Attachment D - sample inpatient record

Attachment D - sample inpatient record

07/08/2011 VER 7.0 MARYLAND HSCRC INPATIENT CONFIDENTIAL FILE
CONFIDENTIAL FILE LAYOUT (1216 CHARACTERS)

RECORD NO.
POSITION BYTES FIELD NAME
-------- ----- ----------
01-34 34 DISCHARGE KEY

01-06 6 PROVIDER NUMBER

07-17 11 MEDICAL RECORD NUMBER (STANDARDIZED)

18-19 2 ADMIT MONTH (MM)
20-21 2 ADMIT DATE (DD)
22-25 4 ADMIT YEAR (CCYY)

26-27 2 DISCHARGE MONTH (MM)
28-29 2 DISCHARGE DATE (DD)
30-33 4 DISCHARGE YEAR (CCYY)

34-34 1 RECORD TYPE 1

35-36 2 ADMIT HOUR

37-37 1 NATURE OF ADMISSION 1=DELIVERY
2=NEWBORN
3=EMERGENCY
4=URGENT
5=SCHEDULED
6=OTHER
8=REHABILITATION
9=UNKNOWN
0=CHRONIC

38-39 2 SOURCE OF ADMISSION
00=TRANSFERRED FROM ON-SITE ACUTE CARE UNIT TO REHAB UNIT
01=TRANSFERRED FOR ANOTHER HOSPITAL TO A SPECIALTY CENTER
02=TRANSFERRED FROM ANOTHER HOSPITAL FOR ANY OTHER REASON
03=TRANSFERRED FROM A NURSING HOME
04=TRANSFERRED FROM ANY OTHER INSTITUTION
05=ADMITTED FROM HOME
06=TRANSFERRED FROM LITHOTRIPSY FACILITY
07=TRANSFERRED FROM ON-SITE AMBULATORY OUTPATIENT SURGERY UNIT
08=TRANSFERRED FROM OFF-SITE AMBULATORY OUTPATIENT UNIT
09=UNKNOWN
10=NEWBORN
11=TRANS FROM ONSITE ACUTE CARE UNIT TO PSYCHE UNIT
12=ADMITTED FROM ON-SITE SUB-ACUTE FACILITY
13=ADMITTED FROM OTHER SUB-ACUTE FACILITY
20=Trans from on-site acute care unit to on-site rehabilitation unit
21=Trans from on-site rehabilitation unit to acute care unit
22=Trans from on-site rehabilitation unit to chronic unit
23=Trans from chronic unit to on-site rehabilitation unit
24=Trans from on-site acute care unit to chronic unit
25=Trans from on-site chronic unit to acute care unit
26=Trans from on-site acute care to on-site psychiatric unit
27=Trans from on-site psychiatric unit to acute care unit
28=Trans from on-site sub-acute unit to acute care unit
29=Admit within 72 hours from on-site ambulatory surgery unit with surgery
30=Newborn (patient born in hospital)
40=Admit from another acute general hospital to MIEMS-designated facility
41=Admit from another acute care hospital inpatient service for any reason
42=Admit from from rehab. hospital or unit of another acute care hospital
43=Admit from private psych. hospital or unit of another acute care hospital
44=Admit from a chronic hospital
45=Admit from other facility at which subacute services were provided
46=Admit within 72 hours from off-site amb. surg. / care of another facility
47=Admit from any other health institution (domiciliary, mental, halfway)
60=Admit from home, physician's office, noninstitutional source
61=Admit from a nursing home
99=Unknown

40-40 1 ADMIT FROM EMERGENCY ROOM 1=ADMITTED FROM
EMERGENCY ROOM
7=NOT APPLICABLE
9=UNKNOWN
41-42 2 BIRTHDATE MONTH (MM)
43-44 2 BIRTHDATE DAY (DD)
45-48 4 BIRTHDATE YEAR (CCYY)

49-49 1 SEX 1=MALE
2=FEMALE
9=UNKNOWN

50-50 1 RACE 1=WHITE
2=AFRICAN AMERICAN
3=ASIAN OR PACIFIC
ISLANDER
4=AMERICAN INDIAN/
ESKIMO/ALEUT
5=OTHER
6=BI-RACIAL
9=UNKNOWN

51-51 1 ETHNICITY 1=SPANISH/HISPANIC
ORIGIN
2=NOT SPANISH/HISPANIC
ORIGIN
9=UNKNOWN

52-52 1 MARTIAL STATUS 1=SINGLE
2=MARRIED
3=SEPARATED
4=DIVORCED
5=WIDOW/WIDOWER
9=UNKNOWN

53-54 2 AREA OF RESIDENCE COUNTY CODE
01=ALLEGANY
02=ANNE ARUNDEL
03=BALTIMORE COUNTY
04=CALVERT
05=CAROLINE
06=CARROLL
07=CECIL
08=CHARLES
09=DORCHESTER
10=FREDERICK
11=GARRETT
12=HARFORD
13=HOWARD
14=KENT
15=MONTGOMERY
16=PRINCE GEORGE'S
17=QUEEN ANNE'S
18=ST. MARY'S
19=SOMERSET
20=TALBOT
21=WASHINGTON
22=WICOMICO
23=WORCESTER
29=UNIDENTIFIED
MARYLAND
30=BALTIMORE CITY
(INDEPENDENT CITY)
39=DELAWARE
49=PENNSYLVANIA
59=WEST VIRGINIA
69=VIRGINIA
79=DISTRICT OF COLUMBIA
89=FOREIGN
98=OTHER STATES
99=UNIDENTIFIED

55-59 5 RESIDENCE ZIP CODE XXXXX ZIP CODE
77777 FOREIGN
99999 UNKNOWN

60-61 2 PRINCIPAL PAYER SOURCE
01=AETNA HEALTH PLANS
02=CAPITOLCARE (B/C-NCA)
03=CFS HEALTH GROUP
04=CHESAPEAKE HEALTH PLAN
05=CIGNA HEALTHCARE MID-ATL
06=COLUMBIA MEDICAL PLAN
07=DELMARVA HEALTH PLAN
08=HUMANA GROUP HEALTH PLAN
09=GWU HEALTH PLAN
10=HEALTHPLUS
11=KAISER PERMANENTE
12=MAMSI
13=TOTAL HEALTH CARE
14=U.S.HEALTHCARE
15=PRUDENTIAL HEALTH CARE
16=PRINCIPAL HEALTH CARE
17=PREFERRED HEALTH NETWORK
18=PHYSICIANS HEALTH PLAN
19=PRINCIPAL HEALTH DELAWARE
20=MARYLAND PHYSICIANS CARE
21=HELIX FAMILY HEALTH
22=JAI MEDICAL
23=PRIORITY PARTNERS
24=UNITED HEALTHCARE
25=NEW AMERICAN HEALTH
26=PRIME HEALTH
27=AMERICAID
29=OTHER HMO
00=Not Applicable
30=Aetna Health Plans
31=CareFirst (i.e., Blue Choice)
32=Cigna Healthcare of Mid-Atlantic
33=Coventry Health Plan of Delaware
34=Kaiser Permanente
35=MAMSI
36=United Healthcare
37=Other HMO/POS
42=Amerigroup
43=Coventry Health Plan of Delaware (Diamond Plan)
44=Helix Family Health
45=JAI Medical Group
46=Medicaid/Uninsured APS - Maryland (psychiatric payer)
47=Maryland Physicians Care
48=Priority Partners
49=United Healthcare (Americhoice)
50=Other Medicaid MCO/HMO
55=Aetna (Golden Choice)
56=ElderHealth
57=United Healthcare (Evercare)
58=Other Medicare HMO
65=Aetna
66=CareFirst - CFMI (Maryland) (PPO, POS, Blue Preferred, FEP)
67=CareFirst - GHMSI (DC) (PPO, POS, Blue Preferred, FEP)
68=CCN/First Health
69=Cigna
70=Employer Health Plan (EHP)
71=Fidelity Benefits Administrator
72=Great West One Plan
73=Kaiser Permanente
74=MAMSI (i.e., Alliance PPO and MAMSI Life and Health)
75=National Capital PPO (NCPPO)
76=Private Health Care Systems
77=Other Commercial, PPO, PPN, TPA
85=American Psychiatric Systems (APS)
86=Cigna Behavioral Health
87=ComPsych
88=Magellan
89=Managed Health Network
90=United Behavioral Health
91=Value Options
92=Other Behavioral Health
93=MD Health Insurance Plan (MHIP) EPO
94=MD Health Insurance Plan (MHIP) PPO
95=Tricare - examples: Health Net
96=Uniformed Services Family Health Plan (USFHP)
97=Other Miscellaneous Government Programs
99=Invalid

62-63 2 SECONDARY PAYER SOURCE
01=AETNA HEALTH PLANS
02=CAPITOLCARE (B/C-NCA)
03=CFS HEALTH GROUP
04=CHESAPEAKE HEALTH PLAN
05=CIGNA HEALTHCARE MID-ATL
06=COLUMBIA MEDICAL PLAN
07=DELMARVA HEALTH PLAN
08=HUMANA GROUP HEALTH PLAN
09=GWU HEALTH PLAN
10=HEALTHPLUS
11=KAISER PERMANENTE
12=MAMSI
13=TOTAL HEALTH CARE
14=U.S.HEALTHCARE
15=PRUDENTIAL HEALTH CARE
16=PRINCIPAL HEALTH CARE
17=PREFERRED HEALTH NETWORK
18=PHYSICIANS HEALTH PLAN
19=PRINCIPAL HEALTH DELAWARE
20=MARYLAND PHYSICIANS CARE
21=HELIX FAMILY HEALTH
22=JAI MEDICAL
23=PRIORITY PARTNERS
24=UNITED HEALTHCARE
25=NEW AMERICAN HEALTH
26=PRIME HEALTH
27=AMERICAID
29=OTHER HMO
00=Not Applicable
30=Aetna Health Plans
31=CareFirst (i.e., Blue Choice)
32=Cigna Healthcare of Mid-Atlantic
33=Coventry Health Plan of Delaware
34=Kaiser Permanente
35=MAMSI
36=United Healthcare
37=Other HMO/POS
42=Amerigroup
43=Coventry Health Plan of Delaware (Diamond Plan)
44=Helix Family Health
45=JAI Medical Group
46=Medicaid/Uninsured APS - Maryland (psychiatric payer)
47=Maryland Physicians Care
48=Priority Partners
49=United Healthcare (Americhoice)
50=Other Medicaid MCO/HMO
55=Aetna (Golden Choice)
56=ElderHealth
57=United Healthcare (Evercare)
58=Other Medicare HMO
65=Aetna
66=CareFirst - CFMI (Maryland) (PPO, POS, Blue Preferred, FEP)
67=CareFirst - GHMSI (DC) (PPO, POS, Blue Preferred, FEP)
68=CCN/First Health
69=Cigna
70=Employer Health Plan (EHP)
71=Fidelity Benefits Administrator
72=Great West One Plan
73=Kaiser Permanente
74=MAMSI (i.e., Alliance PPO and MAMSI Life and Health)
75=National Capital PPO (NCPPO)
76=Private Health Care Systems
77=Other Commercial, PPO, PPN, TPA
85=American Psychiatric Systems (APS)
86=Cigna Behavioral Health
87=ComPsych
88=Magellan
89=Managed Health Network
90=United Behavioral Health
91=Value Options
92=Other Behavioral Health
93=MD Health Insurance Plan (MHIP) EPO
94=MD Health Insurance Plan (MHIP) PPO
95=Tricare - examples: Health Net
96=Uniformed Services Family Health Plan (USFHP)
97=Other Miscellaneous Government Programs
99=Invalid

64-69 6 CENSUS TRACT

70-71 2 DISPOSITION OF PATIENT
01=HOME OR SELF CARE
02=DO NOT USE
03=HOME HEALTH CARE
04=DO NOT USE
05=ACUTE CARE GEN HOSP
06=OTHER HEALTH CARE FACILITY
07=DIED
08=LEFT AGAINST MEDICAL ADVICE
09=UNKNOWN
10=REHAB FACILITY
11=REHAB UNIT OF HOSP
12=ON-SITE DISTINCT REHAB UNIT
13=TRANS TO NURSING FAC
14=DISCHARGE TO ONSITE PSYCHE
15=DISCHARGE TO ONSITE SUB-ACUTE
16=DISCHARGE TO OTHER SUB-ACUTE FACILITY
20 To distinct on-site rehabilitation unit from acute care
21 To acute care unit from on-site rehabilitation unit
22 To chronic unit from on-site rehabilitation unit
23 To on-site rehabilitation unit from chronic care unit
24 To chronic unit from acute care unit
25 To acute care unit from chronic care unit
26 To on-site psychiatric unit from acute care unit
27 To acute care unit from on-site psychiatric unit
28 To on-site subacute
29 To on-site hospice
40 To another acute care hospital
41 To a rehabilitation hospital or rehab. unit of another hospital
42 To a psychiatric hospital or an off-site psych. unit of another hospital
43 To a chronic hospital
44 To a nursing facility
45 To a subacute facility
46 To other health care facility
60 To home or self-care
61 To home under the care of a home health agency
62 To nursing home
70 Expired
71 Left against medical advice
99 Unknown

72-74 3 ALTERNATIVE RATE METHOD ARM CODE

75-76 2 SOURCE OF PAYMENT EXPECTED PAYOR FOR MOST
OF THIS BILL
01=MEDICARE
02=MEDICAID
03=TITLE V
04=BLUE CROSS OF MD
05=COMMERCIAL
INSURANCE
06=OTHER GOVERNMENT
PROGRAM
07=WORKMEN'S
COMPENSATION
08=SELF PAY
09=CHARITY
10=OTHER
11=DONOR
12=HMO
13=MEDICAID (STATE ONLY)
14=MEDICAID HMO
15=MEDICARE HMO
16=BLUE CROSS (NCA)
17=BLUE CROSS OTHER
99=UNKNOWN

77-78 2 SECONDARY SOURCE OF PAYMENT SECONDARY PAYOR
01=MEDICARE
02=MEDICAID
03=TITLE V
04=BLUE CROSS OF MD
05=COMMERCIAL INSURANCE
06=OTHER GOVERNMENT
PROGRAM
07=WORKMEN'S
COMPENSATION
08=SELF PAY
09=CHARITY
10=OTHER
11=DONOR
12=HMO
13=MEDICAID (STATE
ONLY)
14=MEDICAID HMO
15=MEDICARE HMO
16=BLUE CROSS (NCA)
17=BLUE CROSS OTHER
77=NOT APPLICABLE
99=UNKNOWN

79-84 6 ATTENDING PHYSICIAN XXXXXX PHYSICIAN NUMBER
999999 UNKNOWN

85-90 6 OPERATING PHYSICIAN XXXXXX PHYSICIAN NUMBER
777777 NOT APPLICABLE
999999 UNKNOWN

91-92 2 MAJOR SERVICE 01,B1=MEDICINE
02,B2=SURGERY
03,B3=OBSTETRICS
04,B4=NEWBORN
05,B5=PEDIATRIC
06,B6=PSYCHIATRIC
07,B7=OTHER
08,B8=REHABILITATION
09,B9,99=UNKNOWN B=SPACE
10=CHRONIC

93-94 2 TYPE OF DAILY SERVICE 01=ALL OTHER
02=SHOCK TRAUMA
03=ONCOLOGY
04=SKILLED NURSING CARE
05=INTERMEDIATE
(CHRONIC) CARE
06=NEO-NATAL INTENSIVE
CARE
07=BURN CARE
08=REHAB
09=CHRONIC

95-97 3 NON-PSYCHIATRIC DAYS 001-776 NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

98-100 3 PSYCHIATRIC DAYS 001-776 NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

101-101 1 READMISSION 1=YES
2=NO

102-104 3 MEDICAL/SURGICAL ICU DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

105-107 3 CORONARY CARE DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

108-110 3 BURN CARE DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

111-113 3 NEO-NATAL ICU DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

114-116 3 PEDIATRIC ICU DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

117-119 3 SHOCK TRAUMA DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

120-122 3 OTHER CARE DAYS XXX=NUMBER OF DAYS
777=NOT APPLICABLE
999=UNKNOWN

123-126 4 NEWBORN BIRTH WEIGHT XXXX=ACTUAL WEIGHT AT
BIRTH IN GRAMS
7777=PATIENT NOT A
NEWBORN
9999=UNKNOWN

127-128 2 UMD-SERVICE

129-129 1 FILLER

130-136 7 PRINCIPAL DIAGNOSIS

137-143 7 OTHER DIAGNOSIS1
144-150 7 OTHER DIAGNOSIS2
151-157 7 OTHER DIAGNOSIS3
158-164 7 OTHER DIAGNOSIS4
165-171 7 OTHER DIAGNOSIS5
172-178 7 OTHER DIAGNOSIS6
179-185 7 OTHER DIAGNOSIS7
186-192 7 OTHER DIAGNOSIS8
193-199 7 OTHER DIAGNOSIS9
200-206 7 OTHER DIAGNOSIS10
207-213 7 OTHER DIAGNOSIS11
214-220 7 OTHER DIAGNOSIS12
221-227 7 OTHER DIAGNOSIS13
228-234 7 OTHER DIAGNOSIS14

235-241 7 E-CODE XXXXXXX=ICD9-CM CODE
BBBBBBB=NOT APPLICABLE
bbbbbbb=SPACES
242-242 1 RESERVE FLAG

243-250 8 AMBULANCE RUN NUMBER (THRU 06/2011 ONLY)

251-257 7 PRINCIPAL PROCEDURE XXXXXXX=ICD9-CM CODE
BBBBBBB=NOT APPLICABLE
bbbbbbb=SPACES

258-265 8 PRINCIPAL PROCEDURE DATE 01-12=MONTH
77=NOT APPLICABLE
99=UNKNOWN
01-31=DAY
77=NOT APPLICABLE
99=UNKNOWN
XXXX=YEAR
7777=NOT APPLICABLE
9999=UNKNOWN

266-272 7 OTHER PROCEDURE 2 XXXXXXX=ICD9-CM CODE
BBBBBBB=NOT APPLICABLE
bbbbbbb=SPACES

273-280 8 OTHER PROCEDURE DATE 2 01-12=MONTH
77=NOT APPLICABLE
99=UNKNOWN
01-31=DAY
77=NOT APPLICABLE
99=UNKNOWN
XXXX=YEAR
7777=NOT APPLICABLE
9999=UNKNOWN

281-287 7 OTHER PROCEDURE 3 SAME AS OTHER
PROCEDURE 1

288-295 8 OTHER PROCEDURE DATE 3 SAME AS OTHER
PROCEDURE DATE 1

296-302 7 OTHER PROCEDURE 4 SAME AS OTHER
PROCEDURE 1

303-310 8 OTHER PROCEDURE DATE 4 SAME AS OTHER
PROCEDURE DATE 1

311-317 7 OTHER PROCEDURE 5 SAME AS OTHER
PROCEDURE 1

318-325 8 OTHER PROCEDURE DATE 5 SAME AS OTHER
PROCEDURE DATE 1

326-332 7 OTHER PROCEDURE 6 SAME AS OTHER
PROCEDURE 1

333-340 8 OTHER PROCEDURE DATE 6 SAME AS OTHER
PROCEDURE DATE 1

341-347 7 OTHER PROCEDURE 7 SAME AS OTHER
PROCEDURE 1

348-355 8 OTHER PROCEDURE DATE 7 SAME AS OTHER
PROCEDURE DATE 1

356-362 7 OTHER PROCEDURE 8 SAME AS OTHER
PROCEDURE 1

363-370 8 OTHER PROCEDURE DATE 8 SAME AS OTHER
PROCEDURE DATE 1

371-377 7 OTHER PROCEDURE 9 SAME AS OTHER
PROCEDURE 1

378-385 8 OTHER PROCEDURE DATE 9 SAME AS OTHER
PROCEDURE DATE 1

386-392 7 OTHER PROCEDURE 10 SAME AS OTHER
PROCEDURE 1

393-400 8 OTHER PROCEDURE DATE 10 SAME AS OTHER
PROCEDURE DATE 1

401-407 7 OTHER PROCEDURE 11 SAME AS OTHER
PROCEDURE 1

408-415 8 OTHER PROCEDURE DATE 11 SAME AS OTHER
PROCEDURE DATE 1

416-422 7 OTHER PROCEDURE 12 SAME AS OTHER
PROCEDURE 1

423-429 7 OTHER PROCEDURE 13 SAME AS OTHER
PROCEDURE 1

430-436 7 OTHER PROCEDURE 14 SAME AS OTHER
PROCEDURE 1

437-443 7 OTHER PROCEDURE 15 SAME AS OTHER

444-444 1 REHABILITATION ADMISSION CLASS
1=INITIAL REHABILITATION
2=EVALUATION
3=READMISSION
4=UNPLANNED DISCHARGE
5=CONTINUING REHABILITATION

445-451 7 REHABILITATION IMPAIRMENT GROUP CODE

452-457 6 PROVIDER SPECIFIC ADMIT CODE
458-463 6 PROVIDER SPECIFIC DISCHARGE CODE

464-466 3 FILLER
467-468 2 CMS MDC CODE
469-471 3 CMS DRG CODE
472-500 29 FILLER

501-501 1 POA FOR PRIMARY DIAGNOSIS
N Diagnosis Not Present on Admission
U Diagnosis Insufficient Documentation to Determine
W Diagnosis Unable to Clinically Determine
E Diagnosis Exempt from Reporting
502-502 1 POA FOR OTHER DIAGNOSIS1
503-503 1 POA FOR OTHER DIAGNOSIS2
504-504 1 POA FOR OTHER DIAGNOSIS3
505-505 1 POA FOR OTHER DIAGNOSIS4
506-506 1 POA FOR OTHER DIAGNOSIS5
507-507 1 POA FOR OTHER DIAGNOSIS6
508-508 1 POA FOR OTHER DIAGNOSIS7
509-509 1 POA FOR OTHER DIAGNOSIS8
510-510 1 POA FOR OTHER DIAGNOSIS9
511-511 1 POA FOR OTHER DIAGNOSIS10
512-512 1 POA FOR OTHER DIAGNOSIS11
513-513 1 POA FOR OTHER DIAGNOSIS12
514-514 1 POA FOR OTHER DIAGNOSIS13
515-515 1 POA FOR OTHER DIAGNOSIS14

516-516 1 FILLER
517-517 1 ATTENDING PHYSICIAN FLAG 0=VALID PHYSICIAN
NUMBER
1=INVALID PHYSICIAN
NUMBER
518-523 6 ATTENDING PHYSICIAN GHOST NUMBER

524-524 1 OPERATING PHYSICIAN FLAG 0=VALID PHYSICIAN
NUMBER
1=INVALID PHYSICIAN
NUMBER
525-530 6 OPERATING PHYSICIAN GHOST NUMBER

531-533 3 AGE IN YEARS
534-538 5 AGE IN DAYS (IF AGE IN YEARS = 000)

539-541 3 LENGTH OF STAY

542-542 1 FILLER

543-543 1 METROPOLITAN CODE 0=NOT METROPOLITAN
1=BALTIMORE
METROPOLITAN
2=WASHINGTON
METROPOLITAN

544-544 1 TEACHING HOSPITAL CODE 0=NOT TEACHING
1=TEACHING

545-545 1 BED CAPACITY (HOSPITAL BED SIZE) 0=NOT OVER 400 BEDS
1=OVER 400 BEDS

546-546 1 PSRO AREA 1=WESTERN MARYLAND
2=BALTIMORE CITY
3=MONTGOMERY
4=PRINCE GEORGES
5=CENTRAL MARYLAND
6=SOUTHERN MARYLAND
7=DELMARVA

547-547 1 HSA (HEALTH STATIC AREA 1=CENTRAL MARYLAND
GROUPED BY COUNTY) 2=EASTERN SHORE
3=SOUTHERN MARYLAND
4=WESTERN MARYLAND
5=MONTGOMERY COUNTY

548-548 1 ICG CODE
549-549 1 ADMIT DAY OF WEEK
550-550 1 DISCHARGE DAY OF WEEK

551-553 3 PREOP TIME FOR PRIMARY PROCEDURE
554-556 3 OTHER PREOP TIME 1
557-559 3 OTHER PREOP TIME 2
560-562 3 OTHER PREOP TIME 3
563-565 3 OTHER PREOP TIME 4
566-568 3 OTHER PREOP TIME 5
569-571 3 OTHER PREOP TIME 6
572-574 3 OTHER PREOP TIME 7
575-577 3 OTHER PREOP TIME 8
578-580 3 OTHER PREOP TIME 9
581-583 3 OTHER PREOP TIME 10

584-584 1 CLASS FOR PRIMARY PROCEDURE
585-585 1 CLASS FOR 1ST SECONDARY PROCEDURE
586-586 1 CLASS FOR 2ND SECONDARY PROCEDURE
587-587 1 CLASS FOR 3RD SECONDARY PROCEDURE
588-588 1 CLASS FOR 4TH SECONDARY PROCEDURE
589-589 1 CLASS FOR 5TH SECONDARY PROCEDURE
590-590 1 CLASS FOR 6TH SECONDARY PROCEDURE
591-591 1 CLASS FOR 7TH SECONDARY PROCEDURE
592-592 1 CLASS FOR 8TH SECONDARY PROCEDURE
593-593 1 CLASS FOR 9TH SECONDARY PROCEDURE
594-594 1 CLASS FOR 10TH SECONDARY PROCEDURE
595-595 1 CLASS FOR 11TH SECONDARY PROCEDURE
596-596 1 CLASS FOR 12TH SECONDARY PROCEDURE
597-597 1 CLASS FOR 13TH SECONDARY PROCEDURE
598-598 1 CLASS FOR 14TH SECONDARY PROCEDURE
599-607 9 DAILY ROOM & BED CHARGES IMPLIED DECIMAL POINT ON
608-616 9 OPERATING ROOM CHARGES ALL CHARGES 9999999V99
617-625 9 DRUGS CHARGES
626-634 9 RADIOLOGY CHARGES
635-643 9 LABORATORY CHARGES
644-652 9 SUPPLIES CHARGES
653-661 9 THERAPY CHARGES
662-670 9 OTHER CHARGES
671-679 9 TOTAL CHARGES

680-682 3 FILLER

683-691 9 IP Med/Surg Acute CHARGES
692-700 9 Coronary Care CHARGES
701-709 9 ICU CHARGES
710-718 9 Nursery CHARGES
719-727 9 Oncology CHARGES
728-736 9 SNF CHARGES
737-745 9 Psychiatric CHARGES
746-754 9 OR CHARGES
755-763 9 Drugs CHARGES
764-772 9 Radiology Diagnostic CHARGES
773-781 9 Radiation Therapy CHARGES
782-790 9 Nuclear Medicine CHARGES
791-799 9 CT CHARGES
800-808 9 MRI CHARGES
809-817 9 IVC CHARGES
818-826 9 Lab CHARGES
827-835 9 Supplies CHARGES
836-844 9 Respiratory Therapy CHARGES
845-853 9 PT CHARGES
854-862 9 OT CHARGES
863-871 9 Speech/Audiology CHARGES
872-880 9 Pulmonary Function CHARGES
881-889 9 Anesthesia CHARGES
890-898 9 Not Used
899-907 9 Emergency Room CHARGES
908-916 9 Clinic CHARGES
917-925 9 Freestanding Clinic CHARGES
926-934 9 Labor & Delivery CHARGES
935-943 9 EKG CHARGES
944-952 9 EEG CHARGES
953-961 9 OTHER CHARGES
962-970 9 TOTAL CHARGES

971-1000 30 FILLER

1001-1007 7 OTHER DIAGNOSIS15
1008-1014 7 OTHER DIAGNOSIS16
1015-1021 7 OTHER DIAGNOSIS17
1022-1028 7 OTHER DIAGNOSIS18
1029-1035 7 OTHER DIAGNOSIS19
1036-1042 7 OTHER DIAGNOSIS20
1043-1049 7 OTHER DIAGNOSIS21
1050-1056 7 OTHER DIAGNOSIS22
1057-1063 7 OTHER DIAGNOSIS23
1064-1070 7 OTHER DIAGNOSIS24
1071-1077 7 OTHER DIAGNOSIS25
1078-1084 7 OTHER DIAGNOSIS26
1085-1091 7 OTHER DIAGNOSIS27
1092-1098 7 OTHER DIAGNOSIS28
1099-1105 7 OTHER DIAGNOSIS29

1106-1106 1 POA FOR OTHER DIAGNOSIS 15
N Diagnosis Not Present on Admission
U Diagnosis Insufficient Documentation to Determine
W Diagnosis Unable to Clinically Determine
E Diagnosis Exempt from Reporting
1107-1107 1 POA FOR OTHER DIAGNOSIS 16
1108-1108 1 POA FOR OTHER DIAGNOSIS 17
1109-1109 1 POA FOR OTHER DIAGNOSIS 18
1110-1110 1 POA FOR OTHER DIAGNOSIS 19
1111-1111 1 POA FOR OTHER DIAGNOSIS 20
1112-1112 1 POA FOR OTHER DIAGNOSIS 21
1113-1113 1 POA FOR OTHER DIAGNOSIS 22
1114-1114 1 POA FOR OTHER DIAGNOSIS 23
1115-1115 1 POA FOR OTHER DIAGNOSIS 24
1116-1116 1 POA FOR OTHER DIAGNOSIS 25
1117-1117 1 POA FOR OTHER DIAGNOSIS 26
1118-1118 1 POA FOR OTHER DIAGNOSIS 27
1119-1119 1 POA FOR OTHER DIAGNOSIS 28
1120-1120 1 POA FOR OTHER DIAGNOSIS 29

1121-1130 10 ATTENDING PHYSICIAN NPI NUMBER (07/2009+)
1131-1140 10 OPERATING PHYSICIAN NPI NUMBER (07/2009+)

1141-1151 11 MEDICAID ID NUMBER (07/2011+)
1152-1169 18 PATIENT ACCOUNT NUMBER (07/2011+)
1170-1180 11 MAIS AMBULANCE RUNSHEET NUMBER (07/2011+)

1170-1216 47 FILLER