Ambulatory Surgery Center Patient Record Form Changes 2015

Attachment O

Changes to 2015 Ambulatory Surgery Patient Record Form (PRF)

Proposed changes are indicated in RED; variable names are in [ ].

• Removed Operating room [ORIN_TIME/ORIN_DATE, OROUT_TIME/OROUT_DATE] and post-operative care entry and exit times [POIN_TIME/POIN_DATE, POUT_TIME/POUT_DATE]

• Modified-Checkbox list of patient’s underlying chronic conditions [OTH_DIAG]

Does patient have any of the following conditions? (NOTE: These conditions could impact this surgery or procedure)
Enter all that apply, separate with commas.
Old	New
Airway problem	Airway problem
Asthma	Asthma
Cardiac surgery history	Cardiac surgery history
Cerebrovascular disease/ stroke (CVA) or transient ischemic attack (TIA)	Cerebrovascular disease/history of stroke (CVA) or transient ischemic attack (TIA)
Chronic kidney disease (CKD)	Chronic kidney disease (CKD)
Chronic obstructive pulmonary disease (COPD)	Chronic obstructive pulmonary disease (COPD)
Congestive heart failure (CHF)	Congestive heart failure (CHF)
Coronary artery disease (CAD), ischemic heart disease (IHD) or history of myocardial infarction (MI)	Coronary artery disease (CAD), ischemic heart disease (IHD) or history of myocardial infarction (MI)
Diabetes mellitus (DM), Type I	Diabetes mellitus (DM), Type I
Diabetes mellitus (DM), Type II	Diabetes mellitus (DM), Type II
Diabetes mellitus (DM), Type unspecified	Diabetes mellitus (DM), Type unspecified
End-stage renal disease (ESRD)	End-stage renal disease (ESRD)
Hypertension	Hypertension
Obesity	Obesity
Obstructive sleep apnea (OSA)	Obstructive sleep apnea (OSA)
None of the above	None of the above

• Add CPT codes [CPTCODE]

Old: No CPT codes were collected

New: Allow up to 7 CPT codes (optional)

• Add optional ICD-9 CM procedure codes [ICD9CM]

Old: No ICD-9 CM procedure codes were collected

New: Allow up to 7 ICD-9 CM procedure codes (optional)

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