Future of Future of OSHPD DataOSHPD Data

Presenters:Starla Ledbetter

Ginger Cox

Present on AdmissionPrincipal Language SpokenMS-DRGsClinical MeasurementsPatient AddressExternal Cause of InjuryPayer TypologyFacility Summary ReportICD-10 Code Sets

Future EnhancementsFuture Enhancements

Collection: January 1, 1996

THREE Values Y = Yes N = No U = Uncertain

Reported on principal and secondary diagnoses for all inpatient records

Condition Present At Admission

Condition Present At Admission

National Standard: October 1, 2007OSHPD Collection: July 1, 2008

FIVE ValuesY = YesN = NoU = No Information in the RecordW = Clinically UndeterminedBlank = Exempt from POA Reporting

Reported on all diagnoses and external cause of injury codes (E-codes)

Present On Admission (POA)

Present On Admission (POA)

Oct 1, 2007 through Jun 30, 2008

Allowed the reporting of two additional values for POA, with no validation

W = Reported as Clinically Undetermined

1 = Reported as Exempt

Interim Present On Admission

Interim Present On Admission

POA FrequenciesPOA Frequencies

Medicare Severity Diagnosis Related Groups

Transition from DRG Grouper: 500+ DRGs

Jan- Dec 2007

Implement MS-DRG Grouper: 900+ DRGs

Jan – June 2008

MS-DRGsMS-DRGs

Collection: IP, ED, AS data

Collection begins: January 1, 2009

Available to you with 2009 data!

Principal Language Spoken

Principal Language Spoken

HIN – Hindi HUN – Hungarian ITA – Italian JPN – Japanese KOR – Korean LAO – Laotian HMN – Miao, Hmong KHM – Mon-Khmer, Cambodian NAV – NavajoPER – Persian

POL – Polish POR – Portuguese RUS – Russian SCR – Serbo-Croatian SPA – Spanish TGL – Tagalog THA – Thai URD – Urdu VIE – Vietnamese YID – Yiddish 999 – Unknown

Principal Language SpokenPrincipal Language Spoken

ENG – English ARA – Arabic ARM – Armenian CHI – Chinese FRE – French CPF – French Creole GER – German GRE – Greek GUJ – GujarathiHEB – Hebrew

24 spaces for write-in language24 spaces for write-in language

Albumin, serumASTBUNCreatinineHemoglobinINR

Clinical MeasurementsClinical Measurements

Oxygen SaturationpHPlatelet countPotassiumSodiumWhite blood cell count

Business Case

Technical Solution

Three data typesInpatientEmergency DepartmentAmbulatory Surgery

HOME

Patient AddressPatient Address

Codes E870-E876 for misadventures

Codes E878-E879 for abnormal reactions

Proposed date: January 1, 2010

External Cause of InjuryExternal Cause of Injury

Need for comprehensive, mutually exclusive categories and definitions

Developed and maintained by the Public Health Data Standards Consortium

Updated annually each October

http://www.phdsc.org/standards/payer-typology-source.asp

Payer TypologyPayer Typology

01 Medicare02 Medical03 Private Coverage04 Workers Comp05 County Indigent 06 Other Govt.07 Other Indigent08 Self Pay09 Other Payer

1 Managed Care*

(Knox Keene/MCOHS)

2 Managed Care Other

3 Traditional Coverage

*Name of Plan

OSHPD IP Payer CodesOSHPD IP Payer Codes

09 Self-pay11 Other Non-Federal

Programs12 Preferred Provider

Organization (PPO)13 Point of Service (POS)14 Exclusive Provider

Organization (EPO)16 Health Maintenance

Organization (HMO) Medicare Risk

AM Automobile MedicalBL Blue Cross/Blue

Shield

CH Champus

CI Commercial Insurance Company

DS DisabilityHM Health Maintenance

OrganizationMA Medicare Part AMB Medicare Part BMC MedicaidOF Other Federal

ProgramTV Title VVA Veteran Affairs PlanWC Workers’

Compensation 00 Other

OSHPD ED and AS Payer Codes

OSHPD ED and AS Payer Codes

1

2

3

4

5

6

7

8

9

Medicare

Medicaid

Other Government (not Medicare, Medicaid or corrections)

Department of Corrections

Private Health Insurance

Blue Cross/Blue Shield

Managed Care, unspecified

No payment from organization

Miscellaneous/other

Payer Typology: 1st LevelPayer Typology: 1st Level

1 MEDICARE

11    Medicare (Managed Care)

111    Medicare HMO

112    Medicare PPO

113    Medicare POS

119    Medicare Managed Care Other

12    Medicare (Non-managed Care)

121    Medicare FFS

122    Medicare Drug Benefit

123  Medicare Medical Savings Account (MSA)

129    Medicare Non-managed Care Other

19    Medicare Other

Payer Typology: ExpandedPayer Typology: Expanded

8 NO PAYMENT from an  Organization/Agency/Program/Private Payer Listed

81 Self-pay 

82 No Charge

821 Charity

822 Professional Courtesy

823 Research/Clinical Trial

83 Refusal to Pay/Bad Debt

84 Hill Burton Free Care

85 Research/Donor

89 No Payment, Other

Payer Typology: ExpandedPayer Typology: Expanded

Facility Summary ReportsFacility Summary Reports

Data Distribution ReportImmediate feedback to the reporting facility

Facility Profile ReportWithin 15 days of approval

Revised Facility Summary ReportWithin 15 days of approval

http://www.oshpd.ca.gov/MIRCal/Default.aspxhttp://www.oshpd.ca.gov/MIRCal/Default.aspx

Choose Date Type : ED or AS or IP

Choose Date Type : ED or AS or IP

Select which facilitySelect which facility

Select which report periodSelect which report period

Click on “List Report”Click on “List Report”

ICD-10-CM Diagnosis External cause of injury, poisoning,

adverse effect

ICD-10-PCS Inpatient procedure

Effective date: October 1, 2013

ICD-10-CM and ICD-10-PCS Code Sets

ICD-10-CM and ICD-10-PCS Code Sets

ICD-10-CM FormatICD-10-CM Format

ICD-9-CM 365.83 aqueous misdirection (malignant glaucoma)

ICD-10-CM H40.839 aqueous misdirection (malignant glaucoma)

H40.831 Aqueous misdirection, right eyeH40.832 Aqueous misdirection, left eyeH40.833 Aqueous misdirection, bilateral eyesH40.839 Aqueous misdirection, unspecified eye

ICD-9-CM vs ICD-10-CM Diagnosis

ICD-9-CM vs ICD-10-CM Diagnosis

ICD-10-PCS FormatICD-10-PCS Format

Section

Body

System

Root

Operation

Body

Part

Approach

Device

Extension

1 2 3 4 5 6 7

ICD-9-CM 42.41 Partial esophagectomy

No further breakdown for what part of esophagus was resected

ICD-10-PCS ODT10ZZ Open resection of

upper esophagectomy

4th digit = body part = upper esophagus

ICD-9-CM vs ICD-10-PCS Procedure

ICD-9-CM vs ICD-10-PCS Procedure

Effective Date: October 1, 2013Impact AnalysisBudget PlanningSystem upgradesLimit to basic edits Regulation proposalEducationTestGo LiveContinue updates as usual

Next StepsNext Steps

Any Questions ??Any Questions ??