Texas Administrative Code
Title 25 - HEALTH SERVICES
Part 1 - DEPARTMENT OF STATE HEALTH SERVICES
Chapter 421 - HEALTH CARE INFORMATION
Subchapter D - COLLECTION AND RELEASE OF OUTPATIENT SURGICAL AND RADIOLOGICAL PROCEDURES AT HOSPITALS AND AMBULATORY SURGICAL CENTERS
Section 421.62 - Collection of Hospital Outpatient and Ambulatory Surgical Center Data

Universal Citation: 25 TX Admin Code § 421.62

Current through Reg. 49, No. 38; September 20, 2024

(a) Each facility in operation for all or any of the reporting periods described in § 421.63 of this title (relating to Schedule for Filing Event Files) shall submit to DSHS event claims as specified in § 421.67 of this title (relating to Event Files--Records, Data Fields and Codes) on all patient events in which the patient received one or more of the surgical procedures or radiological services covered by the revenue codes or surgical and radiological categories specified in § 421.67(f) or (g) of this title. All facilities that are exempt under the Health and Safety Code, Chapter 108, but choose to participate in reporting under this subchapter, shall comply with the requirements in this subchapter. To the extent the medical screening examination, triage, observation, diagnosis or treatment is made by a health professional, other than a physician, data elements specified in §421.67(d)(25) - (30) or (e)(19) of this title shall be filled accordingly or data elements in §421.67(d)(26) or (29) in the modified ANSI 837 Institutional Guide or §421.67(e)(20) in the modified ANSI 837 Professional Guide shall be marked with one of DSHS approved temporary "Physician" or "Other health professional" code numbers and data elements in §421.67(d)(25)(A) - (C) or (28)(A) - (C) in the ANSI 837 Institutional Guide format or §421.67(e)(19)(A) - (C) in the ANSI 837 Professional Guide format may be left blank.

(b) All patient events in which the patient received one or more of the surgical procedures or radiological services covered by the revenue codes or surgical and radiological categories specified in § 421.67(f) or § 421.67(g) of this title shall be reported by the facility that prepares one or more bills for patient services.

(1) The facility shall submit an event claim corresponding to each bill containing the data elements required by § 421.67 of this title. For all patients who received one or more of the surgical procedures or radiological services covered by the revenue codes or surgical and radiological categories specified in § 421.67(f) or § 421.67(g) of this title for which the facility does not prepare a bill for patient services, the facility shall submit an event claim containing the required minimum data set.

(2) For all patients that are covered by 42 USC § 290dd-2 and 42 CFR Part 2.1, a hospital or ambulatory surgical center shall submit a discharge claim containing the required data elements specified by § 421.67 of this title. The hospital or ambulatory surgical center shall replace the patient identifying information with the default values specified in § 421.67(h) of this title or submit the patient identifying information if release of patient identifying information is authorized in writing by the patient or patient's guardian.

(c) Each facility shall submit event files by electronic filing unless the facility receives an exemption letter from DSHS.

(d) Each facility shall submit event claims and event files in the format specified in § 421.67 of this title.

(e) Each facility shall submit event files, data certifications and other required information to DSHS or its agents at physical or telephonic addresses specified by DSHS. DSHS shall notify all facilities and submitters in writing and by publication in the Texas Register at least 30 calendar days before any change in the addresses.

(f) Each facility may submit event files, or may designate an agent to submit the event files. If a facility designates an agent, it shall inform DSHS of the designation in writing at least 30 calendar days prior to the agent's submission of any discharge report. The facility shall inform DSHS in writing at least 30 calendar days prior to changing agents or making the submissions itself.

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