| (37) Outpatient or patient--For the purposes of this
subchapter, a patient who receives surgical or radiological services
from an ambulatory surgical center, or a patient who receives surgical
or radiological services from a hospital and is not admitted to a
hospital for inpatient services. Outpatients include patients who
receive one or more services covered by the revenue codes or surgical
and radiological categories that are specified in §421.67(f)
or §421.67(g) of this title, which may occur in the emergency
department, ambulatory care, radiological, imaging or other types
of hospital units. Outpatient includes a patient who is transferred
from an ambulatory surgical center to another facility or a hospital
patient who is under observation and not admitted to the hospital.
(38) Patient account number--A number assigned to each
patient by the facility which appears on each computer record in a
patient event claim. This number is not consistent for a given patient
from one facility to the next, or from one admission to the next in
the same facility. DSHS will delete or encrypt this number to protect
patient confidentiality prior to release of data.
(39) Physician--An individual licensed under the laws
of this state to practice medicine under the Medical Practice Act,
Occupations Code, Chapter 151 et seq.
(40) Provider--For the purposes of this subchapter,
a physician or facility.
(41) Public use data file--For the purposes of this
subchapter, a data file composed of event claims which have been altered
by the deletion, encryption or other modification of data fields to
protect patient and physician confidentiality and to satisfy other
restrictions on the release of data imposed by statute.
(42) Race--A division of patients according to traits
that are transmissible by descent and sufficient to characterize them
as distinctly human types. Facilities shall report this data element
according to the following racial types: American Indian, Eskimo,
or Aleut; Asian or Pacific Islander; Black; White; or Other.
(43) Radiological procedures--For the purposes of this
subchapter, diagnostic procedures performed on a patient using radiant
energy devices (Projection Radiology (for example - X-ray), Computed
Tomography, or other ionizing radiation) or diagnostic radioactive
material or other non-ionizing imaging devices (e.g., Magnetic Resonance
Imaging, Nuclear Medicine devices (for example Positron Emission Tomography),
Sound Imaging devices (for example Ultrasound or Echocardiography),
Thermal imaging devices, Diagnostic Light imaging devices (for example
- diagnostic photography, endoscopy, and fundoscopy) and other diagnostic
imaging devices.
(44) Rendering provider or rendering other health professional--For
the purposes of reporting on the modified ANSI 837 Professional Guide,
the physician or other health professional who performed the surgical
or radiological procedure on the patient for the event. In the case
where a substitute provider (locum tenans) is used, that physician
or other health professional shall be submitted as specified in this
subchapter. For purposes of this definition, the term "provider" is
not limited to only a physician or facility as defined in paragraphs
(26), (36), and (40) of this subsection.
(45) Required minimum data set--The list of data elements
for which facilities may submit an event claim for each patient event
occurring in the facility. The required minimum data sets are specified
in §421.67(d) and (e) of this title. This list does not include
all the data elements that are required by the modified ANSI 837 Institutional
Guide or modified ANSI 837 Professional Guide to submit an acceptable
event file. For example: Interchange Control Headers and Trailers,
Functional Group Headers and Trailers, Transaction Set Headers and
Trailers and Qualifying Codes (which identify or qualify subsequent
data elements).
(46) Research data file--A customized data file, which
may include the data elements in the public use file and may include
data elements other than the required minimum data set submitted to
DSHS, except those data elements that could reasonably identify a
patient or physician.
(47) Submission--The transfer of a set of computer
records as specified in §421.67 of this title that constitutes
the event file for one or more reporting hospitals under this subchapter.
(48) Submitter--The person or organization which physically
prepares an event file for one or more facilities and submits them
under this subchapter. A submitter may be a facility or an agent designated
by a facility or its owner.
(49) Surgical procedure--For the purposes of this subchapter,
an invasive procedure that penetrates or breaks the skin or other
patient tissue (in vivo) for the purpose diagnosing, evaluating, analyzing,
monitoring or treating a patient.
(50) THCIC Identification Number--A string of 6 characters
assigned by DSHS to identify facilities for reporting and tracking
purposes. For a facility operating multiple facility locations under
one license number and duplicating services at those locations, DSHS
will assign a distinguishable identifier for each separate facility
location under one license number. The relationship of the identifier
to the name and license number of the facility is public information.
(51) Uniform patient identifier--A unique identifier
assigned by DSHS to an individual patient and composed of numeric,
alpha, or alphanumeric characters, which remains constant across facilities
and patient events. The relationship of the identifier to the patient-specific
data elements used to assign it is confidential.
(52) Uniform physician identifier--A unique identifier
assigned by DSHS to a physician or other health professional who is
reported as operating, rendering or other provider providing health
care services or treating a patient in a facility and which remains
constant across facilities. The relationship of the identifier to
the physician-specific data elements used to assign it is confidential.
The uniform physician identifier shall consist of alphanumeric characters.
(53) Validation--The process by which a provider verifies
the accuracy and completeness of data and corrects any errors identified
before certification.
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| Source Note: The provisions of this §421.61 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 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 |
