| (a) DSHS records are public records under Government
Code, Chapter 552, except as specifically exempted by Texas Health
and Safety Code, §§108.010, 108.011 and 108.013 or other
state or federal law. Copies of such records may be obtained upon
request and upon payment of user fees established by DSHS. Event claims
in any format as submitted to DSHS are not available to the public
and are exempt from disclosure pursuant to Texas Health and Safety
Code, §§108.010, 108.011 and 108.013, and shall not be released.
Likewise, patient and physician identifying data collected by the
DSHS through editing of facility data shall not be released.
(b) Creation of codes and identifiers. DSHS shall develop
the following codes and identifiers, as listed in paragraphs (1) -
(2) of this subsection, required for creation of the public use data
file and for other purposes.
(1) DSHS shall create a process for assigning uniform
patient identifiers, uniform physician identifiers and uniform other
health professional identifiers using data elements collected. This
process is confidential and not subject to public disclosure. Any
documents or records produced describing the process or disclosing
the person associated with an identifier are confidential and not
subject to public disclosure.
(2) DSHS shall create a process for assigning geographic
identifiers to each event record.
(c) The data elements specified for emergency visit
reports in this section do not constitute "Provider Quality Data"
as discussed in Texas Health and Safety Code, §108.010.
(d) Creation of public use data file. DSHS will create
a public use data file by creating a single record for each reportable
emergency visit and adding, modifying, or deleting data elements in
the following manner as listed in this subsection:
(1) delete patient and insured name, Social Security
number, address and certificate data elements, any patient identifying
information, and patient control and medical record numbers;
(2) convert patient birth date to age;
(3) convert procedure dates to a code for the day of
the week;
(4) convert occurrence dates to day values;
(5) delete physician and other health professional
names and numbers and assign an alphanumeric uniform physician identifier
for the physicians and other health professionals who were reported
as "Attending," or "operating or other" on patients;
(6) assign codes indicating the primary and secondary
sources of payment;
(7) suppress the record level data elements in a way
that the aggregate numbers for a facility or geographic region for
that data element is below the number five. Five is the established
minimum cell size required by Texas Health and Safety Code, §108.011(i),
unless DSHS determines that a higher cell size is required to protect
the confidentiality of an individual patient or physician;
(8) convert all procedure codes to HCPCS codes (in
the version that is current for the date the data was due to be submitted
or the version in effect at the date of service);
(9) add nationally accepted risk and severity adjustment
scores utilizing an algorithm approved by DSHS, when available and
applicable;
(10) include the following data elements in the public
use data file, unless the data element needs to be suppressed for
patient or physician confidentiality as noted under paragraph (7)
of this subsection:
(A) Event Year and Quarter;
(B) Provider Name (Facility Name);
(C) THCIC Identification Number;
(D) Facility Type Indicators;
(E) Patient Sex/Gender;
(F) Patient ZIP Code;
(G) County Code;
(H) Health Service Region Code;
(I) Patient State;
(J) Patient Race;
(K) Patient Ethnicity;
(L) Claim Type Indicator;
(M) Type of Bill;
(N) Principal Diagnosis Code (Current version of ICD
codes at the time data is submitted);
(O) Other Diagnosis Codes (Up to 24 diagnosis codes
can be submitted and reported. Current version of ICD codes at the
time data is submitted);
(P) Procedure codes (Up to 24 procedure codes can be
submitted and reported. Current version of HCPCS codes at the time
data is submitted);
(Q) Reason For Visit (Current version of ICD or HCPCS
codes at the time data is submitted);
(R) External Cause of Injury (E-codes), (if applicable)
(Current version of ICD codes at the time data is submitted. Up to
nine (9) E-codes can be submitted and reported);
(S) Related Cause Code, (if applicable) (Up to three
(3) codes can be submitted and reported);
(T) Day of Week Patient is provided services code (Sunday
= 1, Monday = 2, Tuesday = 3, Wednesday = 4, Thursday = 5, Friday
= 6, Saturday = 7);
(U) Age group of the patient;
(V) APG Code (Obtained from 3M™ APG Grouper)
if applicable (Up to 10);
(W) APG Category Code (Obtained from 3M™ APG
Grouper) if applicable (Up to 10);
(X) APG Type Code (Obtained from 3M™ APG Grouper)
if applicable (Up to 10);
(Y) Final APG Assignment Code (Obtained from 3M™
APG Grouper) if applicable (Up to 10);
(Z) Final APG Category Code (Obtained from 3M™
APG Grouper) if applicable (Up to 10);
(AA) APC Procedure Code (if applicable) (Up to 10);
(BB) APC Procedure Status Indicator Code (if applicable)
(Up to 10);
(CC) APC Diagnosis Edits (if applicable) (Up to 10);
(DD) APC Procedure Code Edits (if applicable) (Up to
10);
(EE) APC Weight (if applicable) (Up to 10);
(FF) APC Base Procedure (if applicable) (Up to 10);
(GG) Clinical Classification Software Category Codes
and associated codes, if applicable;
(HH) Uniform Physician Identifier assigned to Rendering
Physician or Rendering Other Health Professional;
(II) Uniform Physician Identifier assigned to Operating
Physician or Other Physician or Other Health Professional;
(JJ) Uniform Physician Identifier assigned to Other
Provider or Other Health Professional;
(KK) Ancillary Service--Other Charges;
(LL) Ancillary Service--Pharmacy Charges;
(MM) Ancillary Service--Medical/Surgical Supply Charges;
(NN) Ancillary Service--Durable Medical Equipment Charges;
(OO) Ancillary Service--Used Durable Medical Equipment
Charges;
(PP) Ancillary Service--Physical Therapy Charges;
(QQ) Ancillary Service--Occupational Therapy Charges;
(RR) Ancillary Service--Speech Pathology Charges;
(SS) Ancillary Service--Inhalation Therapy Charges;
(TT) Ancillary Service--Blood Charges;
(UU) Ancillary Service--Blood Administration Charges;
(VV) Ancillary Service--Operating Room Charges;
(WW) Ancillary Service--Lithotripsy Charges;
(XX) Ancillary Service--Cardiology Charges;
(YY) Ancillary Service--Anesthesia Charges;
(ZZ) Ancillary Service--Laboratory Charges;
(AAA) Ancillary Service--Radiology Charges;
(BBB) Ancillary Service--MRI Charges;
(CCC) Ancillary Service--Outpatient Services Charges;
(DDD) Ancillary Service--Emergency Service Charges;
(EEE) Ancillary Service--Ambulance Charges;
(FFF) Ancillary Service--Professional Fees Charges;
(GGG) Ancillary Service--Organ Acquisition Charges;
(HHH) Ancillary Service--ESRD Revenue Setting Charges;
(III) Ancillary Service--Clinic Visit Charges;
(JJJ) Total Charges--Ancillary;
(KKK) Total Non-Covered Ancillary Charges;
(LLL) Total Charges;
(MMM) Total Non-Covered Charges;
(NNN) Encounter Identifier--a unique number for each
encounter for the quarter;
(OOO) Service Line Revenue Code;
(PPP) Service Line Procedure Code;
(QQQ) HCPCS Procedure Code;
(RRR) HCPCS Procedure Modifiers (Up to 4 may be submitted
and reported);
(SSS) Service Line Charge Amount;
(TTT) Service Line Unit Code;
(UUU) Service Line Unit Count;
(VVV) Service Line Non-Covered Charge Amount; and
(WWW) Patient Country (when the address is not in the
United States of America and confidentiality can be maintained).
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| Source Note: The provisions of this §421.78 adopted to be effective December 18, 2014, 39 TexReg 7582; amended to be effective July 5, 2017, 42 TexReg 3373; amended to be effective January 30, 2019, 44 TexReg 429; amended to be effective June 17, 2020, 45 TexReg 4041 |
