12 Va. Admin. Code § 5-217-20 - [Effective7/16/2023]Reporting requirements for patient level data elements

Current through Register Vol.. 38, No. 17, April 11, 2022

Every inpatient hospital shall submit a complete filing of each patient level data element listed in the table in this section for each hospital inpatient, including a separate record for each infant, if applicable. Most of these data elements are currently collected from a Uniform Billing Form located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee. The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Uniform Billing Manual provides a detailed field description and any special instruction pertaining to that element. An asterisk (*) indicates when the required data element is either not on the billing form or in the Uniform Billing Manual. The instructions provided under that particular data element should then be followed. Inpatient hospitals that submit patient level data directly to the board or the nonprofit organization shall submit it in an electronic data format.

Data Element

1. Hospital identifier.*

Enter the six-digit Medicare provider number or a number assigned by the board or its designee.

* *

2. Attending physician identifier.

Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician assigned as the attending physician for an inpatient.

3. Other physician identifier.

Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician identified as the operating physician for the principal procedure reported.

4. Payor identifier.

5. Employer identifier.

6. Patient identifier.*

Enter the nine-digit social security number of the patient. If a social security number has not been assigned, leave blank. The nine-digit social security number is not required for patients under four years of age.

* *

7a. Patient sex.

7b. Race code.*

If an inpatient hospital collects information regarding the choices listed below, the appropriate one-digit code reflecting the race of the patient should be entered. If a hospital only collects information for categories 0, 1, or 2, then the appropriate code should be entered from those three selections.

0 = White

1 = Black

2 = Other

3 = Asian

4 = American Indian

5 = White Hispanic

6 = Black Hispanic

* *

7c. Date of birth.

7d. Street address, city or county, and zip code.

7e. Employment status code.

7f. Patient status (i.e., discharge).

Inpatient codes only.

7g. Birth weight (for infants)*

Enter the birth weight of newborns in grams.

* *

8a. Admission type.

8b. Admission source.

8c. Admission date.

8d. Admission hour.

8e. Admission diagnosis code.

9a. Discharge date.

Only enter date of discharge.

* *

10. Principal diagnosis code.

Enter secondary diagnoses (up to eight).

In addition, include diagnoses recorded in the comments section for DX6-DX9.

11. External cause of injury code (E-code).

Record all external cause of injury codes in secondary diagnoses position after recording all treated secondary diagnoses.

12. Co-morbid conditions existing but not treated.

13. Principal procedure code and date.

Enter other procedures and dates (up to five). In addition, include procedures recorded in the comments section for PX4-PX6.

14. Revenue code (up to 23).

Units of service (up to 23).

Units of service charges (up to 23).

15. Total charges (by revenue code category or by HCPCS code).

(R.C. Code 001 is for total charges. See page 47-1.)

Notes

12 Va. Admin. Code § 5-217-20
Former 12VAC25-40-20 derived from VR370-01-003 § 2.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-20, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; Amended, Virginia Register Volume 32, Issue 08, eff. 2/1/2016.

Statutory Authority: §§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

The following state regulations pages link to this page.



State regulations are updated quarterly; we currently have two versions available. Below is a comparison between our most recent version and the prior quarterly release. More comparison features will be added as we have more versions to compare.