Current through Reg. 50, No. 187; September 24, 2024
(1) An
ambulatory center shall report data for all surgical procedures or services
performed in the operating room, or for ambulatory surgical care, cardiology
(cardiac catheterization and percutaneous transluminal coronary angioplasty
(PTCA)), gastro intestinal, extra-corporeal shock wave treatment (lithotripsy)
surgery, or endoscopy corresponding to the following Current Procedural
Terminology (CPT) and corresponding HCPCS Codes. A hospital facility reporting
type of service "1", ambulatory surgical procedures, shall only include visits
where the CPT codes are in the reportable range defined in paragraphs
59B-9.034(1)(a), and
(b), F.A.C., and have revenue charges for
36XX, 48XX, 49XX, 75XX or 79XX as used in the UB-04. Visits without these
revenue charges should not be reported even if the CPT codes are in the
reportable range. Type of service "2", Emergency Room, visits are not
restricted to a CPT-HCPCS reportable range and should report all procedure
codes.
(a) 10001 through 69999. Including
surgery, cardiac catheterization, endoscopy procedures, and lithotripsy revenue
associated procedure codes.
(b)
92920 through 92998 and 93451 through 93533. Includes percutaneous transluminal
coronary angioplasty (PTCA) and Cardiac Catheterization.
(c) Exclude visits where the primary reason
for the visit is venipuncture for laboratory services.
(d) Report one record for each visit, except
pre-operation visits may be combined with the record of the associated
ambulatory surgery visit. See subsection
59B-9.031(11),
F.A.C.
(2) Emergency
departments (ED) shall report data for:
(a)
Emergency department visits in which emergency department registration occurs
for the purpose of seeking emergency care services, including observation, and
the patient is not admitted for inpatient care at the reporting
entity.
(b) The CPT-HCPCS codes
representing the services provided as part of the emergency department visit.
CPT-HCPCS codes are reported in the 'OTHER CPT-HCPCS' fields (1-30) and are not
restricted to the CPT-HCPCS reportable range defined in paragraph
59B-9.034(1)(a),
F.A.C., for an ambulatory center.
(c) An Emergency Department Evaluation and
Management Procedure code representing the patient's acuity as part of the
emergency department visit.
(d) An
ED visit occurs even if the only service provided to a registered patient is
triage or screening. If a registered patient leaves prior to being seen by a
physician, report the discharge status as "07" "AMA/discontinued care" and
charges if incurred. Report zero if charges are not incurred.
(e) Do not include visits for registrations
that occur in the Emergency Department when the hospital central registration
department is closed unless emergency services are
provided.
(3) Hospitals
shall exclude records of any patient visit in which the outpatient and
inpatient billing record is combined because the patient was admitted to
inpatient care within a facility at the same location per Section
408.061(3),
F.S.
(4) For each patient visit,
ambulatory centers shall report all services provided using procedural codes
specified in Rules 59B-9.037 and
59B-9.038, F.A.C.
(5) A facility must register through the FDDC
portal to submit its data file according to the specifications in paragraphs
(a) and (b), below.
(a) Internet Transmission.
The Internet address for submitting ambulatory patient data files is
https://apps.ahca.myflorida.com/Fddc/.
(b) Beginning with the fourth quarter 2022
data reporting period as defined in paragraph
59B-9.033(1)(d),
F.A.C., ambulatory patient data files must be submitted using Ambulatory
Patient Data XML Schema AS10-5, available at:
http://ahca.myflorida.com/xmlschemas/AS10-5.xsd,
The Ambulatory patient Data XML AS10-5 Schema (effective January 2023) is
incorporated by reference at
https://www.flrules.org/Gateway/reference.asp?No=Ref-15078.
The data in the XML file shall contain the data elements, codes and standards
required in Rules 59B-9.037 and
59B-9.038,
F.A.C.
Rulemaking Authority 408.15(8) FS. Law Implemented 408.061,
408.062, 408.063 FS.
New 1-1-10, Formerly
59B-9.015, Amended 12-5-10,
10-1-15, 1-1-18, 2-16-23.
