New Mexico Administrative Code
Title 7 - HEALTH
Chapter 1 - HEALTH GENERAL PROVISIONS
Part 27 - HEALTH INFORMATION SYSTEM REPORTING REQUIREMENTS FOR HEALTHCARE FACILITIES AND ACCESS TO DATA AND REPORTS
Section 7.1.27.7 - DEFINITIONS
Universal Citation: 7 NM Admin Code 7.1.27.7
Current through Register Vol. 35, No. 18, September 24, 2024
In addition to the definitions in the HIS Act, Sections 24-14A-1 to -10, NMSA 1978, the following terms have the following meaning for purposes of this rule.
A. All definitions that begin with the letter A.
(1)
Accident
state means the two-digit state abbreviation where the accident occurred
when services are related to an auto accident.
(2)
Admission hour means the
hour and minute the patient was admitted as an inpatient, coded in military
time (e.g., 2:45 p.m. is represented as 1445).
(3)
Aggregate analysis means
information in report form that contains data combined in a manner which
precludes specific identification of a single patient or health care
provider.
(4)
Annual
permanent database means one calendar year of permanent hospital
inpatient discharge data or any other database collected under the HIS Act that
is deemed complete by division staff.
(5)
Attending physician NPI
means the national provider identifier (NPI), a unique, government-issued,
standard identification 10-digit number for individual health care providers
and provider organizations like clinics, hospitals, schools and group
practices.
B. All definitions that begin with the letter B. Birth weight means weight of newborns coded in grams.
C. All definitions that begin with the letter C.
(1)
Centers for medicare and medicaid
services or CMS means the United States federal agency which administers
medicare, medicaid, and the state children's health insurance
programs.
(2)
1st condition
code, 2nd condition code, 3rd condition code, 4th condition code, 5th condition
code, 6th condition code, 7th condition code, 8th condition code, 9th condition
code, 10th condition code, 11th condition code means the codes used to
identify conditions or events relating to the billing claim that may affect
processing as defined in the form locators 18-28 of the UB-04 manual.
(Usage note: The state requires public health data reporting to indicate
that a patient was admitted directly from the facility's emergency
room/department. Provider will use the code "P7" to indicate the patient was
admitted from the provider facility's emergency
room/department).
D. All definitions that begin with the letter D.
(1)
Data provider means a data
source that has provided data to the health information system on a regular
basis.
(2)
Data source
has the meaning given in Section
24-14A-2
of the HIS Act, and includes those categories of persons or entities that
possess health information, including any public or private sector licensed
hospital, health care practitioner, primary care clinic, ambulatory surgery
center, ambulatory urgent care center, ambulatory dialysis unit, home health
agency, long-term care facility, pharmacy, third-party payer, and any public
entity that has health information.
(3)
Database means a set of data
based on individual patient hospital discharge abstract data or any other
database collected under the HIS Act.
(4)
Department means the New
Mexico department of health.
(5)
Division means the epidemiology and response division of the
department, P.O. Box 26110, Santa Fe, NM 87502-6110.
(6)
Discharge hour means the
hour and minute the patient was discharged as an inpatient, coded in military
time (e.g., 2:45 p.m. is represented as 1445).
(7)
Durable medical equipment or
DME means medical equipment used in the home to aid in a better quality
of living.
E. All definitions that begin with the letter E.
(1)
1st e-code means the first code for external causes of injury,
poisoning, or adverse effect. (Usage note: If a patient has an injury diagnosis
in a range of ICD-9-CM 800-999, an e-code is required. This is the primary
(first-listed) external cause of injury).
(2)
2nd e-code means the second
code for external causes of injury, poisoning, or adverse effect.
(3)
3rd e-code means the third
code for external causes of injury, poisoning, or adverse effect.
F. All definitions that begin with the letter F. Federal agency means any agency, department, bureau, board, division, institution, or other organization of the United States government.
G. All definitions that begin with the letter G.
H. All definitions that begin with the letter H.
(1)
Health care means any care, treatment, service, or procedure to
maintain, diagnose or otherwise affect an individual's physical or mental
condition.
(2)
Health care
professional means any individual licensed, certified, or otherwise
authorized or permitted by law to provide health care in the practice of a
profession.
(3)
Health care
provider means any individual, corporation, partnership, organization,
facility, institution, or other entity licensed, certified, or otherwise
authorized or permitted by law to provide health care in the ordinary course of
business or practice of a profession.
(4)
Health information system or
HIS means the health information system established by the Health
Information System Act, Sections
24-14A-1
to
24-14A-10,
NMSA 1978.
(5)
HIS advisory
committee means individuals from the division pursuant to Subsection
24-14A-3.1
of the HIS Act.
(6)
Health
Information System Act (HIS Act) means the Health Information System
Act, Sections
24-14A-1
to
24-14A-10,
NMSA 1978.
(7)
Health
insurance prospective payment system (HIPPS) rate code means the
three-digit codes that represent specific sets of patient characteristics (or
case-mix groups) on which payment determinations are made under several
prospective payment systems. Case-mix groups are developed based on research
into utilization patterns among various provider types. For the payment systems
that use HIPPS codes, clinical assessment data is the basic input used to
determine which case-mix group applies to a particular patient. A standard
patient assessment instrument is interpreted by case-mix grouping software
algorithms, which assign the case mix group. For payment purposes, at least one
HIPPS code is defined to represent each case-mix group. These HIPPS codes are
reported on claims to insurers and reported in form locator 71 of the UB-04
manual.
I. All definitions that begin with the letter I.
(1)
ICD-9-CM is the international classification of disease, ninth
revision, clinical modification for clinical diagnosis and procedure coding
(October 2011) American medical association.
(2)
ICD-10-CM is the
international classification of disease, 10th revision, clinical modification
for clinical diagnosis coding.
(3)
ICD-10-PCS is the international classification of disease, 10th
revision, clinical modification for procedure coding.
(4)
Identifier means any
information that reveals the identity of, or could reasonably be used to reveal
the identity of, a single patient, or health care professional, but does not
include a number assigned to a single patient for the purpose of conducting
longitudinal or linking studies.
(5)
Inpatient health care
facility means a hospital or other health facility which admits patients
for overnight or longer (and therefore is responsible for patients' room and
board) for the purpose of providing diagnostic treatment or other health
services.
(6)
Inpatient
rehabilitation facility or IRF is an inpatient rehabilitation hospital
or part of a rehabilitation hospital, which provides an intensive
rehabilitation program for inpatients.
(7)
ISO 3166 is the codes for
representation of names of countries issued by the American national standards
institute (ANSI) (latest release).
J. All definitions that begin with the letter J.
K. All definitions that begin with the letter K.
L. All definitions that begin with the letter L. Long-term care hospital or LTCH means an acute care hospital certified by the centers for medicare and medicaid services (CMS) that provide rehabilitative, restorative, or on-going skilled nursing care to patients or residents in need of assistance with activities of daily living. Long-term care facilities include nursing homes, rehabilitation facilities, inpatient behavioral health facilities, and long-term chronic care hospitals.
M. All definitions that begin with the letter M. Medicare provider number means the six digit number assigned by medicare to the data source providing the reported service(s).
N. All definitions that begin with the letter N.
(1)
National provider identifier
(NPI) means the 10-digit NPI from the national plan and provider
enumeration system (NPPES).
(2)
New Mexico state license number means the four to eight digit
license number issued by the New Mexico health department for the data source
providing the reported service(s).
(3)
National uniform billing committee
or NUBC is an entity formed by the American hospital association (AHA)
in 1975, which includes participation by all major national provider and payer
organizations and develops single billing forms and standard data sets that are
used nationwide by institutional providers and payers for handling health care
claims.
O. All definitions that begin with the letter O.
(1)
Operating physician NPI means the national provider identifier
(NPI), a unique, government-issued, standard identification 10-digit number for
individual health care providers and provider organizations like clinics,
hospitals, schools and group practices.
(2)
Outpatient health care
facility means a hospital or other health facility that provides
ambulatory care to a patient without admitting the patient to the facility or
providing lodging services.
P. All definitions that begin with the letter P.
(1)
Patient means a person who
has received or is receiving health care.
(2)
Patient admission date means
the date the patient was admitted by the provider for inpatient care. Format
as, "mmddyyyy". For example, if the admission date was July 1, 1983, "07011983"
would be coded.
(3)
Patient
admitting diagnosis code, patient principle diagnosis code, patient 2nd
diagnosis code, patient 3rd diagnosis code, patient 4th diagnosis code, patient
5th diagnosis code, patient 6th diagnosis code, patient 7th diagnosis code,
patient 8th diagnosis code, patient 9th diagnosis
code, patient 10th diagnosis code, patient 11th diagnosis code, patient 12th
diagnosis code, patient 13th diagnosis code, patient 14th diagnosis code,
patient 15th diagnosis code, patient 16th diagnosis code, patient 17th
diagnosis code, and patient 18th diagnosis code means the ICD-9-CM (or
ICD-10-CM or subsequent versions of ICD coding) diagnosis codes corresponding
to additional conditions that co-exist at the time of admission, or develop
subsequently, and which have an effect on the treatment received or the length
of stay.
(4)
Patient
city means the city of the patient's residence at the time of
discharge.
(5)
Patient
control number means the patient's unique alpha-numeric number assigned
by the provider.
(6)
Patient
country code means the two-digit alpha-two codes of the patient's
residence at the time of discharge, from Part I of the ISO 3166 as required in
form locator 9e of the UB-04 manual. (Usage note: Reported only if other than a
United States residence).
(7)
Patient county means the county of the patient's residence at the
time of discharge.
(8)
Patient date of birth means the date of birth of the patient.
Required format is "mmddyyyy". Note that all four digits of year are required
(e.g., "08191898" is for August 19, 1898).
(9)
Patient diagnosis related group
(DRG) code means the diagnostic related group code used for the HIPPS
code in form locator 71 of the UB-04 manual.
(10)
Patient diagnostic code
qualifier means the revision number of the international classifications
of disease diagnosis codes used to record the diagnoses represented by
Paragraph (20) of Subsection P of 7.1.27.7 NMAC.
(a) 9-ICD-9-CM, ninth revision required on
claims through September 30, 2013.
(b) 0-ICD-10-CM, 10th revision when
implemented.
(c) 1-ICD-11-CM, 11th
revision reservation for future reporting requirements.
(11)
Patient's discharge date
means the date the patient was discharged by the provider from the inpatient
health care facility. Formatted as "mmddyyyy" (i.e., an admission date of July
1, 1983, would be coded "07011983").
(12)
Patient's emergency medical
services (EMS) ambulance run number means the emergency medical services
ambulance run number.
(13)
Patient's ethnicity means the gross classification of a patient's
stated ethnicity, coded as follows:
(a)
E1-Hispanic or Latino;
(b) E2-not
Hispanic or Latino;
(c)
E6-declined;
(d) E7-unknown or
unable to obtain.
(14)
Patient's first name means the first name of the
patient.
(15)
Patient's
medicaid number means the patient's unique identification number
assigned by medicaid.
(16)
Patient's medical record number means the medical record number
used by the provider to identify the patient.
(17)
Patient's middle initial
means the middle initial of the patient.
(18)
Patient's last name means
the last name of patient. Last name should not have a space between a prefix
and a name as in "MacBeth", but hyphenated names retain the hyphen as in
"Smith-Jones". Titles should not be recorded. If the last name has a suffix,
put the last name, a space, and then the suffix as in "Snyder III". Last name
does not include abbreviations of academic achievement or profession, such as
"M.D.", "Ph.D." etc.
(19)
Patient's phone number means the 10 digit phone number provided by
the patient, without section separating characters like dashes, hyphens or
slashes (i.e., "5051234567").
(20)
Patient's principle diagnosis code, present on admission; patient 2nd
diagnosis code; present on admission; patient 3rd diagnosis code, present on
admission; patient 4th diagnosis code, present on admission; patient 5th
diagnosis code, present on admission; patient 6th diagnosis code, present on
admission; patient 7th diagnosis code, present on admission; patient 8th
diagnosis code, present on admission; patient 9th diagnosis code, present on
admission; patient 10th diagnosis code, present on admission; patient 11th
diagnosis code, present on admission; patient 12th diagnosis code, present on
admission; patient 13th diagnosis code, present on admission; patient 14th
diagnosis code, present on admission; patient 15th diagnosis code, present on
admission; patient 16th diagnosis code, present on admission; patient 17th
diagnosis code, present on admission; patient 18th diagnosis code, present on
admission means diagnosis was present at the time the order for
inpatient admission occurs-conditions that develop during an outpatient
encounter, including emergency room, observation, or outpatient surgery are
considered as present on admission.
(a)
Y-yes.
(b) N-no.
(c) U-no information on the record.
(d) W-clinically undetermined.
(e) 1-exempt.
(21)
Patient principal procedure code,
patient 2nd procedure code, patient 3rd procedure code, patient 4th procedure
code, patient 5th procedure code, patient 6th procedure code means the
codes identifying the significant procedures, performed during the patient's
stay.
(22)
Patient
race means the classification(s) of a patient's stated race to include
one or multiple reported classifications, coded as shown below. When reporting
multiple classifications do not use spaces or delimiters. For example, if a
patient states that he or she is both American Indian and other the race field
would be R1R9.
(a) R1-American Indian or
Alaska Native.
(b) R2-Asian
(including Asian Indian, Chinese, Filipino, Japanese, Korean, and
Vietnamese).
(c) R3-Black or
African American.
(d) R4-Native
Hawaiian or Pacific Islander (including Chamorro and Samoan) .
(e) R5-White.
(f) R6-declined.
(g) R7-unknown or unable to obtain.
(h) R9-other race.
(23)
Patient's social security
number means the nine digit social security number provided by the
patient, without section separating characters like dashes, hyphens or slashes
(i.e., "123456789").
(24)
Patient's state means the two-digit state code of the patient's
residence at the time of discharge.
(25)
Patient's status means the
code indicating patient's disposition at time of discharge. The codes are:
(a) 01-discharged to home or self care
(routine discharge); (usage note: includes discharge to home; home on oxygen if
DME only; any other DME only; group home; foster care; independent living and
other residential care arrangements; outpatient programs, such as partial
hospitalization of outpatient chemical dependency programs);
(b) 02-discharged/transferred to a short-term
general hospital for inpatient care;
(c) 03-discharged/transferred to skilled
nursing facility (SNF) with medicare certification in anticipation of skilled
care; (usage note: medicare-indicates that the patient is
discharged/transferred to a medicare certified nursing facility; for hospitals
with an approved swing bed arrangement, use code 61-swing bed; for reporting
other discharges/transfers to nursing facilities see definitions for codes 04
and 64 in accordance with 7.1.27.7 NMAC);
(d) 04-discharged/transferred to a facility
that provides custodial or supportive care; (usage note: includes intermediate
care facilities (ICF) if specifically designated at the state level; also used
to designate patients that are discharged/transferred to a nursing facility
with neither medicare nor medicaid certification and for discharges/transfers
to assisted living facilities);
(e)
05-discharged/transferred to a designated cancer center of children's
hospital;
(f)
06-discharged/transferred to home under care of an organized home health
service organization in anticipation of covered skilled care; (usage note:
report this code when a patient is discharged/transferred to home with a
written plan of care (tailored to the patient's medical needs) for home care
services; not used for home health services provided by a DME supplier or from
a home IV provider for home IV services);
(g) 07-left against medical advice or
discontinued care;
(h) 08-reserved
for national assignment by the NUBC;
(i) 09-admitted as an inpatient to this
hospital; (usage note: this is for use only on medicare outpatient claims;
applies only to those medicare outpatient services that begin greater than
three days prior to admission and therefore should not be reported for
inpatient discharges);
(j) 10-19
reserved for national assignment by the NUBC;
(k) 20-expired;
(l) 21-discharged/transferred to court/law
enforcement (covers patients sent to jail, prison or other detention
facilities);
(m) 22-29-reserved for
national assignment by the NUBC;
(n) 30-still patient or expected to return
for outpatient services; (usage note: used when patient is still within the
same facility; typically used when billing for leave of absence days or interim
bills);
(o) 31-39-reserved for
national assignment by the NUBC;
(p) 40-expired at home (hospice claims
only);
(q) 41-expired in a medical
facility, such as a hospital, SNF, ICF, or freestanding hospice (hospice claims
only);
(r) 42-expired-place unknown
(hospice claims only);
(s)
43-discharged/transferred to a federal health care facility; (usage note:
discharges and transfers to a government operated health care facility such as
a department of defense hospital, a veteran's administration (VA) hospital or a
VA nursing facility; to be used whenever the destination at discharge is a
federal health care facility, whether the patient lives there or
not);
(t) 44-49-reserved for
national assignment by the NUBC;
(u) 50-discharged/transferred to
hospice-home;
(v)
51-discharged/transferred to hospice-medical facility (certified) providing
hospice level of care;
(w)
52-60-reserved for national assignment by the NUBC;
(x) 61-discharged/transferred within this
institution to a hospital based medicare approved swing bed; (usage note:
medicare-used for reporting patients discharged/transferred to SNF level of
care within the hospital's approved swing bed arrangement);
(y) 62-discharged/transferred to an IRF
including rehabilitation distinct part units of a hospital;
(z) 63-discharged/transferred to a LTCH;
(usage note: for hospitals that meet the medicare criteria for LTCH
certification);
(aa)
64-discharged/transferred to a nursing facility certified under medicaid but
not certified under medicare;
(bb)
65-discharged/transferred to a psychiatric hospital or psychiatric distinct
part unit of a hospital;
(cc)
66-discharged/transferred to a critical access hospital (CAH);
(dd) 67-69 reserved for national assignment
by the NUBC;
(ee)
70-discharge/transfer to another type of health care institution not defined
elsewhere in the code list;
(ff)
71-99-reserved for national assignment by the NUBC.
(26)
Patient's street address
means the mailing address of the patient at the time of discharge including
street name and number or post office box number or rural route
number.
(27)
Patient's tribal
affiliation means the classification(s) of patient's stated New Mexico
tribal affiliation, if stated race indicates American Indian. Up to five
reported affiliations can be reported, coded as shown below. When reporting
multiple affiliations do not use spaces or delimiters. For example, if a
patient states that he or she has affiliations with both Acoma pueblo and the
Navajo nation the tribal affiliation field would be T1T10:
(a) T1-Acoma pueblo;
(b) T2-Cochiti pueblo;
(c) T3-Isleta pueblo;
(d) T4-Jemez pueblo;
(e) T5-Jicarilla Apache nation;
(f) T6-Kewa/Santo Domingo pueblo;
(g) T7-Laguna pueblo;
(h) T8-Mescalero Apache nation;
(i) T9-Nambe pueblo;
(j) T10-Navajo nation;
(k) T11-Ohkay Owingeh pueblo;
(l) T12-Picuris pueblo;
(m) T13-Pojoaque pueblo;
(n) T14-San Felipe pueblo;
(o) T15-San Ildefonso pueblo;
(p) T16-Sandia pueblo;
(q) T17-Santa Ana pueblo;
(r) T18-Santa Clara pueblo;
(s) T19-Taos pueblo;
(t) T20-Tesuque pueblo;
(u) T21-Zia pueblo;
(v) T22-Zuni pueblo;
(w) T100-other tribal affiliation;
(x) T200-declined;
(y) T300-unknown.
(28)
Patient's zip code means
the zip code of the patient's residence at the time of discharge. Use either
five or nine digits (e.g., 87501 or 875010968).
(29)
Permanent hospital inpatient
discharge data means hospital inpatient discharge data contained in a
data set created by the division after submitting data the provider has either
(1) reviewed and approved a division statistical report based on the data
provider's patient discharges; or (2) been provided a 30-day period to review
the division's statistical report.
(30)
Point of origin for admission or
visit means the source of referral for this admission.
(a)
Adults and pediatrics:
Source of admission codes for adults and pediatrics are:
(i) 1-non-health care facility point of
origin-the patient was admitted to this facility upon the recommendation of his
or her personal physician if other than a clinic physician or a health
maintenance organization (HMO) physician (this includes patients coming from
home, a physician's office, or workplace;
(ii) 2-clinic referral-the patient was
admitted to this facility as a transfer from a freestanding or non-freestanding
clinic;
(iii) 4-transfer from a
hospital-the patient was admitted to this facility as a transfer from an acute
care facility where he or she was an inpatient or outpatient (excludes
transfers from hospital inpatient in the same facility);
(iv) 5-transfer from SNF or ICF-the patient
was admitted to this facility as a transfer from a SNF or ICF where he or she
was a resident;
(v) 6-transfer from
another health care facility-the patient was admitted to this facility as a
transfer from a health care facility not defined elsewhere in this code list
(i.e., other than an acute care facility or skilled nursing
facility);
(vi) 8-court/law
enforcement-the patient was admitted to this facility upon the direction of a
court of law, or upon a request of a law enforcement agency representative
(includes transfers from incarceration facilities);
(vii) 9-information not available-the means
by which the patient was referred to this facility is not known;
(viii) A-reserved for national
assignment;
(ix) D-transfer from
hospital inpatient in the same facility resulting in a separate claim to the
payer-the patient was admitted to this facility as a transfer from hospital
inpatient within this facility resulting in a separate claim to the
payer;
(x) E-transfer from
ambulatory surgery center-the patient was admitted to this facility from an
ambulatory or same-day surgery center (does not include patients admitted from
the same facilities' outpatient surgery department);
(xi) F-transfer from hospice and is under a
hospice plan of care or enrolled in a hospice program-the patient was admitted
to this facility as acute inpatient status and was receiving hospice
care;
(xii) G-Z-reserved for
national assignment.
(b)
Newborns: Newborn codes must be used when the type of
admission is code 4. The codes are:
(i)
5-born inside this facility-a baby born inside this facility;
(ii) 6-born outside of this facility-a baby
born outside of this facility.
(31)
Primary payer category
means one of the following broad categories assigned by the data provider to
the payment source identified in the primary payer identification name field:
(a) 1-medicare is the primary
payer from which the provider might expect some payment;
(b) 2-medicaid is the primary
payer from which the provider might expect some payment;
(c) 3-other government
(federal/state/local) is the primary payer from which the provider might
expect some payment (excluding department of corrections);
(d) 4-department of corrections
is the primary payer from which the provider might expect some
payment;
(e) 5-private health
insurance is the primary payer from which the provider might expect some
payment;
(f) 6-blue
cross/blue shield is the primary payer from which the provider might
expect some payment;
(g)
7-managed care, unspecified is the primary payer from which the
provider might expect some payment (to be used only if one cannot distinguish
public from private);
(h)
8-no payment from an organization, agency, program or private
payer is listed as the primary payer;
(i) 9-miscellaneous/other
primary payer source from which the provider might expect some
payment.
(32)
Primary payer identification name means the name identifying the
primary payer from which the provider might expect some payment for the
reported service(s).
(33)
Primary payer type means the type of primary payer as defined
below from which the provider might expect some payment for the reported
services(s):
(a) 1-HMO-health
maintenance organization;
(b)
2-other managed care-includes provider service networks;
(c) 3-indemnity plan;
(d) 88-unknown.
(34)
Procedure code
qualifier means the revision number of the international classifications
of disease diagnosis codes used to record the procedure represented by
Paragraph (21) of Subsection P of 7.1.27.7 NMAC.
(a) 9-ICD-9-PCS, ninth revision required on
claims through September 30, 2013.
(b) 0-ICD-10-PCS, 10th revision to take
effect October 1, 2013 or such later date as required by the CMS.
(c) 1-ICD-11-PCS, 11th revision reservation
for future reporting requirements.
(35)
Procedure date for patient's
principal procedure code; procedure date for 2nd procedure code; procedure date
for 3rd procedure code; procedure date for 4th procedure code; procedure date
for 5th procedure code; procedure date for 6th procedure code means the
date of the procedure that is reported as it coincides with the procedure code
that was performed (mmddyyyy).
(36)
Proprietary information means confidential technical information,
administrative information, or business methods that are the property of the
data provider and are perceived to confer a competitive position in the health
care market by not being openly known by competitors.
(37)
Provider zip code means the
zip code whose boundaries physically contain the facility where the reported
service(s) were provided. Use either five or nine digits (i.e., 12345 or
123456789).
Q. All definitions that begin with the letter Q.
R. All definitions that begin with the letter R.
(1)
Requestor means a person
who makes a request for access to health information system data or reports
pursuant to this rule.
(2)
Routine report means a report that contains information of use to
the general public that is issued by the division on its own initiative and not
in response to a specific, individualized request.
(3)
1st revenue code, 2nd revenue code,
3rd revenue code, 4th revenue code, 5th revenue code, 6th revenue code, 7th
revenue code, 8th revenue code, 9th revenue code, 10th revenue code, 11th
revenue code, 12th revenue code, 13th revenue code, 14th revenue code, 15th
revenue code, 16th revenue code, 17th revenue code, 18th revenue code, 19th
revenue code, 20th revenue code, 21st revenue code, and 22nd revenue
code means the four-digt revenue codes that identify the specific
accommodation, ancillary service or unique billing calculations, or
arrangements made during the patient's stay.
(4)
1st revenue description, 2nd
revenue description, 3rd revenue description, 4th revenue description, 5th
revenue description, 6th revenue description, 7th revenue description, 8th
revenue description, 9th revenue description, 10th revenue description, 11th
revenue description, 12th revenue description, 13th revenue description, 14th
revenue description, 15th revenue description, 16th revenue description, 17th
revenue description, 18th revenue description, 19th revenue description, 20th
revenue description, 21st revenue description, and 22nd revenue
description means the revenue standard abbreviated descriptions that
identify the specific accommodation, ancillary service or unique billing
calculations, or arrangements made during the patient's stay.
(5)
1st revenue line item charges, 2nd
revenue line item charges, 3rd revenue line item charges, 4th revenue line item
charges, 5th revenue line item charges, 6th revenue line item charges, 7th
revenue line item charges, 8th revenue line item charges, 9th revenue line item
charges, 10th revenue line item charges, 11th revenue line item charges, 12th
revenue line item charges, 13th revenue line item charges, 14th revenue line
item charges, 15th revenue line item charges, 16th revenue line item charges,
17th revenue line item charges, 18th revenue line item charges, 19th revenue
line item charges, 20th revenue line item charges, 21st revenue line item
charges, and 22nd revenue line item charges means the revenue line item
charges, rounded to the whole dollar, for the specific accommodation, ancillary
service or unique billing calculations, or arrangements made during the
patient's stay.
(6)
1st
revenue non-covered charges, 2nd revenue non-covered charges, 3rd revenue
non-covered charges, 4th revenue non-covered charges, 5th revenue non-covered
charges, 6th revenue non-covered charges, 7th revenue non-covered charges, 8th
revenue non-covered charges, 9th revenue non-covered charges, 10th revenue
non-covered charges, 11th revenue non-covered charges, 12th revenue non-covered
charges, 13th revenue non-covered charges, 14th revenue non-covered charges,
15th revenue non-covered charges, 16th revenue non-covered charges, 17th
revenue non-covered charges, 18th revenue non-covered charges, 19th revenue
non-covered charges, 20th revenue non-covered charges, 21st revenue non-covered
charges, and 22nd revenue non-covered charges means the revenue
non-covered charges, rounded to the whole dollar, for the specific
accommodation, ancillary service or unique billing calculations, or
arrangements made during the patient's stay.
(7)
1st revenue service date, 2nd
revenue service date, 3rd revenue service date, 4th revenue service date, 5th
revenue service date, 6th revenue service date, 7th revenue service date, 8th
revenue service date, 9th revenue service date, 10th revenue service date, 11th
revenue service date, 12th revenue service date, 13th revenue service date,
14th revenue service date, 15th revenue service date, 16th revenue service
date, 17th revenue service date, 18th revenue service date, 19th revenue
service date, 20th revenue service date, 21st revenue service date, and 22nd
revenue service date means the revenue service dates that the specific
accommodation, ancillary service or unique billing calculations, or
arrangements occurred on.
(8)
1st revenue service units, 2nd revenue service units, 3rd revenue service
units, 4th revenue service units, 5th revenue service units, 6th revenue
service units, 7th revenue service units, 8th revenue service units, 9th
revenue service units, 10th revenue service units, 11th revenue service units,
12th revenue service units, 13th revenue service units, 14th revenue service
units, 15th revenue service units, 16th revenue service units, 17th revenue
service units, 18th revenue service units, 19th revenue service units, 20th
revenue service units, 21st revenue service units, and 22nd revenue service
units means the quantitative measure of services rendered by the revenue
category to or for the patient to include items such as number of accommodation
dates, miles, pints of blood, renal dialysis treatments, etc.
S. All definitions that begin with the letter S.
(1)
Secondary payer
category means one of the following broad categories assigned by the
data provider to the payment source identified in the secondary payer
identification name field:
(a)
1-medicare is the secondary payer from which the provider might
expect some payment;
(b)
2-medicaid is the secondary payer from which the provider might
expect some payment;
(c)
3-other government (federal/state/local) is the secondary payer
from which the provider might expect some payment (excluding department of
corrections);
(d)
4-department of corrections is the secondary payer from which the
provider might expect some payment;
(e) 5-private health insurance
is the secondary payer from which the provider might expect some
payment;
(f) 6-blue
cross/blue shield is the secondary payer from which the provider might
expect some payment;
(g)
7-managed care, unspecified is the secondary payer from which the
provider might expect some payment (to be used only if one cannot distinguish
public from private);
(h)
8-no payment from an organization, agency, program, or private
payer is listed as the secondary payer;
(i) 9-miscellaneous/other
secondary payer source from which the provider might expect some
payment.
(2)
Secondary payer identification name means the name identifying a
secondary payer from which the provider might expect some payment for the
reported service(s).
(3)
Secondary payer type means the type of secondary payer as defined
below from which the provider might expect some payment for the reported
service(s):
(a) 1-HMO-health
maintenance organization;
(b)
2-other managed care-includes provider service networks;
(c) 3-indemnity plan;
(d) 88-unknown.
(4)
Secretary means
the cabinet secretary of the department of health.
(5)
Sex of patient means the sex
of the patient as recorded at discharge. Enter the sex of the patient, coded as
follows:
(a) F-female;
(b) M-male;
(c) U-unknown.
(6)
Skilled nursing facility or
SNF means a type of nursing home recognized by the medicare and medicaid
systems as meeting long-term health care needs for individuals who the
potential to function independently after a limited period of care.
(7)
State agency means any
agency, department, division, bureau, board, commission, institution, or other
organization of a state government, including state educational institutions
and political subdivisions. "State agency" does not include any health care
facility operated by a state agency.
T. All definitions that begin with the letter T.
(1)
Tertiary payer category
means one of the following broad categories assigned by the data provider to
the payment source identified in the tertiary payer identification name field:
(a) 1-medicare is the tertiary
payer from which the provider might expect some payment;
(b) 2-medicaid is the tertiary
payer from which the provider might expect some payment;
(c) 3-other government
(federal/state/local) is the tertiary payer from which the provider
might expect some payment (excluding the department of corrections);
(d) 4-department of corrections
is the tertiary payer from which the provider might expect some
payment;
(e) 5-private health
insurance is the tertiary payer from which the provider might expect
some payment;
(f) 6-blue
cross/blue shield is the tertiary payer from which the provider might
expect some payment;
(g)
7-managed care, unspecified is the tertiary payer from which the
provider might expect some payment (to be used only if one cannot distinguish
public from private);
(h)
8-no payment from an organization, agency, program, or private
payer is listed as the tertiary payer;
(i) 9-miscellaneous/other
tertiary payer source from which the provider might expect some
payment.
(3)
Tertiary payer identification name means the name identifying a
tertiary payer from which the provider might expect some payment for the
reported service(s).
(4)
Tertiary payer type means the type of tertiary payer as defined
below from which the provider might expect some payment for the reported
service(s):
(a) 1-HMO-health
maintenance organization;
(b)
2-other managed care-includes provider service networks;
(c) 3-indemnity plan;
(d) 88-unknown.
(5)
Total charges
means an 11 digit number rounded to the whole dollar for the total charges for
all inpatient services reported. This is the sum of all revenue service line
charges.
(6)
Traffic crash
report number means the six digit number of the traffic crash/accident
report form.
(7)
Type of
admission means an inpatient code indicating the priority of the
admission. Type of admission codes are:
(a)
1-emergency-the patient requires immediate medical intervention as a result of
severe, life threatening or potentially disabling conditions; generally, the
patient is admitted through the emergency room;
(b) 2-urgent-the patient requires immediate
medical attention for the care and treatment of a physical or mental disorder;
generally, the patient is admitted to the first available and suitable
accommodation;
(c) 3-elective-the
patient's condition permits adequate time to schedule the availability of a
suitable accommodation;
(d)
4-newborn-a baby born within this facility; use of this code necessitates the
use of special source of admission codes-see source of admission;
(e) 9-information not available.
(8)
Type of bill
means the specific type of bill code indicating the type of billing for
inpatient services.
U. All definitions that begin with the letter U.
(1)
UB-04 manual is the official
NUBC data specifications manual for (© AHA) issued by the NUBC.
V. All definitions that begin with the letter V.
W. All definitions that begin with the letter W.
X. All definitions that begin with the letter X.
Y. All definitions that begin with the letter Y.
Z. All definitions that begin with the letter Z.
Disclaimer: These regulations may not be the most recent version. New Mexico may have more current or accurate information. We make no warranties or guarantees about the accuracy, completeness, or adequacy of the information contained on this site or the information linked to on the state site. Please check official sources.
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