Current through Register Vol. 35, No. 18, September 24, 2024
C.
Data required to be reported:
All licensed non-federal general and specialty inpatient health care facilities
in New Mexico shall report to the division the following data elements, in the
record layout provided by the division. Required data items:
(1) New Mexico state license number, left
justified;
(2) medicare provider
number, left justified;
(3)
provider zip code (five or nine digits), left justified;
(4) admission hour (military time);
(5) patient's admission date
(mmddyyyy);
(6) point of origin (1
to 9, a, d, e, and f);
(7) type of
admission (1 to 4, 9);
(8)
patient's ems ambulance run number, left justified;
(9) traffic crash report number, left
justified;
(10) accident state
(two-digit code), left justified;
(11) patient's medical record number, left
justified;
(12) patient's medicaid
id number;
(13) patient's control
number, left justified;
(14) birth
weight (grams);
(15) attending
physician NPI (assigned by medicare);
(16) operating physician NPI (assigned by
medicare);
(17) discharge hour
(military time);
(18) patient's
discharge date (mmddyyyy);
(19)
patient's status (01 to 99);
(20)
primary payer category (1 to 10, 88), right justified;
(21) primary payer identification name, left
justified;
(22) primary payer type
(1 to 3, 88), right justified;
(23)
secondary payer category (1 to 10, 88), right justified;
(24) secondary payer identification name,
left justified;
(25) secondary
payer type (1 to 3, 88), right justified;
(26) tertiary payer category (1 to 10, 88),
right justified;
(27) tertiary
payer identification name, left justified;
(28) tertiary payer type (1 to 3, 88), right
justified;
(29) 1st condition code,
left justified;
(30) 2nd condition
code, left justified;
(31) 3rd
condition code, left justified;
(32) 4th condition code, left
justified;
(33) 5th condition code,
left justified;
(34) 6th condition
code, left justified;
(35) 7th
condition code, left justified;
(36) 8th condition code, left
justified;
(37) 9th condition code,
left justified;
(38) 10th condition
code, left justified;
(39) 11th
condition code, left justified;
(40) 1st revenue code, left
justified;
(41) 1st revenue code
description, left justified;
(42)
1st revenue code service date (mmddyyyy), left justified;
(43) 1st revenue code service units, right
justified;
(44) 1st revenue code
line item charges, right justified;
(45) 1st revenue code non-covered charges,
right justified;
(46) 2nd revenue
code, left justified;
(47) 2nd
revenue code description, left justified;
(48) 2nd revenue code service date
(mmddyyyy), left justified;
(49)
2nd revenue code service units, right justified;
(50) 2nd revenue code line item charges,
right justified;
(51) 2nd revenue
code non-covered charges, right justified;
(52) 3rd revenue code description, left
justified;
(53) 3rd revenue code
service date (mmddyyyy), left justified;
(54) 3rd revenue code service units, right
justified;
(55) 3rd revenue code
line item charges, right justified;
(56) 3rd revenue code non-covered charges,
right justified;
(57) 4th revenue
code, left justified;
(58) 4th
revenue code description, left justified;
(59) 4th revenue code service date
(mmddyyyy), left justified;
(60)
4th revenue code service units, right justified;
(61) 4th revenue code line item charges,
right justified;
(62) 4th revenue
code non-covered charges, right justified;
(63) 5th revenue code, left
justified;
(64) 5th revenue code
description, left justified;
(65)
5th revenue code service date (mmddyyyy), left justified;
(66) 5th revenue code service units, right
justified;
(67) 5th revenue code
line item charges, right justified;
(68) 5th revenue code non-covered charges,
right justified;
(69) 6th revenue
code, left justified;
(70) 6th
revenue code description, left justified;
(71) 6th revenue code service date
(mmddyyyy), left justified;
(72)
6th revenue code service units, right justified;
(73) 6th revenue code line item charges,
right justified;
(74) 6th revenue
code non-covered charges, right justified;
(75) 7th revenue code, left
justified;
(76) 7th revenue code
description, left justified;
(77)
7th revenue code service date (mmddyyyy), left justified;
(78) 7th revenue code service units, right
justified;
(79) 7th revenue code
line item charges, right justified;
(80) 7th revenue code non-covered charges,
right justified;
(81) 8th revenue
code, left justified;
(82) 8th
revenue code description, left justified;
(83) 8th revenue code service date
(mmddyyyy), left justified;
(84)
8th revenue code service units, right justified;
(85) 8th revenue code line item charges,
right justified;
(86) 8th revenue
code non-covered charges, right justified;
(87) 9th revenue code, left
justified;
(88) 9th revenue code
description, left justified;
(89)
9th revenue code service date (mmddyyyy), left justified;
(90) 9th revenue code service units, right
justified;
(91) 9th revenue code
line item charges, right justified;
(92) 9th revenue code non-covered charges,
right justified;
(93) 10th revenue
code, left justified;
(94) 10th
revenue code description, left justified;
(95) 10th revenue code service date
(mmddyyyy), left justified;
(96)
10th revenue code service units, right justified;
(97) 10th revenue code line item charges,
right justified;
(98) 10th revenue
code non-covered charges, right justified;
(99) 11th revenue code, left
justified;
(100) 11th revenue code
description, left justified;
(101)
11th revenue code service date (mmddyyyy), left justified;
(102) 11th revenue code service units, right
justified;
(103) 11th revenue code
line item charges, right justified;
(104) 11th revenue code non-covered charges,
right justified;
(105) 12th revenue
code, left justified;
(106) 12th
revenue code description, left justified;
(107) 12th revenue code service date
(mmddyyyy), left justified;
(108)
12th revenue code service units, right justified;
(109) 12th revenue code line item charges,
right justified;
(110) 12th revenue
code non-covered charges, right justified;
(111) 13th revenue code, left
justified;
(112) 13th revenue code
description, left justified;
(113)
13th revenue code service date (mmddyyyy), left justified;
(114) 13th revenue code service units, right
justified;
(115) 13th revenue code
line item charges, right justified;
(116) 13th revenue code non-covered charges,
right justified;
(117) 14th revenue
code, left justified;
(118) 14th
revenue code description, left justified;
(119) 14th revenue code service date
(mmddyyyy), left justified;
(120)
14th revenue code service units, right justified;
(121) 14th revenue code line item charges,
right justified;
(122) 14th revenue
code non-covered charges, right justified;
(123) 15th revenue code, left
justified;
(124) 15th revenue code
description, left justified;
(125)
15th revenue code service date (mmddyyyy), left justified;
(126) 15th revenue code service units, right
justified;
(127) 15th revenue code
line item charges, right justified;
(128) 15th revenue code non-covered charges,
right justified;
(129) 16th revenue
code, left justified;
(130) 16th
revenue code description, left justified;
(131) 16th revenue code service date
(mmddyyyy), left justified;
(132)
16th revenue code service units, right justified;
(133) 16th revenue code line item charges,
right justified;
(134) 16th revenue
code non-covered charges, right justified;
(135) 17th revenue code, left
justified;
(136) 17th revenue code
description, left justified;
(137)
17th revenue code service date (mmddyyyy), left justified;
(138) 17th revenue code service units, right
justified;
(139) 17th revenue code
line item charges, right justified;
(140) 17th revenue code non-covered charges,
right justified;
(141) 18th revenue
code, left justified;
(142) 18th
revenue code description, left justified;
(143) 18th revenue code service date
(mmddyyyy), left justified;
(144)
18th revenue code service units, right justified;
(145) 18th revenue code line item charges,
right justified;
(146) 18th revenue
code non-covered charges, right justified;
(147) 19th revenue code, left
justified;
(148) 19th revenue code
description, left justified;
(149)
19th revenue code service date (mmddyyyy), left justified;
(150) 19th revenue code service units, right
justified;
(151) 19th revenue code
line item charges, right justified;
(152) 19th revenue code non-covered charges,
right justified;
(153) 20th revenue
code, left justified;
(154) 20th
revenue code description, left justified;
(155) 20th revenue code service date
(mmddyyyy), left justified;
(156)
20th revenue code service units, right justified;
(157) 20th revenue code line item charges,
right justified;
(158) 20th revenue
code non-covered charges, right justified;
(159) 21st revenue code, left
justified;
(160) 21st revenue code
description, left justified;
(161)
21st revenue code service date (mmddyyyy), left justified;
(162) 21st revenue code service units, right
justified;
(163) 21st revenue code
line item charges, right justified;
(164) 21st revenue code non-covered charges,
right justified;
(165) 22nd revenue
code, left justified;
(166) 22nd
revenue code description, left justified;
(167) 22nd revenue code service date
(mmddyyyy), left justified;
(168)
22nd revenue code service units, right justified;
(169) 22nd revenue code line item charges,
right justified;
(170) 22nd revenue
code non-covered charges, right justified;
(171) patient's last name, left
justified;
(172) patient's middle
initial;
(173) patient's social
security number;
(174) patient's
street address, left justified;
(175) patient's city, left
justified;
(176) patient's county,
left justified;
(177) patient's
state, left justified;
(178)
patient's zip code (five or nine digits), left justified;
(179) patient's date of birth
(mmddyyyy);
(180) patient's
race-multiple (r1 to r7. r9);
(181)
patient's ethnicity (e1, e2, e6, e7);
(182) patient's tribal affiliation-up to five
(t1 to t22, t100, t200, t300);
(183) sex of patient (m, f, u);
(184) patient's phone number, left
justified;
(185) patient's
admitting diagnosis code, left justified;
(186) patient's principal diagnosis code,
left justified;
(187) patient's 2nd
diagnosis code, left justified;
(188) patient's 3rd diagnosis code, left
justified;
(189) patient's 4th
diagnosis code, left justified;
(190) patient's 5th diagnosis code, left
justified;
(191) patient's 6th
diagnosis code, left justified;
(192) patient's 7th diagnosis code, left
justified;
(193) patient's 8th
diagnosis code, left justified;
(194) patient's 9th diagnosis code, left
justified;
(195) patient's 10th
diagnosis code, left justified;
(196) patient's 11th diagnosis code, left
justified;
(197) patient's 12th
diagnosis code, left justified;
(198) patient's 13th diagnosis code, left
justified;
(199) patient's 14th
diagnosis code, left justified;
(200) patient's 15th diagnosis code, left
justified;
(201) patient's 16th
diagnosis code, left justified;
(202) patient's 17th diagnosis code, left
justified;
(203) patient's 18th
diagnosis code, left justified;
(204) patient's admitting diagnosis code
qualifier (9, 0, 1), left justified;
(205) patient's principal diagnosis code
qualifier (9, 0, 1), left justified;
(206) patient's 2nd diagnosis code qualifier
(9, 0, 1), left justified;
(207)
patient's 3rd diagnosis code qualifier (9, 0, 1), left justified;
(208) patient's 4th diagnosis code qualifier
(9, 0, 1), left justified;
(209)
patient's 5th diagnosis code qualifier (9, 0, 1), left justified;
(210) patient's 6th diagnosis code qualifier
(9, 0, 1), left justified;
(211)
patient's 7th diagnosis code qualifier (9, 0, 1), left justified;
(212) patient's 8th diagnosis code qualifier
(9, 0, 1), left justified;
(213)
patient's 9th diagnosis code qualifier (9, 0, 1), left justified;
(214) patient's 10th diagnosis code qualifier
(9, 0, 1), left justified;
(215)
patient's 11th diagnosis code qualifier (9, 0, 1), left justified;
(216) patient's 12th diagnosis code qualifier
(9, 0, 1), left justified;
(217)
patient's 13th diagnosis code qualifier (9, 0, 1), left justified;
(218) patient's 14th diagnosis code qualifier
(9, 0, 1), left justified;
(219)
patient's 15th diagnosis code qualifier (9, 0, 1), left justified;
(220) patient's 16th diagnosis code qualifier
(9, 0, 1), left justified;
(221)
patient's 17th diagnosis code qualifier (9, 0, 1), left justified;
(222) patient's 18th diagnosis code qualifier
(9, 0, 1), left justified;
(223)
1st e-code, left justified, (required);
(224) 2nd e-code, left justified;
(225) 3rd e-code, left justified;
(226) patient's admitting diagnosis, present
on admission, left justified;
(227)
patient's principal diagnosis, present on admission, left justified;
(228) patient's 2nd diagnosis, present on
admission, left justified ;
(229)
patient's 3rd diagnosis, present on admission, left justified ;
(230) patient's 4th diagnosis, present on
admission, left justified ;
(231)
patient's 5th diagnosis, present on admission, left justified ;
(232) patient's 6th diagnosis, present on
admission, left justified ;
(233)
patient's 7th diagnosis, present on admission, left justified ;
(234) patient's 8th diagnosis, present on
admission, left justified ;
(235)
patient's 9th diagnosis, present on admission, left justified ;
(236) patient's 10th diagnosis, present on
admission, left justified ;
(237)
patient's 11th diagnosis, present on admission, left justified ;
(238) patient's 12th diagnosis, present on
admission, left justified ;
(239)
patient's 13th diagnosis, present on admission, left justified ;
(240) patient's 14th diagnosis, present on
admission, left justified ;
(241)
patient's 15th diagnosis, present on admission, left justified ;
(242) patient's 16th diagnosis, present on
admission, left justified ;
(243)
patient's 17th diagnosis, present on admission, left justified ;
(244) patient's 18th diagnosis, present on
admission, left justified ;
(245)
patient's diagnosis related group (DRG) code ;
(246) patient's principal procedure code,
left justified;
(247) patient's 2nd
procedure code, left justified;
(248) patient's 3rd procedure code, left
justified;
(249) patient's 4th
procedure code, left justified;
(250) patient's 5th procedure code, left
justified;
(251) patient's 6th
procedure code, left justified;
(252) patient's 2nd procedure code, left
justified;
(253) patient's 3rd
procedure code, left justified;
(254) patient's 4th procedure code, left
justified;
(255) patient's 5th
procedure code, left justified;
(256) patient's 6th procedure code, left
justified;
(257) patient's
principal procedure code qualifier (9, 0, 1), left justified;
(258) patient's 2nd procedure code qualifier
(9, 0, 1), left justified;
(259)
patient's 3rd procedure code qualifier (9, 0, 1), left justified;
(260) patient's 4th procedure code qualifier
(9, 0, 1), left justified;
(261)
patient's 5th procedure code qualifier (9, 0, 1), left justified;
(262) patient's 6th procedure code qualifier
(9, 0, 1), left justified;
(263)
patient's 2nd procedure code qualifier (9, 0, 1), left justified;
(264) patient's 3rd procedure code qualifier
(9, 0, 1), left justified;
(265)
patient's 4th procedure code qualifier (9, 0, 1), left justified;
(266) patient's 5th procedure code qualifier
(9, 0, 1), left justified;
(267)
patient's 6th procedure code qualifier (9, 0, 1), left justified;