Fla. Admin. Code Ann. R. 59B-9.034 - Reporting Instructions

(1) An ambulatory center shall report data for all surgical procedures or services performed in the operating room, or for ambulatory surgical care, cardiology (cardiac catheterization and percutaneous transluminal coronary angioplasty (PTCA)), gastro intestinal, extra-corporeal shock wave treatment (lithotripsy) surgery, or endoscopy corresponding to the following Current Procedural Terminology (CPT) and corresponding HCPCS Codes. A hospital facility reporting type of service "1", ambulatory surgical procedures, shall only include visits where the CPT codes are in the reportable range defined in paragraphs 59B-9.034(1)(a), and (b), F.A.C., and have revenue charges for 36XX, 48XX, 49XX, 75XX or 79XX as used in the UB-04. Visits without these revenue charges should not be reported even if the CPT codes are in the reportable range. Type of service "2", Emergency Room, visits are not restricted to a CPT-HCPCS reportable range and should report all procedure codes.

(a) 10001 through 69999. Including surgery, cardiac catheterization, endoscopy procedures, and lithotripsy revenue associated procedure codes.

(b) 92920 through 92998 and 93451 through 93533. Includes percutaneous transluminal coronary angioplasty (PTCA) and Cardiac Catheterization.

(c) Exclude visits where the primary reason for the visit is venipuncture for laboratory services.

(d) Report one record for each visit, except pre-operation visits may be combined with the record of the associated ambulatory surgery visit. See subsection 59B-9.031(11), F.A.C.

(2) Emergency departments (ED) shall report data for:

(a) Emergency department visits in which emergency department registration occurs for the purpose of seeking emergency care services, including observation, and the patient is not admitted for inpatient care at the reporting entity.

(b) The CPT-HCPCS codes representing the services provided as part of the emergency department visit. CPT-HCPCS codes are reported in the 'OTHER CPT-HCPCS' fields (1-30) and are not restricted to the CPT-HCPCS reportable range defined in paragraph 59B-9.034(1)(a), F.A.C., for an ambulatory center.

(c) An Emergency Department Evaluation and Management Procedure code representing the patient's acuity as part of the emergency department visit.

(d) An ED visit occurs even if the only service provided to a registered patient is triage or screening. If a registered patient leaves prior to being seen by a physician, report the discharge status as "07" "AMA/discontinued care" and charges if incurred. Report zero if charges are not incurred.

(e) Do not include visits for registrations that occur in the Emergency Department when the hospital central registration department is closed unless emergency services are provided.

(3) Hospitals shall exclude records of any patient visit in which the outpatient and inpatient billing record is combined because the patient was admitted to inpatient care within a facility at the same location per Section 408.061(3), F.S.

(4) For each patient visit, ambulatory centers shall report all services provided using procedural codes specified in Rules 59B-9.037 and 59B-9.038, F.A.C.

(5) A facility must register through the FDDC portal to submit its data file according to the specifications in paragraphs (a) and (b), below.

(a) Internet Transmission. The Internet address for submitting ambulatory patient data files is https://apps.ahca.myflorida.com/Fddc/.

(b) Beginning with the fourth quarter 2022 data reporting period as defined in paragraph 59B-9.033(1)(d), F.A.C., ambulatory patient data files must be submitted using Ambulatory Patient Data XML Schema AS10-5, available at: http://ahca.myflorida.com/xmlschemas/AS10-5.xsd, The Ambulatory patient Data XML AS10-5 Schema (effective January 2023) is incorporated by reference at https://www.flrules.org/Gateway/reference.asp?No=Ref-15078. The data in the XML file shall contain the data elements, codes and standards required in Rules 59B-9.037 and 59B-9.038, F.A.C.

Notes

Fla. Admin. Code Ann. R. 59B-9.034

Rulemaking Authority 408.15(8) FS. Law Implemented 408.061, 408.062, 408.063 FS.

New 1-1-10, Formerly 59B-9.015, Amended 12-5-10, Amended by Florida Register Volume 41, Number 106, June 2, 2015 effective 10/1/2015, Amended by Florida Register Volume 43, Number 233, December 5, 2017 effective 1/1/2018, Amended by Florida Register Volume 49, Number 020, January 31, 2023 effective 2/16/2023.

New 1-1-10, Formerly 59B-9.015, Amended 12-5-10, 10-1-15, 1-1-18, 2-16-23.