sparcs data dictionary - new york state department of health · 2019-03-19 · sparcsdatadictionary...

SPARCS Data DictionaryOffice of Quality and Patient Safety

Bureau of All Payer Database

18 March, 2019

Contents

Introduction 10Overview . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10Background . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 10SPARCS and Patient Privacy . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11Data Source . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11File Types . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 11File Format . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 12Notes: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 13

CLAIM TABLE 14Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 15Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 16Accident Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 17Accident Related Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 18Admit Weekday . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 19Admission Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 20Source of Admission/Point of Origin . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 21Priority (Type) of Admission or Visit . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 23Age . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 24Patient Age Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 25Newborn Age in Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 26Age Warning Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 27Alternate Care Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 28Diastolic BP on Arrival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 29Systolic BP on Arrival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 30Heart Rate on Arrival . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 31Accommodation Total Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 32Total Non-Covered Accommodation Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 33Ancillary Total Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 34Total Non-Covered Ancillary Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 35Total Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 36Medicaid Income Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 37Total Non-Covered Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 38Workers Compensation / No Fault Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 39Blood Furnished Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 40Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 41Procedure Coding Method . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 42SPARCS Collector Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 43Accident Related Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 44Admission Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 45Method of Anesthesia Used . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 46Statement From Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 47Statement Thru Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 48Discharge Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 49

1

CONTENTS

Patient Birth Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 50Discharge Weekday . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 51Discharge Hour . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 52Exempt Unit Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 53PFI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 54Facility Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 55National Provider ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 56Historic Source File Type (Complete/Incomplete) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 57Patient Sex . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 58Health Service Area . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 59Facility County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 60Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 62Emergency Department (ED) Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 63Admission via the Emergency Department . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 64AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 65Medicaid Income Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 66Newborn Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 67Same Day Discharge Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 68Special Program - Disability . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 69Special Program - Family Planning . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 70Special Program - Physically Handicapped Children . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 71Special Program - Special Fund Project . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 72Workers Compensation / No Fault Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 73Leave of Absence Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 74Length of Stay . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 75Log Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 76Medical Record Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 77Mother’s Medical Record Number (MRN) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 78Medicaid Rate Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 79Newborn Birth Weight . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 87Non-Covered Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 88Covered Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 89Procedure Time . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 90Operating Certificate Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 91Patient Control Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 92Patient Discharge Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 93Expected Principal Reimbursement . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 95Procedure Date Warning Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 96Expected Reimbursement Other 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 97Expected Reimbursement Other 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 98Record Sequence Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 99Residence Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 100Service Category . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 101Record Sequence Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 102SPARCS Region Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 103Transaction Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 104Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 105Unique Personal identifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 106Previous Patient Control Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 107Type of Bill Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 108Claim Frequency Type Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 109Payer Responsibility Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 110Patient Responsibility Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 111Patient Individual Relationship Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 112

Version 2.318 March, 2019

2

CONTENTS

Subscriber Group Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 113Member Identification Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 114Patient Marital Status . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 115Service Provider Employer Identification Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 116Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 117Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 118Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 119Submitted File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 120OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 121Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 122Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 123Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 124Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 125Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 126

CONDITION_CODE TABLE 127Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 128Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 129Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 130Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 131Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 132Health Care Condition Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 133Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 137Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 138Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 139OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 140Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 141Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 142Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 143Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 144Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 145Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 146AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 147

DIAG TABLE 148Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 149Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 150Diagnosis Type Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 151Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 152Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 153Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 154Diagnosis Category Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 155CCS Diagnosis Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 156Diagnosis Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 163Present on Admission Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 164ICD9 or ICD10 Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 165Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 166Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 167Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 168OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 169Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 170Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 171Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 172Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 173Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 174


3

CONTENTS

Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 175AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 176

DRG TABLE 177Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 178Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 179Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 180Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 181MS-DRG - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 182MS-DRG MDC - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 183MS-DRG - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 184MS-DRG MDC - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 185MS-DRG - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 186MS-DRG MDC - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 187AP-DRG - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 188AP-DRG MDC - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 189AP-DRG - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 190AP-DRG MDC - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 191All Patient Diagnostic Related Groups (AP-DRG); Next Version . . . . . . . . . . . . . . . . . . . . . . . . . 192AP-DRG MDC - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 193APR-DRG - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 194APR-DRG MDC - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 195APR-DRG ROM - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 196APR-DRG SOI - Current Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 197APR- DRG - Current Version for POA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 198APR-DRG MDC - Current Version for POA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 199APR-DRG ROM - Current Version for POA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 200APR-DRG SOI - Current Version for POA . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 201APR-DRG - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 202APR-DRG MDC - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 203APR-DRG ROM - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 204APR-DRG SOI - Previous Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 205APR-DRG- Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 206APR-DRG MDC - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 207APR-DRG ROM - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 208APR-DRG SOI - Next Version . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 209Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 210Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 211Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 212OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 213Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 214Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 215Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 216Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 217Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 218Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 219AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 220

LOCATION TABLE 221Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 222Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 223Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 224Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 225Patient Street Address Line 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 226Patient Street Address Line 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 227


4

CONTENTS

Patient City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 228Patient State . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 229Patient County Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 230Residence Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 232Patient Zip Code Extension . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 233Patient Country Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 234Patient Zip Code 5 Digits . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 235Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 236Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 237Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 238OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 239Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 240Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 241Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 242Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 243Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 244Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 245AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 246

NDC TABLE 247Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 248Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 249Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 250Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 251Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 252National Drug Code (NDC) . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 253NDC Unit Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 254NDC Unit Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 255Prescription Number Qualifier . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 256Prescription Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 257Service Line Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 258Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 259Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 260Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 261OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 262Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 263Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 264Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 265Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 266Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 267Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 268AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 269

OCCURRENCE TABLE 270Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 271Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 272Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 273Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 274Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 275Occurrence Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 276Occurrence Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 278Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 279Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 280Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 281Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 282


5

CONTENTS

OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 283Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 284Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 285Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 286Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 287Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 288AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 289

OCCURRENCE_SPAN TABLE 290Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 291Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 292Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 293Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 294Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 295Occurrence Span Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 296Occurrence Span From Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 297Occurrence Span Through Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 298Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 299Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 300Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 301OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 302Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 303Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 304Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 305Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 306Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 307Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 308AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 309

PAYOR TABLE 310Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 311Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 312Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 313Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 314Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 315Source of Payment . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 316Insurance Policy Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 317Payor ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 318Claim Filing Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 325Provider ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 326Payer ID Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 327Payer Secondary ID 1 Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 328Payor Secondary ID 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 329Payer Secondary ID 2 Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 330Payor Secondary ID 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 331Payer Secondary ID 3 Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 332Payor Secondary ID 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 333Payer Organization Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 334Source of Payment Typology . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 335Subscriber Individual Relationship Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 339Subscriber Group Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 340Subscriber Group Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 341Subscriber Individual or Organization Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 342Subscriber Member Identification Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 343Payer Responsibility Sequence Number Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 344


6

CONTENTS

Subscriber City . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 345Subscriber Street Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 346Subscriber Zip Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 347Subscriber Country . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 348Subscriber County . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 349Payer Type Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 351Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 352Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 353Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 354OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 355Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 356Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 357Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 358Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 359Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 360Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 361AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 362

PROC TABLE 363Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 364Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 365Procedure Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 366Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 367Procedure Charge Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 368Total Procedure Non-Covered Charges . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 369Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 370Procedure Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 371Post-Op Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 372Pre-Admit Indicator . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 373Pre-Op Days . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 374Procedure Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 375Procedure Modifier Code 1 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 376Procedure Modifier Code 2 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 377Procedure Modifier Code 3 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 378Procedure Modifier Code 4 . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 379CCS Procedure Group . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 380Service Unit Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 386Number of Units . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 387Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 388Service Line Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 389Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 390Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 391Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 392OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 393Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 394Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 395Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 396Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 397Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 398Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 399AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 400

PROVIDER TABLE 401Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 402Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 403


7

CONTENTS

Provider Type Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 404Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 405Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 406Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 407Provider Last Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 408Provider First Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 409Provider Middle Name or Initial . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 410Provider Name Suffix . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 411Provider NPI . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 412Provider State License Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 413Service Line Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 414Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 415Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 416Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 417OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 418Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 419Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 420Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 421Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 422Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 423Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 424AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 425

RACE TABLE 426Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 427Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 428Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 429Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 430Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 431Patient Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 432Patient Race . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 433Patient Race/Ethnicity . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 434Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 456Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 457Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 458OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 459Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 460Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 461Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 462Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 463Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 464Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 465AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 466

REV TABLE 467Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 468Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 469Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 470Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 471Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 472Record Sequence . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 473Revenue Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 474Ancillary/Accommodation Revenue Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 488Service Unit Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 489Service Unit Count . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 490


8

CONTENTS

Service Line Charge Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 491Service Line Non-Covered Charge . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 492Date of Service . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 493Service Line Number . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 494Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 495Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 496Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 497OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 498Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 499Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 500Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 501Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 502Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 503Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 504AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 505

VALUE TABLE 506Claim Transaction ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 507Discharge Year . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 508Order Sequence ID . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 509Claim Type . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 510Unique Personal ID Enhanced Encrypted . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 511Value Code . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 512Value Code Amount . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 515Claim Key . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 516Active Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 517Latest Claim Record Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 518OTVM Process Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 519Record Created By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 520Record Update Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 521Last Updated By . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 522Source File Name . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 523Row Insert Date . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 524Abortion Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 525AIDS/HIV Flag . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . 526


9

INTRODUCTION

Introduction

Overview

The Statewide Planning and Research Cooperative System (SPARCS) is a comprehensive hospital discharge data re-porting system. SPARCS was established in 1979 in conjunction with the health care industry and New York Stategovernment to collect patient-level detail on patient characteristics, diagnoses, treatments, and services. The purposeof SPARCS, as outlined in the regulations, is to create a statewide hospital discharge data set with the goal of providinghigh quality medical care at a reasonable cost to the residents of New York State. This goal is accomplished by servingas an information source for organizations and agencies seeking to promote the efficient delivery of health care ser-vices (Title 10 (Health) NYCRR 400.18 (e)(1)(i)). SPARCS now collects data for every inpatient (IP) hospital dischargebeginning in 1980, ambulatory surgery (AS) visit beginning in 1983, emergency department (ED) admission beginningin 2003, and outpatient (OP) visits beginning in 2011, from health care facilities certified under Article 28 of the NewYork State Public Health Law (NYSPHL). Article 28 facilities are hospitals, diagnostic and treatment centers (also calledclinics), and nursing homes. The enabling legislation and regulations for SPARCS are located under Section 2816 of thePublic Health Law and Section 400.18 of Title 10 (Health) of the Official Compilation of Codes, Rules, and Regulationsof the State of New York (NYCRR).

Background

The SPARCS program was initiated when the NYS Department of Health received grant funding from the federal gov-ernment in October 1977. After establishing the necessary forms, procedures, and involvement of the health carecommunity, data collection began in 1979 as a demonstration project. In 1980, the first regulations were establishedin the Title 10 NYCCR to continue SPARCS under regulatory authority to collect inpatient data. The regulations requiredthat all Article 28 facilities certified for inpatient services submit their data to New York State. In April 1983 and June1985, the State Hospital Review and Planning Council adopted additional regulations authorizing the reporting of ambu-latory surgery data (AS) to the New York State Department of Health. These additional regulations, similarly, requiredthat outpatient data be submitted by all facilities providing ambulatory surgery services. In April 1993, a national adhoc task force released a new Universal Data Set (UDS) Specification that included reporting codes for use with the Uni-form Bill (UB-92) paper form as well as a new electronic format. The UDS system streamlined multiple data submissionformats into a single format, removing redundant reporting requirements for hospitals and other health care facilities.SPARCS adopted these national formats for billing and claims processing to simplify data reporting. To progress withthe current health care industry data standards, SPARCS continues to adopt changes approved by the National UniformBilling Committee (NUBC). Recognizing the need for emergency department (ED) data, the New York State Legislaturepassed legislation in September 2001 mandating the collection of these data through SPARCS. After identifying dataelements that satisfied public health and health services administration information needs, voluntary submission beganin 2003. Once the regulations were established for the collection of ED data in January 2005, mandatory collectionbegan. In April 2006, the New York State Legislature again amended Article 28 Section 2816 (2) (a) (iv) to mandatethe reporting of all outpatient (OP) clinic visit data. This new information was added to the collection of AS and EDvisits on the outpatient file. This initiative became known as the Expanded Outpatient Data Collection (EODC) Project.Data collection began with a phased-in approach by collecting hospital outpatient data in the summer of 2011. Theoutput files needed to be restructured because of this new data collection. In 2012, the structure of the output filesfor both the inpatient and outpatient data were modified to organize the data elements into segments. In Septem-ber 2014, SPARCS regulations were amended to delete obsolete language, realign to current practice and add newprovisions. These provisions included the creation of a Data Governance Committee, superseding the Data ProtectionReview Board, to review requests from external researchers for identifiable data. Some of the other provisions of theamended regulations included that health care facilities, or their vendor, must submit, on a monthly basis, data for allinpatient discharges and outpatient visits; at least 95 percent of data for all inpatient discharges and outpatient visitsmust be submitted within sixty (60) days from the end of the month of a patient’s discharge or visit; and 100 percentof data for all inpatient discharges and outpatient visits must be submitted within one hundred eighty (180) days fromthe end of the month of a patient’s discharge or visit. The September 2014 regulations also included that the SPARCSprogram would audit the quality of the submitted SPARCS data. In 2018, the SPARCS program further evolved to alignwith the technological advances of the NYS All Payer Database, resulting in revised regulations (October 2018), a new


10

INTRODUCTION

data intake system (March 2018), and a relational file format that could be trended over time (“history of history”)resulting in an update data dictionary and updated output files.

SPARCS and Patient Privacy

The Bureau of the All Payer Database is responsible for tracking and monitoring the technical functioning of collectingSPARCS data. Staff are available to assist with every phase of the SPARCS data system. As a public health entity,the NYS Department of Health and the SPARCS data set are not covered under the Health Insurance Portability andAccountability Act (HIPAA) of 1996. However, the NYS Department of Health takes very seriously the protection ofpatient privacy. The NYS Department of Health created a Data Governance Committee (DGC) to review and approve allapplications for identifiable data. All users of the SPARCS Limited and Identifiable data must sign Data Use Agreements(DUAs). Regardless of the type of data or file being used, these DUAs are strictly enforced.

Data Source

SPARCS inpatient and outpatient data is provided by facilities certified under Article 28 of the Public Health Law. Anyfacility certified to provide inpatient services, ambulatory surgery services, emergency department services or outpa-tient services can be required to submit data to SPARCS. This includes all New York State Hospitals and Diagnostic andTreatment Centers (D&TCs). Free-standing Diagnostic and Treatment Centers as well as hospital-owned and operatedfacilities are also included. Regardless of their ownership, each facility must report data for each specific facility loca-tion. That is, if a hospital owns more than one location, each location is required to report the data from each facilityseparately to SPARCS. Currently SPARCS does not have outpatient data from all facilities. Reporting facilities can befound in the SPARCS Audit Reports.

File Types

SPARCS data is a national information resource. To enable all researchers to contribute to the goal of providing highquality medical care at a reasonable cost, there are three distinct files available for usage. Additional information onthese data sets is available on the NYS Health Department’s website at https://www.health.ny.gov/statistics/sparcs/.

• De-Identified - This data file contains basic record level detail; it does not contain data that is protected healthinformation (PHI) under HIPAA. The health information is not individually identifiable; all data elements that areconsidered identifiable have been redacted. For example, the direct identifiers regarding a date (admission date,procedure date, etc.) have the day and month portion of the date removed. De-Identified data files can beaccessed through the State’s open data initiative at Health Data New York. For more information on obtainingthis data file, please contact the Bureau of the All Payer Database at the Empire State Plaza, Corning Tower Room1911, Albany, New York, 12237. Questions may also be directed to [email protected].

• Limited - This data file contains more information than the De-Identified File that is described as limited underHIPAA. That is, the additional information does not contain any direct identifiers under HIPAA; it is limited bymodifying the data elements. Specifically, the data is encrypted to render protected health information unusable,unreadable, or indecipherable to unauthorized individuals. The encryption processes used by SPARCS have beentested by the National Institute of Standards and Technology (NIST) and judged to meet their standards. Otherdirect identifiers regarding a date (admission date, procedure date, etc.) have the day portion of the dateremoved while the month and year are retained in the file.

This data file also requires users to submit an application and sign a Data Use Agreement (DUA). The signed DUAallows the NYS Department of Health to disclose this information to users of the data without authorization fromthe data subjects. To obtain this data file, a completed DOH-5132 limited data application and signed DUAs foreach individual with need for access to the data should be submitted to [email protected].

• Identifiable - This file contains direct identifiers under HIPAA, such as patient address, patient date of birth,patient record numbers (medical record number, patient control number, etc.), and specific dates. Each data


11

https://www.health.ny.gov/statistics/sparcs/reports/audit.htm

https://www.health.ny.gov/statistics/sparcs/

https://healthdata.ny.gov/en/browse?q=sparcs

https://www.health.ny.gov/statistics/sparcs/forms/

INTRODUCTION

element page within this document will indicate if the data element is contained on the Identifiable Data Set. Toobtain this data file, a completed DOH-5132 identifiable data application and signed DUAs for each individualwith need for access to the data must be submitted to [email protected].

To determine if a data element is included in one of the above datasets, please see the specific data elementpage in this document or the Table of Contents document on our website.

File Format

Between October 2017 and March 2018, the SPARCS program migrated to a new data intake system, resulting in anew data format. The new format reflects a relational database structure, providing greater flexibility and efficiencyfor data users. The new system impacts records with service dates of October 1, 2017 forward. Data submitted prioris retained and considered historical data. The new data format consists of 14 relational tables. Patient records can belinked across tables by the Claim Transaction ID variable (CLM_TRANS_ID).

• CLAIM - This table contains claim information, including: Claim Type, Discharge Year, Source of Admission/Pointof Origin, Priority (Type) of Admission or Visit, Charge Amounts, Dates, PFI, Patient Age, Patient Sex, and PatientMarital Status.

• CONDITION_CODE - This table contains condition code information used to identify conditions or events relatedto the claim. Condition codes are a national code set maintained by NUBC. For example, condition code ’P7’indicates a direct inpatient admission from Emergency Department; ’17’ indicates the patient is homeless; ’25’indicates the patient is a non-US Resident; ’A5’ indicates a disability and is used to set the SP_DISAB_IND; ’A4’indicates Family Planning and is used to set the SP_FAM_PLAN_IND; ’A2’ indicates a Physically HandicappedChildren’s Program and is used to set the SP_HANDICAP_CHILD_IND; and ’A3’ indicates Special Federal Fundingand is used to set the SP_SPECIAL_FUNDING_IND.

• DIAG - This table contains information related to the Diagnosis Codes associated with a SPARCS claim. Someincluded diagnosis codes are principal diagnosis, admitting diagnosis, patient reason for visit, external causeof injury, among other diagnoses. For example, this table includes: Claim Type, Discharge Year, DiagnosisType Code, Diagnosis Code, Present on Admission Indicator, ICD9 or ICD10 Indicator, and Clinical ClassificationsSoftware (CCS) Diagnosis Group.

• DRG - This table contains the Diagnostic Related Group (DRG) information of a SPARCS claim. For example, itincludes: Claim Type, Discharge Year, MS-DRG, MS-DRG MDC, AP-DRG, AP-DRG MDC, APR-DRG, APR-DRG MDC,APR-DRG ROM, and APR-DRG SOI. For process dates after October 1, 2017, it contains the APR- DRG, APR-DRGMDC, APR-DRG ROM, and APR-DRG SOI based on diagnoses that were present on admission. Historically, itcontained the previous and next version of MS-DRG, MS-DRG MDC, AP-DRG, AP-DRG MDC, APR-DRG, APR-DRGMDC, APR-DRG ROM, and APR-DRG SOI.

• LOCATION - This table contains patient address information as reported on the claim. For example, it includesClaim Type, Discharge Year, Patient Address (Street, City, State, Zip Code), County, Country (if non-US resident),and Geocoding information.

• NDC (National Drug Code) - This table contains the NDC and the quantity of a medication dispensed during anoutpatient service and is reported at the line level. It will be reported when the provider or submitter choosesto report NDC numbers to enhance the claim reporting or adjudication processes. Drugs and biologics reportedare a further specification of service or services reported at the line level.

• OCCURRENCE - This table contains information related to significant events and date reported. Occurrencecodes are a national code set maintained by NUBC. For example, occurrence code ’01’ indicates Accident/MedicalCoverage and ’02’ indicates No Fault Insurance Involved Including Auto Accident/Other will be used to report theaccident date. Occurrence code ’42’ indicates a discharge date when it differs from the Statement Thru Date.

• OCCURRENCE_SPAN - This table contains information related to significant events and date spans reported.Occurrence Span codes are a national code set maintained by NUBC. For example, occurrence span code ’74’indicates Non-Covered Level of Care/Leave of Absence Dates. Historically, this information was maintained inthe SPARCS_NONACUTE table.


12

https://www.health.ny.gov/statistics/sparcs/forms/

https://www.health.ny.gov/statistics/sparcs/datadic.htm

INTRODUCTION

• PAYOR - This table contains information related to the payers reported. For example, this includes Claim TypeCode, Discharge Year, Source of Payment Typology, Source of Payment, Claim Filing Indicator, Payer Respon-sibility Sequence Number Code, Insurance Policy Number, Payer ID, Payer Organization Name, and Subscriberinformation.

• PROC - This table contains information related to the inpatient ICD and outpatient HCPCS procedures reported.For example, this includes Claim Type, Discharge Year, Procedure Type, Procedure Date, Post-Op Days, Pre-AdmitIndicator, Pre-Op Days, CCS Procedure Group, and Procedure Code. Similarly, HCPCS codes will include charges,procedure modifiers, Service Unit Type and Number of Units.

• PROVIDER - This table contains information related to the providers reported. For example, this includes ClaimType Code, Discharge Year, Provider Type Code (including ”AT” Attending, ”OP” Operating, ”OO” Other Operating,”RF” Referring, and ”RN” Rendering), Provider NPI, and Provider State License Number. Provider State LicenseNumber was collected historically and is not being collected on transactions with process dates after October 1,2017.

• RACE - This table contains information related to the race and ethnicity reported for the patient. For example,this includes Claim Type Code, Discharge Year, Patient Ethnicity, Patient Race, Patient Race Claritas Code, andPatient Race/Ethnicity.

• REV - This table contains the revenue codes reported at the line level. Revenue codes are a national code setmaintained by NUBC. They identify specific accommodation, ancillary service, or unique billing calculations orarrangements. For example, this includes Claim Type, Discharge Year, Revenue Code, Ancillary/AccommodationRevenue Type, Service Unit Type, Service Unit Count, Service Line Charge Amount, and Service Line Non-CoveredCharge.

• VALUE - This table contains the value codes and their related amounts reported. Value codes are a national codeset maintained by NUBC. For example, this includes Claim Type, Discharge Year, Value Code, and Value CodeAmount. For example, value codes are used to report Units of Blood Furnished (’37’), Medicaid Recurring MonthlyIncome (’23’), Medicaid Rate Code (’24’), Newborn Weight in Grams (’54’), and Worker’s Compensation (’15’).

Notes:

AIDS/HIV EDITS - all identifiable data elements are redacted (blank/zeroed out) leaving all other data elements intact.All exact dates are modified to give only month and year. Birth weights are truncated, rounded down to nearest 100grams.

ABORTION EDITS - all identifiable data elements are redacted, including Physician license numbers, when there is anyindication of abortion.


13

CLAIM TABLE

CLAIM TABLE

This table contains claim information. For example it includes: Claim Type, Discharge Year, Source of Admission/Pointof Origin, Priority (Type) of Admission or Visit, Charge Amounts, Dates, PFI, Patient Age, Patient Sex, and PatientMarital Status.


14

CLAIM TABLE

Claim Transaction ID

Variable Name: CLM_TRANS_ID

Variable Type: VARCHAR2

Variable Length: 12

Table/File: SPARCS_CLAIM

Variable Index: 1

Availability:This variable is included in the limited dataset.

Description:Unique identifier for the transaction processed (Foreign key that links all tables to the claim table) .

New to APD


15

CLAIM TABLE

Discharge Year

Variable Name: DISCH_YR


Variable Length: 4


Variable Index: 2


Description:Year the patient was discharged or death occurred.

New to APD


16

CLAIM TABLE

Accident Hour

Variable Name: ACCID_HR


Variable Length: 2


Variable Index: 3


Description:Hour that the accident occurred.

Obsolete:This element is no longer collected in the APD, and is stored as historical data only.

Special Notes:This is an obsolete NYS specific data element. It is reported as a value code “45” in the value amount.

Former variable name: ACCHR

This is an outpatient variable only. (Ambulatory Surgery Visit, Emergency Room Visit)


17

CLAIM TABLE

Accident Related Code

Variable Name: ACCID_TYPE


Variable Length: 2


Variable Index: 4


Description:Identifies the specific type of accident suffered by the patient.


Special Notes:This is an obsolete NYS specific data element. History data was converted to the SPARCS_OCCURRENCE table. It isreported as an occurrence date with the occurrence codes “01”, “02”, “03”, “04”, “05” and “06”.

Former variable name: ACCTP

Reference table name: REF_ACCID_TYPE

ACCID_TYPE ACCID_TYPE_DESCR

1 Accident/Medical Coverage2 No Fault Insurance Involved/Including Auto Accident/Other3 Accident/Tort Liability4 Accident/Employment Related5 Accident/No Medical or Liability Coverage6 Crime Victim


18

CLAIM TABLE

Admit Weekday

Variable Name: ADMIT_DAY


Variable Length: 3


Variable Index: 5


Description:Weekday of admission/start of care (1st three letters).

Former variable name: ADMWK


19

CLAIM TABLE

Admission Hour

Variable Name: ADMIT_HR


Variable Length: 2


Variable Index: 6


Description:Hour that patient was admitted.

Former variable name: ADMHR


20

CLAIM TABLE

Source of Admission/Point of Origin

Variable Name: ADMIT_SRC_CD


Variable Length: 1


Variable Index: 7


Description:Code indicating point of patient origin for this admission/visit. Note that for newborn admissions (ADMIT_TYPE_CD= “4”), “5” indicates born in this hospital and “6” indicates born outside this hospital. For all other admissions, “5”indicates a transfer from a SNF, ALF, ICR or NF and “6” indicates a transfer from another Health Care Facility.

Former variable name: SCADM

This is an inpatient variable only.

Reference table name: REF_ADMIT_SRC_CD

ADMIT_SRC_CD ADMIT_SRC_CD_DESCR

1 Non-Health Facility Point of Origin: The patient wasadmitted to this facility upon an order of a physician.

2 Clinic: The patient was referred to this facility as a transferfrom a freestanding or non-freestanding clinic.

3 Reserved for assignment by the NUBC4 Transfer From a Hospital (Different Facility) Inpatient: The

patient was admitted to this facility as a hospital transferfrom an acute care facility where he or she was aninpatient or outpatient.

5 Transfer From a Skilled Nursing Facility (SNF) orIntermediate Care Facility (ICF) Inpatient: The patient wasadmitted to this facility as a transfer from a SNF or ICFwhere he or she was a resident.

6 Transfer From Another Health Care Facility Inpatient: Thepatient was admitted to this facility as a transfer fromanother type of health care facility not defined elsewhere inthis code list.

7 Emergency Room (Discontinued Effective 7/1/2010)Inpatient: The patient was admitted to this facility afterreceiving services in this facilitys emergency department.Excludes: Patients who came to the emergency room fromanother health care facility.

8 Court/Law Enforcement Inpatient: The patient wasadmitted to this facility upon the direction of a court of law,or upon the request of a law enforcement agencyrepresentative.

9 Information Not Available The means by which the patientwas admitted to this hospital was not known.


21

CLAIM TABLE

(continued)

ADMIT_SRC_CD ADMIT_SRC_CD_DESCR

A Transfer from a Rural Primary Care Hospital (Only valid fordischarges prior to 10/1/2007) The patient was admitted tothis facility as a transfer from a Rural Primary Care Hospital(RPCH) where he or she was an inpatient.

D Transfer from One Distinct Unit of the Hospital to anotherDistinct Unit of the Same Hospital Resulting in a SeparateClaim to the Payer (only valid for discharges prior to10/1/2007). Inpatient: The patient was admitted to thisfacility as a transfer from hospital inpatient within thisfacility resulting in a separate claim to the payer.

E Transfer from Ambulatory Surgery Center (Effective10/1/2007) Inpatient: The patient was admitted to thisfacility as a transfer from an ambulatory surgery center.

F Transfer from Hospice and is Under a Hospice Plan of Careor Enrolled in a Hospice Program (Effective 10/1/2007)Inpatient: The patient was admitted to this facility as atransfer from a hospice.


22

CLAIM TABLE

Priority (Type) of Admission or Visit

Variable Name: ADMIT_TYPE_CD


Variable Length: 1


Variable Index: 8


Description:Code indicating the priority of the admission/visit.

Former variable name: TPADM


Reference table name: REF_ADMIT_TYPE_CD

ADMIT_TYPE_CD ADMIT_TYPE_CD_DESCR

1 Emergency2 Urgent3 Elective4 Newborn5 Trauma9 Information not available


23

CLAIM TABLE

Age

Variable Name: AGE

Variable Type: NUMBER

Variable Length: 22


Variable Index: 9


Description:Patient’s age calculated at time of admission/visit.

Former variable name: AGE


24

CLAIM TABLE

Patient Age Group

Variable Name: SPARCS_AGE_GRP_CD


Variable Length: 1


Variable Index: 10


Description:Patient’s age categorized into broad age groupings.

New to APD

Reference table name: REF_SPARCS_AGE_GRP_CD

SPARCS_AGE_GRP_CD SPARCS_AGE_GRP_CD_DESCR

0 newborn1 0-22 3-53 6-144 15-19

5 20-446 45-647 65-748 75-849 Other


25

CLAIM TABLE

Newborn Age in Days

Variable Name: AGE_IN_DAYS


Variable Length: 22


Variable Index: 11


Description:Patient’s age calculated in days for patients under one year of age.

Former variable name: AGEDAYS


26

CLAIM TABLE

Age Warning Flag

Variable Name: AGE_WARNING_IND


Variable Length: 1


Variable Index: 12


Description:Flags a conflict between reported diagnosis and ICD-9/ICD-10 CM reference file’s age-specific edits. “1” indicates therewas an age conflict. “Blank” indicates there was no conflict.


Special Notes:This is an obsolete NYS specific data element.

Former variable name: AGEWARN

Reference table name: REF_AGE_WARNING_IND

AGE_WARNING_IND AGE_WARNING_IND_DESCR

N NoY Yes


27

CLAIM TABLE

Alternate Care Days

Variable Name: ALT_CARE_DAYS


Variable Length: 22


Variable Index: 13


Description:Number of days at level of non-acute care.


Special Notes:This is an obsolete NYS specific data element. It is reported as an Occurrence Span.

Former variable name: ACDAYSn



28

CLAIM TABLE

Diastolic BP on Arrival

Variable Name: AMI_BP_DIASTOLIC


Variable Length: 3


Variable Index: 14


Description:Diastolic BP in mg/dl at first patient contact after arrival with principal diagnosis of AMI.

Former variable name: DIABP

Reference table name: REF_AMI_BP_DIASTOLIC

AMI_BP_DIASTOLIC AMI_BP_DIASTOLIC_DESCR

888 Undocumented in Medical Chart999 UnknownNA Not Applicable


29

CLAIM TABLE

Systolic BP on Arrival

Variable Name: AMI_BP_SYSTOLIC


Variable Length: 3


Variable Index: 15


Description:Systolic BP in mg/dl at first patient contact after arrival with principal diagnosis of AMI.

Former variable name: SYSBP

Reference table name: REF_AMI_BP_SYSTOLIC

AMI_BP_SYSTOLIC AMI_BP_SYSTOLIC_DESCR



30

CLAIM TABLE

Heart Rate on Arrival

Variable Name: AMI_HEART_RATE


Variable Length: 3


Variable Index: 16


Description:Patient heart rate (bpm) at first patient contact after arrival with principal diagnosis of AMI.

Former variable name: HEARTRATE

Reference table name: REF_AMI_HEART_RATE

AMI_HEART_RATE AMI_HEART_RATE_DESCR



31

CLAIM TABLE

Accommodation Total Charges

Variable Name: CHRG_ACCOM_AMT


Variable Length: 22


Variable Index: 17


Description:Total of line charge amounts for accommodation revenue codes (codes beginning with “01”).

Former variable name: TOTACCHG



32

CLAIM TABLE

Total Non-Covered Accommodation Charges

Variable Name: CHRG_ACCOM_NOCVRD_AMT


Variable Length: 22


Variable Index: 18


Description:Total of line denied charge amounts for accommodation revenue codes (codes beginning with “01”).

Former variable name: NCACCHG



33

CLAIM TABLE

Ancillary Total Charges

Variable Name: CHRG_ANCIL_AMT


Variable Length: 22


Variable Index: 19


Description:Total of line charge amounts for ancillary revenue codes (codes not beginning with “01”).

Former variable name: TOTANCHG


34

CLAIM TABLE

Total Non-Covered Ancillary Charges

Variable Name: CHRG_ANCIL_NOCVRD_AMT


Variable Length: 22


Variable Index: 20


Description:Total of line denied charge amounts for ancillary revenue codes (codes not beginning with “01”).

Former variable name: NCANCHG


35

CLAIM TABLE

Total Charges

Variable Name: CHRG_TOT_AMT


Variable Length: 22


Variable Index: 21


Description:Total charge amount for claim.

Former variable name: TOTCHG


36

CLAIM TABLE

Medicaid Income Amount

Variable Name: MCAID_INCOME_AMT


Variable Length: 22


Variable Index: 22


Description:Monthly payment amount required of Medicaid patient towards cost of visit.

Special Notes:This is set based on the value amount for value codes “21”, “22” and “23” which are reflected in MCAID_INCOME_IND

Former variable name: MDCDAMT



37

CLAIM TABLE

Total Non-Covered Charges

Variable Name: CHRG_NOCVRD_AMT


Variable Length: 22


Variable Index: 23


Description:Total of line denied charge amounts.

Former variable name: TOTNCCHG


38

CLAIM TABLE

Workers Compensation / No Fault Amount

Variable Name: PAID_WC_AMT


Variable Length: 22


Variable Index: 24


Description:Amount paid by Workers Compensation / No Fault.

Former variable name: WCAMT



39

CLAIM TABLE

Blood Furnished Amount

Variable Name: BLOOD_FURNISHED


Variable Length: 22


Variable Index: 25


Description:The total number of pints of whole blood or units of packed red cells furnished

Special Notes:This is set based on the value amount for value code “37”

Former variable name: BLOOD



40

CLAIM TABLE

Claim Type

Variable Name: CLM_TYPE_CD


Variable Length: 1


Variable Index: 26


Description:Code indicating whether the claim is: Inpatient (“I”), Ambulatory Surgery (“A”), Emergency Department (“E”), orOutpatient Services (“O”).

Former variable name: CLAIMTYP

Reference table name: REF_CLM_TYPE_CD

CLM_TYPE_CD CLM_TYPE_CD_DESCR

A Ambulatory Surgery VisitE Emergency Room VisitI Inpatient DischargeO Outpatient Services Visit


41

CLAIM TABLE

Procedure Coding Method

Variable Name: CODING_METHOD_CD


Variable Length: 1


Variable Index: 27


Description:Identifies the coding structure used for reporting procedures performed during the outpatient visit.


Special Notes:This is an obsolete NYS specific data element. This was available only from January 1, 1994 - January 1, 2003.

Former variable name: METHCODE


42

CLAIM TABLE

SPARCS Collector Code

Variable Name: DATA_COLLECTOR


Variable Length: 5


Variable Index: 28


Description:Three-digit identification number used to identify the facility or vendor (data collector) submitting the data.

Former variable name: COLLECTR


43

CLAIM TABLE

Accident Related Date

Variable Name: ACCID_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 29

Availability:Dates are an identifiable data element. They are included in the limited dataset, but day is set to the first the month.Additionally dates are blank for abortion and HIV/AIDS records, unless the requestor is explicitly approved for thesetypes of records.

Description:The date on which the specific type of accident occurred to the patient.


Special Notes:This is an obsolete NYS specific data element. History data was converted to the SPARCS_OCCURRENCE table. It isreported as an occurrence date with the occurrence codes “01”, “02”, “03”, “04”, “05” and “06”.

Former variable name: ACCDT


44

CLAIM TABLE

Admission Date

Variable Name: ADMIT_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 30


Description:Date of admission/start of care

Former variable name: ADMDT


45

CLAIM TABLE

Method of Anesthesia Used

Variable Name: ANEST_METHOD


Variable Length: 2


Variable Index: 31


Description:Type of anesthesia administered



Former variable name: METHANES

Reference table name: REF_ANEST_METHOD

ANEST_METHOD ANEST_METHOD_DESCR

0 No Anesthesia10 Local Anesthesia20 General Anesthesia30 Regional Anesthesia40 Other


46

CLAIM TABLE

Statement From Date

Variable Name: CLM_FROM_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 32


Description:Beginning date of the billing period.

Former variable name: CLMDTFR


47

CLAIM TABLE

Statement Thru Date

Variable Name: CLM_THRU_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 33


Description:Ending date of the billing period.

Former variable name: CLMDTTH


48

CLAIM TABLE

Discharge Date

Variable Name: DISCH_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 34


Description:Date of discharge/end of care or death.

Former variable name: DISDT


49

CLAIM TABLE

Patient Birth Date

Variable Name: BIRTH_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 35

Availability:This is an identifiable variable and is blank on the limited dataset. Requests for the encrypted or unencrypted versionof this variable will be considered based on merit.

Description:Patient’s birth date.

Former variable name: DOB


50

CLAIM TABLE

Discharge Weekday

Variable Name: DISCH_DAY


Variable Length: 3


Variable Index: 36


Description:Weekday of patient discharge/end of care (1st three letters).

Former variable name: DISCHWK


51

CLAIM TABLE

Discharge Hour

Variable Name: DISCH_HR


Variable Length: 2


Variable Index: 37


Description:Hour when the patient was discharged or death occurred.

Former variable name: DISHR


52

CLAIM TABLE

Exempt Unit Indicator

Variable Name: UNIT_EXEMPT_CD


Variable Length: 3


Variable Index: 38


Description:Identifies discharge from unit exempt from Diagnosis Related Group (DRG) reimbursement.


Special Notes:This is an obsolete NYS specific data element. It was specific to the mainframe SPARCS system.

Former variable name: EXEMUI


Reference table name: REF_UNIT_EXEMPT_CD

UNIT_EXEMPT_CD UNIT_EXEMPT_CD_DESCR

ALC Alternate Level of CareALR Alcohol RehabilitationCEP Comprehensive Psychiatric Emergency Program

ObservationDGR Drug RehabilitationEPI Epilepsy

EXH All Services at Hospital are ExemptMRH Medical RehabilitationNDB Non-DRG Billable ClaimPSY PsychiatricTBI Traumatic Brain Injury

VTD Ventilator DependentXYZ HIV-AIDSNA not applicable


53

CLAIM TABLE

PFI

Variable Name: FAC_ID


Variable Length: 12


Variable Index: 39


Description:Permanent Facility Identifier (PFI) is a six-digit Facility Identifier used for a specific physical building location.

Former variable name: PFI


54

CLAIM TABLE

Facility Name

Variable Name: FAC_NAME


Variable Length: 200


Variable Index: 40


Description:Facility Name as maintained by the NYSDOH Division of Health Facility Planning.

Former variable name: FACNAME


55

CLAIM TABLE

National Provider ID

Variable Name: FAC_NPI


Variable Length: 12


Variable Index: 41


Description:Service Provider National Provider Identifier (NPI) reported on the claim.

Former variable name: NPID


56

CLAIM TABLE

Historic Source File Type (Complete/Incomplete)

Variable Name: FILE_TYPE


Variable Length: 1


Variable Index: 42


Description:As of January 1, 1994, all records have a value of “C”. For pre-1994 SPARCS inpatient data, Complete File (“C”)represents records with a match between the Discharge Data Abstract File (DDA) and the Uniform Billing File (UBF).The Incomplete File (“I”) represents records from the DDA file and UBF not contained in the Complete File.


Special Notes:This is an obsolete NYS specific data element. It applied to records pre-1994, when data files consisted of matchedrecords between the DDA file and the UB file.

Former variable name: FILETYPE

Reference table name: REF_FILE_TYPE

FILE_TYPE FILE_TYPE_DESCR

C CompleteI Incomplete


57

CLAIM TABLE

Patient Sex

Variable Name: GENDER_CD


Variable Length: 1


Variable Index: 43


Description:Gender of patient

Former variable name: SEX

Reference table name: REF_GENDER_CD

GENDER_CD GENDER_CD_DESCR

F FEMALEM MALET TRANSGENDERU UNDETERMINED


58

CLAIM TABLE

Health Service Area

Variable Name: HSA


Variable Length: 12


Variable Index: 44


Description:Geographical subdivision of NYS within which the health care facility is located assigned based upon the county of thefacility.

Former variable name: HSA


59

CLAIM TABLE

Facility County

Variable Name: HOSP_CNTY_CD


Variable Length: 12


Variable Index: 45


Description:Five digit FIPS county code of the facility.

Former variable name: HOSPCO

Reference table name: REF_APD_CNTY_CD

APD_CNTY_CD NAME_CNTY

36001 Albany36003 Allegany36005 Bronx36007 Broome36009 Cattaraugus

36011 Cayuga36013 Chautauqua36015 Chemung36017 Chenango36019 Clinton

36021 Columbia36023 Cortland36025 Delaware36027 Dutchess36029 Erie

36031 Essex36033 Franklin36035 Fulton36037 Genesee36039 Greene

36041 Hamilton36043 Herkimer36045 Jefferson36047 Kings36049 Lewis

36051 Livingston36053 Madison36055 Monroe36057 Montgomery36059 Nassau

36061 New York


60

CLAIM TABLE

(continued)


36063 Niagara36065 Oneida36067 Onondaga36069 Ontario

36071 Orange36073 Orleans36075 Oswego36077 Otsego36079 Putnam

36081 Queens36083 Rensselaer36085 Richmond36087 Rockland36089 Saint Lawrence

36091 Saratoga36093 Schenectady36095 Schoharie36097 Schuyler36099 Seneca

36101 Steuben36103 Suffolk36105 Sullivan36107 Tioga36109 Tompkins

36111 Ulster36113 Warren36115 Washington36117 Wayne36119 Westchester

36121 Wyoming36123 Yates36898 Unknown36899 Out Of Country36917 Unknown

36927 Unknown36931 Unknown36960 NEW YORK CITY36967 Unknown36978 Unknown

36987 Unknown36990 Unknown36995 Unknown36996 Not Coded36997 Unknown

36998 Homeless36999 Out Of State


61

CLAIM TABLE

Abortion Flag

Variable Name: ABORT_IND


Variable Length: 1


Variable Index: 46


Description:Indication of abortion in claim (“Y” OR “N”).

Former variable name: ABORTFLG


62

CLAIM TABLE

Emergency Department (ED) Indicator

Variable Name: EMERG_IND


Variable Length: 1


Variable Index: 47


Description:Indicates that this was Emergency Department claim based on submitted revenue codes.

Special Notes:For transactions processed prior to 10/1/2017 “E” indicates an emergency. For transactions processed after 10/1/2017“Y” indicates an emergency and “N” indicates a non-emergency.

Former variable name: EDI


63

CLAIM TABLE

Admission via the Emergency Department

Variable Name: EMERG_ADMIT_IND


Variable Length: 1


Variable Index: 48


Description:Indicates if the admission came from the Emergency Department (“Y”/NULL).

Special Notes:Set based on Condition Code = “P7”. Also stored in Condition Code Table.

New to APD


Reference table name: REF_EMERG_ADMIT_IND

EMERG_ADMIT_IND EMERG_ADMIT_IND_DESCR

N NoY Yes


64

CLAIM TABLE

AIDS/HIV Flag

Variable Name: HIV_IND


Variable Length: 1


Variable Index: 49


Description:Indication of AIDS/HIV in claim (“Y”/“N”).

Former variable name: AIDSFLG

Reference table name: REF_HIV_IND

HIV_IND HIV_IND_DESCR

N NoY Yes


65

CLAIM TABLE

Medicaid Income Code

Variable Name: MCAID_INCOME_IND


Variable Length: 1


Variable Index: 50


Description:Indicates type of Medicaid income (’“1” - Surplus; “2” - Catastrophic; “3” - Recurring Monthly Income).

Special Notes:This is set to “1” for value code “22”; “2” for value code “21”; “3” for value code “23”

Former variable name: MDCD


Reference table name: REF_MCAID_INCOME_IND

MCAID_INCOME_IND MCAID_INCOME_IND_DESCR

1 Surplus2 Catastrophic.3 Recurring Monthly IncomeNA not applicable


66

CLAIM TABLE

Newborn Flag

Variable Name: NEWBORN_IND


Variable Length: 1


Variable Index: 51


Description:For process dates prior to 10/1/2017, this indicates the patient’s newborn status as determined by the first 5 charactersof the Principal/Primary Diagnosis Code (“0” not a newborn; “1” newborn; “2” one of multiple newborns). For processdates on or after 10/1/2017, this indicates the patient is under 29 days old (“0” not a newborn; “1” newborn).

Former variable name: NEWBORN

Reference table name: REF_NEWBORN_IND

NEWBORN_IND NEWBORN_IND_DESCR

0 Not newborn1 Newborn2 One of multiple newborns


67

CLAIM TABLE

Same Day Discharge Indicator

Variable Name: DISCH_SAME_DAY_IND


Variable Length: 1


Variable Index: 52


Description:Indicates if patient admitted and discharged on the same day (“1”) or not (“0”).

Former variable name: SDDISCH

Reference table name: REF_DISCH_SAME_DAY_IND

DISCH_SAME_DAY_IND DISCH_SAME_DAY_IND_DESCR

0 Not same day1 Same day


68

CLAIM TABLE

Special Program - Disability

Variable Name: SP_DISAB_IND


Variable Length: 1


Variable Index: 53


Description:Code indicating entitlement to Medicaid benefits due to disability (“Y”).

Special Notes:Set based on Condition Code = “A5”. Also stored in Condition Code Table.

Former variable name: DIS


Reference table name: REF_SP_DISAB_IND

SP_DISAB_IND SP_DISAB_IND_DESCR

N NoY Yes


69

CLAIM TABLE

Special Program - Family Planning

Variable Name: SP_FAM_PLAN_IND


Variable Length: 1


Variable Index: 54


Description:Code indicating entitlement to Medicaid benefits due to Family Planning Procedures (“Y”).


Former variable name: FP


Reference table name: REF_SP_FAM_PLAN_IND

SP_FAM_PLAN_IND SP_FAM_PLAN_IND_DESCR

N NoY Yes


70

CLAIM TABLE

Special Program - Physically Handicapped Children

Variable Name: SP_HANDICAP_CHILD_IND


Variable Length: 1


Variable Index: 55


Description:Code indicating entitlement to Medicaid benefits under Physically Handicapped Children’s Program (PHC) (“Y”).


Former variable name: PHC


Reference table name: REF_SP_HANDICAP_CHILD_IND

SP_HANDICAP_CHILD_IND SP_HANDICAP_CHILD_IND_DESCR

N NoY Yes


71

CLAIM TABLE

Special Program - Special Fund Project

Variable Name: SP_SPECIAL_FUNDING_IND


Variable Length: 1


Variable Index: 56


Description:Code indicating entitlement to Medicaid benefits under the Special Funding Project (SFP). (“Y”).


Former variable name: SFP


Reference table name: REF_SP_SPECIAL_FUNDING_IND

SP_SPECIAL_FUNDING_IND SP_SPECIAL_FUNDING_IND_DESCR

N NoY Yes


72

CLAIM TABLE

Workers Compensation / No Fault Indicator

Variable Name: WC_IND


Variable Length: 2


Variable Index: 57


Description:Code indicating the claim was related to Workers Compensation.

Former variable name: WCOMP


Reference table name: REF_WC_IND

WC_IND WC_IND_DESCR

NF No Fault; Including Auto/OtherWC Workers Compensation


73

CLAIM TABLE

Leave of Absence Days

Variable Name: LEAVE_DAYS


Variable Length: 22


Variable Index: 58


Description:Number of days in leave of absence status.


Special Notes:This is an obsolete NYS specific data element. It is reported as a occurrence span code “74” in the occurrence spandates.

Former variable name: ABSDAYSn TOTABS



74

CLAIM TABLE

Length of Stay

Variable Name: LENGTH_OF_STAY


Variable Length: 22


Variable Index: 59


Description:Total number of patient days (excluding leave of absence days)

Former variable name: LENSTY



75

CLAIM TABLE

Log Number

Variable Name: LOG_NUMB


Variable Length: 6


Variable Index: 60


Description:Sequential number historically assigned by the mainframe SPARCS system that identifies the submission to which therecord belonged.



Former variable name: LOGNO


76

CLAIM TABLE

Medical Record Number

Variable Name: MED_REC_NUMB




Variable Index: 61


Description:Identifier used by the Medical Records Department for patient’s permanent medical record file.

Former variable name: MEDREC


77

CLAIM TABLE

Mother’s Medical Record Number (MRN)

Variable Name: MED_REC_MOM_NUMB




Variable Index: 62


Description:Medical Record Number of the newborn’s mother.

Former variable name: MMEDRECE



78

CLAIM TABLE

Medicaid Rate Code

Variable Name: MCAID_RATE_CD


Variable Length: 4


Variable Index: 63


Description:Identifies the type of rate based services paid for by Medicaid.

Special Notes:This is the value amount when the value code is “24”

Former variable name: MEDRATE

This is an outpatient variable only. (Ambulatory Surgery Visit, Emergency Room Visit, Inpatient Discharge,Outpatient Services Visit)

Reference table name: REF_MCAID_RATE_CD

MCAID_RATE_CD MCAID_RATE_CD_DESCR

1000 RESERVED FUTURE PROGRAMS1003 RESERVED FUTURE PROGRAMS1040 RESERVED FUTURE PROGRAMS1042 RESERVED FUTURE PROGRAMS1045 RESERVED FUTURE PROGRAMS




1116 RESERVED FUTURE PROGRAMS1118 RESERVED FUTURE PROGRAMS1120 RESERVED FUTURE PROGRAMS1122 OMH APG ARTICLE 31 INTEGRATED SERVICES1124 OMH APG ARTICLE 31 INTEGRATED SERVICES SED

1126 MA CVRD NON MEDICARE CVRD SRVCS FOR DUALS OPDAPG


79

CLAIM TABLE

(continued)


1128 MA CVRD NON MEDICARE CVRD SRVCS FOR DUALS DTCAPG

1130 OASAS FREE STANDING MMTP INTEGRATED SERVICES1132 OASAS HOSPITAL ARTICLE 32 CLINIC INTEGR SERVICES1134 OASAS HOSPITAL MMTP INTERGATED SERVICES

1136 OMH DTC ARTICLE 31 CLINIC UT EXEMPT APG1138 OMH DTC ARTICLE 31 CLINIC SED UT EXEMPT APG1140 OMH HOSP ARTICLE 31 CLINIC UT EXEMPT APG1142 OMH HOSP ARTICLE 31 CLINIC SED UT EXEMPT APG1200 HOPD ORDERED AM INSTITUTIONAL CLAIM XOVER

1319 CAMT IND RATE SED1342 PVOC SRV GROUP RATE DD1381 SBHC FLU SEASONAL VACCINES ADMINISTRATION ONLY1383 SBHC PNEUMO VACCINES ADMINISTRATION ONLY1386 HEALTH HOME SERVICES

1387 HEALTH HOME SERVICES OUTREACH1400 HOSPITAL OUTPATIENT APG1401 HOSPITAL AMBULATORY SURGERY APG1402 HOSPITAL EMERGENCY ROOM APG1403 HOSPITAL OUTPATIENT APG CAPTIAL ADD ON

1404 HOSPITAL AMBULATORY SURGERY APG CAPTIAL ADD ON1405 HOSPITAL EMERGENCY ROOM APG CAPITAL ADD ON1406 HOSPITAL OUTPATIENT APG EXISTING RATE FOR BLEND1407 D T CLINIC APG1408 D T AMBULATORY SURGERY APG

1409 D T CLINIC APG CAPITAL ADD ON1410 D T AMBULATORY SURGERY APG CAPITAL ADD ON1412 D T AMBULATORY SURGERY APG EXIST RATE BLEND1413 HOSPITAL OP APG OUT OF STATE1416 HOSPITAL AMB SURG APG OUT OF STATE

1419 HOSPITAL ER APG OUT OF STATE1420 RESERVED FOR FUTURE USE1422 DTC GENERAL CLINIC APG EPISODE BASE RATE1423 DTC GENERAL CLINIC APG EPISODE BLEND PAYMENT1425 DTC CLINIC MR DD TBI APG EPISODE BASE RATE

1428 D T CLINIC APG DENTAL CLINIC1430 D T CLINIC APG EXIST RATE BLEND DENTAL CLINIC1431 D T CLINIC APG CAPITAL ADD ON DENTAL CLINIC1432 HOSPITAL CLINIC APG EPISODE BASE RATE1433 HOSPITAL CLINIC APG EPISODE BLEND PAYMENT

1434 HOSPITAL CLINIC APG EPISODE CAPITAL ADD ON1435 D T CLINIC APG GEN CLINIC MR DD TBI PATIENT1438 D T CLINIC APG RENAL CLINIC1440 D T CLINIC APG CAPITAL ADD ON RENAL CLINIC1441 HOSPITAL OUT OF STATE CLINIC EPISODE PAYMENT

1444 HOSPITAL OUTPATIENT APG SCHOOL BASED HEALTH PRO1447 D T CLINIC APG SCHOOL BASED HEALTH PROJECT


80

CLAIM TABLE

(continued)


1450 HOSPITAL APG SCHOOL BASED HEALTH CLINIC EPISODE1453 D T CLINIC APG SCHOOL BASED HEALTH EPISODE1456 D T CLINIC APG RENAL EPISODE

1462 RESERVED FUTURE PROGRAMS1477 RESERVED FOR FUTURE USE APG1480 OMH APG ARTICLE 31 INTEGRATED SERVICES1482 OMH ART 31 APG MEDICAL VISIT B CAPITAL ADD ON1483 OMH APG ARTICLE 31 INTEGRATED SERVICES SED

1487 RESERVED FOR FUTURE USE APG1489 HOSPITAL OP APG MR DD TBI PATIENT EPISODE1495 APG GEN CLINIC MR DD TBI EPISODE PYMT EDIT EXMPT1498 APG GEN CLINIC MR DD TBI EDIT EXEMPT1501 HOSPITAL OPD APG MR DD TBI PATIENT VISIT BASED

1502 HOSPITAL OPD APG BLEND PAYMENT MR DD TBI VISIT1504 OMH APG FREE STANDING ARTICLE 31 CLINIC1507 OMH APG FS ARTICLE 31 CLINIC OFF SITE1510 OMH APG FREE STANDING ARTICLE 31 CLINIC SED1516 OMH APG HOSPITAL ARTICLE 31 CLINIC

1519 OMH APG HOSPITAL ARTICLE 31 CLINIC OFF SITE1522 OMH APG HOSPITAL ARTICLE 31 CLINIC SED1525 OMH APG HOSPITAL ARTICLE 31 CLINIC OFFSITE SED1528 OASAS HOSPITAL ARTICLE 32 CLINIC1531 OASAS HOSPITAL MMTP

1537 OPWDD APG HOSPITAL ARTICLE 16 CLINIC OFF SITE1540 OASAS FREE STANDING ARTICLE 32 CLINIC1546 OPWDD APG FREE STANDING ARTICLE 16 CLINIC1549 OPWDD APG FREE STANDING ARTICLE 16 CLINIC OFF SITE1552 OASAS APG ARTICLE 32 CLINIC MEDICAL VISIT

1555 OASAS APG MMTP CLINIC MEDICAL VISIT1561 OASAS APG HOSPITAL ARTICLE 32 OUTPATIENT REHAB1564 OASAS FREE STANDING MMTP WEEKLY VISIT BASED1567 OASAS HOSPITAL MMTP WEEKLY VISIT BASED1573 OASAS APG ARTICLE 32 OUTPATIENT REHAB

1576 OMH APG HOSPITAL ARTICLE 31 CLINIC CRISIS1582 OMH APG HOSP ARTICLE 31 CLINIC CRISIS SED1588 OMH APG HOSPITAL ARTICLE 31 MEDICAL VISIT1591 OMH APG HOSPITAL ARTICLE 31 MEDICAL VISIT SED1597 DOH DTC APG INTEGRATED SERVICES

1601 D T PCAP INITIAL PRENATAL CARE VISIT1602 D T PCAP FOLLOW UP PRENATAL CARE VISIT1604 MOMS HEALTH SUPPORTIVE SERVICE1609 FQHC SHORTFALL PAYMENT1610 ALL INCLUSIVE

1621 DENTAL SCHOOL MANAGED CARE EXEMPT1679 COMP ASSESSMENT DIAG CL BEHAVIORAL ASSESSMENT1700 OTHER PAS AMBULATORY SURGERY PROCEDURE S1702 PAS 2 EYE THERAPEUTIC


81

CLAIM TABLE

(continued)


1708 PAS 8 EAR THERAPEUTIC

1732 PAS 32 DILATION AND CURETTAGE1804 PAS GROUPER ACCESS CODE PRINCIPAL PROCEDURE1851 HEALTH HOME OMH TCM1852 HEALTH HOME OUTREACH OMH TCM1853 HEALTH HOME PLUS CARE MANAGEMENT

2039 AUDIO EVAL PROC CODE 92568 SSHSP2046 AUDIO EVAL PROC CODE 92582 SSHSP2242 HIP 1 UNDER AGE 652386 RESERVED FUTURE PROGRAMS2401 CONSUMER DIRECT PERS ASSIST 1 CLIENT HOURLY

2408 CONS DIR PERS ASSIST DAILY CAPITATED ENHANCED2414 LMTD LIC HC SVCS AGNCY RUGS II GRP CC DAILY2420 LMTD LIC HC SVCS AGNCY RUGS II GRP PC DAILY2503 PCAIII SHARED AIDE BASIC HOURLY2531 MMTP BUPRENORPH LOWDO 2 10 MGS

2532 MMTP BUPRENORPH MEDDO 12 20 MGS2533 MMTP BUPRENORPH HIDO 22 26 MGS2534 MMTP BUPRENORPH MAXDO 28 MGS2572 MEDICAL LANGUAGE ASSISTANCE SERVICE INPATIENT2598 PCA LVL 2 2 CLNTS CLNT HARD TO SERVE 1 4 HOUR

2670 CONTINUOUS NURSING SERVICES HOURLY2800 DAY CARE PER VISIT2820 INPATIENT GENERAL RESPITE2844 OCCUPATIONAL THERAPY2845 PHYSICAL THERAPY

2847 SPEECH PATHOLOGY2852 HOSPITAL SUBDIVISION PSYCH DRG EXEMPT2853 HOSPITAL SUBDIVISION REHAB DRG EXEMPT2861 NON OCCUPANT SERVICE SUBCHAPTER H2870 OUTPATIENT DEPARTMENT

2877 AMBULATORY SURGERY HOSPITAL BASED2879 GENERAL ER2880 PART TIME CLINIC SERVICES2883 RENAL OR HEMODIALYSIS2886 REFERRED AMBULATORY

2887 CHILD REHABILITATION2888 COMP PHYSICAL EXAM SCHOOL HLTH PROJECT2889 ROUTINE VISIT SCHOOL HEALTH PROJECT2903 AMBULATORY SURGERY LEVEL IV2909 AIDS CLINIC

2910 HEMODIALYSIS FACILITY SESSION2912 HOME HEMODIALYSIS CAPD CCPD DAILY2940 AIDS CLINIC INITIAL VISIT2941 AIDS CLINIC FOLLOW UP VISIT EXTENDED2942 AIDS CLINIC FOLLOW UP VISIT ROUTINE


82

CLAIM TABLE

(continued)


2943 AIDS CLINIC INFUSION THERAPY BLOOD2944 AIDS CLINIC INFUSION THERAPY CHEMOTHERAPY2945 AIDS CLINIC SUBSEQUENT COMPREHENSIVE VISIT2946 DIAGNOSIS RELATED GROUPS2947 CANCER HOSPITALS DRG EXEMPT

2948 REHABILITATION HOSPITALS DRG EXEMPT2950 AWAITING ALC RES HLTH CARE FAC DRG FAC2956 LONG STAY DAY OUTLIERS2957 ALCOHOLISM REHAB DRG EXEMPT2961 AIDS CLINIC THERAPEUTIC VISIT

2963 AWAITING ALC MED RELATED HC NON DRG PSYCH2964 AWAITING ALC PLACEMENNT RHCF NON DRG AIDS CENTER2970 AWAITING ALC RHCF NON DRG MEDICAL REHAB UNIT2973 METHADONE MAINTENANCE TREATMENT PROGRAM

WEEKLY2983 HIV COUNSELING AND TESTING VISIT

2984 POST TEST HIV COUNSELING VISIT NEGATIVE RESULT2985 INITIAL COMP HIV MEDICAL EVALUATION VISIT2986 DRUG IMMUNOTHERAPY VISIT HIV INFECTED PATIENT2987 MONITORING VISIT ASYMPTOMATIC HIV DISEASE2993 DRUG REHABILITATION UNIT DRG EXEMPT

2996 TOP 20 DRGS GROUP OPERATING CPD2999 PRIMARY CARE HOSPITAL PER DIEM3017 PAS 17 UPPER G I DIAGNOSTIC THERAPEUTIC3025 PAS 25 LITHOTRIPSY3039 PAS 39 BREAST REPAIR

3088 PAC GROUPER ACCESS CODE3089 PAS GROUPER ACCESS CODE PRINCIPAL PROC3092 CHEMO CLINIC SERVICE3100 ORTHOPEDIC REHAB CLINIC3101 HOSP BASED PCAP INITIAL PRENATAL CARE VISIT

3102 HOSP BASED PCAP FOLLOW UP PRENATAL VISIT3103 HOSPITAL BASED PCAP POST PARTUM CARE3106 HEMO EPO ADD ON PER 1 000 UNITS3107 MONTHLY DIALYSIS SVCS MEDICARE CROSSOVER3109 HIV COUNSELING VISIT NO TESTIING

3111 POST TEST HIV COUNSELING VISIT POS RESULT3130 GME WORKER INCENTIVE DRG DISCHARGE3131 GME WORKER INCENTIVE EXEMPT UNIT DSCGE PSYCH3132 GME WORKER INCNTVE EXMPT UNIT DSCGE MED REHAB3137 GME WKR INCENT EXEMPT UNIT DISCGE SPEC HOSP

3138 NEWBORN HEARING SCRNG SVC 1ST INITIAL STAGE3139 NEWBORN HEARING SCRNG SVC 2ND FOLLOWUP STG3140 HYPERBARIC THERAPY 1 2 HOUR3257 INDIVID BRIEF PSYCHOTHERAPY 20 30 MIN WITH PATIENT3258 INDIVID COMPR PSYCHOTHERAPY 45 50 MIN WITH

PATIENT


83

CLAIM TABLE

(continued)


3259 FAMILY PSYCHOTHERAPY WITH OR W O PATIENT PRESENT3308 RUGS II GROUP CA MEDICARE3411 RUGS III GROUP PC2 NON MEDICARE3860 LONG TERM HOME CARE MOVING ASSISTANCE ROOM3941 RHCF DAY CARE 8 HRS RESPITE

4007 BRIEF EVALUATION4008 FULL EVALUATION4009 CRISIS OUTREACH VISIT4010 INTERIM CRISIS VISIT4011 FQHC FQHC GROUP PSYCHOTHERAPY

4012 FQHC FQHC OFF SITE SERVICES INDIV4013 FQHC INDIVIDUAL THRESHOLD VISIT4022 FQHC MONITORING VISIT ASYMPTOMATIC HIV4024 FQHC HIV COUNSELING AND TESTING VISIT4028 FQHC INDIVIDUAL THRESHOLD VISIT COURT ORDERED

4049 CPEP EXTENDED OBSERVATION BEDS4093 OMH CLINIC CRISIS COPS4096 OMH CLINIC GROUP COPS4097 OMH CLINIC BRIEF COPS4098 OMH COPS MANAGED CARE REGULA

4102 OMRDD ST OP ICF DD SMALL RESIDENTIAL UNIT4104 ICF VOL DAY SERVICE FULL UNIT4200 STATE OPERATED ALCOHOLISM REHABILITATION4250 ALCOHOLISM CLINIC TREATMENT REGULAR4251 ALCOHOLISM CLINIC TREATMENT BRIEF

4257 INDIVID BRIEF PSYCHOTHERAPY 20 30 MIN WITH PATIENT4258 INDIVID COMPR PSYCHOTHERAPY 45 50 MIN WITH

PATIENT4259 FAMILY PSYCHOTHERAPY WITH OR W O PATIENT PRESENT4271 MED SUP SUBSTANCE ABUSE VISIT4273 CD CLINIC ASSESS AT LEAST 30 MIN ART 28

4274 CD CLINIC INDIV SESSION AT LEAST 30 MIN ART284275 CD CLINIC GRP SESSION AT LEAST 30 MIN ART 284276 OASAS CD REHAB ASSESSMENT ARTICLE 284277 OASAS CD REHAB SESSION AT LEAST 4 HRS ART 284278 OASAS CD REHAB AT LEAST 2 HRS BUT 4 HRS ART 28

4279 OASAS OUTPATIENT DETOX ARTICLE 284283 CD CLINIC ASSESS 30 MIN FREE STANDING OCDY ART 284301 OMH CLINIC REGULAR4302 OMH CLINIC BRIEF4303 OMH CLINIC GROUP

4304 OMH CLINIC COLLATERAL4305 OMH CLINIC GRP COLLATERAL4306 OMH CLINIC CRISIS4307 CONTINUING DAY TREATMENT RESERVED4308 CONTINUING DAY TREATMENT RESERVED


84

CLAIM TABLE

(continued)


4310 CONTINUING DAY TREATMENT HALF DAY 1 404311 CONTINUING DAY TREATMENT HALF DAY 41 644313 CONTINUING DAY TREATMENT RESERVED4316 CONTINUING DAY TREATMENT FULL DAY 1 404317 CONTINUING DAY TREATMENT FULL DAY 41 64

4319 CONTINUING DAY TREATMENT RESERVED4322 CONTINUING DAY TREATMENT RESERVED4325 CONTINUING DAY TREATMENT COLLATERAL4331 CONTINUING DAY TREATMENT GROUP COLLATERAL4337 CONTINUING DAY TREATMENT CRISIS

4346 CONTINUING DAY TREATMENT PRE ADMISSION4349 PARTIAL HOSPITALIZATION REGULAR 4 HOURS4350 PARTIAL HOSPITALIZATION REGULAR 5 HOURS4351 PARTIAL HOSPITALIZATION REGULAR 6 HOURS4352 PARTIAL HOSPITALIZATION REGULAR 7 HOURS

4353 PARTIAL HOSPITAL COLLATERAL 1 HOUR4354 PARTIAL HOSPITAL COLLATERAL 2 HOURS4355 PARTIAL HOSPITAL GROUP COLLATERAL 1 HOUR4357 PARTIAL HOSPITALIZATION CRISIS 1 HOUR4358 PARTIAL HOSPITALIZATION CRISIS 2 HOURS

4359 PARTIAL HOSPITALIZATION CRISIS 3 HOURS4360 PARTIAL HOSPITALIZATION CRISIS 4 HOURS4361 PARTIAL HOSPITALIZATION CRISIS 5 HOURS4362 PARTIAL HOSPITALIZATION CRISIS 6 HOURS4363 PARTIAL HOSPITALIZATION CRISIS 7 HOURS

4364 INTENSIVE PSYCH REHAB TREATMENT 1 HOUR4365 INTENSIVE PSYCH REHAB TREATMENT 2 HOURS4366 INTENSIVE PSYCH REHAB TREATMENT 3 HOURS4367 INTENSIVE PSYCH REHAB TREATMENT 4 HOURS4368 INTENSIVE PSYCH REHAB TREATMENT 5 HOURS

4398 HCBS FLEXIBLE RECIPIENT SERVICE DOLLARS4508 ACT INTENSIVE FULL PAYMENT4509 ACT INTENSIVE PART PAYMENT4510 PROS PREADMISSION4511 ACT INPATIENT

4512 ACT SERVICES4601 OMH CLINIC REGULAR MC SED4602 OMH CLINIC BRIEF MC SED4603 OMH CLINIC GROUP MC SED4604 OMH CLINIC COLLATERAL MC SED

4605 OMH CLINIC GROUP COLLATERAL MC SED4606 OMH CLINIC CRISIS MC SED4650 ICC MONTHLY4651 ICC HALF MONTH4652 OMH HCBS CHILDREN S WAIVER

4653 RESPITE INDIVIDUAL


85

CLAIM TABLE

(continued)


4655 FAMILY SUPPORT INDIVIDUAL4656 SKILL BUILDING INDIVIDUAL4657 INTENSIVE IN HOME HOURLY4658 INTENSIVE IN HOME ICC STAFF

4659 CRISIS RESPONSE HOURLY4660 CRISIS RESPONSE ICC STAFF4661 ICC CASE MGT START UP FULL MONTH4662 ICC CASE MGT START UP HALF MONTH4663 ICC INPATIENT FULL MONTH

4664 ICC INPATIENT HALF MONTH4726 CIDP MCCF MONTHLY CARE COORDINATION FEE4800 Medically Managed Detox w or w o OBS Days4801 Medically Supervised Detox w o OBS Days4802 Medically Supervised Detox W 1 OBS DAY

4803 Medically Supervised Detox W 2 OBS DAYS5205 OMH SCM COMMUNITY 205206 OMH SCM COMMUNITY 305246 COLLABORATIVE CARE MONTHLY CASE PAYMENT YEAR 15247 COLLABORATIVE CARE MONTHLY CASE PAYMENT YEAR 2

5248 COLLABORATIVE CARE RETAINAGE YEAR 15250 OMH ICM TEAM5251 OMH 1ICM 1SCM5252 OMH 1ICM 2SCM5253 OMH 2ICM 1SCM

5313 TB DIRECTLY OBSERVED THERAPY DNST LEVEL 25426 EI BASIC NURSING SRVS HOME COMM BASED IND COL


86

CLAIM TABLE

Newborn Birth Weight

Variable Name: NEO_BIRTH_WT


Variable Length: 22


Variable Index: 64


Description:Reported weight of the newborn in grams.

Special Notes:This is the value amount when the value code is “54”

Former variable name: NBWT



87

CLAIM TABLE

Non-Covered Days

Variable Name: NOCVRD_DAYS


Variable Length: 22


Variable Index: 65


Description:Number of days not covered by insurance



Former variable name: NCDAYSn



88

CLAIM TABLE

Covered Days

Variable Name: NUMB_DAYS_COV


Variable Length: 22


Variable Index: 66


Description:Number of days covered by insurance.



Former variable name: CODAYSn



89

CLAIM TABLE

Procedure Time

Variable Name: OPER_TIME


Variable Length: 3


Variable Index: 67


Description:Total time in hours and minutes that the patient was actually in the operating room exclusive of pre-op (preparation)and post-op (recovery) time.



Former variable name: OPTIME

This is an outpatient variable only. (Ambulatory Surgery Visit, Emergency Room Visit)


90

CLAIM TABLE

Operating Certificate Number

Variable Name: OPCERT_NUMB


Variable Length: 12


Variable Index: 68


Description:Number of the operating certificate for the facility issued by the Division of Health Facility Planning.

Former variable name: OPERCTF


91

CLAIM TABLE

Patient Control Number

Variable Name: PAT_CTRL_NUMB




Variable Index: 69


Description:Unique number assigned by the provider to facilitate retrieval of individual financial and clinical records and posting ofthe payment.

Former variable name: PTCTN


92

CLAIM TABLE

Patient Discharge Status

Variable Name: PAT_STATUS_CD


Variable Length: 2


Variable Index: 70


Description:Code indicating the patient’s destination or status upon discharge.

Former variable name: DISP

Reference table name: REF_PAT_STATUS_CD

PAT_STATUS_CD PAT_STATUS_CD_DESCR

1 DISCHARGE / TRANSFER TO HOME/SELF CARE2 TRANSFER TO A DRG HOSPITAL3 DISCHARGE / TRANSFER TO SKILLED NURSING FACILITY4 DISCHARGE/TRANSFER TO INTER CARE FACILITY/HRF5 TRANSFERRED TO A CANCER CTR/CHILDREN HOSPITAL

6 DISCHARGE TO HOME UNDER CARE OF HOME HEALTHORG.

7 LEFT AGAINST MEDICAL ADVICE8 DISCHARGED TO HOME IV THERAPY9 ADMITTED TO INPATIENT HOSPITAL20 EXPIRED

21 DISCHARGE/TRANSFER TO COURT/LAW ENFORCEMENT30 STILL A PATIENT/RESIDENT40 EXPIRED AT HOME41 EXPIRED AT MEDICAL FACILITY42 EXPIRED - PLACE UNKNOWN

43 DISCHARGED TO FEDERAL HOSPITAL50 HOSPICE - HOME51 HOSPICE - MEDICAL FACILITY61 TRANSFER WITHIN FACILITY - MDCR SWING BED62 DISCHARGE/TRANSFER TO INPATIENT REHAB FACILITY

63 DISCHARGE/TRANSFER TO MCARE LTC HOSPITAL64 DISCHARGE/TRANSFER TO SNF CERTIFIED UNDER MCAID65 DISCHAGE /TRANSFER TO PSYCHIATRIC HOSPITAL66 DISCHARGE TRANSFER TO CRITICAL ACCESS HOSPITAL69 DESIGNATED DISASTER ALTERNATIVE CARE SITE

70 DISCHARGE/TRANSFER TO ANOTHER HEALTH CARE INST81 HOME-SELF CARE WITH PLANNED READMISSION82 SHORT TERM HOSPITAL WITH PLANNED READMISSION83 SNF WITH PLANNED READMISSION84 CUST/SUPP CARE WITH PLANNED READMISSION


93

CLAIM TABLE

(continued)

PAT_STATUS_CD PAT_STATUS_CD_DESCR

85 CANCER/CHILD HOSP WITH PLANNED READMISSION86 HOME HEALTH SERVICE WITH PLANNED READMISSION87 COURT/LAW ENFORCEMENT WITH PLANNED READMISSION88 FEDERAL HOSPITAL WITH PLANNED READMISSION89 SWING BED WITH PLANNED READMISSION

90 REHAB FACILITY/UNIT WITH PLANNED READMISSION91 LTCH WITH PLANNED READMISSION92 NURSING FACILITY MCR-CERTIFIED W PLANNED READMIT93 PSYCHIATRIC HOSPITAL/UNIT W PLANNED READMISSION94 CRITICAL ACCESS HOSPITAL WITH PLANNED

READMISSION95 OTHER INSTITUTION WITH PLANNED READMISSION


94

CLAIM TABLE

Expected Principal Reimbursement

Variable Name: PRIM_REIMB_CD


Variable Length: 2


Variable Index: 71


Description:Code identifying the payer expected to pay a portion of the patient’s bill.



Former variable name: REIMB


95

CLAIM TABLE

Procedure Date Warning Flag

Variable Name: PROC_DT_WARNING_CD


Variable Length: 1


Variable Index: 72


Description:Code indicating the procedure date conflicts with (is no more than three (3) days prior to) Admission Date/Start ofCare. “1” = Conflict / blank = No conflict.



Former variable name: PRDTWR


96

CLAIM TABLE

Expected Reimbursement Other 1

Variable Name: OTHR_REIMB_1_CD


Variable Length: 2


Variable Index: 73


Description:Code identifying the secondary payer expected to pay a portion of the patient’s bill.



Former variable name: REIMBO1



97

CLAIM TABLE

Expected Reimbursement Other 2

Variable Name: OTHR_REIMB_2_CD


Variable Length: 2


Variable Index: 74


Description:Code identifying the secondary payer expected to pay a portion of the patient’s bill.



Former variable name: REIMBO2



98

CLAIM TABLE

Record Sequence Number

Variable Name: REC_SEQ


Variable Length: 3


Variable Index: 75


Description:Assigned by SPARCS to indicate the record’s position within a set of records for a particular patient discharge.



Former variable name: SEQ


99

CLAIM TABLE

Residence Indicator

Variable Name: RESID_CD


Variable Length: 1


Variable Index: 76


Description:Code indicating whether the patient is Homeless (“H”) / Non-US Resident (“F”).

Special Notes:Set based on Condition Code. “H” set when condition code = “17”. “F” set when condition code = “25”. Also stored inCondition Code Table.

Former variable name: RESIND

Reference table name: REF_RESID_CD

RESID_CD RESID_CD_DESCR

F Non-US Resident (Foreign Born)H HomelessNA Not Applicable


100

CLAIM TABLE

Service Category

Variable Name: SVC_CATGY_CD


Variable Length: 1


Variable Index: 77


Description:Code indicating the service category group of the claim (“1” Medical, “2” Surgical. “3” Pediatric, “4” Obstetrical, “5”Nursery/Newborn, and “6 “Psychiatric).

Former variable name: SRVCCTGRY

Reference table name: REF_SVC_CATGY_CD

SVC_CATGY_CD SVC_CATGY_CD_DESCR

1 Medical2 Surgical3 Pediatric4 Obstetrical5 Nursery/Newborn6 Psychiatric


101

CLAIM TABLE

Record Sequence Count

Variable Name: SEQ_CNT


Variable Length: 3


Variable Index: 78


Description:Total number of records reported for a particular patient stay/discharge. This data element is assigned in conjunctionwith Record Sequence Number.




102

CLAIM TABLE

SPARCS Region Code

Variable Name: REGION_CD


Variable Length: 2


Variable Index: 79


Description:Geographical subdivision of NYS assigned based upon the county of the facility.



Former variable name: REG

Reference table name: REF_REGION_CD

REGION_CD REGION_CD_DESCR

1 Western NY2 Finger Lakes3 Central NY4 Northeastern NY5 Hudson Valley

6 Bronx7 Brooklyn8 Manhattan9 Manhattan10 Queens/Staten Island11 Long Island


103

CLAIM TABLE

Transaction Code

Variable Name: TRANS_CD


Variable Length: 1


Variable Index: 80


Description:Code indicating the type of transaction. “1” Delete (claim frequency type code “8”); “2” Add (claim frequency typecode “1”); “3” Correction (claim frequency type code “7”).


Special Notes:This is an obsolete NYS specific data element. It is reported as a Claim Frequency Type Code (CLM_FREQ_CD).

Former variable name: TRAN


104

CLAIM TABLE

Unique Personal ID Enhanced Encrypted

Variable Name: UPIDE




Variable Index: 81

Availability:This variable is only available in the encrypted version.

Description:Encrypted Unique Personal ID Enhanced.


105

CLAIM TABLE

Unique Personal identifier

Variable Name: UNIQUE_PERSONAL_ID




Variable Index: 82


Description:Composite field composed of portions of the patient’s last name, first name, social security number.

Former variable name: UPID


106

CLAIM TABLE

Previous Patient Control Number

Variable Name: PREV_PAT_CTRL_NUMB




Variable Index: 83


Description:Original Patient Control Number submitted on adjustment or void transaction.

New to APD


107

CLAIM TABLE

Type of Bill Code

Variable Name: FAC_TYPE_CD


Variable Length: 2


Variable Index: 84


Description:Code indicating the type of bill.

Former variable name: BILLTP


108

CLAIM TABLE

Claim Frequency Type Code

Variable Name: CLM_FREQ_CD


Variable Length: 1


Variable Index: 85


Description:Code indicating whether this is an original (“1”), adjustment (“7”) or void (“8”) transaction.


109

CLAIM TABLE

Payer Responsibility Amount

Variable Name: PAYR_RESP_AMT


Variable Length: 22


Variable Index: 86


Description:Estimated payer responsibility amount.

New to APD


110

CLAIM TABLE

Patient Responsibility Amount

Variable Name: PAT_RESP_AMT


Variable Length: 22


Variable Index: 87


Description:Amount patient will be responsible for paying.

New to APD


111

CLAIM TABLE

Patient Individual Relationship Code

Variable Name: PAT_INDVDL_RLTNSHP_CD


Variable Length: 10


Variable Index: 88


Description:Code indicating the relationship between the patient and the subscriber.

New to APD


112

CLAIM TABLE

Subscriber Group Number

Variable Name: PAT_GRP_NUMB




Variable Index: 89


Description:Subscriber’s group number.

New to APD


113

CLAIM TABLE

Member Identification Number

Variable Name: PAT_MBR_ID_NUMB




Variable Index: 90


Description:Patient’s member identification number.

New to APD


114

CLAIM TABLE

Patient Marital Status

Variable Name: PAT_MRITL_STS


Variable Length: 10


Variable Index: 91


Description:Code indicating the patient’s marital status.

New to APD


115

CLAIM TABLE

Service Provider Employer Identification Number

Variable Name: SVC_PROV_EMP_ID_ID




Variable Index: 92


Description:Employer identification number of the Service Provider.

New to APD


116

CLAIM TABLE

Claim Key

Variable Name: CLM_KEY


Variable Length: 12


Variable Index: 93


Description:Unique identifier for linking together multiple transaction submissions (e.g., Original, Adjustment and Void).(CLM_TRANS_ID is the unique identifier for the claim).

New to APD


117

CLAIM TABLE

Active Flag

Variable Name: ACTV_FLAG


Variable Length: 1


Variable Index: 94


Description:Indicates whether the record is active (“1”) or inactive (“0”). If set to “0”, the record has been adjusted or voided.

New to APD


118

CLAIM TABLE

Latest Claim Record Flag

Variable Name: LTST_FLAG


Variable Length: 1


Variable Index: 95


Description:Identifies the most recent transaction. “0” indicates it is not the most recent transaction. “1” indicates it is the mostrecent transaction.

New to APD


119

CLAIM TABLE

Submitted File Name

Variable Name: FILE_NM




Variable Index: 96


Description:Name of the file submitted to SPARCS by the facility.

Special Notes:Data submitted prior to October 2017 will have “HIST”.


120

CLAIM TABLE

OTVM Process Date

Variable Name: PROCESSED_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 97


Description:Date the record was created in OTVM

Former variable name: PROCDT


121

CLAIM TABLE

Record Update Date

Variable Name: LAST_UPDD_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 98


Description:Date record was last updated

New to APD


122

CLAIM TABLE

Record Created By

Variable Name: CREATED_BY


Variable Length: 20


Variable Index: 99


Description:Name of system/application that created the record.

New to APD


123

CLAIM TABLE

Last Updated By

Variable Name: LAST_UPDD_BY


Variable Length: 20


Variable Index: 100


Description:System that last updated the record.

New to APD


124

CLAIM TABLE

Source File Name

Variable Name: SRC_NM


Variable Length: 30


Variable Index: 101


Description:Name of the data source file.

New to APD


125

CLAIM TABLE

Row Insert Date

Variable Name: INSERT_ROW_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 102


Description:Date record was inserted in the ODS.

New to APD


126

CONDITION_CODE TABLE


This table contains condition code information used to identify conditions or events related to the claim. Condition codesare a national code set maintained by NUBC. For example: condition code ‘P7’ indicates a direct inpatient admission fromEmergency Room; ‘17’ indicates the patient is homeless; ‘25’ indicates the patient is a non-US Resident; ‘A5’ indicates adisability and is used to set the SP_DISAB_IND; ‘A4’ indicates Family Planning and is used to set the SP_FAM_PLAN_IND;‘A2’ indicates a Physically Handicapped Children’s Program and is used to set the SP_HANDICAP_CHILD_IND; and ‘A3’indicates Special Federal Funding and is used to set the SP_SPECIAL_FUNDING_IND.


127





Variable Length: 12

Table/File: SPARCS_CONDITION_CODE

Variable Index: 1


Description:Unique identifier for the transaction processed (Foreign key that links all tables to the claim table).

New to APD


128


Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


129


Order Sequence ID

Variable Name: SEQ_ID


Variable Length: 22


Variable Index: 3


Description:Order in which the condition codes were reported.


130


Claim Type



Variable Length: 1


Variable Index: 4








131







Variable Index: 5




132


Health Care Condition Code

Variable Name: COND_CD


Variable Length: 10


Variable Index: 6


Description:Code indicating a condition or event related to the claim.

Special Notes:History data was converted to the SPARCS_CONDITION_CODE table. EMERG_ADMIT_IND was stored as “P7”,RESID_CD=“H” was stored as “17”, RESID_CD “F” was stored as “25”, SP_DISAB_IND was stored as “A5”,SP_FAM_PLAN_IND was stored as “A4”, SP_HANDICAP_CHILD_IND was stored as “A2”, SP_SPECIAL_FUNDING_INDwas stored as “A3”.

New to APD

Reference table name: REF_COND_CD

COND_CD COND_CD_DESCR

01 MILITARY SERVICE RELATED02 CONDITION IS EMPLOYMENT RELATED03 PATIENT COVERED BY INSURANCE NOT REFLECTED HERE04 INFORMATION ONLY BILL05 LIEN HAS BEEN FILED

06 ESRD PATIENT IN FIRST 30 MONTHS OF ENTITLEMENTCOVERED BY EMPLOYER GROUP HEALTH INSURANCE

07 TREATMENT OF NON-TERMINAL CONDITION FOR HOSPICEPATIENT

08 BENEFICIARY WOULD NOT PROVIDE INFORMATIONCONCERNING OTHER INSURANCE COVERAGE

09 NEITHER PATIENT NOR SPOUSE IS EMPLOYED10 PATIENT AND/OR SPOUSE IS EMPLOYED BUT NO EGHP

EXISTS

11 DISABLED BENEFICIARY BUT NO LGHP17 PATIENT IS HOMELESS18 MAIDEN NAME RETAINED19 CHILD RETAINS MOTHER’S NAME20 BENEFICIARY REQUESTED BILLING

21 BILLING FOR DENIAL NOTICE22 PATIENT ON MULTIPLE DRUG REGIMEN23 HOME CARE GIVER AVAILABLE24 HOME IV PATIENT ALSO RECEIVING HHA SERVICES25 PATIENT IS NON-U.S. RESIDENT

26 VA ELIGIBLE PATIENT CHOOSES TO RECEIVE SERVICES INA MEDICARE CERTIFIED FACILITY


133


(continued)


27 PATIENT REFERRED TO A SOLE COMMUNITY HOSPITALFOR A DIAGNOSTIC LABORATORY TEST

28 PATIENT AND/OR SPOUSE’S EGHP IS SECONDARY TOMEDICARE

29 DISABLED BENEFICIARY AND/OR FAMILY MEMBER’S LGHPIS SECONDARY TO MEDICARE

30 QUALIFYING CLINICAL TRIALS

31 PATIENT IS STUDENT (FULL TIME – DAY)32 PATIENT IS STUDENT (COOPERATIVE/WORK STUDY

PROGRAM)33 PATIENT IS STUDENT (FULL TIME – NIGHT)34 PATIENT IS STUDENT (PART TIME)36 GENERAL CARE PATIENT IN A SPECIAL UNIT

37 WARD ACCOMMODATION AT PATIENT REQUEST38 SEMI-PRIVATE ROOM NOT AVAILABLE39 PRIVATE ROOM MEDICALLY NECESSARY40 SAME DAY TRANSFER41 PARTIAL HOSPITALIZATION

42 CONTINUING CARE NOT RELATED TO INPATIENTADMISSION

43 CONTINUING CARE NOT PROVIDED WITHIN PRESCRIBEDPOST-DISCHARGE WINDOW

44 INPATIENT ADMISSION CHANGED TO OUTPATIENT45 AMBIGUOUS GENDER CATEGORY46 NON-AVAILABILITY STATEMENT ON FILE

47 TRANSFER FROM ANOTHER HOME HEALTH AGENCY48 PSYCHIATRIC RESIDENTIAL TREATMENT CENTERS FOR

CHILDREN AND ADOLESCENTS (RTCS)49 PRODUCT REPLACEMENT WITHIN PRODUCT LIFECYCLE

(EFFECTIVE 1/1/15)50 PRODUCT REPLACEMENT FOR KNOWN RECALL OF A

PRODUCT51 ATTESTATION OF UNRELATED OUTPATIENT

NONDIAGNOSTIC SERVICES (EFFECTIVE 4/1/11)

53 INITIAL PLACEMENT OF A MEDICAL DEVICE PROVIDED ASPART OF A CLINICAL TRIAL OR A FREE SAMPLE (EFFECTIVE7/1/15)

55 SNF BED NOT AVAILABLE57 SNF READMISSION58 TERMINATED MEDICARE ADVANTAGE ENROLLEE59 NON-PRIMARY ESRD FACILITY

61 COST OUTLIER67 BENEFICIARY ELECTS NOT TO USE LIFE TIME RESERVE

(LTR) DAYS68 BENEFICIARY ELECTS TO USE LIFE TIME RESERVE (LTR)

DAYS69 IME/DGME/N&AH PAYMENT ONLY70 SELF-ADMINISTERED ANEMIA MANAGEMENT DRUG


134


(continued)


71 FULL CARE IN UNIT72 SELF CARE IN UNIT73 ESRD SELF CARE TRAINING74 HOME75 HOME – 100 PERCENT REIMBURSEMENT

76 BACK-UP IN FACILITY DIALYSIS77 PROVIDER ACCEPTS OR IS OBLIGATED/REQUIRED DUE TO

A CONTRACTUAL ARRANGEMENT OR LAW TO ACCEPTPAYMENT BY A PRIMARY PAYER AS PAYMENT IN FULL.

78 NEW COVERAGE NOT IMPLEMENTED BY MANAGED CAREPLAN

80 HOME DIALYSIS - NURSING FACILITY81 C-SECTIONS/INDUCTIONS < 39 WEEKS - MEDICAL

NECESSITY (EFFECTIVE 10/1/13)

82 C-SECTIONS/INDUCTIONS < 39 WEEKS - ELECTIVE(EFFECTIVE 10/1/13)

83 C-SECTIONS/INDUCTIONS 39 WEEKS OR GREATER(EFFECTIVE 10/1/13)

84 DIALYSIS FOR ACUTE KIDNEY INJURY (AKI) (EFFECTIVE1/1/17)

A0 TRICARE EXTERNAL PARTNERSHIP PROGRAMA1 EPSDT/CHAP

A2 PHYSICALLY HANDICAPPED CHILDREN’S PROGRAMA3 SPECIAL FEDERAL FUNDINGA4 FAMILY PLANNINGA5 DISABILITYA6 VACCINES/MEDICARE 100% PAYMENT

AB ABORTION PERFORMED DUE TO INCESTAC ABORTION PERFORMED DUE TO SERIOUS FETAL GENETIC

DEFECT, DEFORMITY, OR ABNORMALITYAD ABORTION PERFORMED DUE TO A LIFE ENDANGERING

PHYSICAL CONDITIONAE ABORTION PERFORMED DUE TO PHYSICAL HEALTH OF

MOTHER THAT IS NOT LIFE ENDANGERINGAF ABORTION PERFORMED DUE TO

EMOTIONAL/PSYCHOLOGICAL HEALTH OF THE MOTHER

AG ABORTION PERFORMED DUE TO SOCIAL OR ECONOMICREASONS

AH ELECTIVE ABORTIONAI STERILIZATIONAJ PAYER RESPONSIBLE FOR COPAYMENTAK AIR AMBULANCE REQUIRED

B0 MEDICARE COORDINATED CARE DEMONSTRATION CLAIMB1 BENEFICIARY IS INELIGIBLE FOR DEMONSTRATION

PROGRAMB2 CRITICAL ACCESS HOSPITAL AMBULANCE ATTESTATIONB3 PREGNANCY INDICATORB4 ADMISSION UNRELATED TO DISCHARGE ON SAME DAY


135


(continued)


C1 APPROVED AS BILLEDC3 PARTIAL APPROVALC4 ADMISSION/SERVICES DENIEDC5 POST PAYMENT REVIEW APPLICABLEC6 ADMISSION PREAUTHORIZATION

D0 CHANGES TO SERVICE DATESD1 CHANGES TO CHARGESD2 CHANGES IN REVENUE CODES/HCPCS/HIPPS RATE CODESD3 SECOND OR SUBSEQUENT INTERIM PPS BILLD4 CHANGE IN CLINICAL CODES (ICD) AND/OR PROCEDURE

CODES

D5 CANCEL TO CORRECT INSURED’S ID OR PROVIDER IDD6 CANCEL ONLY TO REPAY A DUPLICATE OR OIG

OVERPAYMENTD7 CHANGE TO MAKE MEDICARE THE SECONDARY PAYERD8 CHANGE TO MAKE MEDICARE THE PRIMARY PAYERD9 ANY OTHER CHANGE

E0 CHANGE IN PATIENT STATUSG0 DISTINCT MEDICAL VISITH0 DELAYED FILING; STATEMENT OF INTENT SUBMITTEDH2 DISCHARGE BY A HOSPICE PROVIDER FOR CAUSE

(EFFECTIVE 1/1/09)H3 RECOCCURRENCE OF GI BLEED COMORBID CATEGORY

(EFFECTIVE 1/1/11)

P7 DIRECT INPATIENT ADMISSION TO EMERGENCY ROOMW2 DUPLICATE OF ORIGINAL BILL


136


Claim Key



Variable Length: 12


Variable Index: 7



New to APD


137


Active Flag



Variable Length: 1


Variable Index: 8



New to APD


138





Variable Length: 1


Variable Index: 9



New to APD


139


OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 10





140


Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 11



New to APD


141


Record Created By



Variable Length: 20


Variable Index: 12



New to APD


142


Last Updated By



Variable Length: 20


Variable Index: 13



New to APD


143


Source File Name



Variable Length: 30


Variable Index: 14



New to APD


144


Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 15



New to APD


145


Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 16





146


AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 17


Description:Indication of HIV/AIDS in claim (“Y”/“N”).




N NoY Yes


147

DIAG TABLE

DIAG TABLE

This table contains information related to the Diagnosis Codes associated with a SPARCS claim. Including the principaldiagnosis, admitting diagnosis, patient reason for visit, external cause of injury, and other diagnoses. For example itincludes: Claim Type, Discharge Year, Diagnosis Type Code, Diagnosis Code, Present on Admission Indicator, ICD9 orICD10 Indicator and CCS Diagnosis Group.


148

DIAG TABLE




Variable Length: 12

Table/File: SPARCS_DIAG

Variable Index: 1



New to APD


149

DIAG TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


150

DIAG TABLE

Diagnosis Type Code

Variable Name: DX_TYPE_CD


Variable Length: 2


Variable Index: 3


Description:Indicates type of diagnosis code: “PR” Principal; “OT” Other; “EX” External Cause of Injury; “AD” Admitting; “RV”Reason for Visit.

Special Notes:History data was converted from SPARCS_CLAIM and SPARCS_DIAG tables. If DX_CD is populated from CAUSE_OFINJ_CD then “EC”; if DX_CD is populated from PLACE_OF_INJ_CD then “EP”; if DX_CD is populated from DX_ADMIT_CDand CLM_TYPE_CD = ‘I’ then “AD” else ‘RV’; if DX_CD is populated from SPARCS_DIAG and SEQ = ‘1’ then ‘PR’ else‘OT’

New to APD


151

DIAG TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 4


Description:Order in which the diagnosis codes were reported.


152

DIAG TABLE

Claim Type



Variable Length: 1


Variable Index: 5








153

DIAG TABLE






Variable Index: 6




154

DIAG TABLE

Diagnosis Category Code

Variable Name: DX_CATGY_CD


Variable Length: 2


Variable Index: 7


Description:Code indicating a broad category of diagnosis.

New to APD


155

DIAG TABLE

CCS Diagnosis Group

Variable Name: DX_GRP_CD


Variable Length: 3


Variable Index: 8


Description:Clinical Classification Software (CCS) clinical grouper Diagnosis Category is the single level classification system thataggregates illness and conditions into mutually exclusive categories.

Former variable name: DIAGGRP

Reference table name: REF_DX_GRP_CD

DX_GRP_CD DX_GRP_CD_DESCR

1 BACTERIAL INFECTION2 BACTERIAL INFECTION3 BACTERIAL INFECTION4 MYCOSES5 VIRAL INFECTION

6 VIRAL INFECTION7 VIRAL INFECTION8 OTHER INFECTIONS INCLUDING PARASITIC9 BACTERIAL INFECTION10 IMMUNIZATIONS SCREENING FOR INFECTIOUS DISEASE

11 CANCER OTHER PRIMARY12 OTHER GASTROINTESTINAL CANCER13 OTHER GASTROINTESTINAL CANCER14 COLORECTAL CANCER15 COLORECTAL CANCER

16 OTHER GASTROINTESTINAL CANCER17 OTHER GASTROINTESTINAL CANCER18 OTHER GASTROINTESTINAL CANCER19 CANCER OF BRONCHUS LUNG20 CANCER OTHER PRIMARY

21 CANCER OTHER PRIMARY22 CANCER OF SKIN23 CANCER OF SKIN24 CANCER OF BREAST25 CANCER OF UTERUS CERVIX

26 CANCER OF UTERUS CERVIX27 CANCER OF OVARY OTHER FEMALE GENITAL ORGANS28 CANCER OF OVARY OTHER FEMALE GENITAL ORGANS29 CANCER OF MALE GENITAL ORGANS30 CANCER OF MALE GENITAL ORGANS


156

DIAG TABLE

(continued)


31 CANCER OF MALE GENITAL ORGANS32 CANCER OF URINARY ORGANS33 CANCER OF URINARY ORGANS34 CANCER OF URINARY ORGANS35 CANCER OTHER PRIMARY

36 CANCER OTHER PRIMARY37 CANCER OF LYMPHATIC HEMATOPOIETIC TISSUE38 CANCER OF LYMPHATIC HEMATOPOIETIC TISSUE39 CANCER OF LYMPHATIC HEMATOPOIETIC TISSUE40 CANCER OF LYMPHATIC HEMATOPOIETIC TISSUE

41 CANCER OTHER PRIMARY42 SECONDARY MALIGNANCIES43 MALIGNANT NEOPLASM WITHOUT SPECIFICATION OF SITE44 NEOPLASMS OF UNSPECIFIED NATURE OR UNCERTAIN

BEHAVIOR45 MAINTENANCE CHEMOTHERAPY RADIOTHERAPY

46 BENIGN NEOPLASMS47 BENIGN NEOPLASMS48 THYROID DISORDERS49 DIABETES MELLITUS WITHOUT COMPLICATION50 DIABETES MELLITUS WITH COMPLICATIONS

51 OTHER ENDOCRINE DISORDERS52 NUTRITIONAL DEFICIENCIES53 DISORDERS OF LIPID METABOLISM54 GOUT OTHER CRYSTAL ARTHROPATIES55 FLUID ELECTROLYTE DISORDERS

56 CYSTIC FIBROSIS57 IMMUNITY DISORDERS58 OTHER NUTRITIONAL ENDOCRINE METABOLIC DISORDERS59 ANEMIA60 ANEMIA

61 ANEMIA62 COAGULATION HEMORRHAGIC DISORDERS63 DISEASES OF WHITE BLOOD CELLS64 OTHER HEMATOLIGIC CONDITIONS76 CENTRAL NERVOUS SYSTEM INFECTION

77 CENTRAL NERVOUS SYSTEM INFECTION78 CENTRAL NERVOUS SYSTEM INFECTION79 HEREDITARY DEGENERATIVE NERVOUS SYSTEM

CONDITIONS80 HEREDITARY DEGENERATIVE NERVOUS SYSTEM

CONDITIONS81 HEREDITARY DEGENERATIVE NERVOUS SYSTEM

CONDITIONS

82 PARALYSIS83 EPILEPSY CONVULSIONS84 HEADACHE INCLUDING MIGRAINE


157

DIAG TABLE

(continued)


85 COMA STUPOR BRAIN DAMAGE86 EYE DISORDERS

87 EYE DISORDERS88 EYE DISORDERS89 EYE DISORDERS90 EYE DISORDERS91 EYE DISORDERS

92 EAR CONDITIONS93 EAR CONDITIONS94 EAR CONDITIONS95 OTHER NERVOUS SYSTEM DISORDERS96 DISEASES OF THE HEART

97 DISEASES OF THE HEART98 HYPERTENSION99 HYPERTENSION100 DISEASES OF THE HEART101 DISEASES OF THE HEART

102 DISEASES OF THE HEART103 DISEASES OF THE HEART104 DISEASES OF THE HEART105 DISEASES OF THE HEART106 DISEASES OF THE HEART

107 DISEASES OF THE HEART108 DISEASES OF THE HEART109 CEREBROVASCULAR DISEASE110 CEREBROVASCULAR DISEASE111 CEREBROVASCULAR DISEASE

112 CEREBROVASCULAR DISEASE113 CEREBROVASCULAR DISEASE114 DISEASES OF ARTERIES ARTERIOLES CAPILLARIES115 DISEASES OF ARTERIES ARTERIOLES CAPILLARIES116 DISEASES OF ARTERIES ARTERIOLES CAPILLARIES

117 DISEASES OF ARTERIES ARTERIOLES CAPILLARIES118 DISEASES OF VEINS LYMPHATICS119 DISEASES OF VEINS LYMPHATICS120 DISEASES OF VEINS LYMPHATICS121 DISEASES OF VEINS LYMPHATICS

122 RESPIRATORY INFECTIONS123 RESPIRATORY INFECTIONS124 RESPIRATORY INFECTIONS125 RESPIRATORY INFECTIONS126 RESPIRATORY INFECTIONS

127 CHRONIC OBSTRUCTIVE PULMONARY DISEASEBRONCHIECTASIS

128 ASTHMA129 ASPIRATION PNEUMONITIS FOOD VOMITUS130 PLEURISY PNEUMOTHORAX PULMINARY COLLAPSE


158

DIAG TABLE

(continued)


131 RESPIRATORY FAILURE INSUFFICIENCY ARREST ADULT

132 LUNG DISEASE DUE TO EXTERNAL AGENTS133 OTHER LOWER RESPIRATORY DISEASE134 OTHER UPPER RESPIRATORY DISEASE135 INTESTINAL INFECTION136 DISORDERS OF TEETH JAW

137 DISEASES OF MOUTH EXCLUDING DENTAL138 UPPER GASTROINTESTINAL DISORDERS139 UPPER GASTROINTESTINAL DISORDERS140 UPPER GASTROINTESTINAL DISORDERS141 UPPER GASTROINTESTINAL DISORDERS

142 LOWER GASTROINTESTINAL DISORDERS143 ABDOMINAL HERNIA144 LOWER GASTROINTESTINAL DISORDERS145 LOWER GASTROINTESTINAL DISORDERS146 LOWER GASTROINTESTINAL DISORDERS

147 LOWER GASTROINTESTINAL DISORDERS148 LOWER GASTROINTESTINAL DISORDERS149 BILIARY TRACT DISEASE150 LIVER DISEASE151 LIVER DISEASE

152 PANCREATIC DISORDERS NOT DIABETES153 GASTROINTESTINAL HEMORRHAGE154 NONINFECTIOUS GASTROENTERITIS155 OTHER GASTROINTESTINAL DISORDERS156 DISEASES OF URINARY SYSTEM

157 DISEASES OF URINARY SYSTEM158 DISEASES OF URINARY SYSTEM159 DISEASES OF URINARY SYSTEM160 DISEASES OF URINARY SYSTEM161 DISEASES OF URINARY SYSTEM

162 DISEASES OF URINARY SYSTEM163 DISEASES OF URINARY SYSTEM164 DISEASES OF MALE GENITAL ORGANS165 DISEASES OF MALE GENITAL ORGANS166 DISEASES OF MALE GENITAL ORGANS

167 DISEASES OF FEMALE GENITAL ORGANS168 DISEASES OF FEMALE GENITAL ORGANS169 DISEASES OF FEMALE GENITAL ORGANS170 DISEASES OF FEMALE GENITAL ORGANS171 DISEASES OF FEMALE GENITAL ORGANS

172 DISEASES OF FEMALE GENITAL ORGANS173 DISEASES OF FEMALE GENITAL ORGANS174 DISEASES OF FEMALE GENITAL ORGANS175 DISEASES OF FEMALE GENITAL ORGANS176 CONTRACEPTIVE PROCREATIVE MANAGEMENT


159

DIAG TABLE

(continued)


177 ABORTION RELATED DISORDERS178 ABORTION RELATED DISORDERS179 ABORTION RELATED DISORDERS180 COMPLICATIONS MAINLY RELATED TO PREGNANCY181 COMPLICATIONS MAINLY RELATED TO PREGNANCY

182 COMPLICATIONS MAINLY RELATED TO PREGNANCY183 COMPLICATIONS MAINLY RELATED TO PREGNANCY184 COMPLICATIONS MAINLY RELATED TO PREGNANCY185 COMPLICATIONS MAINLY RELATED TO PREGNANCY186 COMPLICATIONS MAINLY RELATED TO PREGNANCY

187 INDICATIONS FOR CARE IN PREGNANCY LABOR DELIVERY188 INDICATIONS FOR CARE IN PREGNANCY LABOR DELIVERY189 INDICATIONS FOR CARE IN PREGNANCY LABOR DELIVERY190 INDICATIONS FOR CARE IN PREGNANCY LABOR DELIVERY191 INDICATIONS FOR CARE IN PREGNANCY LABOR DELIVERY

192 COMPLICATIONS DURING LABOR193 COMPLICATIONS DURING LABOR194 COMPLICATIONS DURING LABOR195 OTHER COMPLICATIONS OF BIRTH PUERPERIUM

AFFECTING MANAGEMENT OF MOTHER196 NORMAL PREGNANCY AND OR DELIVERY

197 SKIN SUBCUTANEOUS TISSUE INFECTION198 OTHER INFLAMMATORY CONDITION OF SKIN199 CHRONIC ULCER OF SKIN200 OTHER SKIN DISORDERS201 INFECTIVE ARTHRITIS OSTEOMYELITIS

202 NON TRAUMATIC JOINT DISORDERS203 NON TRAUMATIC JOINT DISORDERS204 NON TRAUMATIC JOINT DISORDERS205 SPONDYLOSIS INTERVERTEBRAL DISC DISORDERS OTHER

BACK PROBLEMS206 OSTEOPOROSIS

207 PATHOLOGICAL FRACTURES208 ACQUIRED DEFORMATIES209 ACQUIRED DEFORMATIES210 SYSTEMIC LUPUS ERYTHEMATOSUS CONNECTIVE TISSUE

DISORDERS211 OTHER CONNECTIVE TISSUE DISEASE

212 OTHER BONE DISEASE MUSCULOSKELETAL DEFORMITIES213 CARDIAC CIRCULATORY CONGENITAL ANOMALIES214 DIGESTIVE CONGENITAL ANOMALIES215 GENITOURINARY CONGENITAL ANOMALIES216 NERVOUS SYSTEM CONGENITAL ANOMALIES

217 OTHER CONGENITAL ANOMALIES218 LIVEBORN219 SHORT GESTATION LOW BIRTH WEIGHT FETAL GROWTH

RETARDATION


160

DIAG TABLE

(continued)


220 INTRAUTERINE HYPOXIA BIRTH ASPHYXIA221 RESPIRATORY DISTRESS SYNDROME

222 HEMOLYTIC JAUNDICE PERINATAL JAUNDICE223 BIRTH TRAUMA224 OTHER PERINATAL CONDITIONS225 JOINT DISORDERS DISLOCATIONS TRAUMA RELATED226 FRACTURES

227 SPINAL CORD INJURY228 FRACTURES229 FRACTURES230 FRACTURES231 FRACTURES

232 SPRAINS STRAINS233 INTRACRANIAL INJURY234 CRUSHING INJURY OR INTERNAL INJURY235 OPEN WOUNDS236 OPEN WOUNDS

237 COMPLICATIONS238 COMPLICATIONS239 SUPERFICIAL INJURY CONTUSION240 BURNS241 POISONING

242 POISONING243 POISONING244 OTHER INJURIES CONDITIONS DUE TO EXTERNAL CAUSES245 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS246 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS

247 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS248 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS249 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS250 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS251 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS

252 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS253 SYMPTOMS SIGNS AND ILL DEFINED CONDITIONS254 FACTORS INFLUENCING HEALTH CARE255 FACTORS INFLUENCING HEALTH CARE256 FACTORS INFLUENCING HEALTH CARE

257 FACTORS INFLUENCING HEALTH CARE258 FACTORS INFLUENCING HEALTH CARE259 RESIDUAL CODES UNCLASSIFIED ALL E CODES650 ADJUSTMENT DISORDERS651 ANXIETY DISORDERS

652 ATTENTION DEFICIT CONDUCT DISRUPTIVE BEHAVIORDISORDERS

653 DELIRIUM DEMENTIA AMNESTIC OTHER COGNITIVEDISORDERS

654 DEVELOPMENTAL DISORDERS


161

DIAG TABLE

(continued)


655 DISORDERS USUALLY DIAGNOSED IN INFANCYCHILDHOOD OR ADOLESCENCE

656 IMPULSE CONTROL DISORDERS NOT ELSEWHERECLASSIFIED

657 MOOD DISORDERS658 PERSONALITY DISORDERS659 SCHIZOPHRENIA OTHER PSYCHOTIC DISORDERS660 ALCOHOL RELATED DISORDERS661 SUBSTANCE RELATED DISORDERS

662 SUICIDE INTENTIONAL SELF INFLICTED INJURY663 SCREENING HISTORY OF MENTAL HEALTH SUBSTANCE

ABUSE CODES670 MISCELLANEOUS MENTAL DISORDERS999 UNGROUPABLE


162

DIAG TABLE

Diagnosis Code

Variable Name: DX_CD


Variable Length: 7


Variable Index: 9


Description:Code indicating the International Classification of Diseases (Version 9 or 10) diagnosis that identifies the condition(s)related to the claim.

Former variable name: DXA ECAUSE DXn EPLACE dx00


163

DIAG TABLE

Present on Admission Indicator

Variable Name: POA_IND


Variable Length: 1


Variable Index: 10


Description:Code indicating whether the diagnosis was present on admission to the hospital.

Former variable name: DXEMn


Reference table name: REF_POA_IND

POA_IND POA_IND_DESCR

1 Exempt from ReportingN No - Not present at the time of inpatient admissionU Clinically Undetermined - Provider is unable to clinically

determine whether condition was present on admission ornot

W Unknown - Documentation is insufficient to determine ifcondition is present on admission

Y Yes - Present at the time of inpatient admissionNA Exempt from Reporting


164

DIAG TABLE

ICD9 or ICD10 Indicator

Variable Name: ICD_TYPE_CD


Variable Length: 1


Variable Index: 11


Description:International Classification of Diseases, Ninth Revision (ICD-9-CM) and Tenth Revision (ICD-10-CM) are systems usedby physicians and other healthcare providers to classify and code all diagnoses, symptoms and procedures recorded inconjunction with hospital care in the United States. “9” ICD9 code / “1” ICD10 code.

New to APD


165

DIAG TABLE

Claim Key



Variable Length: 12


Variable Index: 12



New to APD


166

DIAG TABLE

Active Flag



Variable Length: 1


Variable Index: 13



New to APD


167

DIAG TABLE




Variable Length: 1


Variable Index: 14



New to APD


168

DIAG TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 15





169

DIAG TABLE

Record Created By



Variable Length: 20


Variable Index: 16



New to APD


170

DIAG TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 17



New to APD


171

DIAG TABLE

Last Updated By



Variable Length: 20


Variable Index: 18



New to APD


172

DIAG TABLE

Source File Name



Variable Length: 30


Variable Index: 19



New to APD


173

DIAG TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 20



New to APD


174

DIAG TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 21





175

DIAG TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 22






N NoY Yes


176

DRG TABLE

DRG TABLE

This table contains Diagnostic Related Group (DRG) information related to a SPARCS claim. For example it in-cludes: Claim Type, Discharge Year, MS-DRG, MS-DRG MDC, AP-DRG, AP-DRG MDC, APR-DRG, APR-DRG MDC, APR-DRG ROM, and APR-DRG SOI. For process dates after 10/1/2017, it contains the APR- DRG, APR-DRG MDC, APR-DRGROM, and APR-DRG SOI based on diagnoses that were present on admission. Historically it contained the previousand next version of MS-DRG, MS-DRG MDC, AP-DRG, AP-DRG MDC, APR-DRG, APR-DRG MDC, APR-DRG ROM, andAPR-DRG SOI.


177

DRG TABLE




Variable Length: 12

Table/File: SPARCS_DRG

Variable Index: 1



New to APD


178

DRG TABLE

Discharge Year



Variable Length: 4


Variable Index: 2


Description:Year the patient was discharged or death occurred

New to APD


179

DRG TABLE

Claim Type



Variable Length: 1


Variable Index: 3








180

DRG TABLE






Variable Index: 4




181

DRG TABLE

MS-DRG - Current Version

Variable Name: CUR_FED_DRG_CD


Variable Length: 3


Variable Index: 5


Description:Medicare Severity Diagnosis Related Group (MS-DRG) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This DRG is specific to the year of the date ofdischarge.

Former variable name: FEDDRG



182

DRG TABLE

MS-DRG MDC - Current Version

Variable Name: CUR_FED_MDC_CD


Variable Length: 2


Variable Index: 6


Description:Medicare Severity Major Diagnostic Category (MDC) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This MDC is specific to the year of the date ofdischarge.

Former variable name: FEDMDC



183

DRG TABLE

MS-DRG - Previous Version

Variable Name: PREV_FED_DRG_CD


Variable Length: 3


Variable Index: 7


Description:Medicare Severity Diagnosis Related Group (MS-DRG) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This DRG is specific to the calendar year priorto the date of discharge.


Special Notes:This is an obsolete NYS specific data element. This data element is generated on load of data into the warehouse. Onlythe current version of the DRG is being generated.

Former variable name: PFEDDRG



184

DRG TABLE

MS-DRG MDC - Previous Version

Variable Name: PREV_FED_MDC_CD


Variable Length: 2


Variable Index: 8


Description:Medicare Severity Major Diagnostic Category (MDC) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This MDC is specific to the year prior to thedate of discharge.


Special Notes:This is an obsolete NYS specific data element. This data element is generated on load of data into the warehouse. Onlythe current version of the MDC is being generated.

Former variable name: PFEDMDC



185

DRG TABLE

MS-DRG - Next Version

Variable Name: NEXT_FED_DRG_CD


Variable Length: 3


Variable Index: 9


Description:Medicare Severity Diagnosis Related Group (MS-DRG) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This DRG is specific to the calendar yearfollowing the date of discharge.



Former variable name: NFEDDRG



186

DRG TABLE

MS-DRG MDC - Next Version

Variable Name: NEXT_FED_MDC_CD


Variable Length: 2


Variable Index: 10


Description:Medicare Severity Major Diagnostic Category (MDC) developed by the U.S. Department of Health and Human Servicesto categorize patient records for reimbursement and research purposes. This MDC is specific to the year following thedate of discharge.


Special Notes:This is an obsolete NYS specific data element. This data element is generated on load of data into the warehouse. Onlythe current version of the MDC is being generated.

Former variable name: NFEDMDC



187

DRG TABLE

AP-DRG - Current Version

Variable Name: CUR_AP_DRG_CD


Variable Length: 3


Variable Index: 11


Description:All Patient Diagnostic Related Groups (AP-DRG) assigned to the claim to categorize patient records for reimbursementand research purposes. This DRG is specific to the year of discharge.


Special Notes:This is an obsolete NYS specific data element. The All Payer (AP) DRG was replaced with the All Payer Refined (APR)DRG for years starting in 2009.

Former variable name: STDRG



188

DRG TABLE

AP-DRG MDC - Current Version

Variable Name: CUR_AP_MDC_CD


Variable Length: 2


Variable Index: 12


Description:All Patient Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimbursement andresearch purposes. This MDC is specific to the year of the date of discharge.



Former variable name: STMDC



189

DRG TABLE

AP-DRG - Previous Version

Variable Name: PREV_AP_DRG_CD


Variable Length: 3


Variable Index: 13


Description:All Patient Diagnosis Related Group (AP-DRG) developed by the NYS Department of Health and 3M Health InformationSystems to categorize patient records for reimbursement and research purposes. This DRG is specific to the year priorto the date of discharge.



Former variable name: PAPRSOI



190

DRG TABLE

AP-DRG MDC - Previous Version

Variable Name: PREV_AP_MDC_CD


Variable Length: 2


Variable Index: 14


Description:All Patient Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimbursement andresearch purposes. This MDC is specific to the year prior to the date of discharge.



Former variable name: PSTDRG



191

DRG TABLE

All Patient Diagnostic Related Groups (AP-DRG); Next Version

Variable Name: NEXT_AP_DRG_CD


Variable Length: 3


Variable Index: 15


Description:All Patient Diagnostic Related Groups (AP-DRG) assigned to the claim to categorize patient records for reimbursementand research purposes. This DRG is specific to the year following the date of discharge.



Former variable name: NSTDRG



192

DRG TABLE

AP-DRG MDC - Next Version

Variable Name: NEXT_AP_MDC_CD


Variable Length: 2


Variable Index: 16


Description:All Patient Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimbursement andresearch purposes. This MDC is specific to the year following the date of discharge.



Former variable name: NSTMDC



193

DRG TABLE

APR-DRG - Current Version

Variable Name: CUR_APR_DRG_CD


Variable Length: 3


Variable Index: 17


Description:All Patient Refined Diagnostic Related Groups (APR-DRG) assigned to the claim to categorize patient records for reim-bursement and research purposes. This DRG is specific to the year of the date of discharge.

Former variable name: CAPRDRG



194

DRG TABLE

APR-DRG MDC - Current Version

Variable Name: CUR_APR_MDC_CD


Variable Length: 2


Variable Index: 18


Description:All Patient Refined Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimburse-ment and research purposes. This MDC is specific to the year of the date of discharge.

Former variable name: CAPRMDC



195

DRG TABLE

APR-DRG ROM - Current Version

Variable Name: CUR_APR_ROM_CD


Variable Length: 1


Variable Index: 19


Description:All Patient Refined Risk of Mortality (ROM) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This ROM is specific to the year of the date of discharge.

Former variable name: CAPRROM



196

DRG TABLE

APR-DRG SOI - Current Version

Variable Name: CUR_APR_SOI_CD


Variable Length: 1


Variable Index: 20


Description:All Patient Refined Severity of Illness (SOI) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This SOI is specific to the year of the date of discharge.

Former variable name: CAPRSOI



197

DRG TABLE

APR- DRG - Current Version for POA

Variable Name: CUR_APR_DRG_POA


Variable Length: 3


Variable Index: 21


Description:All Patient Refined Diagnostic Related Groups (APR- DRG) assigned to the claim to categorize patient records for reim-bursement and research purposes. This DRG is specific to the diagnosis codes flagged as present on admission (POA)and the year of the date of discharge.

New to APD


198

DRG TABLE

APR-DRG MDC - Current Version for POA

Variable Name: CUR_APR_MDC_POA


Variable Length: 2


Variable Index: 22


Description:All Patient Refined Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimburse-ment and research purposes. This MDC is specific to the diagnosis codes flagged as present on admission (POA) andthe year of the date of discharge.

New to APD


199

DRG TABLE

APR-DRG ROM - Current Version for POA

Variable Name: CUR_APR_ROM_POA


Variable Length: 1


Variable Index: 23


Description:All Patient Refined Risk of Mortality (ROM) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This ROM is specific to the diagnosis codes indicated as present on admission (POA) and theof the date of discharge.

New to APD


200

DRG TABLE

APR-DRG SOI - Current Version for POA

Variable Name: CUR_APR_SOI_POA


Variable Length: 1


Variable Index: 24


Description:All Patient Refined Severity of Illness (SOI) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This SOI is specific to the diagnosis codes indicated as present on admission (POA) and theyear of the date of discharge.

New to APD


201

DRG TABLE

APR-DRG - Previous Version

Variable Name: PREV_APR_DRG_CD


Variable Length: 3


Variable Index: 25


Description:All Patient Refined Diagnosis Related Group (DRG) assigned to the claim to categorize patient records for reimbursementand research purposes. This DRG is specific to the year prior to the date of discharge.



Former variable name: PSTMDC



202

DRG TABLE

APR-DRG MDC - Previous Version

Variable Name: PREV_APR_MDC_CD


Variable Length: 2


Variable Index: 26


Description:All Patient Refined Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimburse-ment and research purposes. This MDC is specific to the year prior to the date of discharge.



Former variable name: PAPRDRG



203

DRG TABLE

APR-DRG ROM - Previous Version

Variable Name: PREV_APR_ROM_CD


Variable Length: 1


Variable Index: 27


Description:All Patient Refined Risk of Mortality (ROM) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This ROM is specific to the year prior to the date of discharge.



Former variable name: PAPRMDC



204

DRG TABLE

APR-DRG SOI - Previous Version

Variable Name: PREV_APR_SOI_CD


Variable Length: 1


Variable Index: 28


Description:All Patient Refined Severity of Illness (SOI) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This SOI is specific to the year prior to the date of discharge.



Former variable name: PAPRROM



205

DRG TABLE

APR-DRG- Next Version

Variable Name: NEXT_APR_DRG_CD


Variable Length: 3


Variable Index: 29


Description:All Patient Refined Diagnosis Related Group (APR-DRG) assigned to the claim to categorize patient records for reim-bursement and research purposes. This DRG is specific to the year following the date of discharge.



Former variable name: NAPRDRG



206

DRG TABLE

APR-DRG MDC - Next Version

Variable Name: NEXT_APR_MDC_CD


Variable Length: 2


Variable Index: 30


Description:All Patient Refined Major Diagnostic Category (MDC) assigned to the claim to categorize patient records for reimburse-ment and research purposes. This MDC is specific to the year following the date of discharge.



Former variable name: NAPRMDC



207

DRG TABLE

APR-DRG ROM - Next Version

Variable Name: NEXT_APR_ROM_CD


Variable Length: 1


Variable Index: 31


Description:All Patient Refined Risk of Mortality (ROM) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This ROM is specific to the year following the date of discharge.



Former variable name: NAPRROM



208

DRG TABLE

APR-DRG SOI - Next Version

Variable Name: NEXT_APR_SOI_CD


Variable Length: 1


Variable Index: 32


Description:All Patient Refined Severity of Illness (SOI) flag assigned to the claim to categorize patient records for reimbursementand research purposes. This SOI is specific to the year following the date of discharge.



Former variable name: NAPRSOI



209

DRG TABLE

Claim Key



Variable Length: 12


Variable Index: 33



New to APD


210

DRG TABLE

Active Flag



Variable Length: 1


Variable Index: 34



New to APD


211

DRG TABLE




Variable Length: 1


Variable Index: 35



New to APD


212

DRG TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 36





213

DRG TABLE

Record Created By



Variable Length: 20


Variable Index: 37



New to APD


214

DRG TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 38



New to APD


215

DRG TABLE

Last Updated By



Variable Length: 20


Variable Index: 39



New to APD


216

DRG TABLE

Source File Name



Variable Length: 30


Variable Index: 40



New to APD


217

DRG TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 41



New to APD


218

DRG TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 42





219

DRG TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 43






N NoY Yes


220

LOCATION TABLE

LOCATION TABLE

This table contains patient’s address information reported on the claim. For example it includes: Claim Type, DischargeYear, Patient’s Address (Street, City, State, Zip Code), County, Country (if non-US resident) and Geocoding information.


221

LOCATION TABLE




Variable Length: 12

Table/File: SPARCS_LOCATION

Variable Index: 1



New to APD


222

LOCATION TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


223

LOCATION TABLE

Claim Type



Variable Length: 1


Variable Index: 3








224

LOCATION TABLE






Variable Index: 4




225

LOCATION TABLE

Patient Street Address Line 1

Variable Name: PAT_ADDR_LINE1




Variable Index: 5


Description:First line of patient street address.

Former variable name: ADDR1


226

LOCATION TABLE

Patient Street Address Line 2

Variable Name: PAT_ADDR_LINE2




Variable Index: 6


Description:Second line of patient street address.

Former variable name: ADDR2


227

LOCATION TABLE

Patient City

Variable Name: PAT_ADDR_CITY


Variable Length: 30


Variable Index: 7


Description:City name of patient’s address.

Former variable name: PATCITY


228

LOCATION TABLE

Patient State

Variable Name: PAT_ADDR_ST


Variable Length: 12


Variable Index: 8


Description:Patient’s state or province code.

Former variable name: PATST


229

LOCATION TABLE

Patient County Code

Variable Name: PAT_ADDR_CNTY_CD


Variable Length: 12


Variable Index: 9


Description:Five digit FIPS county code of the patient’s address

Former variable name: PATCO









36061 New York


230

LOCATION TABLE

(continued)













231

LOCATION TABLE

Residence Indicator

Variable Name: RESID_CD


Variable Length: 12


Variable Index: 10


Description:Code indicating whether the patient is Homeless (“H”) / Non-US Resident (“F”).


Special Notes:This is an obsolete NYS specific data element. History data was converted to the SPARCS_CONDITION table. It isreported as Condition Code “17 for homeless or Condition Code”25” for Non-US Resident.

Former variable name: RESIND

Reference table name: REF_RESID_CD

RESID_CD RESID_CD_DESCR

F Non-US Resident (Foreign Born)H HomelessNA Not Applicable


232

LOCATION TABLE

Patient Zip Code Extension

Variable Name: PAT_ADDR_ZIP4




Variable Index: 11


Description:Patient’s zip code extension (+4).

Former variable name: ZIPEX


233

LOCATION TABLE

Patient Country Code

Variable Name: PAT_CNTRY_CD


Variable Length: 10


Variable Index: 12


Description:Patient’s country when the address is outside the US.

New to APD


234

LOCATION TABLE

Patient Zip Code 5 Digits

Variable Name: PAT_ADDR_ZIP5


Variable Length: 12


Variable Index: 13


Description:Patient’s 5 digit zip code.

Former variable name: ZIP


235

LOCATION TABLE

Claim Key



Variable Length: 12


Variable Index: 14



New to APD


236

LOCATION TABLE

Active Flag



Variable Length: 1


Variable Index: 15



New to APD


237

LOCATION TABLE




Variable Length: 1


Variable Index: 16



New to APD


238

LOCATION TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 17





239

LOCATION TABLE

Record Created By



Variable Length: 20


Variable Index: 18



New to APD


240

LOCATION TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 19



New to APD


241

LOCATION TABLE

Last Updated By



Variable Length: 20


Variable Index: 20



New to APD


242

LOCATION TABLE

Source File Name



Variable Length: 30


Variable Index: 21



New to APD


243

LOCATION TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 22



New to APD


244

LOCATION TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 23





245

LOCATION TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 24






N NoY Yes


246

NDC TABLE

NDC TABLE

This table contains the NDC and quantity information related to an outpatient service and is reported at the line level.It will be reported when the provider or submitter chooses to report NDC numbers to enhance the claim reporting oradjudication processes. Drugs and biologics reported are a further specification of service(s) reported at the line level.


247

NDC TABLE




Variable Length: 12

Table/File: SPARCS_NDC

Variable Index: 1



New to APD


248

NDC TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


249

NDC TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the NDC codes were reported.


250

NDC TABLE

Claim Type



Variable Length: 1


Variable Index: 4








251

NDC TABLE






Variable Index: 5




252

NDC TABLE

National Drug Code (NDC)

Variable Name: NDC


Variable Length: 48


Variable Index: 6


Description:Unique 10-digit code that identifies the labeler, product, and trade package size. The first segment, the labeler code,is assigned by the FDA.

New to APD


253

NDC TABLE

NDC Unit Type

Variable Name: NDC_UNIT_TYPE


Variable Length: 2


Variable Index: 7


Description:Unit of measure of the drug (“F2” International Unit, “GR” Gram, “ME” Milligram, “ML” Milliliter, “UN” Unit).

New to APD


254

NDC TABLE

NDC Unit Count

Variable Name: NDC_UNIT_CNT


Variable Length: 22


Variable Index: 8


Description:Count of the units of the drug administered.

New to APD


255

NDC TABLE

Prescription Number Qualifier

Variable Name: PRES_NUMB_QUAL


Variable Length: 2


Variable Index: 9


Description:Code indicating the type of prescription number (“VY” - Link Sequence Number or “XZ” Pharmacy Prescription Number).

New to APD


256

NDC TABLE

Prescription Number

Variable Name: PRES_NUMB


Variable Length: 50


Variable Index: 10


Description:Number assigned to the prescription or compound drug.

New to APD


257

NDC TABLE

Service Line Number

Variable Name: SVC_LINE_NUMB


Variable Length: 22


Variable Index: 11


Description:Line number associated with the drug being reported. Secondary foreign key for linking NDC, Proc, Provider, and Revtables.

New to APD


258

NDC TABLE

Claim Key



Variable Length: 12


Variable Index: 12



New to APD


259

NDC TABLE

Active Flag



Variable Length: 1


Variable Index: 13



New to APD


260

NDC TABLE




Variable Length: 1


Variable Index: 14



New to APD


261

NDC TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 15





262

NDC TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 16



New to APD


263

NDC TABLE

Record Created By



Variable Length: 20


Variable Index: 17



New to APD


264

NDC TABLE

Last Updated By



Variable Length: 20


Variable Index: 18



New to APD


265

NDC TABLE

Source File Name



Variable Length: 30


Variable Index: 19



New to APD


266

NDC TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 20



New to APD


267

NDC TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 21





268

NDC TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 22






N NoY Yes


269

OCCURRENCE TABLE

OCCURRENCE TABLE

This table contains information related to significant events and date reported. Occurrence codes are a national codeset maintained by NUBC. For example, occurrence code ‘01’ indicates Accident/Medical Coverage and ‘02’ indicates NoFault Insurance Involved Including Auto Accident/Other will be used to report the accident date. Occurrence code ‘42’indicates a discharge date when it differs from the Statement Thru Date.


270

OCCURRENCE TABLE




Variable Length: 12

Table/File: SPARCS_OCCURRENCE

Variable Index: 1



New to APD


271

OCCURRENCE TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


272

OCCURRENCE TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the occurrence codes were reported.


273

OCCURRENCE TABLE

Claim Type



Variable Length: 1


Variable Index: 4








274

OCCURRENCE TABLE






Variable Index: 5




275

OCCURRENCE TABLE

Occurrence Code

Variable Name: OCCUR_CD


Variable Length: 10


Variable Index: 6


Description:Code indicating the type of event related to the occurrence date reported.

Special Notes:History data form ACCID_DT was converted to the SPARCS_OCCURRENCE table. It is reported as an occurrence datewith the occurrence codes “01”, “02”, “03”, “04”, “05” and “06”.

New to APD

Reference table name: REF_OCCUR_CD

OCCUR_CD OCCUR_CD_DESCR

01 ACCIDENT/MEDICAL COVERAGE02 NO FAULT INSURANCE INVOLVED - INCLUDING AUTO

ACCIDENT/OTHER03 ACCIDENT/ TORT LIABILITY04 ACCIDENT/ EMPLOYMENT RELATED05 ACCIDENT/NO MEDICAL OR LIABILITY COVERAGE

06 CRIME VICTIM09 START OF INFERTILITY TREATMENT CYCLE10 LAST MENSTRUAL PERIOD11 ONSET OF SYMPTOMS/ILLNESS12 DATE OF ONSET FOR A CHRONICALLY DEPENDENT

INDIVIDUAL

16 DATE OF LAST THERAPY17 DATE OUTPATIENT OCCUPATIONAL THERAPY PLAN

ESTABLISHED OR LAST REVIEWED18 DATE OF RETIREMENT - PATIENT/BENEFICIARY19 DATE OF RETIREMENT - SPOUSE20 DATE GUARANTEE OF PAYMENT BEGAN

21 DATE UR NOTICE RECEIVED22 DATE ACTIVE CARE ENDED24 DATE INSURANCE DENIED25 DATE BENEFITS TERMINATED BY PRIMARY PAYER26 DATE SNF BED BECAME AVAILABLE

27 DATE OF HOSPICE CERTIFICATION OR RECERTIFICATION28 DATE COMPREHENSIVE OUTPATIENT REHABILITATION

PLAN ESTABLISHED OR LAST REVIEWED29 DATE OUTPATIENT PHYSICAL THERAPY PLAN ESTABLISHED

OR LAST REVIEWED


276

OCCURRENCE TABLE

(continued)

OCCUR_CD OCCUR_CD_DESCR

30 DATE OUTPATIENT SPEECH PATHOLOGY PLANESTABLISHED OR LAST REVIEWED

31 DATE BENEFICIARY NOTIFIED OF INTENT TO BILL(ACCOMMODATIONS)

32 DATE BENEFICIARY NOTIFIED OF INTENT TO BILL(PROCEDURES OR TREATMENTS)

33 FIRST DAY OF THE MEDICARE COORDINATION PERIODFOR ESRD BENEFICIARIES COVERED BY EGHP

34 DATE OF ELECTION OF EXTENDED CARE FACILITIES35 DATE TREATMENT STARTED FOR PHYSICAL THERAPY36 DATE OF INPATIENT HOSPITAL DISCHARGE FOR COVERED

TRANSPLANT PATIENT

37 DATE OF INPATIENT HOSPITAL DISCHARGE FORNON-COVERED TRANSPLANT PATIENT

38 DATE TREATMENT STARTED FOR HOME IV THERAPY39 DATE DISCHARGED ON A CONTINUOUS COURSE OF IV

THERAPY40 SCHEDULED DATE OF ADMISSION41 DATE OF FIRST TEST FOR PRE-ADMISSION TESTING

42 DATE OF DISCHARGE43 SCHEDULED DATE OF CANCELED SURGERY44 DATE TREATMENT STARTED FOR OCCUPATIONAL THERAPY45 DATE TREATMENT STARTED FOR SPEECH THERAPY46 DATE TREATMENT STARTED FOR CARDIAC

REHABILITATION

47 DATE COST OUTLIER STATUS BEGINS50 ASSESSMENT DATE (EFFECTIVE 1/1/11)51 DATE OF LAST KT/V READING (EFFECTIVE 7/1/10)52 MEDICAL CERTIFICATION/RECERTIFICATION DATE

(EFFECTIVE 1/1/11)54 PHYSICIAN FOLLOW-UP DATE (EFFECTIVE 1/1/11)

55 DATE OF DEATH (EFFECTIVE 10/1/12)A1 BIRTHDATE - INSURED AA2 EFFECTIVE DATE - INSURED A POLICYA3 BENEFITS EXHAUSTED - PAYER AA4 SPLIT BILL DATE

B1 BIRTHDATE - INSURED BB2 EFFECTIVE DATE - INSURED B POLICYB3 BENEFITS EXHAUSTED - PAYER BC1 BIRTHDATE - INSURED CC2 EFFECTIVE DATE - INSURED C POLICYC3 BENEFITS EXHAUSTED - PAYER C


277

OCCURRENCE TABLE

Occurrence Date

Variable Name: OCCUR_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 7


Description:Date the event being reported occurred.

Special Notes:History data form ACCID_DT was converted to the SPARCS_OCCURRENCE table. It is reported as an occurrence datewith the occurrence codes “01”, “02”, “03”, “04”, “05” and “06”.

New to APD


278

OCCURRENCE TABLE

Source File Name



Variable Length: 30


Variable Index: 8



New to APD


279

OCCURRENCE TABLE

Claim Key



Variable Length: 12


Variable Index: 9



New to APD


280

OCCURRENCE TABLE

Active Flag



Variable Length: 1


Variable Index: 10


Description:Indicates whether the record is active (“1”) or inactive (“0”). If set to “0”, the record has been voided.

New to APD


281

OCCURRENCE TABLE




Variable Length: 1


Variable Index: 11



New to APD


282

OCCURRENCE TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 12





283

OCCURRENCE TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 13



New to APD


284

OCCURRENCE TABLE

Record Created By



Variable Length: 20


Variable Index: 14



New to APD


285

OCCURRENCE TABLE

Last Updated By



Variable Length: 20


Variable Index: 15



New to APD


286

OCCURRENCE TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 16



New to APD


287

OCCURRENCE TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 17





288

OCCURRENCE TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 18






N NoY Yes


289

OCCURRENCE_SPAN TABLE


This table contains information related to significant events and date spans reported. Occurrence Span codes area national code set maintained by NUBC. For example, occurrence span code ‘74’ indicates Non-covered Level ofCare/Leave of Absence Dates. Historically, this information was maintained in the SPARCS_NONACUTE table.


290





Variable Length: 12

Table/File: SPARCS_OCCURRENCE_SPAN

Variable Index: 1



Special Notes:The SPARCS_NONACUTE table in history was used to populate the SPARCS_OCCURRENCE_SPAN table.

New to APD


291


Discharge Year



Variable Length: 4


Variable Index: 2




New to APD


292


Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the occurrence span codes were reported.

Special Notes:For history, the SPARCS_NONACUTE table was used to populate the SPARCS_OCCURRENCE_SPAN table


293


Claim Type



Variable Length: 1


Variable Index: 4









294







Variable Index: 5




295


Occurrence Span Code

Variable Name: OCCUR_SPAN_CD


Variable Length: 30


Variable Index: 6


Description:Code indicating the type of event related to the occurrence span dates reported.

Special Notes:The SPARCS_NONACUTE table in history was used to populate the SPARCS_OCCURRENCE_SPAN table. NONACTE_TYPEwas used to populate the OCCUR_SPAN_CD for history.

Former variable name: NACUTPn


Reference table name: REF_OCCUR_SPAN_CD

OCCUR_SPAN_CD OCCUR_SPAN_CD_DESCR

70 QUALIFYING STAY DATES FOR SNF USE ONLY71 PRIOR STAY DATES72 FIRST/LAST VISIT DATES73 BENEFIT ELIGIBILITY PERIOD74 NON-COVERED LEVEL OF CARE/LEAVE OF ABSENCE DATES

75 SNF LEVEL OF CARE DATES76 PATIENT LIABILITY77 PROVIDER LIABILITY PERIOD78 SNF PRIOR STAY DATES81 ANTEPARTUM DAYS AT REDUCED LEVEL OF CARE

(EFFECTIVE 7/1/12)

M0 QIO/UR APPROVED STAY DATESM1 PROVIDER LIABILITY - NO UTILIZATIONM3 ICF LEVEL OF CARE


296


Occurrence Span From Date

Variable Name: OCCUR_SPAN_FROM_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 7


Description:From date for the event being reported.

Special Notes:The SPARCS_NONACUTE table in history was used to populate the SPARCS_OCCURRENCE_SPAN table. NON-ACTE_FROM_DT was used to populate the OCCUR_SPAN_FROM_DT for history.

Former variable name: NACUDTFn



297


Occurrence Span Through Date

Variable Name: OCCUR_SPAN_THRU_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 8


Description:Through date for the event being reported.

Special Notes:The SPARCS_NONACUTE table in history was used to populate the SPARCS_OCCURRENCE_SPAN table. NON-ACTE_THRU_DT was used to populate the OCCUR_SPAN_FROM_DT for history.

Former variable name: NACUDTTn



298


Claim Key



Variable Length: 12


Variable Index: 9



New to APD


299


Active Flag



Variable Length: 1


Variable Index: 10



New to APD


300





Variable Length: 1


Variable Index: 11



New to APD


301


OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 12



Special Notes:For history, the SPARCS_NONACUTE table was used to populate the SPARCS_OCCURRENCE_SPAN table



302


Record Created By



Variable Length: 20


Variable Index: 13



New to APD


303


Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 14



New to APD


304


Last Updated By



Variable Length: 20


Variable Index: 15



New to APD


305


Source File Name



Variable Length: 30


Variable Index: 16



New to APD


306


Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 17



New to APD


307


Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 18





308


AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 19






N NoY Yes


309

PAYOR TABLE

PAYOR TABLE

This table contains information related to the payers reported. For example this includes: Claim Type Code, DischargeYear, Source of Payment Typology, Source of Payment, Claim Filing Indicator, Payer Responsibility Sequence NumberCode, Insurance Policy Number, Payor ID, Payer Organization Name, and Subscriber information.


310

PAYOR TABLE




Variable Length: 12

Table/File: SPARCS_PAYOR

Variable Index: 1



New to APD


311

PAYOR TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


312

PAYOR TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the payors were reported.


313

PAYOR TABLE

Claim Type



Variable Length: 1


Variable Index: 4








314

PAYOR TABLE






Variable Index: 5




315

PAYOR TABLE

Source of Payment

Variable Name: PAYR_SRC_CD


Variable Length: 1


Variable Index: 6


Description:Source of the payment grouped into categories based on the Claim Filing Indicator reported.

Former variable name: SOURCEn

Reference table name: REF_PAYR_SRC_CD

PAYR_SRC_CD PAYR_SRC_CD_DESCR

A Self-PayB Workers CompensationC MedicareD MedicaidE Other Federal Program

F Insurance CompanyG Blue CrossH CHAMPUSI Other Non-Federal ProgramJ Disability

K Title VL Unknown


316

PAYOR TABLE

Insurance Policy Number

Variable Name: POL_NUMB




Variable Index: 7


Description:Subscriber’s identification number as assigned by the payer.

Former variable name: POLICYNn



317

PAYOR TABLE

Payor ID

Variable Name: PAYR_ID


Variable Length: 20


Variable Index: 8


Description:Identification number used to identify the payer.

Former variable name: PAYORIDn

Reference table name: REF_PAYR_ID

PAYR_ID PAYR_ID_DESCR

10 Blue Cross and Blue Shield of Alabama100 Blue Cross and Blue Shield of Georgia Inc110 Blue Cross of Idaho Health Service Inc1111375 MVP1131584 HIP

1143053 Southern Tier Pediatrics11602 Rochester Area HMO Inc1178885 Preferred Care1182503 Wellcare1183013 CDPHP

1202822 HIP1208997 IHA Buffalo121 Blue Cross and Blue Shield of Illinois1220373 Broome Max1220442 Broome Max

1234037 Comprehensive Care Mgmt1237503 United HC NY1249265 Healthnow1278899 Indep Living For Seniors130 Anthem Blue Cross and Blue Shield of Indiana

1381319 Southern Tier Priority Hlthcr140 Wellmark Blue Cross and Blue Shield of Iowa1403176 United HC NY141 Wellmark Blue Cross and Blue Shield of South Dakota1479670 Healthfirst

150 Blue Cross and Blue Shield of Kansas Inc1519162 Loretto HMO1525488 Suffolk HP1527962 Neighborhood1544090 PCMP IIA Gold Choice

1573739 NY Hospital CHP


318

PAYOR TABLE

(continued)


1590830 Broome Max1597479 Broome Max160 Anthem Blue Cross and Blue Shield of Kentucky Inc1617894 Amerigroup NY

1618726 Prepaid MH Program1618735 Prepaid MH Program1618744 Prepaid MH Program1618753 Prepaid MH Program1618762 Prepaid MH Program




1629001 Broome Max1659989 Univera Community Health Inc1674982 Senior Care Connection1687021 Health Choice170 Blue Cross and Blue Shield of Louisiana

1746203 Broome Max1746212 Broome Max1750467 VNS Choice1750476 Co Op Care Plan1751046 Fidelis HC NY

1778523 Senior Network Health1788325 Partners In Community Care180 Blue Cross and Blue Shield of Maine1825947 Elant Choice1827572 Guildnet

1865329 Indep Care Systems Inc1898993 Homefirst190 Blue Cross and Blue Shield of Maryland Inc1995440 Broome Max20 Arkansas Blue Cross and Blue Shield

200 Blue Cross and Blue Shield of Massachusetts Inc210 Blue Cross and Blue Shield of Michigan2104350 Broome Max


319

PAYOR TABLE

(continued)


2104369 Senior Health Partners Inc2188296 Total Aging in Place

2191362 Metplus SN2191582 Vidacare SN2193608 GHI PPO2194003 NY Presb Sys Select Health SN220 Blue Cross and Blue Shield of Minnesota

2289090 GHI HMO Select230 Blue Cross and Blue Shield of Mississippi Inc2367531 Broome Max240 Blue Cross and Blue Shield of Kansas City241 Alliance Blue Cross and Blue Shield of Missouri

250 Blue Cross and Blue Shield of Montana2581753 Neighborhood Health Provider2591073 GHI Provider2594847 Managed Health Inc Provider260 Blue Cross and Blue Shield of Nebraska

2644562 Amerigroup Comm Connections2645710 Wellcare Provider265 Blue Cross and Blue Shield of Nevada2660144 Liberty Health Advantage270 Blue Cross and Blue Shield of New Hampshire

2707899 HIP Advantage2709511 Oxford Provider2710185 CCM Select2738989 Fidelis Provider280 Blue Cross and Blue Shield of New Jersey Inc

2801132 Healthnow Provider2802899 Affinity Provider2825230 Wellcare Provider2825249 Wellcare Advantage Plus2872888 Senior Whole Health of NY

2902761 Touchstone Prestige2914056 VNS Choice Advantage Plus2922750 Metroplus Provider2927631 Fidelis Care of NY2932896 Senior Whole Health Adv Plus

2933315 Fidelis Care of NY 11992942923 Guildnet Advantage Plus30 Blue Cross and Blue Shield of Arizona Inc300 Blue Cross of Northeastern New York301 Blue Cross and Blue Shield of Western New York Inc

302 Excellus Blue Cross and Blue Shield304 The Fingerlakes Companies Inc of New York305 Blue Cross and Blue Shield of Central New York Inc3056544 Total Senior Care306 Blue Cross and Blue Shield of Utica Watertown Inc


320

PAYOR TABLE

(continued)


3072740 CHS Buffalo Pace Life310 Blue Cross and Blue Shield of North Carolina3114514 Archcare Senior Life313979 HIP320 Blue Cross and Blue Shield of North Dakota

332 Anthem Blue Cross and Blue Shield of Ohio340 Blue Cross and Blue Shield of Oklahoma350 Blue Cross and Blue Shield of Oregon351 The Benchmark Group of Oregon361 Capital Blue Cross

362 Independence Blue Cross363 Highmark Blue Cross and Blue Shield of Pennsylvania364 Blue Cross of Northeastern Pennsylvania370 Blue Cross and Blue Shield of Rhode Island380 Blue Cross and Blue Shield of South Carolina

390 Blue Cross and Blue Shield of Tennessee392 Blue Cross and Blue Shield of Memphis40 Blue Cross of California400 Blue Cross and Blue Shield of Texas Inc410 Regence Blue Cross and Blue Shield of Utah

415 Blue Cross and Blue Shield of Vermont423 Trigon Blue Cross and Blue Shield of Virginia430 Blue Cross of Washington and Alaska443 Mountain State Blue Cross and Blue Shield Inc450 Blue Cross and Blue Shield United of Wisconsin

460 Blue Cross and Blue Shield of Wyoming470 La Cruz Axul de Puerto Rico471 Hawaii Medical Service Association477023 Excellus477041 Elderplan Shmo

477156 Affinity Health Plan477183 Total Care477207 Hudson Health Plan480 Alberta Blue Cross Plan481 Manitoba Blue Cross

482 Blue Cross of Atlantic Canada483 Ontario Blue Cross484 Quebec Blue Cross486 Group Medical Services487 Saskatchewan Blue Cross

488 Medical Services Association50 Blue Cross and Blue Shield of Colorado510 Blue Cross and Blue Shield of Alabama520 Arkansas Blue Cross and Blue Shield52624 Atlantis Health Plan Inc

530 Blue Cross and Blue Shield of Arizona Inc


321

PAYOR TABLE

(continued)


542 Blue Shield of California550 Blue Cross and Blue Shield of Colorado55115 Empire Blue Cross and Blue Shield Healthnet560 Blue Cross and Blue Shield of Connecticut Inc

570 Blue Cross and Blue Shield of Delaware Inc580 Columbia National Capital Area Shield of California590 Blue Cross and Blue Shield of Florida60 Blue Cross and Blue Shield of Connecticut Inc600 Blue Cross and Blue Shield of Georgia Inc

610 Blue Cross of Idaho Health Service Inc611 Blue Shield of Idaho621 Blue Cross and Blue Shield of Illinois630 Anthem Blue Cross and Blue Shield of Indiana640 Wellmark Blue Cross and Blue Shield of Iowa

650 Blue Cross and Blue Shield of Kansas Inc660 Anthem Blue Cross and Blue Shield of Kentucky Inc670 Blue Cross and Blue Shield of Louisiana680 Blue Cross and Blue Shield of Maine690 Blue Cross and Blue Shield of Maryland Inc

70 Blue Cross and Blue Shield of Delaware Inc700 Blue Cross and Blue Shield of Massachusetts Inc710 Blue Cross and Blue Shield of Michigan720 Blue Cross and Blue Shield of Minnesota730 Blue Cross and Blue Shield of Mississippi Inc

740 Blue Cross and Blue Shield of Kansas City741 Alliance Blue Cross and Blue Shield of Missouri751 Blue Cross and Blue Shield of Montana760 Blue Cross and Blue Shield of Nebraska765 Blue Cross and Blue Shield of Nevada

770 Blue Cross and Blue Shield of New Hampshire780 Blue Cross and Blue Shield of New Jersey Inc790 Empire HealthChoice HMO Inc798398 Healthplus80 Columbia National Capital Area Shield of California

800 Blue Cross and Blue Shield of New Hampshire801 Blue Cross and Blue Shield of Western New York Inc804 The Fingerlakes Companies Inc of New York805 Blue Cross and Blue Shield of Central New York Inc806 Blue Cross and Blue Shield of Utica Watertown Inc

810 Blue Cross and Blue Shield of North Carolina820 Blue Cross and Blue Shield of North Dakota834 Anthem Blue Cross and Blue Shield of Ohio840 Blue Cross and Blue Shield of Oklahoma850 The Benchmark Group of Oregon

851 Blue Cross and Blue Shield of Oregon865 Pennsylvania Blue Shield870 Blue Cross and Blue Shield of Rhode Island


322

PAYOR TABLE

(continued)


880 Blue Cross and Blue Shield of South Carolina889 South Dakota Blue Shield

890 Blue Cross and Blue Shield of Tennessee892 Blue Cross and Blue Shield of Memphis894519 Metroplus90 Blue Cross and Blue Shield of Florida900 Blue Cross and Blue Shield of Texas Inc

910 Regence Blue Cross and Blue Shield of Utah915 Blue Cross and Blue Shield of Vermont923 Trigon Blue Cross and Blue Shield of Virginia932 Regence Washington Health of Washington934 Blue Cross of Washington and Alaska

936 Medical Service Corporation of Eastern Washington937 Regence Blue Shield of Washington938 Northwest Medical Bureau of Washington943 Mountain State Blue Cross and Blue Shield Inc950 Blue Cross and Blue Shield United of Wisconsin

95041 Prucare of New York95085 United Healthcare of New York Inc95234 Aetna Health Plans of New York Inc95243 Chubbhealth Inc95284 Managed Health Inc

95305 Health Net of New York Inc95308 Independent Health Association Inc95333 Vytra Health Plans Long Island Inc95433 Empire HealthChoice HMO Inc95474 HealthSource HMO of NY Inc

95475 Americhoice of New York Inc95476 MDNY Healthcare Inc95479 Oxford Health Plans of New York95480 North Medical Community Health Plan Inc95488 CIGNA Healthcare of New York Inc

95491 Capital District Physicians Health Plan95521 MVP Health Plan Inc95534 Wellcare of New York Inc95640 MagnaHealth of New York Inc95662 Elderplan Inc

95768 AmeriHealth Health Plan Inc95835 GHI HMO Select Inc95854 Horizon Healthcare of New York Inc960 Blue Cross and Blue Shield of Wyoming96725 Capital Area Community Health Plan Inc

971 Hawaii Medical Service Association973 Triple s of Puerto Rico982 Blue Cross of Atlantic Canada986 Group Medical Services987 Saskatchewan Blue Cross


323

PAYOR TABLE

(continued)


988 Medical Services Association98899 Medicaid Fee for Service98912 Hill Burton Free Care98914 Self Insured Union Membership Coverage98918 Accident Liability Insurance

98989 Medicare Fee for Service98999 Commercial Other DefaultX0065 Health Care Plan IncX0163 HMO BlueX0164 Blue Choice

X0167 Community BlueX0170 Health Services Medical Corporation of Central New YorkX0171 CHP Hudson Valley RegionX0172 HIP Health Maintenance OrganizationX0174 Kaiser Foundation Health Plan of New York

X0176 Metroplus Health PlanX0178 Mohawk Valley Physicians Health Plan IncX0185 Metra Health Care Plan of Upstate NY IncX0234 NYLCare Health Plans of NY IncX0240 HMO CNY Inc

X4289 Excellus Health PlanY1001 Bronx PHSPY1002 SCHC Total CareY1003 Compre Care IncY1004 Hudson Health Plan

Y1005 Center Care IncY1006 Managed Healthcare Systems of New York IncY1007 Catholic Health Services of Brooklyn QueensY1008 Better Health Plan IncY1009 Genesis Healthplan Inc

Y1010 Healthfirst PHSP IncY1011 HealthplusY1012 Suffolk Health PlanY1013 Universal Health PlanY1014 Community Choice Health Plan of Westchester Inc

Y1015 St Barnabas Community Health PlanY1016 Neighborhood Health ProvidersY1017 NY Hospital CHPY1018 ABC Health PlanY1019 Care Plus


324

PAYOR TABLE

Claim Filing Indicator

Variable Name: SRC_PYMT_CD


Variable Length: 2


Variable Index: 9


Description:Code indicating the type of payer.

Former variable name: XSOURCEn

Reference table name: REF_SRC_PYMT_CD

SRC_PYMT_CD SRC_PYMT_CD_DESCR

09 Self-pay11 Other Non-Federal Programs12 Preferred Provider Organization (PPO)13 Point of Service (POS)14 Exclusive Provider Organization (EPO)

15 Indemnity Insurance16 Health Maintenance Organization (HMO) Medicare Risk17 Dental Maintenance OrganizationAM Automobile MedicalBL Blue Cross/Blue Shield

CH CHAMPUSCI Commercial Insurance Co.DS DisabilityFI Federal Employees ProgramHM Health Maintenance Organization

LM Liability MedicalMA Medicare Part AMB Medicare Part BMC MedicaidOF Other Federal Program (Use ?OF? when submitting

Medicare Part D Claims.)

TV Title VVA Veterans Affairs PlanWC Workers? Compensation Health ClaimZZ Type of Insurance is not known.


325

PAYOR TABLE

Provider ID

Variable Name: PROV_ID


Variable Length: 20


Variable Index: 10


Description:The number identifying the provider of services on this claim, assigned by the insurance (payer).

Former variable name: PROVIDNn


326

PAYOR TABLE

Payer ID Type

Variable Name: PAYR_ID_QUAL


Variable Length: 2


Variable Index: 11


Description:Type of identifier used to identify the payer (“PI” Payer Identifier / “XV” CMS Plan ID).

New to APD


327

PAYOR TABLE

Payer Secondary ID 1 Type

Variable Name: PAYR_SEC_ID_QUAL1


Variable Length: 2


Variable Index: 12


Description:Type of identifier sent in the first Payer Secondary ID. “2U” - Payer Identification Number; “EI” - Employer’s IdentificationNumber; “FY” - Claim Office Number; or “NF” - National Association of Insurance Commissioners (NAIC) Code.

New to APD


328

PAYOR TABLE

Payor Secondary ID 1

Variable Name: PAYR_SEC_ID1


Variable Length: 50


Variable Index: 13


Description:Additional identifier for the plan. The type is identified in the first Payer Secondary ID Type and can be: “2U” -Payer Identification Number; “EI” - Employer’s Identification Number; “FY” - Claim Office Number; or “NF” - NationalAssociation of Insurance Commissioners (NAIC) Code.

New to APD


329

PAYOR TABLE




Variable Length: 2


Variable Index: 14


Description:Type of identifier sent in the second Payer Secondary ID. “2U” - Payer Identification Number; “EI” - Employer’s Iden-tification Number; “FY” - Claim Office Number; or “NF” - National Association of Insurance Commissioners (NAIC)Code.

New to APD


330

PAYOR TABLE




Variable Length: 50


Variable Index: 15


Description:Additional identifier for the plan. The type is identified in the second Payer Secondary ID Type and can be: “2U” -Payer Identification Number; “EI” - Employer’s Identification Number; “FY” - Claim Office Number; or “NF” - NationalAssociation of Insurance Commissioners (NAIC) Code.

New to APD


331

PAYOR TABLE




Variable Length: 2


Variable Index: 16


Description:Type of identifier sent in the third Payer Secondary ID. “2U” - Payer Identification Number; “EI” - Employer’s Iden-tification Number; “FY” - Claim Office Number; or “NF” - National Association of Insurance Commissioners (NAIC)Code.

New to APD


332

PAYOR TABLE




Variable Length: 50


Variable Index: 17


Description:Additional identifier for the plan. The type is identified in the third Payer Secondary ID Type and can be: “2U” -Payer Identification Number; “EI” - Employer’s Identification Number; “FY” - Claim Office Number; or “NF” - NationalAssociation of Insurance Commissioners (NAIC) Code.

New to APD


333

PAYOR TABLE

Payer Organization Name

Variable Name: PAYR_NAME


Variable Length: 60


Variable Index: 18


Description:Organization name of the payer.

New to APD


334

PAYOR TABLE

Source of Payment Typology

Variable Name: PAYR_TYPOLOGY_CD


Variable Length: 5


Variable Index: 19


Description:Code indicating the source of payment typology for this payer.

Special Notes:History data was converted from the SPARCS_CLAIM table. PAYR_TYPOLOGY_1_CD was moved to row with SEQ_ID= “1”; PAYR_TYPOLOGY_2_CD was moved to row with SEQ_ID = “2”; PAYR_TYPOLOGY_3_CD was moved to row withSEQ_ID = “3”

Former variable name: PAYTYP1 PAYTYP2 PAYTYP3

Reference table name: REF_PAYR_TYPOLOGY_CD

PAYR_TYPOLOGY_CD PAYR_TYPOLOGY_CD_DESCR

1 MEDICARE11 Medicare (Managed Care)111 Medicare HMO112 Medicare PPO113 Medicare POS

119 Medicare Managed Care Other12 Medicare (Non-managed Care)121 Medicare FFS122 Medicare Drug Benefit123 Medicare Medical Savings Account (MSA)

129 Medicare Non-managed Care Other19 Medicare Other2 MEDICAID21 Medicaid (Managed Care)211 Medicaid HMO

2111 Family Health Plus (NYS ADDITION)2112 Healthy New York (NYS ADDITION)212 Medicaid PPO213 Medicaid PCCM (Primary Care Case Management)219 Medicaid Managed Care Other

22 Medicaid (Non-managed Care Plan)(Fee-For-Service – NYSADDITION)

23 Medicaid/SCHIP(Child Health Plus – NYS ADDITION)24 Medicaid Applicant25 Medicaid - Out of State29 Medicaid Other


335

PAYOR TABLE

(continued)


3 OTHER GOVERNMENT (Federal/State/Local)(excludingDepartment of Corrections)

31 Department of Defense311 TRICARE (CHAMPUS)3111 TRICARE Prime – HMO3112 TRICARE Extra – PPO

3113 TRICARE Standard - Fee For Service3114 TRICARE For Life – Medicare Supplement3115 TRICARE Reserve Select3116 Uniformed Services Family Health Plan (USFHP) – HMO3119 Department of Defense - (other)

312 Military Treatment Facility3121 Enrolled Prime-HMO3122 Non-enrolled Space Available3123 TRICARE For Life (TFL)313 Dental–Stand Alone

32 Department of Veterans Affairs321 Veteran care–Care provided to Veterans3211 Direct Care–Care provided in VA facilities3212 Indirect Care–Care provided outside VA facilities32121 Fee Basis

32122 Foreign Fee/Foreign Medical Program (FMP)32123 Contract Nursing Home/Community Nursing Home32124 State Veterans Home32125 Sharing Agreements32126 Other Federal Agency

322 Non-veteran care3221 Civilian Health and Medical Program for the VA (CHAMPVA)3222 Spina Bifida Health Care Program (SB)3223 Children of Women Vietnam Veterans (CWVV)3229 Other non-veteran care

33 Indian Health Service or Tribe331 Indian Health Service - Regular332 Indian Health Service - Contract333 Indian Health Service - Managed Care334 Indian Tribe - Sponsored Coverage

34 HRSA Program341 Title V (MCH Block Grant)342 Migrant Health Program343 Ryan White Act349 Other

35 Black Lung36 State Government361 State SCHIP program (codes for individual states)362 Specific state programs (list/local code)369 State, not otherwise specified (other state)


336

PAYOR TABLE

(continued)


37 Local Government371 Local - Managed care3711 HMO3712 PPO3713 POS

372 FFS/Indemnity379 Local, not otherwise specified (other local, county)38 Other Government (Federal, State, Local not specified)381 Federal, State, Local not specified managed care3811 Federal, State, Local not specified - HMO

3812 Federal, State, Local not specified - PPO3813 Federal, State, Local not specified - POS3819 Federal, State, Local not specified - not specified managed

care382 Federal, State, Local not specified managed - FFS389 Federal, State, Local not specified managed - Other

39 Other Federal4 DEPARTMENT OF CORRECTIONS41 Corrections Federal42 Corrections State43 Corrections Local

44 Corrections Unknown Level5 PRIVATE HEALTH INSURANCE51 Managed Care (Private)511 Commercial Managed Care - HMO512 Commercial Managed Care - PPO

513 Commercial Managed Care - POS514 Exclusive Provider Organization515 Gatekeeper PPO (GPPO)519 Managed Care, Other (non HMO)52 Private Health Insurance - Indemnity

521 Commercial Indemnity522 Self-insured (ERISA) Administrative Services Only (ASO)

plan523 Medicare supplemental policy (as second payer)529 Private health insurance – other commercial Indemnity53 Managed Care (private) or private health insurance

(indemnity), not otherwise specified

54 Organized Delivery System55 Small Employer Purchasing Group59 Other Private Insurance6 BLUE CROSS/BLUE SHIELD61 BC Managed Care

611 BC Managed Care - HMO612 BC Managed Care - PPO613 BC Managed Care - POS619 BC Managed Care - Other


337

PAYOR TABLE

(continued)


62 BC Indemnity

63 BC (Indemnity or Managed Care) - Out of State64 BC (Indemnity or Managed Care) - Unspecified69 BC (Indemnity or Managed Care) - Other7 MANAGED CARE, UNSPECIFIED (to be used only if one cant

distinguish public from private)71 HMO

72 PPO73 POS79 Other Managed Care, Unknown if public or private8 NO PAYMENT FROM AN

ORGANIZATION/AGENCY/PROGRAM/PRIVATE PAYERLISTED

81 Self-pay

82 No Charge821 Charity822 Professional Courtesy823 Research/Clinical Trial83 Refusal to Pay/Bad Debt

84 Hill Burton Free Care85 Research/Donor89 No Payment, Other9 MISCELLANEOUS/OTHER91 Foreign National

92 Other (Non-government)93 Disability Insurance94 Long-term Care Insurance95 Workers Compensation951 Workers Comp HMO

953 Workers Comp Fee-for-Service954 Workers Comp Other Managed Care959 Workers Comp, Other unspecified96 Auto Insurance (no fault)98 Other specified (includes Hospice - Unspecified plan)

99 No Typology Code available for payment sourceZZZ UNAVAILABLE / UNKNOWN


338

PAYOR TABLE

Subscriber Individual Relationship Code

Variable Name: SUBSCR_INDVDL_RLTNSHP_CD


Variable Length: 2


Variable Index: 20


Description:Code indicating the relationship between the subscriber and the patient.

New to APD


339

PAYOR TABLE

Subscriber Group Number

Variable Name: SUBSCR_GRP_NUMB




Variable Index: 21


Description:Group or policy number for the subscriber’s insurance plan.

New to APD


340

PAYOR TABLE

Subscriber Group Name

Variable Name: SUBSCR_GRP_NAME




Variable Index: 22


Description:Group name for the subscriber’s insurance plan.

New to APD


341

PAYOR TABLE

Subscriber Individual or Organization Indicator

Variable Name: SUBSCR_ENTITY_TYPE_QUAL


Variable Length: 1


Variable Index: 23


Description:Code indicating whether the subscriber is an organization (“2”) or person (“1”).

New to APD


342

PAYOR TABLE

Subscriber Member Identification Number

Variable Name: SUBSCR_MBR_ID_NUMB




Variable Index: 24


Description:Member identification number for the subscriber.

New to APD


343

PAYOR TABLE

Payer Responsibility Sequence Number Code

Variable Name: SUBSCR_PAYR_RESP_SEQ_CD


Variable Length: 2


Variable Index: 25


Description:Code indicating the order of responsibility for the paying the claim (e.g., primary, secondary, tertiary).

New to APD


344

PAYOR TABLE

Subscriber City

Variable Name: SUBSCR_CITY


Variable Length: 30


Variable Index: 26


Description:City name of subscriber’s address.

New to APD


345

PAYOR TABLE

Subscriber Street Name

Variable Name: SUBSCR_ST


Variable Length: 12


Variable Index: 27


Description:Subscriber’s state or province code.

New to APD


346

PAYOR TABLE

Subscriber Zip Code

Variable Name: SUBSCR_ZIP


Variable Length: 20


Variable Index: 28


Description:Subscriber’s zip code (5 or 5+4 ext.).

New to APD


347

PAYOR TABLE

Subscriber Country

Variable Name: SUBSCR_CNTRY_CD


Variable Length: 10


Variable Index: 29


Description:Country name when subscriber’s address is outside the US.

New to APD


348

PAYOR TABLE

Subscriber County

Variable Name: SUBSCR_CNTY_CD


Variable Length: 12


Variable Index: 30


Description:Five digit FIPS county code of the subscriber’s address.

New to APD









36061 New York


349

PAYOR TABLE

(continued)













350

PAYOR TABLE

Payer Type Code

Variable Name: PAYR_TYPE_CD


Variable Length: 2


Variable Index: 31


Description:Code indicating whether the payer was primary (PY) or other (OP).

New to APD


351

PAYOR TABLE

Claim Key



Variable Length: 12


Variable Index: 32



New to APD


352

PAYOR TABLE

Active Flag



Variable Length: 1


Variable Index: 33



New to APD


353

PAYOR TABLE




Variable Length: 1


Variable Index: 34



New to APD


354

PAYOR TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 35





355

PAYOR TABLE

Record Created By



Variable Length: 20


Variable Index: 36



New to APD


356

PAYOR TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 37



New to APD


357

PAYOR TABLE

Last Updated By



Variable Length: 20


Variable Index: 38



New to APD


358

PAYOR TABLE

Source File Name



Variable Length: 30


Variable Index: 39



New to APD


359

PAYOR TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 40



New to APD


360

PAYOR TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 41





361

PAYOR TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 42






N NoY Yes


362

PROC TABLE

PROC TABLE

This table contains information related to the inpatient ICD and outpatient HCPCS procedures reported. For examplethis includes: Claim Type, Discharge Year, Procedure Type, Procedure Date, Post-Op Days, Pre-Admit Indicator, Pre-Op Days, CCS Procedure Group, and Procedure Code. For example HCPCS codes will include: charges, proceduremodifiers, Service Unit Type and Number of Units.


363

PROC TABLE




Variable Length: 12

Table/File: SPARCS_PROC

Variable Index: 1



New to APD


364

PROC TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


365

PROC TABLE

Procedure Type

Variable Name: PROC_TYPE_CD


Variable Length: 2


Variable Index: 3


Description:Code indicating whether the procedure reported was ICD9 (“9”), ICD10 (“1”) or HCPCS/CPT (“H”).

New to APD

Reference table name: REF_PROC_TYPE_CD

PROC_TYPE_CD PROC_TYPE_CD_DESCR

1 ICD-10 code9 ICD-9 codeH HCPCS code


366

PROC TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 4


Description:Order in which the ICD procedure codes were reported.


367

PROC TABLE

Procedure Charge Amount

Variable Name: CHRG_TOT_AMT


Variable Length: 22


Variable Index: 5


Description:Charge reported for the procedure on the service line.

Former variable name: TOTCHG


368

PROC TABLE

Total Procedure Non-Covered Charges

Variable Name: CHRG_NOCVRD_AMT


Variable Length: 22


Variable Index: 6


Description:Line denied charge amount for the procedure.

Former variable name: TOTNCCHG


369

PROC TABLE

Claim Type



Variable Length: 1


Variable Index: 7








370

PROC TABLE

Procedure Date

Variable Name: PROC_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 8


Description:Date the procedure was performed.

Former variable name: PRDTn


371

PROC TABLE

Post-Op Days

Variable Name: POSTOP_DAYS


Variable Length: 22


Variable Index: 9


Description:Number of days from date of procedure to date of discharge

Former variable name: POSTOPDAYn



372

PROC TABLE

Pre-Admit Indicator

Variable Name: PREADMIT_IND


Variable Length: 4


Variable Index: 10


Description:Indicates if procedure was before (-), on (+), or after (+) Admission Date. Blank if no procedure.

Former variable name: PREADMINDn


373

PROC TABLE

Pre-Op Days

Variable Name: PREOP_DAYS


Variable Length: 22


Variable Index: 11


Description:Number of days from date of admission to date of procedure

Former variable name: PREOPDAYn



374

PROC TABLE

Procedure Code

Variable Name: PROC_CD


Variable Length: 7


Variable Index: 12


Description:Code indicating the procedure performed. Procedure codes can be ICD 9, ICD 10 or HCPCS/CPT codes depending onthe procedure type. ICD procedure codes are reported at the claim level while HCPCS codes are reported at the linelevel.

Former variable name: HCPCCDn PRn PR00


375

PROC TABLE

Procedure Modifier Code 1

Variable Name: PROC_MOD1_CD


Variable Length: 2


Variable Index: 13


Description:Code clarifying/improving the reporting accuracy of the associated HCPCS/CPT code.

Former variable name: HCPCMn

This is an outpatient variable only. (Ambulatory Surgery Visit, Emergency Room Visit, Outpatient ServicesVisit)


376

PROC TABLE




Variable Length: 2


Variable Index: 14



Former variable name: HCPC2Mn



377

PROC TABLE




Variable Length: 2


Variable Index: 15



New to APD



378

PROC TABLE




Variable Length: 2


Variable Index: 16



New to APD



379

PROC TABLE

CCS Procedure Group

Variable Name: PROC_GRP_CD


Variable Length: 3


Variable Index: 17


Description:Clinical Classification Software (CCS) clinical grouper Procedure Category is the single level classification system thataggregates procedures into mutually exclusive categories.

Former variable name: PROCGRP

Reference table name: REF_PROC_GRP_CD

PROC_GRP_CD PROC_GRP_CD_DESCR

1 INCISION EXCISION CNS10 THYROIDECTOMY PART FULL100 ENDOSCOPY URINARY TRACT101 TRANSURETHRAL EXCISION102 URETERAL CATHETERIZATN

103 NEPHRO NEPHROS TOMY104 NEPHRECTOMY PART TOTAL105 KIDNEY TRANSPLANT106 GENI INCONTINENCE PRCS107 EXTRACORP LTIHO URINARY

108 INDWELLING CATHETER109 PRCS ON THE URETHRA11 DX ENDOCRINE PRCS110 OT DX PRCS URINARY TRCT111 OT NON OR THER PRC URIN

112 OT OR THER PRCS URINARY113 TRANS RES PROSTATE TURP114 OPEN PROSTATECTOMY115 CIRCUMCISION116 DX PRCS MALE GENITAL

117 OT NON OR THER PRCS M118 OT OR THER PRCS MALE119 OOPHORECTOMY UNI BILAT12 OT THER ENDOCRINE PRCS120 OT OPERATIONS ON OVARY

121 LIG OCCL FALLOPIAN TUBE122 RMVL ECTOPIC PREGNANCY123 OT OPER FALLOPIAN TUBES124 HYSTERECTOMY AB VAG125 OT EXC CERVIX UTERUS


380

PROC TABLE

(continued)


126 ABORTION TERM OF PREG127 D C ASPIR AFT DLV ABOR128 DX DILAT CURETTAGE D C129 REPAIR CYST RECT OCELE13 CORNEAL TRANSPLANT

130 OT DX PRCS FEMALE ORGN131 OT NON OR THER PRC FEM132 OT OR THER PRC FEM ORG133 EPISIOTOMY134 CESAREAN SECTION

135 FORCEP VAC BREACH DELIV136 ART RUPT MEMB ASSIS DLV137 OT PRCS TO ASSIST DELIV138 DX AMNIOCENTESIS139 FETAL MONITORING

14 GLAUCOMA PROCEDURES140 REPAIR CUR OBS LACERATN141 OT THER OBSTETRICAL PRC142 PARTIAL EXCISION BONE143 BUNIONECTOMY TOE DEFORM

144 TRTMNT FACE FRACT DISLC145 TRTMNT FRAC RADIUS ULNA146 TRTMNT FRAC HIP FEMUR147 TRTMNT FRAC LOWR EXTREM148 OT FRACTURE DISLOC PRC

149 ARTHROSCOPY15 LENS CATARACT PRCS150 DIV OF JOINT CAPSULE151 EXC OF SEMI CART KNEE152 ARTHROPLASTY KNEE

153 HIP REPLACEMENT TOT PRT154 ARTHROPLASTY NOT HIP KN155 ARTHROCENTESIS156 INJ ASP MUSC TENDONS ST157 AMPUTATE LOWER EXTRMITY

158 SPINAL FUSION159 OT DX PRCS ON MUSC SKEL16 REPAIR RETINAL TEAR160 OT THER PRCS ON MUSCLES161 OT OR THER PRCS ON BONE

162 OT OR THER PRC ON JOINT163 OT NON OR THER PRC MUSC164 OT OR THER PRC MUSC SKL165 BREAST BIOPSY DX PRCS166 LUMPECTOMY QUAD BREAST

167 MASTECTOMY


381

PROC TABLE

(continued)


168 INCIS DRAIN SKIN SUBCU169 DEBRIDE WOUND INF BURN17 DES LES RETINA CHOROID170 EXCISION OF SKIN LESION

171 SUTURE SKIN SUBCUT TISS172 SKIN GRAFT173 OT DX PRC SKIN SUBCUTAN174 OT NON OR THER PRC SKIN175 OT OR THER PRC SKN BRST

176 OT ORGAN TRANSPLANTATN177 COMP AXIAL TOMOGR CT178 CT SCAN CHEST179 CT SCAN ABDOMEN18 DX PRCS ON EYE

180 OTHER CT SCAN181 MYELOGRAM182 MAMMOGRAPHY183 ROUTINE CHEST X RAY184 INTRAOP CHOLANGIOGRAM

185 UPPER GI X RAY186 LOWER GI X RAY187 INTRAVENOUS PYELOGRAM188 CEREBRAL ARTERIOGRAM189 CONTRAST AORTOGRAM

19 OT THER PRCS EYELIDS190 ARTERIO FEMORAL LOW ART191 ARTERIO VENOGRAM NOT HH192 DX ULTRASOUND HEAD NECK193 DX ULTRASOUND HEART

194 DX ULTRASOUND OF GI195 DX ULTRASOUND URINARY196 DX ULTRASOUND AB RETRO197 OTHER DX ULTRASOUND198 MAG RESONANCE IMAGING

199 ELECTROENCEPHALOGRAM2 IRR XCRANIAL VENT SHUNT20 OT INTRAOCULAR THER PRC200 NONOP URINARY SYS MEASR201 CARDIAC STRESS TESTS

202 ELECTROCARDIOGRAM203 ELECTROGR CARDIAC MONIT204 SWAN GANZ CATH MONITOR205 ARTERIAL BLOOD GASES206 MICRO EX BACT SMEAR

207 RADIOISOTOPE BONE SCAN208 RADIOISOTOPE PULM SCAN209 RADIOISOTOPE SCAN FUNCT


382

PROC TABLE

(continued)


21 OT EXTRAOCULAR MUSC ORB210 OTHER RADIOISOTOPE SCAN

211 THERAPEUTIC RADIOLOGY212 DX PHYSICAL THERAPY213 PHYS THER EXER MANIPUL214 TRACTN SPLNT OT WOUND215 OT PHYS THER REHAB

216 RESP INTUB MECH VENTIL217 OTHER RESP THERAPY218 PSYCHO PSYCHI EVAL THER219 ALCO DRUG REHAB DETOX22 TYMPANOPLASTY

220 OPHTHALM OT OLOGIC DX221 NASOGASTRIC TUBE222 BLOOD TRANSFUSION223 ENTERAL PARENTERAL NUTR224 CANCER CHEMOTHERAPY

225 CONV OF CARDIAC RHYTHM226 OT DX RADIO RELATED227 OT DX PRC INTERVW EVAL228 PROPHYLACTIC VAC INOCUL229 NONOP RMVL FOREIGN BODY

23 MYRINGOTOMY230 EXTRACORP SHOCK WAVE231 OTHER THERAPEUTIC PRCS24 MASTOIDECTOMY25 DX PRCS ON EAR

26 OT THERAPEUTIC EAR PRCS27 CONTROL OF EPISTAXIS28 PLASTIC PRCS ON NOSE29 ORAL AND DENTAL SVCS3 LAMINECTOMY EXC IV DSC

30 TONSIL ADENOID ECTOMY31 DX PRCS ON NOSE MOUTH32 OT NON OR THER PRC NOSE33 OTHER OR THER PRCS NOSE34 TRACHEOSTOMY TEMP PERM

35 TRACHE LARYNG OSCOPY36 LOBECTOMY PNEUMONECTOMY37 DX BRONCHOSCOPY BIOPS38 OT DX PRCS ON LUNG39 INCISION OF PLEURA

4 DIAGNOSTIC SPINAL TAP40 OT DX PRCS OF RESP TRCT41 OT NON OR THER PRC RESP42 OT OR RX PRCS RESP SYS43 HEART VALVE PRCS


383

PROC TABLE

(continued)


44 COR ARTERY BYP GRF CABG45 PERC TRANSLUM COR ANGIO46 CORONARY THROMBOLYSIS47 DX CARDIAC CATHETERIZTN48 CARDIAC PACEMAKER DEFIB

49 OTHER OR HEART PRCS5 INS CATHETER SPNL STIM50 EXTRA CIRC AUX OPEN HRT51 ENDARTERECTOMY VES HEAD52 AORTIC RESECTION REPL

53 VARI VEIN STRIP LOW LMB54 OT VASC CATH NOT HEART55 PERIPH VASCULAR BYPASS56 OT VASCULAR BYP SHUNT57 ARTERIOVENOUS FISTULA

58 HEMODIALYSIS59 OT OR PRCS ON VES HEAD6 DECOMP PERIPHERAL NERVE60 EMBOL ENDARTER ECTOMY61 OT OR PRCS VES NOT HEAD

62 OT DX CARDIOVASC PRCS63 OT NON OR THER CARDIO64 BONE MARROW TRANSPLANT65 BONE MARROW BIOPSY66 PRCS ON SPLEEN

67 OT THER PRCS HEM LYMPH68 INJ LIG ESOPH VARICES69 ESOPHAGEAL DILATATION7 OTHER DX NERV SYS PRCS70 UP GASTRO ENDOSC BIOPSY

71 GASTROSTOMY TEMP PERM72 COLOSTOMY TEMP PERM73 ILEO OT ENTER OSTOMY74 GASTRECTOMY PART TOTAL75 SMALL BOWEL RESECTON

76 COLONOSCOPY AND BIOPSY77 PROCTOSCOPY AR BIOPSY78 COLORECTAL RESECTION79 LOC EXC LRG INTEST LESN8 OT NON OR THER NERV SYS

80 APPENDECTOMY81 HEMORRHOID PRCS82 ENDO RETRO CAN OF PANCR83 BIOPSY OF LIVER84 CHOLECYSTECTOMY EXPLOR

85 INGUINAL FEMORAL HERNIA


384

PROC TABLE

(continued)


86 OTHER HERNIA REPAIR87 LAPAROSCOPY88 ABDOMINAL PARACENTESIS89 EXPLORATORY LAPAROTOMY

9 OTHER OR THER NERV SYS90 EXCISION LYS PERI ADHS91 PERITONEAL DIALYSIS92 OTHER BOWEL DX PRCS93 OT NON OR UP GI THER PR

94 OT OR UP GI THER PRCS95 OT NON OR LW GI THER PR96 OT OR LOW GI THER PRCS97 OTHER GI DX PRCS98 OT NON OR GI THER PRCS

99 OT OR GI THER PRCS999 UNKNOWN


385

PROC TABLE

Service Unit Type

Variable Name: UNIT_TYPE_CD


Variable Length: 2


Variable Index: 18


Description:Unit of measure of the HCPCS/CPT procedure being reported (“DA” Days or “UN” Units).

Former variable name: UNITQTn

Reference table name: REF_UNIT_TYPE_CD

UNIT_TYPE_CD UNIT_TYPE_CD_DESCR

DA DaysUN Unit


386

PROC TABLE

Number of Units

Variable Name: UNIT_QTY


Variable Length: 22


Variable Index: 19


Description:Count of the HCPCS/CPT procedure being reported.

Former variable name: UNITYPn


387

PROC TABLE






Variable Index: 20




388

PROC TABLE

Service Line Number



Variable Length: 22


Variable Index: 21


Description:Line number associated with the HCPCS/CPT procedure being reported. Secondary foreign key for linking NDC, Proc,Provider, and Rev tables.

New to APD


389

PROC TABLE

Claim Key



Variable Length: 12


Variable Index: 22



New to APD


390

PROC TABLE

Active Flag



Variable Length: 1


Variable Index: 23



New to APD


391

PROC TABLE




Variable Length: 1


Variable Index: 24



New to APD


392

PROC TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 25





393

PROC TABLE

Record Created By



Variable Length: 20


Variable Index: 26



New to APD


394

PROC TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 27



New to APD


395

PROC TABLE

Last Updated By



Variable Length: 20


Variable Index: 28



New to APD


396

PROC TABLE

Source File Name



Variable Length: 30


Variable Index: 29



New to APD


397

PROC TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 30



New to APD


398

PROC TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 31





399

PROC TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 32






N NoY Yes


400

PROVIDER TABLE

PROVIDER TABLE

This table contains information related to the providers reported. For example this includes: Claim Type Code, Dis-charge Year, Provider Type Code (“AT” Attending, “OP” Operating, “OO” Other Operating, “RF” Referring, and “RN”Rendering), Provider NPI, and Provider State License Number. Provider State License Number was collected histori-cally. It is not being collected on transactions with process dates after 10/1/2017.


401

PROVIDER TABLE




Variable Length: 12

Table/File: SPARCS_PROVIDER

Variable Index: 1



New to APD


402

PROVIDER TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


403

PROVIDER TABLE

Provider Type Code

Variable Name: PROV_TYPE_CD


Variable Length: 3


Variable Index: 3


Description:Code indicating the type of service provider being reported (“AT” Attending, “OP” Operating, “OO” Other Operating,“RF” Referring, “RN” Rendering).

Special Notes:History data was converted from SPARCS_CLAIM attending_phys, operating_phys, and other_phys. If attending_phys,PROV_TYPE_CD was set to “AT”. If operating_phys, PROV_TYPE_CD was set to “OP”. If other_phys, PROV_TYPE_CDwas set to “OO”.

New to APD


404

PROVIDER TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 4


Description:Order in which the service providers were reported.


405

PROVIDER TABLE

Claim Type



Variable Length: 1


Variable Index: 5








406

PROVIDER TABLE






Variable Index: 6




407

PROVIDER TABLE

Provider Last Name

Variable Name: PROV_LAST_NAME


Variable Length: 65


Variable Index: 7


Description:Last name of the service provider.

New to APD


408

PROVIDER TABLE

Provider First Name

Variable Name: PROV_FIRST_NAME


Variable Length: 35


Variable Index: 8


Description:First name of the service provider.

New to APD


409

PROVIDER TABLE

Provider Middle Name or Initial

Variable Name: PROV_MID_NAME_OR_INIT


Variable Length: 25


Variable Index: 9


Description:Middle name or initial of the service provider.

New to APD


410

PROVIDER TABLE

Provider Name Suffix

Variable Name: PROV_NAME_SFX


Variable Length: 12


Variable Index: 10


Description:Name suffix of the service provider.

New to APD


411

PROVIDER TABLE

Provider NPI

Variable Name: PROV_NPI


Variable Length: 80


Variable Index: 11


Description:Service provider’s National Provider ID (NPI).

New to APD


412

PROVIDER TABLE

Provider State License Number

Variable Name: ST_LIC_NUMB


Variable Length: 50


Variable Index: 12


Description:NYS professional license number used to identify the physician or other health care professional.

Special Notes:History data was converted from SPARCS_CLAIM attending_phys, operating_phys, and other_phys. NYS professionallicense number is not required on transactions processed after 10/1/2017.

Former variable name: ATTEND OPER OTHPHYS


413

PROVIDER TABLE

Service Line Number



Variable Length: 22


Variable Index: 13


Description:Line number associated with the service provider being reported. Secondary foreign key for linking NDC, Proc, Provider,and Rev tables.

New to APD


414

PROVIDER TABLE

Claim Key



Variable Length: 12


Variable Index: 14



New to APD


415

PROVIDER TABLE

Active Flag



Variable Length: 1


Variable Index: 15



New to APD


416

PROVIDER TABLE




Variable Length: 1


Variable Index: 16



New to APD


417

PROVIDER TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 17





418

PROVIDER TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 18



New to APD


419

PROVIDER TABLE

Record Created By



Variable Length: 20


Variable Index: 19



New to APD


420

PROVIDER TABLE

Last Updated By



Variable Length: 20


Variable Index: 20



New to APD


421

PROVIDER TABLE

Source File Name



Variable Length: 30


Variable Index: 21



New to APD


422

PROVIDER TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 22



New to APD


423

PROVIDER TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 23





424

PROVIDER TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 24






N NoY Yes


425

RACE TABLE

RACE TABLE

This table contains information related to the race/ethnicity reported for the patient. For example this includes: ClaimType Code, Discharge Year, Patient Ethnicity, Patient Race, Patient Race Claritas Code and Patient Race/Ethnicity.


426

RACE TABLE




Variable Length: 12

Table/File: SPARCS_RACE

Variable Index: 1



New to APD


427

RACE TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


428

RACE TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the race/ethnicity codes were reported.


429

RACE TABLE

Claim Type



Variable Length: 1


Variable Index: 4








430

RACE TABLE






Variable Index: 5




431

RACE TABLE

Patient Ethnicity

Variable Name: PAT_ETHNIC_CD


Variable Length: 1


Variable Index: 6


Description:Code indicating the ethnicity reported using the CDC Race and Ethnicity Code Set.


Special Notes:This is an obsolete NYS specific data element. This data element is the Group level of the CDC Race/Ethnicity codes.In 2014, NYSDOH expanded the granularity of collection to the individual race or ethnicity for Hispanic, Asian andHawaiian/Pacific Islander. For data going forward in the APD, the RACE_ETHNIC_CD will report the actual code in theRace table.

Former variable name: ETHNIC


432

RACE TABLE

Patient Race

Variable Name: PAT_RACE_CD


Variable Length: 2


Variable Index: 7


Description:Code indicating the race reported using the CDC Race and Ethnicity Code Set.


Special Notes:This is an obsolete NYS specific data element. This data element is the Group level of the CDC Race/Ethnicity codes.In 2014, NYSDOH expanded the granularity of collection to the individual race or ethnicity for Hispanic, Asian andHawaiian/Pacific Islander. For data going forward in the APD, the RACE_ETHNIC_CD code will report the actual code inthe Race table.

Former variable name: RACE


433

RACE TABLE

Patient Race/Ethnicity

Variable Name: RACE_ETHNIC_CD


Variable Length: 21


Variable Index: 8


Description:The reported race(s) and ethnicity(s) of the patient, by the patient. Minimum of one (1) race and ethnicity each.Maximum is ten (10) combined.

New to APD

Reference table name: REF_RACE_ETHNIC_CD

CODE DESCRIPTION

E1 HISPANIC OR LATINOE1.01 SPANIARDE1.01.001 ANDALUSIANE1.01.002 ASTURIANE1.01.003 CASTILLIAN

E1.01.004 CATALONIANE1.01.005 BELEARIC ISLANDERE1.01.006 GALLEGOE1.01.007 VALENCIANE1.01.008 CANARIAN

E1.01.009 SPANISH BASQUEE1.02 MEXICANE1.02.001 MEXICAN AMERICANE1.02.002 MEXICANOE1.02.003 CHICANO

E1.02.004 LA RAZAE1.02.005 MEXICAN AMERICAN INDIANE1.03 CENTRAL AMERICANE1.03.001 COSTA RICANE1.03.002 GUATEMALAN

E1.03.003 HONDURANE1.03.004 NICARAGUANE1.03.005 PANAMANIANE1.03.006 SALVADORANE1.03.007 CENTRAL AMERICAN INDIAN

E1.03.008 CANAL ZONEE1.04 SOUTH AMERICANE1.04.001 ARGENTINEANE1.04.002 BOLIVIANE1.04.003 CHILEAN


434

RACE TABLE

(continued)

CODE DESCRIPTION

E1.04.004 COLOMBIANE1.04.005 ECUADORIANE1.04.006 PARAGUAYANE1.04.007 PERUVIANE1.04.008 URUGUAYAN

E1.04.009 VENEZUELANE1.04.010 SOUTH AMERICAN INDIANE1.04.011 CRIOLLOE1.05 LATIN AMERICANE1.06 PUERTO RICAN

E1.07 CUBANE1.08 DOMINICANE2 NOT HISPANIC OR LATINOE9 UNKNOWNR1 AMERICAN INDIAN OR ALASKA NATIVE

R1.01 AMERICAN INDIANR1.01.001 ABENAKIR1.01.002 ALGONQUIANR1.01.003 APACHER1.01.003.001 CHIRICAHUA

R1.01.003.002 FORT SILL APACHER1.01.003.003 JICARILLA APACHER1.01.003.004 LIPAN APACHER1.01.003.005 MESCALERO APACHER1.01.003.006 OKLAHOMA APACHE

R1.01.003.007 PAYSON APACHER1.01.003.008 SAN CARLOS APACHER1.01.003.009 WHITE MOUNTAIN APACHER1.01.004 ARAPAHOR1.01.004.001 NORTHERN ARAPAHO

R1.01.004.002 SOUTHERN ARAPAHOR1.01.004.003 WIND RIVER ARAPAHOR1.01.005 ARIKARAR1.01.006 ASSINIBOINER1.01.007 ASSINIBOINE SIOUX

R1.01.007.001 FORT PECK ASSINIBOINE SIOUXR1.01.008 BANNOCKR1.01.009 BLACKFEETR1.01.010 BROTHERTONR1.01.011 BURT LAKE BAND

R1.01.012 CADDOR1.01.012.001 OKLAHOMA CADOR1.01.013 CAHUILLAR1.01.013.001 AGUA CALIENTE CAHUILLAR1.01.013.002 AUGUSTINE

R1.01.013.003 CABAZON


435

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.013.004 LOS COYOTESR1.01.013.005 MORONGOR1.01.013.006 SANTA ROSA CAHUILLAR1.01.013.007 TORRES MARTINEZ

R1.01.014 CALIFORNIA TRIBESR1.01.014.001 CAHTOR1.01.014.002 CHIMARIKOR1.01.014.003 COAST MIWOKR1.01.014.004 DIGGER

R1.01.014.005 KAWAIISUR1.01.014.006 KERN RIVERR1.01.014.007 MATTOLER1.01.014.008 RED WOODR1.01.014.009 SANTA ROSA

R1.01.014.010 TAKELMAR1.01.014.011 WAPPOR1.01.014.012 YANAR1.01.014.013 YUKIR1.01.015 CANADIAN AND LATIN AMERICAN INDIAN

R1.01.015.001 CANADIAN INDIANR1.01.015.002 CENTRAL AMERICAN INDIANR1.01.015.003 FRENCH AMERICAN INDIANR1.01.015.004 MEXICAN AMERICAN INDIANR1.01.015.005 SOUTH AMERICAN INDIAN

R1.01.015.006 SPANISH AMERICAN INDIANR1.01.016 CATAWBAR1.01.017 CAYUSER1.01.018 CHEHALISR1.01.019 CHEMAKUAN

R1.01.019.001 HOHR1.01.019.002 QUILEUTER1.01.020 CHEMEHUEVIR1.01.021 CHEROKEER1.01.021.001 CHEROKEE ALABAMA

R1.01.021.002 CHEROKEES OF NORTHEAST ALABAMAR1.01.021.003 CHEROKEES OF SOUTHEAST ALABAMAR1.01.021.004 EASTERN CHEROKEER1.01.021.005 ECHOTA CHEROKEER1.01.021.006 ETOWAH CHEROKEE

R1.01.021.007 NORTHERN CHEROKEER1.01.021.008 TUSCOLAR1.01.021.009 UNITED KEETOWAH BAND OF CHEROKEER1.01.021.010 WESTERN CHEROKEER1.01.022 CHEROKEE SHAWNEE

R1.01.023 CHEYENNER1.01.023.001 NORTHERN CHEYENNER1.01.023.002 SOUTHERN CHEYENNE


436

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.024 CHEYENNE ARAPAHOR1.01.025 CHICKAHOMINY

R1.01.025.001 EASTERN CHICKAHOMINYR1.01.025.002 WESTERN CHICKAHOMINYR1.01.026 CHICKASAWR1.01.027 CHINOOKR1.01.027.001 CLATSOP

R1.01.027.002 COLUMBIA RIVER CHINOOKR1.01.027.003 KATHLAMETR1.01.027.004 UPPER CHINOOKR1.01.027.005 WAKIAKUM CHINOOKR1.01.027.006 WILLAPA CHINOOK

R1.01.027.007 WISHRAMR1.01.028 CHIPPEWAR1.01.028.001 BAD RIVERR1.01.028.002 BAY MILLS CHIPPEWAR1.01.028.003 BOIS FORTE

R1.01.028.004 BURT LAKE CHIPPEWAR1.01.028.005 FOND DU LACR1.01.028.006 GRAND PORTAGER1.01.028.007 GRAND TRAVERSE BAND OF OTTAWA CHIPPEWAR1.01.028.008 KEWEENAW

R1.01.028.009 LAC COURTE OREILLESR1.01.028.010 LAC DU FLAMBEAUR1.01.028.011 LAC VIEUX DESERT CHIPPEWAR1.01.028.012 LAKE SUPERIORR1.01.028.013 LEECH LAKE

R1.01.028.014 LITTLE SHELL CHIPPEWAR1.01.028.015 MILLE LACSR1.01.028.016 MINNESOTA CHIPPEWAR1.01.028.017 ONTONAGONR1.01.028.018 RED CLIFF CHIPPEWA

R1.01.028.019 RED LAKE CHIPPEWAR1.01.028.020 SAGINAW CHIPPEWAR1.01.028.021 ST CROIX CHIPPEWAR1.01.028.022 SAULT STE MARIE CHIPPEWAR1.01.028.023 SOKOAGON CHIPPEWA

R1.01.028.024 TURTLE MOUNTAINR1.01.028.025 WHITE EARTHR1.01.029 CHIPPEWA CREER1.01.029.001 ROCKY BOY S CHIPPEWA CREER1.01.030 CHITIMACHA

R1.01.031 CHOCTAWR1.01.031.001 CLIFTON CHOCTAWR1.01.031.002 JENA CHOCTAWR1.01.031.003 MISSISSIPPI CHOCTAWR1.01.031.004 MOWA BAND OF CHOCTAW


437

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.031.005 OKLAHOMA CHOCTAWR1.01.032 CHUMASHR1.01.032.001 SANTA YNEZR1.01.033 CLEAR LAKER1.01.034 COEUR D ALENE

R1.01.035 COHAR IER1.01.036 COLORADO RIVERR1.01.037 COLVILLER1.01.038 COMANCHER1.01.038.001 OKLAHOMA COMANCHE

R1.01.039 COOS LOWER UMPQUA SIUSLAWR1.01.040 COOSR1.01.041 COQUILLESR1.01.042 COSTANOANR1.01.043 COUSHATTA

R1.01.043.001 ALABAMA COUSHATTAR1.01.044 COWLITZR1.01.045 CREER1.01.046 CREEKR1.01.046.001 ALABAMA CREEK

R1.01.046.002 ALABAMA QUASSARTER1.01.046.003 EASTERN CREEKR1.01.046.004 EASTERN MUSCOGEER1.01.046.005 KIALEGEER1.01.046.006 LOWER MUSCOGEE

R1.01.046.007 MACHIS LOWER CREEK INDIANR1.01.046.008 POARCH BANDR1.01.046.009 PRINCIPAL CREEK INDIAN NATIONR1.01.046.010 STAR CLAN OF MUSCOGEE CREEKSR1.01.046.011 THLOPTHLOCCO

R1.01.046.012 TUCKABACHEER1.01.047 CROATANR1.01.048 CROWR1.01.049 CUPENOR1.01.049.001 AGUA CALIENTE

R1.01.050 DELAWARER1.01.050.001 EASTERN DELAWARER1.01.050.002 LENNI LENAPER1.01.050.003 MUNSEER1.01.050.004 OKLAHOMA DELAWARE

R1.01.050.005 RAMPOUGH MOUNTAINR1.01.050.006 SAND HILLR1.01.051 DIEGUENOR1.01.051.001 CAMPOR1.01.051.002 CAPITAN GRANDE

R1.01.051.003 CUYAPAIPE


438

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.051.004 LA POSTAR1.01.051.005 MANZANITAR1.01.051.006 MESA GRANDER1.01.051.007 SAN PASQUAL

R1.01.051.008 SANTA YSABELR1.01.051.009 SYCUANR1.01.052 EASTERN TRIBESR1.01.052.001 ATTACAPAR1.01.052.002 BILOXI

R1.01.052.003 GEOR GETOWNR1.01.052.004 MOORR1.01.052.005 NANSEMONDR1.01.052.006 NATCHEZR1.01.052.007 NAUSU WAIWASH

R1.01.052.008 NIPMUCR1.01.052.009 PAUGUSSETTR1.01.052.010 POCOMOKE ACOHONOCKR1.01.052.011 SOUTHEASTERN INDIANSR1.01.052.012 SUSQUEHANOCK

R1.01.052.013 TUNICA BILOXIR1.01.052.014 WACCAMAW SIOUSANR1.01.052.015 WICOMICOR1.01.053 ESSELENR1.01.054 FORT BELKNAP

R1.01.055 FORT BERTHOLDR1.01.056 FORT MCDOWELLR1.01.057 FORT HALLR1.01.058 GABRIELENOR1.01.059 GRAND RONDE

R1.01.060 GROS VENTRESR1.01.060.001 ATSINAR1.01.061 HALIWAR1.01.062 HIDATSAR1.01.063 HOOPA

R1.01.063.001 TRINITYR1.01.063.002 WHILKUTR1.01.064 HOOPA EXTENSIONR1.01.065 HOUMAR1.01.066 INAJA COSMIT

R1.01.067 IOWAR1.01.067.001 IOWA OF KANSAS NEBRASKAR1.01.067.002 IOWA OF OKLAHOMAR1.01.068 IROQUOISR1.01.068.001 CAYUGA

R1.01.068.002 MOHAWKR1.01.068.003 ONEIDAR1.01.068.004 ONONDAGA


439

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.068.005 SENECAR1.01.068.006 SENECA NATION

R1.01.068.007 SENECA CAYUGAR1.01.068.008 TONAWANDA SENECAR1.01.068.009 TUSCARORAR1.01.068.010 WYANDOTTER1.01.069 JUANENO

R1.01.070 KALISPELR1.01.071 KARUKR1.01.072 KAWR1.01.073 KICKAPOOR1.01.073.001 OKLAHOMA KICKAPOO

R1.01.073.002 TEXAS KICKAPOOR1.01.074 KIOWAR1.01.074.001 OKLAHOMA KIOWAR1.01.075 KLALLAMR1.01.075.001 JAMESTOWN

R1.01.075.002 LOWER ELWHAR1.01.075.003 PORT GAMBLE KLALLAMR1.01.076 KLAMATHR1.01.077 KONKOWR1.01.078 KOOTENAI

R1.01.079 LASSIKR1.01.080 LONG ISLANDR1.01.080.001 MATINECOCKR1.01.080.002 MONTAUKR1.01.080.003 POOSPATUCK

R1.01.080.004 SETAUKETR1.01.081 LUISENOR1.01.081.001 LA JOLLAR1.01.081.002 PALAR1.01.081.003 PAUMA

R1.01.081.004 PECHANGAR1.01.081.005 SOBOBAR1.01.081.006 TWENTY NINE PALMSR1.01.081.007 TEMECULAR1.01.082 LUMBEE

R1.01.083 LUMMIR1.01.084 MAIDUR1.01.084.001 MOUNTAIN MAIDUR1.01.084.002 NISHINAMR1.01.085 MAKAH

R1.01.086 MALISEETR1.01.087 MANDANR1.01.088 MATTAPONIR1.01.089 MENOMINEER1.01.090 MIAMI


440

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.090.001 ILLINOIS MIAMIR1.01.090.002 INDIANA MIAMIR1.01.090.003 OKLAHOMA MIAMIR1.01.091 MICCOSUKEER1.01.092 MICMAC

R1.01.092.001 AROOSTOOKR1.01.093 MISSION INDIANSR1.01.094 MIWOKR1.01.095 MODOCR1.01.096 MOHEGAN

R1.01.097 MONOR1.01.098 NANTICOKER1.01.099 NARRAGANSETTR1.01.100 NAVAJOR1.01.100.001 ALAMO NAVAJO

R1.01.100.002 CANONCITO NAVAJOR1.01.100.003 RAMAH NAVAJOR1.01.101 NEZ PERCER1.01.102 NOMALAKIR1.01.103 NORTHWEST TRIBES

R1.01.103.001 ALSEAR1.01.103.002 CELILOR1.01.103.003 COLUMBIAR1.01.103.004 KALAPUYAR1.01.103.005 MOLALA

R1.01.103.006 TALAKAMISHR1.01.103.007 TENINOR1.01.103.008 TILLAMOOKR1.01.103.009 WENATCHEER1.01.103.010 YAHOOSKIN

R1.01.104 OMAHAR1.01.105 OREGON ATHABASKANR1.01.106 OSAGER1.01.107 OTOE MISSOURIAR1.01.108 OTTAWA

R1.01.108.001 BURT LAKE OTTAWAR1.01.108.002 MICHIGAN OTTAWAR1.01.108.003 OKLAHOMA OTTAWAR1.01.109 PAIUTER1.01.109.001 BISHOP

R1.01.109.002 BRIDGEPORTR1.01.109.003 BURNS PAIUTER1.01.109.004 CEDARVILLER1.01.109.005 FORT BIDWELLR1.01.109.006 FORT INDEPENDENCE

R1.01.109.007 KAIBAB


441

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.109.008 LAS VEGASR1.01.109.009 LONE PINER1.01.109.010 LOVELOCKR1.01.109.011 MALHEUR PAIUTE

R1.01.109.012 MOAPAR1.01.109.013 NORTHERN PAIUTER1.01.109.014 OWENS VALLEYR1.01.109.015 PYRAMID LAKER1.01.109.016 SAN JUAN SOUTHERN PAIUTE

R1.01.109.017 SOUTHERN PAIUTER1.01.109.018 SUMMIT LAKER1.01.109.019 UTU UTU GWAITU PAIUTER1.01.109.020 WALKER RIVERR1.01.109.021 YERINGTON PAIUTE

R1.01.110 PAMUNKEYR1.01.111 PASSAMAQUODDYR1.01.111.001 INDIAN TOWNSHIPR1.01.111.002 PLEASANT POINT PASSAMAQUODDYR1.01.112 PAWNEE

R1.01.112.001 OKLAHOMA PAWNEER1.01.113 PENOBSCOTR1.01.114 PEORIAR1.01.114.001 OKLAHOMA PEORIAR1.01.115 PEQUOT

R1.01.115.001 MARSHANTUCKET PEQUOTR1.01.116 PIMAR1.01.116.001 GILA RIVER PIMA MARICOPAR1.01.116.002 SALT RIVER PIMA MARICOPAR1.01.117 PISCATAWAY

R1.01.118 PIT RIVERR1.01.119 POMOR1.01.119.001 CENTRAL POMOR1.01.119.002 DRY CREEKR1.01.119.003 EASTERN POMO

R1.01.119.004 KASHIAR1.01.119.005 NORTHERN POMOR1.01.119.006 SCOTTS VALLEYR1.01.119.007 STONYFORDR1.01.119.008 SULPHUR BANK

R1.01.120 PONCAR1.01.120.001 NEBRASKA PONCAR1.01.120.002 OKLAHOMA PONCAR1.01.121 POTAWATOMIR1.01.121.001 CITIZEN BAND POTAWATOMI

R1.01.121.002 FOREST COUNTYR1.01.121.003 HANNAHVILLER1.01.121.004 HURON POTAWATOMI


442

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.121.005 POKAGON POTAWATOMIR1.01.121.006 PRAIRIE BAND

R1.01.121.007 WISCONSIN POTAWATOMIR1.01.122 POWHATANR1.01.123 PUEBLOR1.01.123.001 ACOMAR1.01.123.002 ARIZONA TEWA

R1.01.123.003 COCHITIR1.01.123.004 HOPIR1.01.123.005 ISLETAR1.01.123.006 JEMEZR1.01.123.007 KERES

R1.01.123.008 LAGUNAR1.01.123.009 NAMBER1.01.123.010 PICURISR1.01.123.011 PIROR1.01.123.012 POJOAQUE

R1.01.123.013 SAN FELIPER1.01.123.014 SAN ILDEFONSOR1.01.123.015 SAN JUAN PUEBLOR1.01.123.016 SAN JUAN DER1.01.123.017 SAN JUAN

R1.01.123.018 SANDIAR1.01.123.019 SANTA ANAR1.01.123.020 SANTA CLARAR1.01.123.021 SANTO DOMINGOR1.01.123.022 TAOS

R1.01.123.023 TESUQUER1.01.123.024 TEWAR1.01.123.025 TIGUAR1.01.123.026 ZIAR1.01.123.027 ZUNI

R1.01.124 PUGET SOUND SALISHR1.01.124.001 DUWAMISHR1.01.124.002 KIKIALLUSR1.01.124.003 LOWER SKAGITR1.01.124.004 MUCKLESHOOT

R1.01.124.005 NISQUALLYR1.01.124.006 NOOKSACKR1.01.124.007 PORT MADISONR1.01.124.008 PUYALLUPR1.01.124.009 SAMISH

R1.01.124.010 SAUK SUIATTLER1.01.124.011 SKOKOMISHR1.01.124.012 SKYKOMISHR1.01.124.013 SNOHOMISHR1.01.124.014 SNOQUALMIE


443

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.124.015 SQUAXIN ISLANDR1.01.124.016 STEILACOOMR1.01.124.017 STILLAGUAMISHR1.01.124.018 SUQUAMISHR1.01.124.019 SWINOMISH

R1.01.124.020 TULALIPR1.01.124.021 UPPER SKAGITR1.01.125 QUAPAWR1.01.126 QUINAULTR1.01.127 RAPPAHANNOCK

R1.01.128 RENO SPARKSR1.01.129 ROUND VALLEYR1.01.130 SAC AND FOXR1.01.130.001 IOWA SAC AND FOXR1.01.130.002 MISSOURI SAC AND FOX

R1.01.130.003 OKLAHOMA SAC AND FOXR1.01.131 SALINANR1.01.132 SALISHR1.01.133 SALISH AND KOOTENAIR1.01.134 SCHAGHTICOKE

R1.01.135 SCOTT VALLEYR1.01.136 SEMINOLER1.01.136.001 BIG CYPRESSR1.01.136.002 BRIGHTONR1.01.136.003 FLORIDA SEMINOLE

R1.01.136.004 HOLLYWOOD SEMINOLER1.01.136.005 OKLAHOMA SEMINOLER1.01.137 SERRANOR1.01.137.001 SAN MANUALR1.01.138 SHASTA

R1.01.139 SHAWNEER1.01.139.001 ABSENTEE SHAWNEER1.01.139.002 EASTERN SHAWNEER1.01.140 SHINNECOCKR1.01.141 SHOALWATER BAY

R1.01.142 SHOSHONER1.01.142.001 BATTLE MOUNTAINR1.01.142.002 DUCKWATERR1.01.142.003 ELKOR1.01.142.004 ELY

R1.01.142.005 GOSHUTER1.01.142.006 PANAMINTR1.01.142.007 RUBY VALLEYR1.01.142.008 SKULL VALLEYR1.01.142.009 SOUTH FORK SHOSHONE

R1.01.142.010 TE MOAK WESTERN SHOSHONE


444

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.142.011 TIMBI SHA SHOSHONER1.01.142.012 WASHAKIER1.01.142.013 WIND RIVER SHOSHONER1.01.142.014 YOMBA

R1.01.143 SHOSHONE PAIUTER1.01.143.001 DUCK VALLEYR1.01.143.002 FALLONR1.01.143.003 FORT MCDERMITTR1.01.144 SILETZ

R1.01.145 SIOUXR1.01.145.001 BLACKFOOT SIOUXR1.01.145.002 BRULE SIOUXR1.01.145.003 CHEYENNE RIVER SIOUXR1.01.145.004 CROW CREEK SIOUX

R1.01.145.005 DAKOTA SIOUXR1.01.145.006 FLANDREAU SANTEER1.01.145.007 FORT PECKR1.01.145.008 LAKE TRAVERSE SIOUXR1.01.145.009 LOWER BRULE SIOUX

R1.01.145.010 LOWER SIOUXR1.01.145.011 MDEWAKANTON SIOUXR1.01.145.012 MINICONJOUR1.01.145.013 OGLALA SIOUXR1.01.145.014 PINE RIDGE SIOUX

R1.01.145.015 PIPESTONE SIOUXR1.01.145.016 PRAIRIE ISLAND SIOUXR1.01.145.017 PRIOR LAKE SIOUXR1.01.145.018 ROSEBUD SIOUXR1.01.145.019 SANS ARC SIOUX

R1.01.145.020 SANTEE SIOUXR1.01.145.021 SISSETON WAHPETONR1.01.145.022 SISSETON SIOUXR1.01.145.023 SPIRIT LAKE SIOUXR1.01.145.024 STANDING ROCK SIOUX

R1.01.145.025 TETON SIOUXR1.01.145.026 TWO KETTLE SIOUXR1.01.145.027 UPPER SIOUXR1.01.145.028 WAHPEKUTE SIOUXR1.01.145.029 WAHPETON SIOUX

R1.01.145.030 WAZHAZA SIOUXR1.01.145.031 YANKTON SIOUXR1.01.145.032 YANKTONAI SIOUXR1.01.146 SIUSLAWR1.01.147 SPOKANE

R1.01.148 STEWARTR1.01.149 STOCKBRIDGER1.01.150 SUSANVILLE


445

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.151 TOHONO O ODHAMR1.01.151.001 AK CHIN

R1.01.151.002 GILA BENDR1.01.151.003 SAN XAVIERR1.01.151.004 SELLSR1.01.152 TOLOWAR1.01.153 TONKAWA

R1.01.154 TYGHR1.01.155 UMATILLAR1.01.156 UMPQUAR1.01.156.001 COW CREEK UMPQUAR1.01.157 UTE

R1.01.157.001 ALLEN CANYONR1.01.157.002 UINTAH UTER1.01.157.003 UTE MOUNTAIN UTER1.01.158 WAILAKIR1.01.159 WALLA WALLA

R1.01.160 WAMPANOAGR1.01.160.001 GAY HEAD WAMPANOAGR1.01.160.002 MASHPEE WAMPANOAGR1.01.161 WARM SPRINGSR1.01.162 WASCOPUM

R1.01.163 WASHOER1.01.163.001 ALPINER1.01.163.002 CARSONR1.01.163.003 DRESSLERVILLER1.01.164 WICHITA

R1.01.165 WIND RIVERR1.01.166 WINNEBAGOR1.01.166.001 HO CHUNKR1.01.166.002 NEBRASKA WINNEBAGOR1.01.167 WINNEMUCCA

R1.01.168 WINTUNR1.01.169 WIYOTR1.01.169.001 TABLE BLUFFR1.01.170 YAKAMAR1.01.171 YAKAMA COWLITZ

R1.01.172 YAQUIR1.01.172.001 BARRIO LIBRER1.01.172.002 PASCUA YAQUIR1.01.173 YAVAPAI APACHER1.01.174 YOKUTS

R1.01.174.001 CHUKCHANSIR1.01.174.002 TACHIR1.01.174.003 TULE RIVERR1.01.175 YUCHIR1.01.176 YUMAN


446

RACE TABLE

(continued)

CODE DESCRIPTION

R1.01.176.001 COCOPAHR1.01.176.002 HAVASUPAIR1.01.176.003 HUALAPAIR1.01.176.004 MARICOPAR1.01.176.005 MOH AVE

R1.01.176.006 QUECHANR1.01.176.007 YAVAPAIR1.01.177 YUROKR1.01.177.001 COAST YUROKR1.02 ALASKA NATIVE

R1.02.001 ALASKA INDIANR1.02.001.001 ALASKAN ATHABASCANR1.02.001.001.001 AHTNAR1.02.001.001.002 ALATNAR1.02.001.001.003 ALEXANDER

R1.02.001.001.004 ALLAKAKETR1.02.001.001.005 ALANVIKR1.02.001.001.006 ANVIKR1.02.001.001.007 ARCTICR1.02.001.001.008 BEAVER

R1.02.001.001.009 BIRCH CREEKR1.02.001.001.010 CANTWELLR1.02.001.001.011 CHALKYITSIKR1.02.001.001.012 CHICKALOONR1.02.001.001.013 CHISTOCHINA

R1.02.001.001.014 CHITINAR1.02.001.001.015 CIRCLER1.02.001.001.016 COOK INLETR1.02.001.001.017 COPPER CENTERR1.02.001.001.018 COPPER RIVER

R1.02.001.001.019 DOT LAKER1.02.001.001.020 DOYONR1.02.001.001.021 EAGLER1.02.001.001.022 EKLUTNAR1.02.001.001.023 EVANSVILLE

R1.02.001.001.024 FORT YUKONR1.02.001.001.025 GAKONAR1.02.001.001.026 GALENAR1.02.001.001.027 GRAYLINGR1.02.001.001.028 GULKANA

R1.02.001.001.029 HEALY LAKER1.02.001.001.030 HOLY CROSSR1.02.001.001.031 HUGHESR1.02.001.001.032 HUSLIAR1.02.001.001.033 ILIAMNA

R1.02.001.001.034 KALTAG


447

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.001.001.035 KLUTI KAAHR1.02.001.001.036 KNIKR1.02.001.001.037 KOYUKUKR1.02.001.001.038 LAKE MINCHUMINA

R1.02.001.001.039 LIMER1.02.001.001.040 MCGRATHR1.02.001.001.041 MANLEY HOT SPRINGSR1.02.001.001.042 MENTASTA LAKER1.02.001.001.043 MINTO

R1.02.001.001.044 NENANAR1.02.001.001.045 NIKOLAIR1.02.001.001.046 NINILCHIKR1.02.001.001.047 NONDALTONR1.02.001.001.048 NORTHWAY

R1.02.001.001.049 NULATOR1.02.001.001.050 PEDRO BAYR1.02.001.001.051 RAMPARTR1.02.001.001.052 RUBYR1.02.001.001.053 SALAMATOF

R1.02.001.001.054 SELDOVIAR1.02.001.001.055 SLANAR1.02.001.001.056 SHAGELUKR1.02.001.001.057 STEVENSR1.02.001.001.058 STONY RIVER

R1.02.001.001.059 TAKOTNAR1.02.001.001.060 TANACROSSR1.02.001.001.061 TANAINAR1.02.001.001.062 TANANAR1.02.001.001.063 TANANA CHIEFS

R1.02.001.001.064 TAZLINAR1.02.001.001.065 TELIDAR1.02.001.001.066 TETLINR1.02.001.001.067 TOKR1.02.001.001.068 TYONEK

R1.02.001.001.069 VENETIER1.02.001.001.070 WISEMANR1.02.001.002 SOUTHEAST ALASKAR1.02.001.002.001 TLINGIT HAIDAR1.02.001.002.001.001 ANGOON

R1.02.001.002.001.002 CENTRAL COUNCIL OF TLINGIT AND HAIDA TRIBESR1.02.001.002.001.003 CHILKATR1.02.001.002.001.004 CHILKOOTR1.02.001.002.001.005 CRAIGR1.02.001.002.001.006 DOUGLAS

R1.02.001.002.001.007 HAIDAR1.02.001.002.001.008 HOONAHR1.02.001.002.001.009 HYDABURG


448

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.001.002.001.010 KAKER1.02.001.002.001.011 KASAAN

R1.02.001.002.001.012 KENAITZER1.02.001.002.001.013 KETCHIKANR1.02.001.002.001.014 KLAWOCKR1.02.001.002.001.015 PELICANR1.02.001.002.001.016 PETERSBURG

R1.02.001.002.001.017 SAXMANR1.02.001.002.001.018 SITKAR1.02.001.002.001.019 TENAKEE SPRINGSR1.02.001.002.001.020 TLINGITR1.02.001.002.001.021 WRANGELL

R1.02.001.002.001.022 YAKUTATR1.02.001.002.002 TSIMSHIANR1.02.001.002.002.001 METLAKATLAR1.02.002 ESKIMOR1.02.002.001 GREENLAND ESKIMO

R1.02.002.002 INUPIAT ESKIMOR1.02.002.002.001 AMBLERR1.02.002.002.002 ANAKTUVUKR1.02.002.002.003 ANAKTUVUK PASSR1.02.002.002.004 ARCTIC SLOPE INUPIAT

R1.02.002.002.005 ARCTIC SLOPE CORPORATIONR1.02.002.002.006 ATQASUKR1.02.002.002.007 BARROWR1.02.002.002.008 BERING STRAITS INUPIATR1.02.002.002.009 BREVIG MISSION

R1.02.002.002.010 BUCKLANDR1.02.002.002.011 CHINIKR1.02.002.002.012 COUNCILR1.02.002.002.013 DEERINGR1.02.002.002.014 ELIM

R1.02.002.002.015 GOLOVINR1.02.002.002.016 INALIK DIOMEDER1.02.002.002.017 INUPIAQR1.02.002.002.018 KAKTOVIKR1.02.002.002.019 KAWERAK

R1.02.002.002.020 KIANAR1.02.002.002.021 KIVALINAR1.02.002.002.022 KOBUKR1.02.002.002.023 KOTZEBUER1.02.002.002.024 KOYUK

R1.02.002.002.025 KWIGUKR1.02.002.002.026 MAUNELUK INUPIATR1.02.002.002.027 NANA INUPIATR1.02.002.002.028 NOATAKR1.02.002.002.029 NOME


449

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.002.002.030 NOOR VIKR1.02.002.002.031 NUIQSUTR1.02.002.002.032 POINT HOPER1.02.002.002.033 POINT LAYR1.02.002.002.034 SELAWIK

R1.02.002.002.035 SHAKTOOLIKR1.02.002.002.036 SHISHMAREFR1.02.002.002.037 SHUNGNAKR1.02.002.002.038 SOLOMONR1.02.002.002.039 TELLER

R1.02.002.002.040 UNALAKLEETR1.02.002.002.041 WAINWRIGHTR1.02.002.002.042 WALESR1.02.002.002.043 WHITE MOUNTAINR1.02.002.002.044 WHITE MOUNTAIN INUPIAT

R1.02.002.002.045 MARY S IGLOOR1.02.002.003 SIBERIAN ESKIMOR1.02.002.003.001 GAMBELLR1.02.002.003.002 SAVOONGAR1.02.002.003.003 SIBERIAN YUPIK

R1.02.002.004 YUPIK ESKIMOR1.02.002.004.001 AKIACHAKR1.02.002.004.002 AKIAKR1.02.002.004.003 ALAKANUKR1.02.002.004.004 ALEKNAGIK

R1.02.002.004.005 ANDREAFSKYR1.02.002.004.006 ANIAKR1.02.002.004.007 ATMAUTLUAKR1.02.002.004.008 BETHELR1.02.002.004.009 BILL MOORE S SLOUGH

R1.02.002.004.010 BRISTOL BAY YUPIKR1.02.002.004.011 CALISTA YUPIKR1.02.002.004.012 CHEFORNAKR1.02.002.004.013 CHEVAKR1.02.002.004.014 CHUATHBALUK

R1.02.002.004.015 CLARK S POINTR1.02.002.004.016 CROOKED CREEKR1.02.002.004.017 DILLINGHAMR1.02.002.004.018 EEKR1.02.002.004.019 EKUK

R1.02.002.004.020 EKWOKR1.02.002.004.021 EMMONAKR1.02.002.004.022 GOODNEWS BAYR1.02.002.004.023 HOOPER BAYR1.02.002.004.024 IQURMUIT RUSSIAN MISSION

R1.02.002.004.025 KALSKAG


450

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.002.004.026 KASIGLUKR1.02.002.004.027 KIPNUKR1.02.002.004.028 KOLIGANEKR1.02.002.004.029 KONGIGANAK

R1.02.002.004.030 KOTLIKR1.02.002.004.031 KWETHLUKR1.02.002.004.032 KWIGILLINGOKR1.02.002.004.033 LEVELOCKR1.02.002.004.034 LOWER KALSKAG

R1.02.002.004.035 MANOKOTAKR1.02.002.004.036 MARSHALLR1.02.002.004.037 MEKORYUKR1.02.002.004.038 MOUNTAIN VILLAGER1.02.002.004.039 NAKNEK

R1.02.002.004.040 NAPAUMUTER1.02.002.004.041 NAPAKIAKR1.02.002.004.042 NAPASKIAKR1.02.002.004.043 NEWHALENR1.02.002.004.044 NEW STUYAHOK

R1.02.002.004.045 NEWTOKR1.02.002.004.046 NIGHTMUTER1.02.002.004.047 NUNAPITCHUKVR1.02.002.004.048 OSCARVILLER1.02.002.004.049 PILOT STATION

R1.02.002.004.050 PITKAS POINTR1.02.002.004.051 PLATINUMR1.02.002.004.052 PORTAGE CREEKR1.02.002.004.053 QUINHAGAKR1.02.002.004.054 RED DEVIL

R1.02.002.004.055 ST MICHAELR1.02.002.004.056 SCAMMON BAYR1.02.002.004.057 SHELDON S POINTR1.02.002.004.058 SLEETMUTER1.02.002.004.059 STEBBINS

R1.02.002.004.060 TOGIAKR1.02.002.004.061 TOKSOOKR1.02.002.004.062 TULUKSKAKR1.02.002.004.063 TUNTUTULIAKR1.02.002.004.064 TUNUNAK

R1.02.002.004.065 TWIN HILLSR1.02.002.004.066 GEORGETOWNR1.02.002.004.067 ST MARY SR1.02.002.004.068 UMKUMIATER1.02.003 ALEUT

R1.02.003.001 ALUTIIQ ALEUTR1.02.003.001.001 TATITLEKR1.02.003.001.002 UGASHIK


451

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.003.002 BRISTOL BAY ALEUTR1.02.003.002.001 CHIGNIK

R1.02.003.002.002 CHIGNIK LAKER1.02.003.002.003 EGEGIKR1.02.003.002.004 IGIUGIGR1.02.003.002.005 IVANOF BAYR1.02.003.002.006 KING SALMON

R1.02.003.002.007 KOKHANOKR1.02.003.002.008 PERRYVILLER1.02.003.002.009 PILOT POINTR1.02.003.002.010 PORT HEIDENR1.02.003.003 CHUGACH ALEUT

R1.02.003.003.001 CHENEGAR1.02.003.003.002 CHUGACH CORPORATIONR1.02.003.003.003 ENGLISH BAYR1.02.003.003.004 PORT GRAHAMR1.02.003.004 EYAK

R1.02.003.005 KONIAG ALEUTR1.02.003.005.001 AKHIOKR1.02.003.005.002 AGDAAGUXR1.02.003.005.003 KARLUKR1.02.003.005.004 KODIAK

R1.02.003.005.005 LARSEN BAYR1.02.003.005.006 OLD HARBORR1.02.003.005.007 OUZINKIER1.02.003.005.008 PORT LIONSR1.02.003.006 SUGPIAQ

R1.02.003.007 SUQPIGAQR1.02.003.008 UNANGAN ALEUTR1.02.003.008.001 AKUTANR1.02.003.008.002 ALEUT CORPORATIONR1.02.003.008.003 ALEUTIAN

R1.02.003.008.004 ALEUTIAN ISLANDERR1.02.003.008.005 ATKAR1.02.003.008.006 BELKOFSKIR1.02.003.008.007 CHIGNIK LAGOONR1.02.003.008.008 KING COVE

R1.02.003.008.009 FALSE PASSR1.02.003.008.010 NELSON LAGOONR1.02.003.008.011 NIKOLSKIR1.02.003.008.012 PAULOFF HARBORR1.02.003.008.013 QAGAN TOYAGUNGIN

R1.02.003.008.014 QAWALANGINR1.02.003.008.015 ST GEORGER1.02.003.008.016 ST PAULR1.02.003.008.017 SAND POINTR1.02.003.008.018 SOUTH NAKNEK


452

RACE TABLE

(continued)

CODE DESCRIPTION

R1.02.003.008.019 UNALASKAR1.02.003.008.020 UNGAR2 ASIANR2.01 ASIAN INDIANR2.02 BANGLADESHI

R2.03 BHUTANESER2.04 BURMESER2.05 CAMBODIANR2.06 CHINESER2.07 TAIWANESE

R2.08 FILIPINOR2.09 HMONGR2.10 INDONESIANR2.11 JAPANESER2.12 KOREAN

R2.13 LAOTIANR2.14 MALAYSIANR2.15 OKINAWANR2.16 PAKISTANIR2.17 SRI LANKAN

R2.18 THAIR2.19 VIETNAMESER2.20 IWO JIMANR2.21 MALDIVIANR2.22 NEPALESE

R2.23 SINGAPOREANR2.24 MADAGASCARR3 BLACK OR AFRICAN AMERICANR3.01 BLACKR3.02 AFRICAN AMERICAN

R3.03 AFRICANR3.03.001 BOTSWANANR3.03.002 ETHIOPIANR3.03.003 LIBERIANR3.03.004 NAMIBIAN

R3.03.005 NIGERIANR3.03.006 ZAIREANR3.04 BAHAMIANR3.05 BARBADIANR3.06 DOMINICAN

R3.07 DOMINICA ISLANDERR3.08 HAITIANR3.09 JAMAICANR3.10 TOBAGOANR3.11 TRINIDADIAN

R3.12 WEST INDIAN


453

RACE TABLE

(continued)

CODE DESCRIPTION

R4 NATIVE HAWAIIAN OR OTHER PACIFIC ISLANDERR4.01 POLYNESIANR4.01.001 NATIVE HAWAIIANR4.01.002 SAMOAN

R4.01.003 TAHITIANR4.01.004 TONGANR4.01.005 TOKELAUANR4.02 MICRONESIANR4.02.001 GUAMANIAN OR CHAMORRO

R4.02.002 GUAMANIANR4.02.003 CHAMORROR4.02.004 MARIANA ISLANDERR4.02.005 MARSHALLESER4.02.006 PALAUAN

R4.02.007 CAROLINIANR4.02.008 KOSRAEANR4.02.009 POHNPEIANR4.02.010 SAIPANESER4.02.011 KIRIBATI

R4.02.012 CHUUKESER4.02.013 YAPESER4.03 MELANESIANR4.03.001 FIJIANR4.03.002 PAPUA NEW GUINEAN

R4.03.003 SOLOMON ISLANDERR4.03.004 NEW HEBRIDESR4.04 OTHER PACIFIC ISLANDERR5 WHITER5.01 EUROPEAN

R5.01.001 ARMENIANR5.01.002 ENGLISHR5.01.003 FRENCHR5.01.004 GERMANR5.01.005 IRISH

R5.01.006 ITALIANR5.01.007 POLISHR5.01.008 SCOTTISHR5.02 MIDDLE EASTERN OR NORTH AFRICANR5.02.001 ASSYRIAN

R5.02.002 EGYPTIANR5.02.003 IRANIANR5.02.004 IRAQIR5.02.005 LEBANESER5.02.006 PALESTINIAN

R5.02.007 SYRIANR5.02.008 AFGHANISTANIR5.02.009 ISRAEILI


454

RACE TABLE

(continued)

CODE DESCRIPTION

R5.03 ARABR9 OTHER RACE


455

RACE TABLE

Claim Key



Variable Length: 12


Variable Index: 9



New to APD


456

RACE TABLE

Active Flag



Variable Length: 1


Variable Index: 10



New to APD


457

RACE TABLE




Variable Length: 1


Variable Index: 11



New to APD


458

RACE TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 12





459

RACE TABLE

Record Created By



Variable Length: 20


Variable Index: 13



New to APD


460

RACE TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 14



New to APD


461

RACE TABLE

Last Updated By



Variable Length: 20


Variable Index: 15



New to APD


462

RACE TABLE

Source File Name



Variable Length: 30


Variable Index: 16



New to APD


463

RACE TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 17



New to APD


464

RACE TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 18





465

RACE TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 19






N NoY Yes


466

REV TABLE

REV TABLE

This table contains the revenue codes reported at the line level. Revenue codes are a national code set maintainedby NUBC. They identify specific accommodation, ancillary service or unique billing calculations or arrangements. Forexample this includes: Claim Type, Discharge Year, Revenue Code, Ancillary/Accommodation Revenue Type, ServiceUnit Type, Service Unit Count, Service Line Charge Amount, and Service Line Non-Covered Charge.


467

REV TABLE




Variable Length: 12

Table/File: SPARCS_REV

Variable Index: 1



New to APD


468

REV TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


469

REV TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the revenue codes were reported.


470

REV TABLE

Claim Type



Variable Length: 1


Variable Index: 4








471

REV TABLE






Variable Index: 5




472

REV TABLE

Record Sequence

Variable Name: REC_SEQ


Variable Length: 3


Variable Index: 6


Description:Historic sequence that segmented the revenue codes reported into ‘blocks/records’ of 45.



Former variable name: SEQ


473

REV TABLE

Revenue Code

Variable Name: REV_CD


Variable Length: 4


Variable Index: 7


Description:Code indicating the specific accommodation, ancillary service or unique billing arrangement for the service line.

Former variable name: ANCICDn

Reference table name: REF_REV_CD

REV_CD REV_CD_DESCR

1 TOTAL CHARGE24 HEALTH INSURANCE PROSPECTIVE PAYMENT SYSTEM

HIPPS INPATIENT REHAB FACILITY PPS100 ALL INCLUSIVE RATE ALL INCLUSIVE ROOM AND BOARD

PLUS ANCILLARY101 ALL INCLUSIVE RATE ALL INCLUSIVE ROOM AND BOARD110 ROOM BOARD PRIVATE ONE BED GENERAL

CLASSIFICATION

111 ROOM BOARD PRIVATE ONE BED MEDICAL SURGICAL GYN112 ROOM BOARD PRIVATE ONE BED OBSTETRICS OB113 ROOM BOARD PRIVATE ONE BED PEDIATRIC114 ROOM BOARD PRIVATE ONE BED PSYCHIATRIC115 ROOM BOARD PRIVATE ONE BED HOSPICE

116 ROOM BOARD PRIVATE ONE BED DETOXIFICATION117 ROOM BOARD PRIVATE ONE BED ONCOLOGY118 ROOM BOARD PRIVATE ONE BED REHABILITATION119 ROOM BOARD PRIVATE ONE BED OTHER120 ROOM BOARD SEMI PRIVATE TWO BEDS GENERAL

CLASSIFICATION

121 ROOM BOARD SEMI PRIVATE TWO BEDS MEDICALSURGICAL GYN

122 ROOM BOARD SEMI PRIVATE TWO BEDS OBSTETRICS OB123 ROOM BOARD SEMI PRIVATE TWO BEDS PEDIATRIC124 ROOM BOARD SEMI PRIVATE TWO BEDS PSYCHIATRIC125 ROOM BOARD SEMI PRIVATE TWO BEDS HOSPICE

126 ROOM BOARD SEMI PRIVATE TWO BEDS DETOXIFICATION127 ROOM BOARD SEMI PRIVATE TWO BEDS ONCOLOGY128 ROOM BOARD SEMI PRIVATE TWO BEDS REHABILITATION129 ROOM BOARD SEMI PRIVATE TWO BEDS OTHER130 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDS

GENERAL CLASSIFICATION


474

REV TABLE

(continued)

REV_CD REV_CD_DESCR

131 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSMEDICAL SURGICAL GYN

132 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSOBSTETRICS OB

133 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSPEDIATRIC

134 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSPSYCHIATRIC

136 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSDETOXIFICATION

137 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSONCOLOGY

138 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSREHABILITATION

139 ROOM BOARD SEMI PRIVATE THREE AND FOUR BEDSOTHER

140 ROOM BOARD DELUXE PRIVATE GENERAL CLASSIFICATION141 ROOM BOARD DELUXE PRIVATE MEDICAL SURGICAL GYN

142 ROOM BOARD DELUXE PRIVATE OBSTETRICS OB144 ROOM BOARD DELUXE PRIVATE PSYCHIATRIC148 ROOM BOARD DELUXE PRIVATE REHABILITATION149 ROOM BOARD DELUXE PRIVATE OTHER150 ROOM BOARD WARD GENERAL CLASSIFICATION

151 ROOM BOARD WARD MEDICAL SURGICAL GYN152 ROOM BOARD WARD OBSTETRICS OB153 ROOM BOARD WARD PEDIATRIC154 ROOM BOARD WARD PSYCHIATRIC155 ROOM BOARD WARD HOSPICE

156 ROOM BOARD WARD DETOXIFICATION158 ROOM BOARD WARD REHABILITATION159 ROOM BOARD WARD OTHER160 ROOM BOARD OTHER GENERAL CLASSIFICATION164 ROOM BOARD OTHER STERILE ENVIRONMENT

167 ROOM BOARD OTHER SELF CARE169 ROOM BOARD OTHER OTHER170 NURSERY GENERAL CLASSIFICATION171 NURSERY NEWBORN LEVEL I172 NURSERY NEWBORN LEVEL II

173 NURSERY NEWBORN LEVEL III174 NURSERY NEWBORN LEVEL IV179 NURSERY OTHER NURSERY180 LEAVE OF ABSENCE GENERAL CLASSIFICATION183 LEAVE OF ABSENCE THERAPEUTIC LEAVE

189 LEAVE OF ABSENCE OTHER LOA190 SUBACUTE CARE GENERAL CLASSIFICATION191 SUBACUTE CARE SUBACUTE CARE LEVEL I192 SUBACUTE CARE SUBACUTE CARE LEVEL II


475

REV TABLE

(continued)

REV_CD REV_CD_DESCR

193 SUBACUTE CARE SUBACUTE CARE LEVEL III

194 SUBACUTE CARE SUBACUTE CARE LEVEL IV200 INTENSIVE CARE UNIT GENERAL CLASSIFICATION201 INTENSIVE CARE UNIT SURGICAL202 INTENSIVE CARE UNIT MEDICAL203 INTENSIVE CARE UNIT PEDIATRIC

206 INTENSIVE CARE UNIT INTERMEDIATE ICU207 INTENSIVE CARE UNIT BURN CARE208 INTENSIVE CARE UNIT TRAUMA209 INTENSIVE CARE UNIT OTHER INTENSIVE CARE210 CORONARY CARE UNIT GENERAL CLASSIFICATION

211 CORONARY CARE UNIT MYOCARDIAL INFARCTION212 CORONARY CARE UNIT PULMONARY CARE213 CORONARY CARE UNIT HEART TRANSPLANT214 CORONARY CARE UNIT INTERMEDIATE CCU219 CORONARY CARE UNIT OTHER CORONARY CCU

220 SPECIAL CHARGES GENERAL CLASSIFICATION221 SPECIAL CHARGES ADMISSION CHARGES222 SPECIAL CHARGES TECHNICAL SUPPORT CHARGE223 SPECIAL CHARGES U R SERVICE CHARGE229 SPECIAL CHARGES OTHER SPECIAL CHARGES

230 INCREMENTAL NURSING CHARGE GENERALCLASSIFICATION

231 INCREMENTAL NURSING CHARGE NURSERY232 INCREMENTAL NURSING CHARGE OB233 INCREMENTAL NURSING CHARGE ICU235 INCREMENTAL NURSING CHARGE HOSPICE

239 INCREMENTAL NURSING CHARGE OTHER240 ALL INCLUSIVE ANCILLARY GENERAL CLASSIFICATION241 ALL INCLUSIVE ANCILLARY BASIC242 ALL INCLUSIVE ANCILLARY COMPREHENSIVE243 ALL INCLUSIVE ANCILLARY SPECIALTY

249 ALL INCLUSIVE ANCILLARY OTHER ALL INCLUSIVEANCILLARY

250 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XGENERAL CLASSIFICATION

251 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XGENERIC DRUGS

252 PHARMACY ALSO SEE 063X AN EXTENSION OF 025X NONGENERIC DRUGS

253 PHARMACY ALSO SEE 063X AN EXTENSION OF 025X TAKEHOME DRUGS

254 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XDRUGS INCIDENT TO OTHER DIAGNOSTIC SERVICES

255 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XDRUGS INCIDENT TO RADIOLOGY


476

REV TABLE

(continued)

REV_CD REV_CD_DESCR

256 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XEXPERIMENTAL DRUGS

257 PHARMACY ALSO SEE 063X AN EXTENSION OF 025X NONPRESCRIPTION

258 PHARMACY ALSO SEE 063X AN EXTENSION OF 025X IVSOLUTIONS

259 PHARMACY ALSO SEE 063X AN EXTENSION OF 025XOTHER PHARMACY

260 IV THERAPY GENERAL CLASSIFICATION261 IV THERAPY INFUSION PUMP262 IV THERAPY IV THERAPY PHARMACY SVCS263 IV THERAPY IV THERAPY DRUG SUPPLY DELIVERY

264 IV THERAPY IV THERAPY SUPPLIES269 IV THERAPY OTHER IV THERAPY270 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE

062X AN EXTENSION OF 027 GENERAL CLASSIFICATION271 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE

062X AN EXTENSION OF 027X NON STERILE SUPPLY272 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE

062X AN EXTENSION OF 027X STERILE SUPPLY

273 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X TAKE HOME SUPPLIES

274 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X PROSTHETIC ORTHOTICDEVICES

275 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062 X AN EXTENSION OF 027X PACEMAKER

276 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X INTRAOCULAR LENS

277 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X OXYGEN TAKE HOME

278 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X OTHER IMPLANT

279 MEDICAL SURGICAL SUPPLIES AND DEVICES ALSO SEE062X AN EXTENSION OF 027X OTHER SUPPLIES DEVICES

280 ONCOLOGY GENERAL CLASSIFICATION289 ONCOLOGY OTHER ONCOLOGY290 DURABLE MEDICAL EQUIPMENT OTHER THAN RENAL

GENERAL CLASSIFICATION

291 DURABLE MEDICAL EQUIPMENT OTHER THAN RENALRENTAL

292 DURABLE MEDICAL EQUIPMENT OTHER THAN RENALPURCHASE OF NEW DME

293 DURABLE MEDICAL EQUIPMENT OTHER THAN RENALPURCHASE OF USED DME

294 DURABLE MEDICAL EQUIPMENT OTHER THAN RENALSUPPLIES DRUGS FOR DME

299 DURABLE MEDICAL EQUIPMENT OTHER THAN RENALOTHER EQUIPMENT


477

REV TABLE

(continued)

REV_CD REV_CD_DESCR

300 LABORATORY GENERAL CLASSIFICATION301 LABORATORY CHEMISTRY302 LABORATORY IMMUNOLOGY303 LABORATORY RENAL PATIENT HOME304 LABORATORY NON ROUTINE DIALYSIS

305 LABORATORY HEMATOLOGY306 LABORATORY BACTERIOLOGY MICROBIOLOGY307 LABORATORY UROLOGY309 LABORATORY OTHER LABORATORY310 LABORATORY PATHOLOGY GENERAL CLASSIFICATION

311 LABORATORY PATHOLOGY CYTOLOGY312 LABORATORY PATHOLOGY HISTOLOGY314 LABORATORY PATHOLOGY BIOPSY319 LABORATORY PATHOLOGY OTHER LABORATORY

PATHOLOGY320 RADIOLOGY DIAGNOSTIC GENERAL CLASSIFICATION

321 RADIOLOGY DIAGNOSTIC ANGIOCARDIOGRAPHY322 RADIOLOGY DIAGNOSTIC ARTHROGRAPHY323 RADIOLOGY DIAGNOSTIC ARTERIOGRAPHY324 RADIOLOGY DIAGNOSTIC CHEST X RAY329 RADIOLOGY DIAGNOSTIC OTHER RADIOLOGY

DIAGNOSTIC

330 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION GENERAL CLASSIFICATION

331 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION CHEMOTHERAPY ADMIN INJECTED

332 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION CHEMOTHERAPY ADMINISTRATIONORAL

333 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION RADIATION THERAPY

335 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION CHEMOTHERAPY ADMIN IV

339 RADIOLOGY THERAPEUTIC AND OR CHEMOTHERAPYADMINISTRATION OTHER RADIOLOGY THERAPEUTIC

340 NUCLEAR MEDICINE GENERAL CLASSIFICATION341 NUCLEAR MEDICINE DIAGNOSTIC342 NUCLEAR MEDICINE THERAPEUTIC343 NUCLEAR MEDICINE DIAGNOSTIC

RADIOPHARMACEUTICALS

344 NUCLEAR MEDICINE THERAPEUTICRADIOPHARMACEUTICALS

349 NUCLEAR MEDICINE OTHER NUCLEAR MEDICINE350 CT SCAN GENERAL CLASSIFICATION351 CT SCAN HEAD SCAN352 CT SCAN BODY SCAN

359 CT SCAN CT OTHER


478

REV TABLE

(continued)

REV_CD REV_CD_DESCR

360 OPERATING ROOM SERVICES GENERAL CLASSIFICATION361 OPERATING ROOM SERVICES MINOR SURGERY362 OPERATING ROOM SERVICES ORGAN TRANSPLANT OTHER

THAN KIDNEY367 OPERATING ROOM SERVICES KIDNEY TRANSPLANT

369 OPERATING ROOM SERVICES OTHER OR SERVICES370 ANESTHESIA GENERAL CLASSIFICATION371 ANESTHESIA ANESTHESIA INCIDENT TO RADIOLOGY372 ANESTHESIA ANESTHESIA INCIDENT TO OTHER DX

SERVICES374 ANESTHESIA ACUPUNCTURE

379 ANESTHESIA OTHER ANESTHESIA380 BLOOD AND BLOOD COMPONENTS GENERAL

CLASSIFICATION381 BLOOD AND BLOOD COMPONENTS PACKED RED CELLS382 BLOOD AND BLOOD COMPONENTS WHOLE BLOOD383 BLOOD AND BLOOD COMPONENTS PLASMA

384 BLOOD AND BLOOD COMPONENTS PLATELETS385 BLOOD AND BLOOD COMPONENTS LEUCOCYTES386 BLOOD AND BLOOD COMPONENTS OTHER BLOOD

COMPONENTS387 BLOOD AND BLOOD COMPONENTS OTHER DERIVATIVES

CRYOPRICIPITATE389 BLOOD AND BLOOD COMPONENTS OTHER BLOOD AND

BLOOD COMPONENTS

390 ADMINISTRATION PROCESSING AND STORAGE FORBLOOD AND BLOOD COMPONENTS GENERALCLASSIFICATION

391 ADMINISTRATION PROCESSING AND STORAGE FORBLOOD AND BLOOD COMPONENTS ADMINISTRATION E GTRANSFUSIONS

392 ADMINISTRATION PROCESSING AND STORAGE FORBLOOD AND BLOOD COMPONENTS PROCESSING ANDSTORAGE

399 ADMINISTRATION PROCESSING AND STORAGE FORBLOOD AND BLOOD COMPONENTS OTHER BLOODHANDLING

400 OTHER IMAGING SERVICES GENERAL CLASSIFICATION

401 OTHER IMAGING SERVICES DIAGNOSTIC MAMMOGRAPHY402 OTHER IMAGING SERVICES ULTRASOUND403 OTHER IMAGING SERVICES SCREENING MAMMOGRAPHY404 OTHER IMAGING SERVICES POSITRON EMISSION

TOMOGRAPHY409 OTHER IMAGING SERVICES OTHER IMAGING SERVICES

410 RESPIRATORY SERVICES GENERAL CLASSIFICATION412 RESPIRATORY SERVICES INHALATION SERVICES413 RESPIRATORY SERVICES HYPERBARIC OXYGEN THERAPY419 RESPIRATORY SERVICES OTHER RESPIRATORY SERVICES


479

REV TABLE

(continued)

REV_CD REV_CD_DESCR

420 PHYSICAL THERAPY GENERAL CLASSIFICATION

421 PHYSICAL THERAPY VISIT422 PHYSICAL THERAPY HOURLY423 PHYSICAL THERAPY GROUP424 PHYSICAL THERAPY EVALUATION OR RE EVALUATION429 PHYSICAL THERAPY OTHER PHYSICAL THERAPY

430 OCCUPATIONAL THERAPY GENERAL CLASSIFICATION431 OCCUPATIONAL THERAPY VISIT432 OCCUPATIONAL THERAPY HOURLY433 OCCUPATIONAL THERAPY GROUP434 OCCUPATIONAL THERAPY EVALUATION OR REEVALUATION

439 OCCUPATIONAL THERAPY OTHER OCCUPATIONAL THERAPY440 SPEECH LANGUAGE PATHOLOGY GENERAL

CLASSIFICATION441 SPEECH LANGUAGE PATHOLOGY VISIT442 SPEECH LANGUAGE PATHOLOGY HOURLY443 SPEECH LANGUAGE PATHOLOGY GROUP

444 SPEECH LANGUAGE PATHOLOGY EVALUATION ORREEVALUATION

449 SPEECH LANGUAGE PATHOLOGY OTHER SPEECH THERAPY450 EMERGENCY ROOM GENERAL CLASSIFICATION451 EMERGENCY ROOM EMTALA EMERGENCY MEDICAL

SCREENING SERVICES452 EMERGENCY ROOM ER BEYOND EMTALA SCREENING

456 EMERGENCY ROOM URGENT CARE459 EMERGENCY ROOM OTHER EMERGENCY ROOM460 PULMONARY FUNCTION GENERAL CLASSIFICATION469 PULMONARY FUNCTION OTHER PULMONARY FUNCTION470 AUDIOLOGY GENERAL CLASSIFICATION

471 AUDIOLOGY DIAGNOSTIC472 AUDIOLOGY TREATMENT479 AUDIOLOGY OTHER AUDIOLOGY480 CARDIOLOGY GENERAL CLASSIFICATION481 CARDIOLOGY CARDIAC CATH LAB

482 CARDIOLOGY STRESS TEST483 CARDIOLOGY ECHOCARDIOLOGY489 CARDIOLOGY OTHER CARDIOLOGY490 AMBULATORY SURGICAL CARE GENERAL CLASSIFICATION499 AMBULATORY SURGICAL CARE OTHER AMBULATORY

SURGICAL CARE

500 OUTPATIENT SERVICES GENERAL CLASSIFICATION509 OUTPATIENT SERVICES OTHER OUTPATIENT SERVICE510 CLINIC GENERAL CLASSIFICATION511 CLINIC CHRONIC PAIN CENTER512 CLINIC DENTAL CLINIC

513 CLINIC PSYCHIATRIC CLINIC514 CLINIC OB GYN CLINIC


480

REV TABLE

(continued)

REV_CD REV_CD_DESCR

515 CLINIC PEDIATRIC CLINIC516 CLINIC URGENT CARE CLINIC517 CLINIC FAMILY PRACTICE CLINIC

519 CLINIC OTHER CLINIC520 FREESTANDING CLINIC GENERAL CLASSIFICATION521 FREESTANDING CLINIC CLINIC VISIT BY MEMBER TO RHC

FQHC522 FREESTANDING CLINIC HOME VISIT BY RHC FQHC

PRACTITIONER526 FREESTANDING CLINIC URGENT CARE CLINIC

529 FREESTANDING CLINIC OTHER FREESTANDING CLINIC530 OSTEOPATHIC SERVICES GENERAL CLASSIFICATION531 OSTEOPATHIC SERVICES OSTEOPATHIC THERAPY540 AMBULANCE GENERAL CLASSIFICATION541 AMBULANCE SUPPLIES

542 AMBULANCE MEDICAL TRANSPORT544 AMBULANCE OXYGEN546 AMBULANCE NEONATAL AMBULANCE SERVICES549 AMBULANCE OTHER AMBULANCE550 SKILLED NURSING GENERAL CLASSIFICATION

551 SKILLED NURSING VISIT CHARGE559 SKILLED NURSING OTHER SKILLED NURSING560 HOME HEALTH HH MEDICAL SOCIAL SERVICES GENERAL

CLASSIFICATION561 HOME HEALTH HH MEDICAL SOCIAL SERVICES VISIT

CHARGE562 HOME HEALTH HH MEDICAL SOCIAL SERVICES HOURLY

CHARGE

569 HOME HEALTH HH MEDICAL SOCIAL SERVICES OTHERMED SOCIAL SERVICE

571 HOME HEALTH HH AIDE VISIT CHARGE580 HOME HEALTH HH OTHER VISITS GENERAL

CLASSIFICATION590 HOME HEALTH HH UNITS OF SERVICE GENERAL

CLASSIFICATION601 HOME HEALTH HH OXYGEN OXYGEN STAT EQUIP SUPPL

CONTENT

602 HOME HEALTH HH OXYGEN OXYGEN STAT EQUIP SUPPLY 1LPM

603 HOME HEALTH HH OXYGEN OXYGEN STAT EQUIP SUPPLY 4LPM

609 HOME HEALTH HH OXYGEN OXYGEN OTHER610 MAGNETIC RESONANCE TECHNOLOGY MRT GENERAL

CLASSIFICATION611 MAGNETIC RESONANCE TECHNOLOGY MRT MRI BRAIN

BRAINSTEM

612 MAGNETIC RESONANCE TECHNOLOGY MRT MRI SPINALCORD SPINE


481

REV TABLE

(continued)

REV_CD REV_CD_DESCR

614 MAGNETIC RESONANCE TECHNOLOGY MRT MRI OTHER615 MAGNETIC RESONANCE TECHNOLOGY MRT MRA HEAD

AND NECK616 MAGNETIC RESONANCE TECHNOLOGY MRT MRA LOWER

EXTREMITIES618 MAGNETIC RESONANCE TECHNOLOGY MRT MRA OTHER

619 MAGNETIC RESONANCE TECHNOLOGY MRT OTHER MRT621 MEDICAL SURGICAL SUPPLIES AND DEVICES EXTENSION

OF 027X SUPPLIES INCIDENT TO RADIOLOGY622 MEDICAL SURGICAL SUPPLIES AND DEVICES EXTENSION

OF 027X SUPPLIES INCIDENT TO OTHER DX SERVICES623 MEDICAL SURGICAL SUPPLIES AND DEVICES EXTENSION

OF 027X SURGICAL DRESSINGS624 MEDICAL SURGICAL SUPPLIES AND DEVICES EXTENSION

OF 027X FDA INVESTIGATIONAL DEVICES

631 PHARMACY EXTENSION OF 025X SINGLE SOURCE DRUG632 PHARMACY EXTENSION OF 025X MULTIPLE SOURCE DRUG633 PHARMACY EXTENSION OF 025X RESTRICTIVE

PRESCRIPTION634 PHARMACY EXTENSION OF 025X ERYTHROPOIETIN EPO 10

000 UNITS635 PHARMACY EXTENSION OF 025X ERYTHROPOIETIN EPO 10

000 UNITS

636 PHARMACY EXTENSION OF 025X DRUGS REQUIRINGDETAILED CODING

637 PHARMACY EXTENSION OF 025X SELF ADMINISTRABLEDRUGS

640 HOME IV THERAPY SERVICES GENERAL CLASSIFICATION642 HOME IV THERAPY SERVICES IV SITE CARE CENTRAL LINE646 HOME IV THERAPY SERVICES TRAINING DISABLED

PATIENT CENTRAL LINE

647 HOME IV THERAPY SERVICES TRAINING PATIENTCAREGIVER PERIPHERAL LINE

649 HOME IV THERAPY SERVICES OTHER IV THERAPYSERVICES

650 HOSPICE SERVICE GENERAL CLASSIFICATION651 HOSPICE SERVICE ROUTINE HOME CARE655 HOSPICE SERVICE INPATIENT RESPITE CARE

656 HOSPICE SERVICE GENERAL INPATIENT CARE NONRESPITE

657 HOSPICE SERVICE PHYSICIAN SERVICES659 HOSPICE SERVICE OTHER HOSPICE SERVICE660 RESPITE CARE GENERAL CLASSIFICATION672 OUTPATIENT SPECIAL RESIDENCE CHARGES CONTRACTED

679 OUTPATIENT SPECIAL RESIDENCE CHARGES OTHERSPECIAL RESIDENCE CHARGE

681 TRAUMA RESPONSE LEVEL I TRAUMA682 TRAUMA RESPONSE LEVEL II TRAUMA


482

REV TABLE

(continued)

REV_CD REV_CD_DESCR

683 TRAUMA RESPONSE LEVEL III TRAUMA684 TRAUMA RESPONSE LEVEL IV TRAUMA

689 TRAUMA RESPONSE OTHER TRAUMA RESPONSE700 CAST ROOM GENERAL CLASSIFICATION710 RECOVERY ROOM GENERAL CLASSIFICATION720 LABOR ROOM DELIVERY GENERAL CLASSIFICATION721 LABOR ROOM DELIVERY LABOR

722 LABOR ROOM DELIVERY DELIVERY ROOM723 LABOR ROOM DELIVERY CIRCUMCISION724 LABOR ROOM DELIVERY BIRTHING CENTER729 LABOR ROOM DELIVERY OTHER LABOR ROOM DELIVERY730 EKG ECG ELECTROCARDIOGRAM GENERAL

CLASSIFICATION

731 EKG ECG ELECTROCARDIOGRAM HOLTER MONITOR732 EKG ECG ELECTROCARDIOGRAM TELEMETRY739 EKG ECG ELECTROCARDIOGRAM OTHER EKG ECG740 EEG ELECTROENCEPHALOGRAM GENERAL CLASSIFICATION750 GASTRO INTESTINAL GI SERVICES GENERAL

CLASSIFICATION

760 SPECIALTY SERVICES GENERAL CLASSIFICATION761 SPECIALTY SERVICES TREATMENT ROOM762 SPECIALTY SERVICES OBSERVATION HOURS769 SPECIALTY SERVICES OTHER SPECIALTY SERVICES770 PREVENTIVE CARE SERVICES GENERAL CLASSIFICATION

771 PREVENTIVE CARE SERVICES VACCINE ADMINISTRATION780 TELEMEDICINE GENERAL CLASSIFICATION790 EXTRA CORPOREAL SHOCK WAVE THERAPY FORMERLY

LITHOTRIPSY GENERAL CLASSIFICATION800 INPATIENT RENAL DIALYSIS GENERAL CLASSIFICATION801 INPATIENT RENAL DIALYSIS INPATIENT HEMODIALYSIS

802 INPATIENT RENAL DIALYSIS INPATIENT PERITONEAL NONCAPD

803 INPATIENT RENAL DIALYSIS INPATIENT CONTINUOUSAMBULATORY PERITONEAL DIALYSIS CAPD

804 INPATIENT RENAL DIALYSIS INPATIENT CONTINUOUSCYCLING PERITONEAL DIALYSIS CCPD

809 INPATIENT RENAL DIALYSIS OTHER INPATIENT DIALYSIS810 ACQUISITION OF BODY COMPONENTS GENERAL

CLASSIFICATION

811 ACQUISITION OF BODY COMPONENTS LIVING DONOR812 ACQUISITION OF BODY COMPONENTS CADAVER DONOR813 ACQUISITION OF BODY COMPONENTS UNKNOWN DONOR814 ACQUISITION OF BODY COMPONENTS UNSUCCESSFUL

ORGAN SEARCH DONOR BANK CHARGES815 STEM CELL ACQUISITION ALLOGENEIC EFFECTIVE 1 1 17

819 ACQUISITION OF BODY COMPONENTS OTHER DONOR


483

REV TABLE

(continued)

REV_CD REV_CD_DESCR

820 HEMODIALYSIS OUTPATIENT OR HOME GENERALCLASSIFICATION

821 HEMODIALYSIS OUTPATIENT OR HOME HEMODIALYSISCOMPOSITE OR OTHER RATE

822 HEMODIALYSIS OUTPATIENT OR HOME HOME SUPPLIES823 HEMODIALYSIS OUTPATIENT OR HOME HOME EQUIPMENT

824 HEMODIALYSIS OUTPATIENT OR HOME MAINTENANCE 100825 HEMODIALYSIS OUTPATIENT OR HOME SUPPORT

SERVICES829 HEMODIALYSIS OUTPATIENT OR HOME OTHER OP

HEMODIALYSIS830 PERITONEAL DIALYSIS OUTPATIENT OR HOME GENERAL

CLASSIFICATION831 PERITONEAL DIALYSIS OUTPATIENT OR HOME PERITONEAL

COMPOSITE OR OTHER RATE

839 PERITONEAL DIALYSIS OUTPATIENT OR HOME OTHEROUTPATIENT PERITONEAL DIALYSIS

840 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME GENERAL CLASSIFICATION

841 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME CAPD COMPOSITE OR OTHER RATE

842 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME HOME SUPPLIES

843 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME HOME EQUIPMENT

844 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME MAINTENANCE 100

845 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME SUPPORT SERVICES

849 CONTINUOUS AMBULATORY PERITONEAL DIALYSIS CAPDOUTPATIENT OR HOME OTHER OUTPATIENT CAPD

850 CONTINUOUS CYCLING PERITONEAL DIALYSIS CCPDOUTPATIENT OR HOME GENERAL CLASSIFICATION

851 CONTINUOUS CYCLING PERITONEAL DIALYSIS CCPDOUTPATIENT OR HOME CCPD COMPOSITE OR OTHER RATE

852 CONTINUOUS CYCLING PERITONEAL DIALYSIS CCPDOUTPATIENT OR HOME HOME SUPPLIES

855 CONTINUOUS CYCLING PERITONEAL DIALYSIS CCPDOUTPATIENT OR HOME SUPPORT SERVICES

859 CONTINUOUS CYCLING PERITONEAL DIALYSIS CCPDOUTPATIENT OR HOME OTHER OUTPATIENT CCPD

860 MAGNETOENCEPHALOGRAPHY MEG GENERALCLASSIFICATION

880 MISCELLANEOUS DIALYSIS GENERAL CLASSIFICATION

881 MISCELLANEOUS DIALYSIS ULTRAFILTRATION889 MISCELLANEOUS DIALYSIS OTHER MISCELLANEOUS

DIALYSIS900 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE

091X AN EXTENSION OF 090X GENERAL CLASSIFICATION


484

REV TABLE

(continued)

REV_CD REV_CD_DESCR

901 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X ELECTROSHOCKTREATMENT

902 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X MILIEU THERAPY

903 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X PLAY THERAPY

904 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X ACTIVITY THERAPY

905 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X INTENSIVE OUTPATIENTSERVICES PSYCHIATRIC

906 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X INTENSIVE OUTPATIENTSERVICES CHEMICAL DEPENDENCY

907 BEHAVIORAL HEALTH TREATMENT SERVICES ALSO SEE091X AN EXTENSION OF 090X COMMUNITY BEHAVIORALHEALTH PROGRAM DAY TREATMENT

911 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X REHABILITATION

912 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X PARTIAL HOSPITALIZATION LESS INTENSIVE

913 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X PARTIAL HOSPITALIZATION INTENSIVE

914 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X INDIVIDUAL THERAPY

915 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X GROUP THERAPY

916 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X FAMILY THERAPY

917 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X BIO FEEDBACK

918 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X TESTING

919 BEHAVIORAL HEALTH TREATMENT SERVICES EXTENSIONOF 090X OTHER BEHAVIORAL HEALTH TREATMENTS

920 OTHER DIAGNOSTIC SERVICES GENERAL CLASSIFICATION

921 OTHER DIAGNOSTIC SERVICES PERIPHERAL VASCULARLAB

922 OTHER DIAGNOSTIC SERVICES ELECTROMYELGRAM923 OTHER DIAGNOSTIC SERVICES PAP SMEAR924 OTHER DIAGNOSTIC SERVICES ALLERGY TEST925 OTHER DIAGNOSTIC SERVICES PREGNANCY TEST

929 OTHER DIAGNOSTIC SERVICES OTHER DIAGNOSTICSERVICE

932 MEDICAL REHABILITATION DAY PROGRAM FULL DAY940 OTHER THERAPEUTIC SERVICES ALSO SEE 095X AN

EXTENSION OF 094X GENERAL CLASSIFICATION


485

REV TABLE

(continued)

REV_CD REV_CD_DESCR

941 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X RECREATIONAL THERAPY

942 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X EDUCATION TRAINING

943 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X CARDIAC REHABILITATION

944 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X DRUG REHABILITATION

945 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X ALCOHOL REHABILITATION

946 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X COMPLEX MEDICAL EQUIPMENTROUTINE

947 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X COMPLEX MEDICAL EQUIPMENTANCILLARY

948 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X PULMONARY REHABILITATION

949 OTHER THERAPEUTIC SERVICES ALSO SEE 095X ANEXTENSION OF 094X OTHER THERAPEUTIC SERVICE

951 OTHER THERAPEUTIC SERVICES EXTENSION OF 094XATHLETIC TRAINING

952 OTHER THERAPEUTIC SERVICES EXTENSION OF 094XKINESIOTHERAPY

960 PROFESSIONAL FEES ALSO SEE 097X AND 098X GENERALCLASSIFICATION

961 PROFESSIONAL FEES ALSO SEE 097X AND 098XPSYCHIATRIC

963 PROFESSIONAL FEES ALSO SEE 097X AND 098XANESTHESIOLOGIST MD

964 PROFESSIONAL FEES ALSO SEE 097X AND 098XANESTHETIST CRNA

969 PROFESSIONAL FEES ALSO SEE 097X AND 098X OTHERPROFESSIONAL FEE

971 PROFESSIONAL FEES EXTENSION OF 096X LABORATORY

972 PROFESSIONAL FEES EXTENSION OF 096X RADIOLOGYDIAGNOSTIC

973 PROFESSIONAL FEES EXTENSION OF 096X RADIOLOGYTHERAPEUTIC

975 PROFESSIONAL FEES EXTENSION OF 096X OPERATINGROOM

976 PROFESSIONAL FEES EXTENSION OF 096X RESPIRATORYTHERAPY

978 PROFESSIONAL FEES EXTENSION OF 096X OCCUPATIONALTHERAPY

979 PROFESSIONAL FEES EXTENSION OF 096X SPEECHPATHOLOGY

981 PROFESSIONAL FEES EXTENSION OF 096X AND 097XEMERGENCY ROOM SERVICES


486

REV TABLE

(continued)

REV_CD REV_CD_DESCR

982 PROFESSIONAL FEES EXTENSION OF 096X AND 097XOUTPATIENT SERVICES

983 PROFESSIONAL FEES EXTENSION OF 096X AND 097XCLINIC

984 PROFESSIONAL FEES EXTENSION OF 096X AND 097XMEDICAL SOCIAL SERVICES

985 PROFESSIONAL FEES EXTENSION OF 096X AND 097X EKG986 PROFESSIONAL FEES EXTENSION OF 096X AND 097X EEG987 PROFESSIONAL FEES EXTENSION OF 096X AND 097X

HOSPITAL VISIT988 PROFESSIONAL FEES EXTENSION OF 096X AND 097X

CONSULTATION989 PROFESSIONAL FEES EXTENSION OF 096X AND 097X

PRIVATE DUTY NURSE

990 PATIENT CONVENIENCE ITEMS GENERAL CLASSIFICATION991 PATIENT CONVENIENCE ITEMS CAFETERIA GUEST TRAY992 PATIENT CONVENIENCE ITEMS PRIVATE LINEN SERVICE993 PATIENT CONVENIENCE ITEMS TELEPHONE TELECOM994 PATIENT CONVENIENCE ITEMS TV RADIO

995 PATIENT CONVENIENCE ITEMS NON PATIENT ROOMRENTALS

996 PATIENT CONVENIENCE ITEMS LATE DISCHARGE997 PATIENT CONVENIENCE ITEMS ADMISSION KITS998 PATIENT CONVENIENCE ITEMS BEAUTY SHOP BARBER999 PATIENT CONVENIENCE ITEMS OTHER CONVENIENCE

ITEMS

2100 ALTERNATIVE THERAPY SERVICES GENERALCLASSIFICATION

2101 ALTERNATIVE THERAPY SERVICES ACUPUNCTURE2109 ALTERNATIVE THERAPY SERVICES OTHER ALTERNATIVE

THERAPY SERVICES3103 ADULT CARE ADULT DAY CARE MEDICAL AND SOCIAL

DAILY3104 ADULT CARE ADULT DAY CARE SOCIAL DAILY

3105 ADULT CARE ADULT FOSTER CARE DAILY3109 ADULT CARE OTHER ADULT CARE


487

REV TABLE

Ancillary/Accommodation Revenue Type

Variable Name: REV_TYPE


Variable Length: 1


Variable Index: 8


Description:Code indicating whether the service was an accommodation (“A”) or ancillary (“R”).

Former variable name: ANCTYPn

Reference table name: REF_REV_TYPE

REV_TYPE REV_TYPE_DESCR

A AccommodationR Ancillary


488

REV TABLE

Service Unit Type

Variable Name: UNIT_TYPE_CD


Variable Length: 2


Variable Index: 9


Description:Unit of measure for the number of units (“DA” Days or “UN” Units).

Former variable name: UNITQTn

Reference table name: REF_UNIT_TYPE_CD

UNIT_TYPE_CD UNIT_TYPE_CD_DESCR

DA DaysUN Unit


489

REV TABLE

Service Unit Count

Variable Name: UNIT_QTY


Variable Length: 22


Variable Index: 10


Description:Count of the times the service was provided.

Former variable name: UNITYPn


490

REV TABLE

Service Line Charge Amount

Variable Name: CHRG_SVC_AMT


Variable Length: 22


Variable Index: 11


Description:Charge reported for the service line.

Former variable name: ANCITCn


491

REV TABLE

Service Line Non-Covered Charge

Variable Name: SVC_NOCVRD_AMT


Variable Length: 22


Variable Index: 12


Description:Denied charge amounts for the service line.

Former variable name: ANCINCn


492

REV TABLE

Date of Service

Variable Name: SVC_DT

Variable Type: DATE

Variable Length: 7


Variable Index: 13


Description:Date service was provided.

Former variable name: SERVDTn

This is an outpatient variable only. (Ambulatory Surgery Visit, Emergency Room Visit, Inpatient Discharge,Outpatient Services Visit)


493

REV TABLE

Service Line Number



Variable Length: 22


Variable Index: 14


Description:Line number associated with the revenue code being reported. Secondary foreign key for linking NDC, Proc, Provider,and Rev tables.

New to APD


494

REV TABLE

Claim Key



Variable Length: 12


Variable Index: 15



New to APD


495

REV TABLE

Active Flag



Variable Length: 1


Variable Index: 16



New to APD


496

REV TABLE




Variable Length: 1


Variable Index: 17



New to APD


497

REV TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 18





498

REV TABLE

Record Created By



Variable Length: 20


Variable Index: 19



New to APD


499

REV TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 20



New to APD


500

REV TABLE

Last Updated By



Variable Length: 20


Variable Index: 21



New to APD


501

REV TABLE

Source File Name



Variable Length: 30


Variable Index: 22



New to APD


502

REV TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 23



New to APD


503

REV TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 24





504

REV TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 25






N NoY Yes


505

VALUE TABLE

VALUE TABLE

This table contains the value codes and their related amounts reported. Value codes are a national code set maintainedby NUBC. For example this includes: Claim Type, Discharge Year, Value Code, and Value Code Amount. For example,value codes are used to report: Units of Blood Furnished (‘37’), Medicaid Recurring Monthly Income (‘23’), MedicaidRate Code (‘24’), Newborn Weight in Grams (‘54’) and Worker’s Compensation (‘15’).


506

VALUE TABLE




Variable Length: 12

Table/File: SPARCS_VALUE

Variable Index: 1



New to APD


507

VALUE TABLE

Discharge Year



Variable Length: 4


Variable Index: 2



New to APD


508

VALUE TABLE

Order Sequence ID



Variable Length: 22


Variable Index: 3


Description:Order in which the value codes were reported.


509

VALUE TABLE

Claim Type



Variable Length: 1


Variable Index: 4








510

VALUE TABLE






Variable Index: 5




511

VALUE TABLE

Value Code

Variable Name: VAL_CD


Variable Length: 30


Variable Index: 6


Description:Code indicating the type of amount being reported.

Special Notes:History data was converted to the SPARCS_VALUE table. IF MCAID_INCOME_IND was “1” it was stored as “22”;if MCAID_INCOME_IND was “2” it was stored as “21”; if MCAID_INCOME_IND was “3” it was stored as “23”; ifWC_IND was “N” it was stored as “14”; if WC_IND was “Y” it was stored as “15”; MCAID_RATE_CD was stored as“24”; BLOOD_FURNISHED was stored as “37”; and NEO_BIRTH_WT was stored as “54”

New to APD

Reference table name: REF_VAL_CD

VAL_CD VAL_CD_DESCR

01 MOST COMMON SEMI-PRIVATE RATE02 HOSPITAL HAS NO SEMI-PRIVATE ROOMS04 PROFESSIONAL COMPONENT CHARGES WHICH ARE

COMBINED BILLED05 PROFESSIONAL COMPONENT INCLUDED IN CHARGES AND

ALSO BILLED SEPARATE TO CARRIER08 LIFE TIME RESERVE AMOUNT IN THE FIRST CALENDAR

YEAR

09 COINSURANCE AMOUNT IN THE FIRST CALENDAR YEAR10 LIFETIME RESERVE AMOUNT IN THE SECOND CALENDAR

YEAR11 COINSURANCE AMOUNT IN THE SECOND CALENDAR YEAR12 WORKING AGED BENEFICIARY/SPOUSE WITH EMPLOYER

GROUP HEALTH PLAN13 ESRD BENEFICIARY IN A MEDICARE COORDINATION

PERIOD WITH AN EMPLOYER GROUP HEALTH PLAN

14 NO-FAULT INCLUDING AUTO/OTHER15 WORKER’S COMPENSATION16 PHS OR OTHER FEDERAL AGENCY21 CATASTROPHIC22 SURPLUS

23 RECURRING MONTHLY INCOME24 MEDICAID RATE CODE25 OFFSET TO THE PATIENT-PAYMENT AMOUNT -

PRESCRIPTION DRUGS27 OFFSET TO THE PATIENT-PAYMENT AMOUNT - VISION AND

EYE SERVICES


512

VALUE TABLE

(continued)

VAL_CD VAL_CD_DESCR

28 OFFSET TO THE PATIENT-PAYMENT AMOUNT - DENTALSERVICES

30 PREADMISSION TESTING31 PATIENT LIABILITY AMOUNT35 OFFSET TO THE PATIENT-PAYMENT AMOUNT - HEALTH

INSURANCE PREMIUMS37 UNITS OF BLOOD FURNISHED39 UNITS OF BLOOD REPLACED

40 NEW COVERAGE NOT IMPLEMENTED BY HMO (FORINPATIENT SERVICE ONLY)

41 BLACK LUNG42 VA43 DISABLED BENEFICIARY UNDER AGE 65 WITH LGHP44 AMOUNT PROVIDER AGREED TO ACCEPT FROM PRIMARY

PAYER WHEN THIS AMOUNT IS LESS THAN CHARGES BUTHIGHER THAN PAYMENT RECEIVED.

45 ACCIDENT HOUR46 NUMBER OF GRACE DAYS47 ANY LIABILITY INSURANCE48 HEMOGLOBIN READING49 HEMATOCRIT READING

50 PHYSICAL THERAPY VISIT51 OCCUPATIONAL THERAPY VISITS52 SPEECH THERAPY VISITS53 CARDIAC REHAB VISITS54 NEWBORN BIRTH WEIGHT IN GRAMS

56 SKILLED NURSE - HOME VISIT HOURS (HHA ONLY)59 OXYGEN SATURATION (O2 SAT/OXIMETRY)60 HHA BRANCH MSA61 PLACE OF RESIDENCE WHERE SERVICE IS FURNISHED

(HHA AND HOSPICE)66 MEDICAID SPEND DOWN AMOUNT

68 EPO-DRUG80 COVERED DAYS81 NON-COVERED DAYS82 CO-INSURANCE DAYS83 LIFETIME RESERVE DAYS

84 SHORTER DURATION HEMODIALYSIS (EFFECTIVE 7/1/17)A0 SPECIAL ZIP CODE REPORTINGA3 ESTIMATED RESPONSIBILITY PAYER AA4 COVERED SELF-ADMINISTRABLE DRUGS - EMERGENCYA5 COVERED SELF-ADMINISTRABLE DRUGS - NOT

SELF-ADMINISTRABLE IN FORM AND SITUATIONFURNISHED TO PATIENT

A6 COVERED SELF-ADMINISTRABLE DRUGS - DIAGNOSTICSTUDY AND OTHER

A8 PATIENT WEIGHT


513

VALUE TABLE

(continued)

VAL_CD VAL_CD_DESCR

A9 PATIENT HEIGHTAB OTHER ASSESSMENTS OR ALLOWANCES (E.G., MEDICAL

EDUCATION) PAYER AB3 ESTIMATED RESPONSIBILITY PAYER B

C3 ESTIMATED RESPONSIBILITY PAYER CD3 PATIENT ESTIMATED RESPONSIBILITYD5 LAST KT/V READING (EFFECTIVE 7/1/10)FC PATIENT PAID AMOUNT (EFFECTIVE 7/1/08)FD CREDIT RECEIVED FROM THE MANUFACTURER OF A

REPLACED MEDICAL DEVICE (EFFECTIVE 7/1/15)


514

VALUE TABLE

Value Code Amount

Variable Name: VAL_AMT


Variable Length: 22


Variable Index: 7


Description:Amount associated with reported value code.

Special Notes:History data was converted to the SPARCS_VALUE table. IF MCAID_INCOME_IND was “1” it was stored as “22”;if MCAID_INCOME_IND was “2” it was stored as “21”; if MCAID_INCOME_IND was “3” it was stored as “23”; ifWC_IND was “N” it was stored as “14”; if WC_IND was “Y” it was stored as “15”; MCAID_RATE_CD was stored as“24”; BLOOD_FURNISHED was stored as “37”; and NEO_BIRTH_WT was stored as “54”

New to APD


515

VALUE TABLE

Claim Key



Variable Length: 12


Variable Index: 8



New to APD


516

VALUE TABLE

Active Flag



Variable Length: 1


Variable Index: 9



New to APD


517

VALUE TABLE




Variable Length: 1


Variable Index: 10



New to APD


518

VALUE TABLE

OTVM Process Date


Variable Type: DATE

Variable Length: 7


Variable Index: 11





519

VALUE TABLE

Record Created By



Variable Length: 20


Variable Index: 12



New to APD


520

VALUE TABLE

Record Update Date


Variable Type: DATE

Variable Length: 7


Variable Index: 13



New to APD


521

VALUE TABLE

Last Updated By



Variable Length: 20


Variable Index: 14



New to APD


522

VALUE TABLE

Source File Name



Variable Length: 30


Variable Index: 15



New to APD


523

VALUE TABLE

Row Insert Date


Variable Type: DATE

Variable Length: 7


Variable Index: 16



New to APD


524

VALUE TABLE

Abortion Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 17





525

VALUE TABLE

AIDS/HIV Flag


Variable Type: CHAR

Variable Length: 1


Variable Index: 18






N NoY Yes


526

sparcs data dictionary - new york state department of health · 2019-03-19 · sparcsdatadictionary...

Documents