2002	2001	2000	1999
Inpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`
Outpatient	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`	`orgnpinm`

Contained in

On an institutional claim, the National Provider Identifier (NPI) number assigned to uniquely identify the institutional provider certified by Medicare to provide services to the beneficiary.

NOTE: Effective May 2007, the NPI will be- come the national standard identifier for covered health care providers. NPIs will replace current OSCAR provider number, UPINs, NSC numbers, and local contractor provider identification numbers (PINs) on standard HIPPA claim transactions. (During the NPI transition phase (4/3/06 - 5/23/07) the capability was there for the NCH to receive NPIs along with an existing legacy number (UPIN, PIN, OSCAR provider number, etc.)).

NOTE1: CMS has determined that dual provider identifiers (old legacy numbers and new NPI) must be available in the NCH. After the 5/07 NPI implelmentation, the standard system main- tainers will add the legacy number to the claim when it is adjudicated. We will continue to receive the OSCAR provider number and any currently issued UPINs. Effective May 2007, no NEW UPINs (legacy number) will be generated for NEW physicians (Part B and outpatient claims), so there will only be NPIs sent in to the NCH for those physicians.

Patient Discharge Status Code ¶

Short SAS Name: STUS_CD
Long SAS Name: PTNT_DSCHRG_STUS_CD

Contained in

The code used to identify the status of the patient as of the CLM_THRU_DT.

Values

EXPLANATION OF CLAIM ADJUSTMENT GROUP CODES POSITIONS 1 & 2 OF ANSI CODE

Code	Code Value
0	Unknown Value (but present in data)
1	Discharged to home/self care (routine charge).
2	Discharged/transferred to other short term general hospital for inpatient care.
3	Discharged/transferred to skilled nursing facility (SNF) with Medicare certification in anticipation of covered skilled care -- (For hospitals with an approved swing bed arrangement, use Code 61 - swing bed. For reporting discharges/transfers to a non-certified SNF, the hospital must use Code 04 - ICF.
4	Discharged/transferred to intermediate care facility (ICF).
5	Discharged/transferred to another type of institution for inpatient care (including distinct parts). NOTE: Effective 1/2005, psychiatric hospital or psychiatric distinct part unit of a hospital will no longer be identified by this code. New code is '65'
6	Discharged/transferred to home care of organized home health service organization.
7	Left against medical advice or discontinued care.
8	Discharged/transferred to home under care of a home IV drug therapy provider. (discontinued effective 10/1/05)
9	Admitted as an inpatient to this hospital (effective 3/1/91). In situations where a patient is admitted before midnight of the third day following the day of an outpatient service, the outpatient services are considered inpatient.
20	Expired (did not recover - Christian Science patient).
21	Discharged/transferred to Court/Law Enforcement
30	Still patient
40	Expired at home (hospice claims only)
41	Expired in a medical facility such as hospital, SNF, ICF, or freestanding hospice. (Hospice claims only)
42	Expired - place unknown (Hospice claims only)
43	Discharged/transferred to a federal hospital (eff. 10/1/03)
50	Hospice - home (eff. 10/96)
51	Hospice - medical facility (eff. 10/96)
61	Discharged/transferred within this institution to a hospital-based Medicare approved swing bed (eff. 9/01)
62	Discharged/transferred to an inpatient rehabilitation facility including distinct parts units of a hospital. (eff. 1/2002)
63	Discharged/transferred to a long term care hospitals. (eff. 1/2002)
64	Discharged/transferred to a nursing facility certified under Medicaid but not under Medicare (eff. 10/2002)
65	Discharged/Transferred to a psychiatric hospital or psychiatric distinct unit of a hospital (these types of hospitals were pulled from patient/discharge status code '05' and given their own code). (eff. 1/2005).
66	Discharged/transferred to a Critical Access Hospital (CAH) (eff. 1/1/06)
69	Discharged/transferred to a designated disaster alternative care site (eff. 10/2013)
70	Discharged/transferred to another type of health care institution not defined elsewhere in code list.
71	Discharged/transferred/referred to another institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05)
72	Discharged/transferred/referred to this institution for outpatient services as specified by the discharge plan of care (eff. 9/01) (discontinued effective 10/1/05)
81	Discharged to home or self-care with a planned acute care hospital readmission (eff. 10/2013)
82	Discharged/transferred to a short term general hospital for inpatient care with a planned acute care hospital inpatient readmission (eff. 10/2013)
83	Discharged/transferred to a skilled nursing facility (SNF) with Medicare certification with a planned acute care hospital inpatient readmission (eff. 10/2013)
84	Discharged/transferred to a facility that provides custodial or supportive care with a planned acute care hospital inpatient readmission (eff. 10/2013)
85	Discharged/transferred to a designated cancer center or children’s hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)
86	Discharged/transferred to home under care of organized home health service organization with a planned acute care hospital inpatient readmission (eff. 10/2013)
87	Discharged/transferred to court/law enforcement with a planned acute care hospital inpatient readmission (eff. 10/2013)
88	Discharged/transferred to a federal health care facility with a planned acute care hospital inpatient readmission (eff. 10/2013)
89	Discharged/transferred to a hospital-based Medicare approved swing bed with a planned acute care hospital inpatient readmission (eff. 10/2013)
90	Discharged/transferred to an inpatient rehabilitation facility (IRF) including rehabilitation distinct part units of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)
91	Discharged/transferred to a Medicare certified long term care hospital (LTCH) with a planned acute care hospital inpatient readmission (eff. 10/2103)
92	Discharged/transferred to nursing facility certified under Medicaid but not certified under Medicare with a planned acute care hospital inpatient readmission (eff. 10/2013)
93	Discharged/transferred to a psychiatric hospital/distinct part unit of a hospital with a planned acute care hospital inpatient readmission (eff. 10/2013)
94	Discharged/transferred to a critical access hospital (CAH) with a planned acute care hospital inpatient readmission (eff. 10/2013)
95	Discharged/transferred to another type of health care institution not defined elsewhere in this code list with a planned acute care hospital inpatient readmission (eff. 10/2013)

Code	Code Value
CO	Contractual Obligations -- this group code should be used when a contractual agreement between the payer and payee, or a regulatory requirement, resulted in an adjustment. Generally, these adjustments are considered a write-off for the provider and are not billed to the patient.
CR	Corrections and Reversals - this group code should be used for correcting a prior claim. It applies when there is a change to a previously adjudicated claim.
OA	Other Adjustments - this group code should be used when no other group code applies to the adjustment.
PI	Payer Initiated Reductions -- this group code should be used when, in the opinion of the payer, the adjustment is not the responsibility of the patient, but there is no supporting contract between the provider and the payer (i.e., medical review or professional review organization adjustments).
PR	Patient Responsibility - this group should be used when the adjustment represents an amount that should be billed to the patient or insured. This group would typically be used for deductible and copay adjustments.

Code	Code Value
1	Deductible Amount
2	Coinsurance Amount
3	Co-pay Amount
4	The procedure code is inconsistent with the modifier used or a required modifier is missing.
5	The procedure code/bill type is inconsistent with the place of service.
6	The procedure code is inconsistent with the patient's age.
7	The procedure code is inconsistent with the patient's gender.
8	The procedure code is inconsistent with the provider type.
9	The diagnosis is inconsistent with the patient's age.
10	The diagnosis is inconsistent with the patient's gender.
11	The diagnosis is inconsistent with the procedure.
12	The diagnosis is inconsistent with the provider type.
13	the date of death precedes the date of service.
14	The date of birth follows the date of service.
15	Claim/service adjusted because the submitted authorization number is missing, invalid, or does not apply to the billed services or provider.
16	Claim/service lacks information which is needed for adjudication.
17	Claim/service adjusted because requested information was not provided or was insufficient/incomplete.
18	Duplicate claim/service.
19	Claim denied because this is a work-related injury/illness and thus the liability of the Worker's Compensation Carrier.
20	Claim denied because this injury/illness is covered by the liability carrier.
21	Claim denied because this injury/illness is the liability of the no-fault carrier.
22	Claim adjusted because this care may be covered by another payer per coordination of benefits.
23	Claim adjusted because charges have been paid by another payer.
24	Payment for charges adjusted. Charges are covered under a capitation agreement/managed care plan.
25	Payment denied. Your Stop loss deductible has not been met.
26	Expenses incurred prior to coverage.
27	Expenses incurred after coverage terminated.
28	Coverage not in effect at the time the service was provided.
29	The time limit for filing has expired.
30	Claim/service adjusted because the patient has not met the required eligibility, spend down, waiting, or residency requirements.
31	Claim denied as patient cannot be identified as our insured.
32	Our records indicate that this dependent is not an eligible dependent as defined.
33	Claim denied. Insured has no dependent coverage.
34	Claim denied. Insured has no coverage for newborns.
35	Benefit maximum has been reached.
36	Balance does not exceed copayment amount.
37	Balance does not exceed deductible amount.
38	Services not provided or authorized by designated (network) providers.
39	Services denied at the time authorization/pre-certification was requested.
40	Charges do not meet qualifications for emergency/urgent care.
41	Discount agreed to in Preferred Provider contract.
42	Charges exceed our fee schedule or maximum allowable amount.
43	Gramm-Rudman reduction.
44	Prompt-pay discount.
45	Charges exceed your contracted/legislated fee arrangement.
46	This (these) service(s) is(are) not covered.
47	This (these) diagnosis(es) is(are) not covered, missing, or are invalid.
48	This (these) procedure(s) is(are) not covered.
49	These are non-covered services because this is a routine exam or screening procedure done in conjunction with a routine exam.
50	These are non-covered services because this is not deemed a 'medical necessity' by the payer.
51	These are non-covered services because this a pre existing condition.
52	The referring/prescribing/rendering provider is not eligible to refer/prescribe/order/perform the service billed.
53	Services by an immediate relative or a member of the same household are not covered.
54	Multiple physicians/assistants are not covered in this case.
55	Claim/service denied because procedure/treatment is deemed experimental/investigational by the payer.
56	Claim/service denied because procedure/treatment has not been deemed 'proven to be effective' by payer.
57	Claim/service adjusted because the payer deems the information submitted does not support this level of service, this many services, this length of service, or this dosage.
58	Claim/service adjusted because treatment was deemed by the payer to have been rendered in an inappropriate or invalid place of service.
59	Charges are adjusted based on multiple surgery rules or concurrent anesthesia rules.
60	Charges for outpatient services with the proximity to inpatient services are not covered.
61	Charges adjusted as penalty for failure to obtain second surgical opinion.
62	Claim/service denied/reduced for absence of, or exceeded, precertification/authorization.
63	Correction to a prior claim. INACTIVE
64	Denial reversed per Medical Review. INACTIVE
65	Procedure code was incorrect. This payment reflects the correct code. INACTIVE
66	Blood Deductible.
67	Lifetime reserve days. INACTIVE
68	DRG weight. INACTIVE
69	Day outlier amount.
70	Cost outlier amount.
71	Primary Payer amount.
72	Coinsurance day. INACTIVE
73	Administrative days. INACTIVE
74	Indirect Medical Education Adjustment.
75	Direct Medical Education Adjustment.
76	Disproportionate Share Adjustment.
77	Covered days. INACTIVE
78	Non-covered days/room charge adjustment.
79	Cost report days. INACTIVE
80	Outlier days. INACTIVE
81	Discharges. INACTIVE
82	PIP days. INACTIVE
83	Total visits. INACTIVE
84	Capital adjustments. INACTIVE
85	Interest amount. INACTIVE
86	Statutory adjustment. INACTIVE
87	Transfer amounts.
88	Adjustment amount represents collection against receivable created in prior overpayment.
89	Professional fees removed from charges.
90	Ingredient cost adjustment.
91	Dispensing fee adjustment.
92	Claim paid in full. INACTIVE
93	No claim level adjustment. INACTIVE
94	Process in excess of charges.
95	Benefits adjusted. Plan procedures not followed.
96	Non-covered charges.
97	Payment is included in allowance for another service/procedure.
98	The hospital must file the Medicare claim for this inpatient non-physician service. INACTIVE
99	Medicare Secondary Payer Adjustment Amount. INACTIVE
100	Payment made to patient/insured/responsible party.
101	Predetermination: anticipated payment upon completion of services or claim ajudication.
102	Major medical adjustment.
103	Provider promotional discount (i.e. Senior citizen discount).
104	Managed care withholding.
105	Tax withholding.
106	Patient payment option/election not in effect.
107	Claim/service denied because the related or qualifying claim/service was not paid or identified on the claim.
108	Claim/service reduced because rent/purchase guidelines were not met.
109	Claim not covered by this payer/contractor. You must send the claim to the correct payer/contractor.
110	Billing date predates service date.
111	Not covered unless the provider accepts assignment.
112	Claim/service adjusted as not furnished directly to the patient and/or not documented.
113	Claim denied because service/procedure was provided outside the United States or as a result of war.
114	Procedure/PRODuct not approved by the Food and Drug Administration.
115	Claim/service adjusted as procedure postponed or canceled.
116	Claim/service denied. The advance indemnification notice signed by the patient did not comply with requirements.
117	Claim/service adjusted because transportation is only covered to the closest facility that can provide the necessary care.
118	Charges reduced for ESRD network support.
119	Benefit maximum for this time period has been reached.
120	Patient is covered by a managed care plan. INACTIVE
121	Indemnification adjustment.
122	Psychiatric reduction.
123	Payer refund due to overpayment. INACTIVE
124	Payer refund amount - not our patient. INACTIVE
125	Claim/service adjusted due to a submission/billing error(s).
126	Deductible - Major Medical.
127	Coinsurance - Major Medical.
128	Newborn's services are covered in the mother's allowance.
129	Claim denied - prior processing information appears incorrect.
130	Paper claim submission fee.
131	Claim specific negotiated discount.
132	Prearranged demonstration project adjustment.
133	The disposition of this claim/service is pending further review.
134	Technical fees removed from charges.
135	Claim denied. Interim bills cannot be processed.
136	Claim adjusted. Plan procedures of a prior payer were not followed.
137	Payment/Reduction for Regulatory Surcharges, Assessments, Allowances or Health Related Taxes.
138	Claim/service denied. Appeal procedures not followed or time limits not met.
139	Contracted funding agreement - subscriber is employed by the provider of services.
140	Patient/Insured health identification number and name do not match.
141	Claim adjustment because the claim spans eligible and ineligible periods of coverage.
142	Claim adjusted by the monthly Medicaid patient liability amount.
A0	Patient refund amount
A1	Claim denied charges.
A2	Contractual adjustment.
A3	Medicare Secondary Payer liability met. INACTIVE
A4	Medicare Claim PPS Capital Day Outlier Amount.
A5	Medicare Claim PPS Capital Cost Outlier Amount.
A6	Prior hospitalization or 30 day transfer requirement not met.
A7	Presumptive Payment Adjustment.
A8	Claim denied; ungroupable DRG.
B1	Non-covered visits.
B2	Covered visits. INACTIVE
B3	Covered charges. INACTIVE
B4	Late filing penalty.
B5	Claim/service adjusted because coverage/program guidelines were not met or were exceeded.
B6	This service/procedure is adjusted when performed/billed by this type of provider, by this type of facility, or by a provider of this specialty.
B7	This provider was not certified/eligible to be paid for this procedure/service on this date of service.
B8	Claim/service not covered/reduced because alternative services were available, and should have been utilized.
B9	Services not covered because the patient is enrolled in a Hospice.
B10	Allowed amount has been reduced because a component of the basic procedure/test was paid. The beneficiary is not liable for more than the charge limit for the basic procedure/test.
B11	The claim/service has been transferred to the proper payer/processor for processing. Claim/service not covered by this payer/processor.
B12	Services not documented in patients' medical records.
B13	Previously paid. Payment for this claim/service may have been provided in a previous payment.
B14	Claim/service denied because only one visit or consultation per physician per day is covered.
B15	Claim/service adjusted because this procedure/service is not paid separately.
B16	Claim/service adjusted because 'New Patient' qualifications were not met.
B17	Claim/service adjusted because this service was not prescribed by a physician, not prescribed prior to delivery, the prescription is incomplete, or the prescription is not current.
B18	Claim/service denied because this procedure code/modifier was invalid on the date of service or claim submission.
B19	Claim/service adjusted because of the finding of a Review Organization. INACTIVE
B20	Charges adjusted because procedure/service was partially or fully furnished by another provider.
B21	The charges were reduced because the service/care was partially furnished by another physician. INACTIVE
B22	This claim/service is adjusted based on the diagnosis.
B23	Claim/service denied because this provider has failed an aspect of a proficiency testing program.
W1	Workers Compensation State Fee Schedule Adjustment.

Provider Number ¶

Short SAS Name: PROVIDER
Long SAS Name: PRVDR_NUM

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`provider`	`provider`	`provider`	`provider`	`provider`
Outpatient	`provider`	`provider`	`provider`	`provider`	`provider`

Dataset	2008	2007	2006	2005	2004
Inpatient	`provider`	`provider`	`provider`	`provider`	`provider`
Outpatient	`provider`	`provider`	`provider`	`provider`	`provider`

Dataset	2003	2002	2001	2000	1999
Inpatient	`provider`	`provider`	`provider`	`provider`	`provider`
Outpatient	`provider`	`provider`	`provider`	`provider`	`provider`

Contained in

The identification number of the institutional provider certified by Medicare to provide services to the beneficiary. NOTE: Effective October 1, 2007 the OSCAR Provider Number has been renamed the CMS Certification Number (CCN). The name was changed to avoid confusion with the National Provider Identifier (NPI). The CCN (OSCAR Provider Number) will continue to play a critical role in verifying that a provider has been Medicare certified and for what type of services.

Values

Provider Number Table.txt

Race Code from Claim ¶

Short SAS Name: RACE_CD
Long SAS Name: BENE_RACE_CD

Contained in

The race of a beneficiary.

Values

Code	Code Value
0	Unknown
1	White
2	Black
3	Other
4	Asian
5	Hispanic
6	North American Native

Rendering Physician Specialty Code ¶

Short SAS Name: RNDRNG_PHYSN_SPCLTY_CD
Long SAS Name: REV_CNTR_PHYSN_SPCLTY_CD

Contained in

The code used to identify the CMS specilty code of the rendering physician/practitioner.

(Revenue Center file)

Values

Code	Code Value
00	Carrier wide
01	General practice
02	General surgery
03	Allergy/immunology
04	Otolaryngology
05	Anesthesiology
06	Cardiology
07	Dermatology
08	Family practice
09	Interventional Pain Management (IPM) (eff. 4/1/03)
10	Gastroenterology
11	Internal medicine
12	Osteopathic manipulative therapy
13	Neurology
14	Neurosurgery
15	Speech/language pathology
16	Obstetrics/gynecology
17	Hospice and Palliative Care
18	Ophthalmology
19	Oral surgery (dentists only)
20	Orthopedic surgery
21	Cardiac Electrophysiology
22	Pathology
24	Plastic and reconstructive surgery
25	Physical medicine and rehabilitation
26	Physchiatry
27	General Psychiatry
28	Colorectal surgery (formerly proctology)
29	Pulmonary disease
30	Diagnostic radiology
31	Intensive cardiac rehabilitation
32	Anesthesiologist Assistants (eff. 4/1/03--previously grouped with Certified Registered Nurse Anesthetists (CRNA))
33	Thoracic surgery
34	Urology
35	Chiropractic
36	Nuclear medicine
37	Pediatric medicine
38	Geriatric medicine
39	Nephrology
40	Hand surgery
41	Optometrist
42	Certified nurse midwife
43	Certified Registered Nurse Anesthetist (CRNA) (Anesthesiologist Assistants were removed from this specialty 4/1/03)
44	Infectious disease
45	Mammography screening center
46	Endocrinology
47	Independent Diagnostic Testing Facility (IDTF)
48	Podiatry
49	Ambulatory surgical center (formerly miscellaneous)
50	Nurse practitioner
51	Medical supply company with certified orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
52	Medical supply company with certified prosthetist (certified by American Board for Certification in Prosthetics and Orthotics)
53	Medical supply company with certified prosthetist-orthotist (certified by American Board for Certification in Prosthetics and Orthotics)
54	Medical supply company for DMERC (and not included in 51-53)
55	Individual certified orthotist
56	Individual certified prosthetist
57	Individual certified prosthetist-orthotist
58	Medical supply company with registered pharmacist
59	Ambulance service supplier, (e.g., private ambulance companies, funeral homes, etc.)
60	Public Health or welfare agencies (federal, state, and local)
61	Voluntary health or charitable agencies (e.g. National Cancer Society, National Heart Association, Catholic Charities)
62	Psychologist (billing independently)
63	Portable X-ray supplier
64	Audiologist (billing independently)
65	Physical therapist (private practice added 4/1/03) (independently practicing removed 4/1/03)
66	Rheumatology
67	Occupational therapist (private practice added 4/103) (independently practicing removed 4/1/03)
68	Clinical psychologist
69	Clinical laboratory (billing independently)
70	Multispecialty clinic or group practice
71	Registered Dietician/Nutrition Professional (eff.1/1/02)
72	Pain Management (eff. 1/1/02)
73	Mass Immunization Roster Biller
74	Radiation Therapy Centers (prior to 4/2003 this included Independent Diagnostic Testing Facilities (IDFT))
75	Slide Preparation Facilities (added to differentiate them from Independent Diagnostic Testing Facilities (IDTFs--eff. 4//1/03))
76	Peripheral vascular disease
77	Vascular surgery
78	Cardiac surgery
79	Addiction medicine
80	Licensed clinical social worker
81	Critical care (intensivists)
82	Hematology
83	Hematology/oncology
84	Preventive medicine
85	Maxillofacial surgery
86	Neuropsychiatry
87	All other suppliers (e.g. drug and department stores)
88	Unknown supplier/provider specialty
89	Certified clinical nurse specialist
90	Medical oncology
91	Surgical oncology
92	Radiation oncology
93	Emergency medicine
94	Interventional radiology
95	Competitive Acquisition Program (CAP) Vendor (eff. 07/01/06). Prior to 07/01/06, known as Independent physiological laboratory
96	Optician
97	Physician assistant
98	Gynecologist/oncologist
99	Unknown physician specialty
A0	Hospital (DMERCs only)
A1	SNF (DMERCs only)
A2	Intermediate care nursing facility (DMERCs only)
A3	Nursing facility, other (DMERCs only)
A4	Home Health Agency (DMERCs only)
A5	Pharmacy (DMERC)
A6	Medical supply company with respiratory therapist (DMERCs only)
A7	Department store (DMERC)
A8	Grocery store (DMERC)
A9	Indian Health Service (IHS), tribe and tribal organizations (non-hospital or non-hospital based facilities, eff. 1/2005)
B1	Supplier of oxygen and/or oxygen related equipment (eff. 10/2/07)
B2	Pedorthic Personnel (eff. 10/2/07)
B3	Medical Supply Company with pedorthic personnel (eff. 10/2/07)
B4	Does not meet definition of health care provider (e.g., Rehabilitation agency, organ procurement organizations, histocompatibility labs) (eff. 10/2/07)
B5	Ocularist
C0	Sleep medicine
C1	Centralized flu
C2	Indirect payment procedure
C3	Interventional cardiology
C5	Dentist (eff. 7/2016)

Revenue Center Code ¶

Short SAS Name: REV_CNTR
Long SAS Name: REV_CNTR

Variable Names

Dataset	2013	2012	2011	2010	2009
Inpatient	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`
Outpatient	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`

Dataset	2008	2007	2006	2005	2004
Inpatient	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`
Outpatient	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rev_cntr`

Dataset	2003	2002	2001	2000	1999
Inpatient	`rev_cntr`	`rev_cntr`	`rvcntr`	`rvcntr`	`rvcntr`
Outpatient	`rev_cntr`	`rev_cntr`	`rev_cntr`	`rvcntr`	`rvcntr`

Contained in

The provider-assigned revenue code for each cost center for which a separate charge is billed (type of accommodation or ancillary). A cost center is a division or unit within a hospital (e.g., radiology, emergency room, pathology). EXCEPTION: Revenue center code 0001 represents the total of all revenue centers included on the claim.

Values

Revenue Center Table.txt

Revenue Center Deductible Coinsurance Code ¶

Short SAS Name: REVDEDCD
Long SAS Name: REV_CNTR_DDCTBL_COINSRNC_CD

Contained in

Code indicating whether the revenue center charges are subject to deductible and/or coinsurance

Values

For revenue center code 0001, the following MSP override values may be present:

Code	Code Value
0	Charges are subject to deductible and coinsurance
1	Charges are not subject to deductible
2	Charges are not subject to coinsurance
3	Charges are not subject to deductible or coinsurance
4	No charge or units associated with this revenue center code. (For multiple HCPCS per single revenue center code)

Code	Code Value
M	Override code; EGHP services involved (eff 12/90 for non-institutional claims; 10/93 for institutional claims)
N	Override code; non-EGHP services involved (eff 12/90 for non-institutional claims; 10/93 for institutional claims)
X	Override code: MSP cost avoided (eff 12/90 for non-institutional claims; 10/93 for institutional claims)

Revenue Center HCFA Common Procedure Coding System ¶

Short SAS Name: HCPCS_CD
Long SAS Name: HCPCS_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`
Inpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`
Outpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`

Dataset	2008	2007	2006	2005	2004
Carrier	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`
Inpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`
Outpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`

Dataset	2003	2002	2001	2000	1999
Carrier	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`bhcpcs`
Inpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpscd`	`hcpscd`	`hcpscd`
Outpatient	`hcpcs_cd`	`hcpcs_cd`	`hcpcs_cd`	`hcpscd`	`hcpscd`

Contained in

The Health Care Common Procedure Coding System (HCPCS) is a collection of codes that represent procedures, supplies, products and services which may be provided to Medicare beneficiaries and to individuals enrolled in private health insurance programs. The codes are divided into three levels, or groups as described below:

Level I: Codes and descriptors copyrighted by the American Medical Association's Current Procedural Terminology, Fourth Edition (CPT-4). These are 5 position numeric codes representing physician and nonphysician services.

*Note: CPT-4 codes including both long and short descriptions shall be used in accordance with the CMS/AMA agreement. Any other use violates the AMA copyright.

Level II: Includes codes and descriptors copyrighted by the American Dental Association's Current Dental Terminology, Fifth Edition (CDT-5). These are 5 position alpha-numeric codes comprising the D series. All other level II codes and descriptors are approved and maintained jointly by the alpha-numeric editorial panel (consisting of CMS, the Health Insurance Association of America, and the Blue Cross and Blue Shield Association). These are 5 position alpha-numeric codes representing primarily items and nonphysician services that are not represented in the level I codes.

Level III: Codes and descriptors developed by Medicare carriers for use at the local (carrier) level. These are 5 position alpha-numeric codes in the W, X, Y or Z series representing physician and nonphysician services that are not represented in the level I or level II codes.

HCPCS - General Information (CMS Website)

Revenue Center IDE, NDC, or UPC Number ¶

Short SAS Name: IDENDC
Long SAS Name: REV_CNTR_IDE_NDC_UPC_NUM

Contained in

This field may contain one of three types of identifiers: the National Drug Code (NDC), the Universal Product Code (UPC), or the number assigned by the Food and Drug Administration (FDA) to an investigational device (IDE) after the manufacturer has approval to conduct a clinical trial.The IDEs will have a revenue center code 0624.

This field was renamed to eventually accommodate the National Drug Code (NDC) and the Universal Product Code (UPC). This field could contain either of these 3 fields (there would never be an instance where more than one would come in on a claim). The size of this field was expanded to X(24) to accommodate either of the new fields (under Version 'H' it was X(7).

Revenue Center NDC Quantity ¶

Short SAS Name: REV_CNTR_NDC_QTY
Long SAS Name: REV_CNTR_NDC_QTY

Contained in

Effective with Version 'J', the quantity dispensed for the drug reflected on the revenue center line item.

Revenue Center NDC Quantity Qualifier Code ¶

Short SAS Name: REV_CNTR_NDC_QTY_QLFR_CD
Long SAS Name: REV_CNTR_NDC_QTY_QLFR_CD

Contained in

Effective with Version 'J', the code used to indicate the unit of measurement for the drug that was administered.

Values

Code	Code Value
F2	International Unit
GR	Gram
ML	Milliliter
UN	Unit

Revenue Center Non-Covered Charge Amount ¶

Short SAS Name: REV_NCVR
Long SAS Name: REV_CNTR_NCVRD_CHRG_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`rev_ncvr`	`rev_ncvr`	`rev_ncvr`	`rev_ncvr`	`rev_ncvr`

Dataset	2008	2007	2006	2000	1999
Outpatient	`rev_ncvr`	`rev_ncvr`	`rev_ncvr`	`rvncvr`	`rvncvr`

Contained in

The charge amount related to a revenue center code for services that are not covered by Medicare.

NOTE: Prior to Version H the field size was S9(7)V99 and the element was only present on the Inpatient/SNF format. As of NCH weekly process date 10/3/97 this field was added to all institutional claim types.

Values

Code
XXX.XX

Revenue Center Pricing Indicator Code ¶

Short SAS Name: REV_CNTR_PRCNG_IND_CD
Long SAS Name: REV_PRICNG_IND_CD

Contained in

The code used to identify if there was a deviation from the standard method of calculating payment amount.

This field is populated for those claims that are required to process through the Outpatient PPS PRICER software. The type of bills (TOB) required to process through are: 12X,13X, 14X (except Maryland providers, Indian Health Providers, hospitals located in American Samoa, Guam and Saipan and Critical Access Hospitals [CAH]); 76X; 75X and 34X if certain HCPCS are on the bill; and any outpatient type of bill with a condition code 07 and certain HCPCS. These claim types could have lines that are not required to price under OPPS rules so those lines would not have data in this field. Additional exception: Virgin Island hospitals and hospitals that furnish only inpatient Part B services with dates of service 1/1/02 and forward. It has been discovered that this field may be populated with data on claims with dates of service prior to 7/00 (implementation of Claim Line Expansion OPPS/HHPPS). The original understanding of the new revenue center fields was that data would be populated on claims with dates of service 7/00 and forward. Data has been found in claims with dates of service prior to 7/00 because the Standard Systems have processed any claim coming in 7/00 and after, meeting the above criteria, through the Outpatient Code Editor (OCE) regardless of the dates of service. VALUES D, U & T REPRESENT THE FOLLOWING: D = Discounting fraction (currently 0.5) U = Number of units T = Terminated procedure discount (currently 0.5)

Values

Code	Code Value
A	A valid HCPCS code not subject to a fee schedule payment. Reimbursement is calculated on provider submitted charges.
B	A valid HCPCS code subject to the fee schedule payment. for the provider billed charges. NOTE: There is an exception for Critical Access Hospitals (provider numbers XX1300-XX1399) with reimbursement method 'J' (all-inclusive method) and dates of service on or after 7/1/01. In these situations, reimbursement for professional services (revenue codes 96X, 97X, 98X) is always at the fee schedule amount of logic is not applicable.
C	Unlisted Rehabilitation Carrier Priced HCPCS
D	A valid radiology HCPCS code subject to the Radiology Pricer and the rate is reflected as zeroes on the HCPCS file and cost report. The Radiology Pricer treats this HCPCS as a non-covered service. Reimbursement is calculated on provider submitted charges.
E	A valid ASC HCPCS code subject to the ASC Pricer. The rate is reflected as zeroes on the HCPCS file. The ASC Pricer determines the ASC payment rate and is reported on the cost report.
F	A valid ESRD HCPCS code subject to the parameter rate. Reimbursement is the lesser of provider submitted charges or the fee schedule amount for non-dialysis HCPCS. Reimbursement is calculated on the provider file rates for dialysis HCPCS. NOTE: The ESRD Pricing Indicator is used when processing the ESRD claim. The non-ESRD pricing indicator is used only for Inpatient claims as follows: valid Hemophilia HCPCS for inpatient claim only and code is summed to parameter rate.
G	A valid HCPCS, code is subject to a fee schedule, but the rate is no longer present on the HCPCS file. Reimbursement is calculated on provider submitted charges.
H	A valid DME HCPCS, code is subject to a fee schedule. The rates are reflected under the DME segment. Reimbursement is calculated either on a fee schedule, Medicare FFS Claims (Version K) Codebook 522 May 2017 provider submitted charges or the lesser of provider submitted, or the fee schedule depending on the category of DME.
I	A valid DME category 5 HCPCS, HCPCS is not found on the DME history record, but a match was found on HIC, category and generic code. Claim must be reviewed by Medical Review before payment can be calculated.
J	A valid DME HCPCS, no DME history is present, and a prescription is required before delivery. Claim must be reviewed by Medical Review.
K	A valid DME HCPCS, prescribed has been reviewed, and fee schedule payment is approved as prescription was present before delivery.
L	A valid TENS HCPCS, rental period is six months or greater and must be reviewed by Medical Review. This code will be automatically set by the system.
M	A valid TENS HCPCS, Medical Review has approved the rental charge in excess of five months. This must be set by Medical Review. This must be set by Medical Review when approved for payment.
N	Paid based on the fee amount for non ESRD TOB's. NOTE: Fee amount is paid regardless of charges.
Q	Manual pricing
R	A valid radiology HCPCS code and is subject to APC. The rate is reported on the cost report. Reimbursement is calculated on provider submitted charges.
S	Valid influenza/PPV HCPCS. A fee amount is not applicable. The amount payable is present in the covered charge field. This amount is not subject to the coinsurance and deductible. This charge is subject to the provider's reimbursement rate.
T	Valid HCPCS. A fee amount is present. The amount payable should be the lower of the billed charge or fee amount. The system should compute the fee amount by multiplying the covered units times the rate. The fee amount is not subject to coinsurance and deductible or provider's reimbursement rate.
U	Valid ambulance HCPCS. A fee amount is present. The amount payable is a blended amount based on a percentage of the fee schedule and a percentage of the reasonable cost. The fee amount is subject to coinsurance and deductible.
X	Unclassified drug as subject to manual pricing.

Revenue Center Rate Amount ¶

Short SAS Name: REV_RATE
Long SAS Name: REV_CNTR_RATE_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`rev_rate`	`rev_rate`	`rev_rate`	`rev_rate`	`rev_rate`

Dataset	2008	2007	2006	2005	2004
Outpatient	`rev_rate`	`rev_rate`	`rev_rate`	`rev_rate`	`rev_rate`

Dataset	2003	2002	2001	2000	1999
Outpatient	`rev_rate`	`rev_rate`	`rev_rate`	`rvrt`	`rvrt`

Contained in

Charges relating to unit cost associated with the revenue center code. Exception (encounter data only): If plan (e.g. MCO) does not know the actual rate for the accommodations, $1 will be reported in the field.

NOTE1: For SNF PPS claims (when revenue center code equals 0022), CMS has developed a SNF PRICER to compute the rate based on the provider supplied coding for the MDS RUGS III group and assessment type (HIPPS code, stored in revenue center HCPCS code field).

NOTE2: For OP PPS claims, CMS has developed a PRICER to compute the rate based on the Ambulatory Payment Classification (APC), discount factor, units of service and the wage index.

NOTE3: Under HH PPS (when revenue center code equals 0023), CMS has developed a HHA PRICER to compute the rate. On the RAP, the rate is determined using the case mix weight associated with the HIPPS code, adjusting it for the wage index for the beneficiary's site of service, then multiplying the result by 60% or 50%, depending on whether or not the RAP is for a first episode.

On the final claim, the HIPPS code could change the payment if the therapy threshold is not met, or partial episode payment (PEP) adjustment or a significant change in condition (SCIC) adjustment. In cases of SCICs, there will be more than one 0023 revenue center line, each representing the payment made at each case-mix level.

NOTE4: For IRF PPS claims (when revenue center code equals 0024), CMS has developed a PRICER to compute the rate based on the HIPPS/CMG (HIPPS code, stored in revenue center HCPCS code field).

Revenue Center Rendering Physician NPI ¶

Short SAS Name: RNDRNG_PHYSN_NPI
Long SAS Name: REV_CNTR_RNDRNG_PHYSN_NPI_NUM

Variable Names

Dataset	2013	2012	2011	2010
Outpatient	`rndrng_physn_npi`	`rndrng_physn_npi`	`rndrng_physn_npi`	`rndrng_physn_npi`

Contained in

Effective with Version 'J', the NPI of the rendering physician who performed the service.

Revenue Center Rendering Physician UPIN ¶

Short SAS Name: RNDRNG_PHYSN_UPIN
Long SAS Name: RNDRNG_PHYSN_UPIN

Variable Names

Dataset	2013	2012	2011	2010
Outpatient	`rndrng_physn_upin`	`rndrng_physn_upin`	`rndrng_physn_upin`	`rndrng_physn_upin`

Contained in

Revenue Center Therapy Cap Indicator 1 Code ¶

Short SAS Name: THRPY_CAP_IND_CD1
Long SAS Name: THRPY_CAP_IND_CD1

Contained in

The field used to identify whether the claim line is subject to a therapy cap.

Details regarding the therapy cap can be found on the CMS website, under the Medicare therapy services web page (see, for example: here.)

Values

Code	Code Value
A	Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator is used on institutional claims only).
B	Critical Access Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator will be used on institutional claims only). Note: Currently, Critical Access Hospital claims are not subject to any therapy cap policies. Indicator B is created here to prepare for possible future legislation to include these claims.
C	The therapy cap exceptions process, as indicated by the submission of the KX modifier, no longer applies for this date of service (this indicator will be used on both institutional and professional claims).
D	The $3,700 threshold for review therapy services no longer applies for this date of service (this indicator will be used on both institutional and professional claims).

Revenue Center Therapy Cap Indicator 2 Code ¶

Short SAS Name: THRPY_CAP_IND_CD2
Long SAS Name: THRPY_CAP_IND_CD2

Contained in

The field used to identify whether the claim line is subject to a therapy cap.

Details regarding the therapy cap can be found on the CMS website, under the Medicare therapy services web page (see, for example: here.)

Values

Code	Code Value
A	Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator is used on institutional claims only).
B	Critical Access Hospital outpatient claims are subject to the therapy cap for this date of service (this indicator will be used on institutional claims only). Note: Currently, Critical Access Hospital claims are not subject to any therapy cap policies. Indicator B is created here to prepare for possible future legislation to include these claims.
C	The therapy cap exceptions process, as indicated by the submission of the KX modifier, no longer applies for this date of service (this indicator will be used on both institutional and professional claims).
D	The $3,700 threshold for review therapy services no longer applies for this date of service (this indicator will be used on both institutional and professional claims).

Revenue Center Total Charge Amount ¶

Short SAS Name: REV_CHRG
Long SAS Name: REV_CNTR_TOT_CHRG_AMT

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`rev_chrg`	`rev_chrg`	`rev_chrg`	`rev_chrg`	`rev_chrg`

Dataset	2008	2007	2006	2005	2004
Outpatient	`rev_chrg`	`rev_chrg`	`rev_chrg`	`rev_chrg`	`rev_chrg`

Dataset	2003	2002	2001	2000	1999
Outpatient	`rev_chrg`	`rev_chrg`	`rev_chrg`	`rvchrg`	`rvchrg`

Contained in

The total charges (covered and non-covered) for all accommodations and services (related to the revenue code) for a billing period before reduction for the deductible and coinsurance amounts and before an adjustment for the cost of services provided. NOTE: For accommodation revenue center total charges must equal the rate times units (days).

EXCEPTIONS:

(1) For SNF RUGS demo claims only (9000 series revenue center codes), this field contains SNF customary accommodation charge, (ie., charges related to the accommodation revenue center code that would have been applicable if the provider had not been participating in the demo).

(2) For SNF PPS (non demo claims), when revenue center code = 0022, the total charges will be zero.

(3) For Home Health PPS (RAPs), when revenue center code = 0023, the total charges will equal the dollar amount for the 0023 line.

(4) For Home Health PPS (final claim), when revenue center code = 0023, the total charges will be the sum of the revenue center code lines (other than 0023).

(5) For Inpatient Rehabilitation Facility (IFR) PPS, when the revenue center code = 0024, the total charges will be zero. For accommodation revenue codes (010X - 021X), total charges must equal the rate times the units.

(6) For encounter data, if the plan (e.g. MCO) does not know the actual charges for the accommodations the total charges will be $1 (rate) times units (days).

Limitation

DESCRIPTION : Multiple total charge '0001' revenue center codes appearing on outpatient, hospice and home health claim records. BACKGROUND : On outpatient, home health and hospice it appears that more than one '0001' revenue center code is showing up on the claims. The first total charge line adds the revenue center codes above it correctly; the problem exists below the first total charge line where garbage may be present due to the FI Standard System not clearing out fields before processing the next claim. We believe the error began with the change- over to a different claims processing contractor in 1/98. CORRECTIVE ACTION : CWF created an edit to reject mulitple '0001' revenue center codes, effective 6/28/99. EDG's CWFMQA process implemented an edit to drop any revenue center line items below the first total charge line. The NCH Nearline File, as well as the 1998 Standard Analytic Files (SAFs), have been patched/corrected to delete the multiple '0001' codes where present on any of the institutional claim types. Also, HCIS will be cor- recting the revenue center summaries during the next refresh. The NCH_PATCH_CD field will reflect a value '10'.

Values

Code
XXX.XX

Revenue Center Unit Count ¶

Short SAS Name: REV_UNIT
Long SAS Name: REV_CNTR_UNIT_CNT

Variable Names

Dataset	2013	2012	2011	2010	2009
Outpatient	`rev_unit`	`rev_unit`	`rev_unit`	`rev_unit`	`rev_unit`

Dataset	2008	2007	2006	2005	2004
Outpatient	`rev_unit`	`rev_unit`	`rev_unit`	`rev_unit`	`rev_unit`

Dataset	2003	2002	2001	2000	1999
Outpatient	`rev_unit`	`rev_unit`	`rev_unit`	`rvunt`	`rvunt`

Contained in

A quantitative measure (unit) of the number of times the service or procedure being reported was performed according to the revenue center/HCPCS code definition as described on an institutional claim.

Depending on type of service, units are measured by number of covered days in a particular accommodation, pints of blood, emergency room visits, clinic visits, dialysis treatments (sessions or days), outpatient therapy visits, and outpatient clinical diagnostic laboratory tests.

NOTE1: When revenue center code = 0022 (SNF PPS) the unit count will reflect the number of covered days for each HIPPS code and, if applicable, the number of visits for each rehab therapy code.

Description of the different unit of service measures by revenue center code beginning on page 18: here

State Code from Claim (SSA)¶

Short SAS Name: STATE_CD
Long SAS Name: BENE_STATE_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`state_cd`	`state_cd`	`state_cd`	`state_cd`
Inpatient	`state_cd`	`state_cd`	`state_cd`	`state_cd`	`state_cd`
MedPAR	`state_cd`	`state_cd`	`state_cd`	`state_cd`	`state_cd`
Outpatient	`state_cd`	`state_cd`	`state_cd`	`state_cd`	`state_cd`

Dataset	2008	2007	2006	2005	2004
Carrier	`state_cd`	`state_cd`	`state_cd`	`state`	`state`
Inpatient	`state_cd`	`state_cd`	`state_cd`	`state`	`state`
MedPAR	`state_cd`	`state_cd`	`state_cd`	`state`	`state`
Outpatient	`state_cd`	`state_cd`	`state_cd`	`state`	`state`

Dataset	2003	2002	2001	2000	1999
Carrier	`state`	`state`	`state_cd`	`state_cd`	`bstate`
Inpatient	`state`	`state`	`state_cd`	`state_cd`	`state_cd`
MedPAR	`state`	`state`	`mstate`	`mstate`	`mstate`
Outpatient	`state`	`state`	`state`	`state_cd`	`state_cd`

Contained in

The SSA standard state code of a beneficiary's residence.

Values

Code	Code Value
1	Alabama
2	Alaska
3	Arizona
4	Arkansas
5	California
6	Colorado
7	Connecticut
8	Delaware
9	District of Columbia
10	Florida
11	Georgia
12	Hawaii
13	Idaho
14	Illinois
15	Indiana
16	Iowa
17	Kansas
18	Kentucky
19	Louisiana
20	Maine
21	Maryland
22	Massachusetts
23	Michigan
24	Minnesota
25	Mississippi
26	Missouri
27	Montana
28	Nebraska
29	Nevada
30	New Hampshire
31	New Jersey
32	New Mexico
33	New York
34	North Carolina
35	North Dakota
36	Ohio
37	Oklahoma
38	Oregon
39	Pennsylvania
40	Puerto Rico
41	Rhode Island
42	South Carolina
43	South Dakota
44	Tennessee
45	Texas
46	Utah
47	Vermont
48	Virgin Islands
49	Virginia
50	Washington
51	West Virginia
52	Wisconsin
53	Wyoming
54	Africa
55	Asia
56	Canada
57	Central America and West Indies
58	Europe
59	Mexico
60	Oceania
61	Philippines
62	South America
63	U.S. Possessions
97	Saipan - MP
98	Guam
99	American Samoa

Zip Code of Residence from Claim ¶

Short SAS Name: ZIP_CD
Long SAS Name: BENE_MLG_CNTCT_ZIP_CD

Variable Names

Dataset	2013	2012	2011	2010	2009
Carrier		`zip_cd`	`zip_cd`	`zip_cd`	`zip_cd`
Inpatient	`zip_cd`	`zip_cd`	`zip_cd`	`zip_cd`	`zip_cd`
Outpatient	`zip_cd`	`zip_cd`	`zip_cd`	`zip_cd`	`zip_cd`

Dataset	2008	2007	2006	2005	2004
Carrier	`zip_cd`	`zip_cd`	`zip_cd`	`zipcode`	`zipcode`
Inpatient	`zip_cd`	`zip_cd`	`zip_cd`	`zipcode`	`zipcode`
Outpatient	`zip_cd`	`zip_cd`	`zip_cd`	`zipcode`	`zipcode`

Dataset	2003	2002	2001	2000	1999
Carrier	`zipcode`	`zipcode`	`bene_zip`	`bene_zip`	`bzip`
Inpatient	`zipcode`	`zipcode`	`bene_zip`	`bene_zip`	`bene_zip`
Outpatient	`zipcode`	`zipcode`	`zipcode`	`bene_zip`	`bene_zip`

Contained in

The ZIP code of the mailing address where the beneficiary may be contacted.

ResDAC variable note: The zip code variable in the claims data appears as a 9-digit variable. However, the field only presents the 5-digit zip code followed by trailing zeros. For example, a zip code of 55455 would appear as 554550000 in the data.