| (145) Treatment, fracture or dislocation of lower extremity
(other than hip or femur) (requiring surgical or radiological procedures);
(146) Other fracture and dislocation procedure (requiring
surgical or radiological procedures);
(147) Arthroscopy;
(148) Division of joint capsule, ligament or cartilage;
(149) Excision of semilunar cartilage of knee;
(150) Arthroplasty knee;
(151) Hip replacement, total or partial;
(152) Arthroplasty other than hip or knee;
(153) Arthrocentesis;
(154) Injections and aspirations of muscles, tendons,
bursa, joints and soft tissue (requiring surgical or radiological
procedures);
(155) Amputation of lower extremity;
(156) Spinal fusion (requiring surgical or radiological
procedures);
(157) Other diagnostic procedures on musculoskeletal
system (requiring surgical or radiological procedures);
(158) Other therapeutic procedures on muscles and tendons
(requiring surgical or radiological procedures);
(159) Other operating room therapeutic procedures on
bone (requiring surgical or radiological procedures);
(160) Other operating room therapeutic procedures on
joints (requiring surgical or radiological procedures);
(161) Other non-operating room therapeutic procedures
on musculoskeletal system (requiring surgical or radiological procedures);
(162) Other operating room therapeutic procedures on
musculoskeletal system (requiring surgical or radiological procedures);
(163) Breast biopsy or other diagnostic procedures
on breast (requiring surgical or radiological procedures);
(164) Lumpectomy, quadrantectomy of breast;
(165) Mastectomy;
(166) Incision and drainage, skin and subcutaneous
tissue (requiring surgical or radiological procedures);
(167) Excision of skin lesion;
(168) Suture of skin or subcutaneous tissue;
(169) Skin graft;
(170) Other diagnostic procedures on skin or subcutaneous
tissue;
(171) Other non-operating room therapeutic procedures
on skin or breast (requiring surgical or radiological procedures);
(172) Other operating room therapeutic procedures on
skin or breast (requiring surgical or radiological procedures);
(173) Other organ transplantation;
(174) Computerized axial tomography (CT) scan head;
(175) Computerized axial tomography (CT) scan chest;
(176) Computerized axial tomography (CT) scan abdomen;
(177) Other Computerized axial tomography (CT) scan;
(178) Myelogram;
(179) Mammography;
(180) Routine chest X-ray;
(181) Intraoperative cholangiogram;
(182) Upper gastrointestinal X-ray;
(183) Lower gastrointestinal X-ray;
(184) Intravenous pyelogram;
(185) Cerebral arteriogram;
(186) Contrast aortogram;
(187) Contrast arteriogram of femoral or lower extremity
arteries;
(188) Arteriogram or venogram (not heart or head);
(189) Diagnostic ultrasound of head or neck;
(190) Diagnostic ultrasound of heart (echocardiogram);
(191) Diagnostic ultrasound of gastrointestinal tract;
(192) Diagnostic ultrasound of urinary tract;
(193) Diagnostic ultrasound of abdomen or retroperitoneum;
(194) Other diagnostic ultrasound;
(195) Magnetic resonance imaging;
(196) Electroencephalogram (EEG) (requiring surgical
or radiological procedures);
(197) Swan-Ganz catheterization for monitoring;
(198) Radioisotope bone scan;
(199) Radioisotope pulmonary scan;
(200) Radioisotope scan or function studies;
(201) Other radioisotope scan;
(202) Therapeutic Radiology;
(203) Traction, splints, or other wound care (requiring
surgical or radiological procedures);
(204) Ophthalmologic or otologic diagnosis and treatment
(requiring surgical or radiological procedures);
(205) Nasogastric tube (requiring radiological procedures);
(206) Blood transfusion;
(207) Parenteral nutrition (via intravenous methods);
(208) Cancer chemotherapy (requiring surgical or radiological
procedures);
(209) Conversion of Cardiovascular (Cardiac) rhythm;
(210) Other diagnostic radiology and related (requiring
surgical or radiological procedures);
(211) Other therapeutic procedures (requiring surgical
or radiological procedures);
(212) Infertility Services (requiring surgical or radiological
procedures);
(213) Medications (Infusions and other forms requiring
surgical or radiological procedures); and
(214) Gastric bypass and volume reduction (requiring
surgical or radiological procedures).
(h) For patients that are covered by 42 USC §290dd-2
and 42 CFR Part 2, the hospital shall submit the following patient
identifying information or default values in the specified record
and field locations as required by subsection (a) of this section:
(1) Patient Account Number - This alphanumeric patient
control number shall be reported. This number is unique to the institution
and episode of care and will be used by the health care facility to
review and certify data.
(2) Last Name--The patient's last name shall be removed
and replaced with "Doe."
(3) First Name--The patient's first name shall be removed
and replaced with "Jane" if female, or "John" if male, and can include
a sequential number (e.g., John1, John2, John3... etc.).
(4) Middle Initial--The patient's middle initial shall
be removed and left blank (space filled).
(5) Date of Birth--"January 1" and the patient's year
of birth shall be reported.
(6) Address--The patient's residence address shall
be removed and replaced with the health care facility's street address.
(7) City--The patient's city of residence shall be
removed and replaced with the hospital's city.
(8) State--The patient's state of residence shall be
reported.
(9) ZIP Code--The patient's ZIP code of residence shall
be removed and replaced with the health care facility's ZIP code.
(10) Medical Record Number--The patient's medical record
number shall be reported. This number is unique to the institution
and episode of care and will be used by DSHS to process the claim
data and for the health care facility to review and certify the patient's
data.
(11) Social Security Number--The Patient's Social Security
Number shall be removed and replaced with "999999999."
(12) Statement Dates--The month, day, and year of the
statement from and statement through dates shall be reported as required.
Only the year of service will be retained with record after transfer
to the DSHS program administering and completing the processing of
the data for the health care data collection system under Health and
Safety Code, Chapter 108.
|
| Source Note: The provisions of this §421.67 adopted to be effective August 29, 2004, 29 TexReg 8123; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective February 26, 2009, 33 TexReg 9694; amended to be effective October 31, 2011, 36 TexReg 5214; amended 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 |
