| (a) DSHS records are public records under Government
Code, Chapter 552, except as specifically exempted by Health and Safety
Code, §108.010 and §108.013. Copies of such records may
be obtained upon request and upon payment of user fees established
by DSHS. The public use data files shall be available for public inspection
during normal business hours within ten business days of a written
or oral request. Discharge claims in the original format as submitted
to DSHS are not available to the public, are not stored at DSHS' office
and are exempt from disclosure pursuant to Health and Safety Code, §108.010
and §108.013, and shall not be released. Likewise, patient and
physician identifying data collected by DSHS through editing of hospital
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) The executive director 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) The executive director shall create a process for
assigning geographic identifiers to each discharge record.
(c) Creation of public use data file. DSHS will create
a public use data file by creating a single record for each inpatient
discharge and adding, modifying or deleting data elements in the following
manner as listed in paragraphs (1) - (11) of this subsection:
(1) delete patient, and insured name, Social Security
Number, address and certificate data elements and any patient identifying
information, if submitted; delete patient control and medical record
numbers.
(2) convert patient birth date to age group;
(3) convert admission and discharge dates to a length
of stay measured in days and a code for the day of the week of the
admission;
(4) convert procedure and occurrence dates to day of
stay 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 discharged 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 §108.011(i) of the Health and Safety
Code, 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 ICD 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 risk and severity adjustment scores utilizing
an algorithm approved by DSHS;
(10) suppress admission source data at patient level
when the admission type code represents "Newborn;"
(11) 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 paragraphs (7),
(10), or (12) of this subsection:
(A) Discharge Year and Quarter;
(B) Provider Name (Facility Name);
(C) THCIC Identification Number;
(D) Facility Type Indicators;
(E) Patient Sex/Gender;
(F) Type of Admission;
(G) Source of Admission;
(H) Patient ZIP Code;
(I) County Code;
(J) Public Health Region Code;
(K) Patient State;
(L) Patient Status;
(M) Patient Race;
(N) Patient Ethnicity;
(O) Claim Type Indicator Code;
(P) Type of Bill;
(Q) Encounter Indicator: This indicates whether more
than one claim was used to create the encounter;
(R) Principal Diagnosis Code (Current version of ICD
codes at the time data is submitted);
(S) Other Diagnosis Codes (Up to 24 diagnosis codes
can be submitted and reported. Current version of ICD codes at the
time data is submitted);
(T) Principal Procedure code (if applicable) (Current
version of ICD codes at the time data is submitted);
(U) Other Procedure codes (Up to 24 procedure codes
can be submitted and report Current version of ICD codes at the time
data is submitted);
(V) Admitting Diagnosis (Current version of ICD codes
at the time data is submitted);
(W) External Cause of Injury (E-codes), (if applicable)
(Current version of ICD codes at the time data is submitted) up to
9 E-codes can be submitted and reported;
(X) Day of Week Patient is admitted code (Sun. = 1,
Mon. = 2, Tues. = 3, Wed. = 4, Thur. = 5, Fri. = 6, Sat. = 7);
(Y) Length of Stay;
(Z) Age group of the patient;
(AA) Day number of Principal Procedure (Calculated:
Principal Procedure Date minus Admission/Start of Care Date);
(BB) Day number of Procedure (1) (Calculated: Procedure
Date (1) minus Admission/Start of Care Date);
(CC) Day number of Procedure (2) (Calculated: Procedure
Date (2) minus Admission/Start of Care Date);
(DD) Day number of Procedure (3) (Calculated: Procedure
Date (3) minus Admission/Start of Care Date);
(EE) Day number of Procedure (4) (Calculated: Procedure
Date (4) minus Admission/Start of Care Date);
(FF) Day number of Procedure (5) (Calculated: Procedure
Date (5) minus Admission/Start of Care Date);
(GG) Major Diagnostic Category (MDC);
(HH) HCFA-DRG Code (Obtained from the 3M HCFA-DRG Grouper);
(II) APR-DRG Code (Obtained from 3M APR-DRG Grouper);
(JJ) Risk of Mortality Score (Obtained from 3M APR-DRG
Grouper);
(KK) Severity of Illness Score (Obtained from 3M APR-DRG
Grouper);
(LL) Uniform Physician Identifier assigned to Attending
Physician;
(MM) Uniform Physician Identifier assigned to Operating
or Other Physician;
(NN) Service unit indicator from which the patient
received services;
(OO) Accommodations Private Room Charges;
(PP) Accommodations Semi-Private Charges;
(QQ) Accommodations Ward Charges;
(RR) Accommodations Intensive Care Charges;
(SS) Accommodations Coronary Care Charges;
(TT) Ancillary Service - Other Charges;
(UU) Ancillary Service - Pharmacy Charges;
(VV) Ancillary Service - Medical/Surgical Supply Charges;
(WW) Ancillary Service - Durable Medical Equipment
Charges;
(XX) Ancillary Service - Used Durable Medical Equipment
Charges;
(YY) Ancillary Service - Physical Therapy Charges;
(ZZ) Ancillary Service - Occupational Therapy Charges;
(AAA) Ancillary Service - Speech Pathology Charges;
(BBB) Ancillary Service - Inhalation Therapy Charges;
(CCC) Ancillary Service - Blood Charges;
(DDD) Ancillary Service - Blood Administration Charges;
(EEE) Ancillary Service - Operating Room Charges;
(FFF) Ancillary Service - Lithotripsy Charges;
(GGG) Ancillary Service - Cardiology Charges;
(HHH) Ancillary Service - Anesthesia Charges;
(III) Ancillary Service - Laboratory Charges;
(JJJ) Ancillary Service - Radiology Charges;
(KKK) Ancillary Service - MRI Charges;
(LLL) Ancillary Service - Outpatient Services Charges;
(MMM) Ancillary Service - Emergency Service Charges;
(NNN) Ancillary Service - Ambulance Charges;
(OOO) Ancillary Service - Professional Fees Charges;
(PPP) Ancillary Service - Organ Acquisition Charges;
(QQQ) Ancillary Service - ESRD Revenue Setting Charges;
Cont'd... |
