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 421.67 - Event Files-Records, Data Fields and Codes

Universal Citation: 25 TX Admin Code § 421.67

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

(a) Facilities shall submit event files, electronically in the file format for outpatient bills defined by the American National Standards Institute (ANSI), commonly known as the ANSI ASC X12N form 837 Health Care Claims transaction for institutional claims or ANSI ASC X12N form 837 Health Care Claims transaction for professional claims. ANSI updates these formats from time to time by issuing new versions and the United States Department of Health and Human Services adopts regulations regarding HIPAA that update the version allowed for claim submissions.

(b) DSHS will make detailed specifications for these data elements available to submitters and to the public.

(c) In addition to the data elements contained in the ANSI 837 Institutional Guide and the ANSI 837 Professional Guide, DSHS has specified the location where each of the following data elements in this subsection shall be reported in the ANSI 837 Institutional Guide format and the ANSI 837 Professional Guide format. Data element content, format and locations may change as state legislative requirements, or federal legislative or regulation requirements change (i.e., HIPAA).

(1) Patient race - This data element shall be reported at Loop 2300 in the K3 segment as the second numeric value in this data segment. Acceptable codes are 1 = American Indian/Eskimo/Aleut, 2 = Asian or, Pacific Islander, 3 = Black, 4 = White and 5 = Other Race. In order to obtain this data, the facility staff retrieves the patient's response from a written form or asks the patient, or the person speaking for the patient to classify the patient. If the patient, or person speaking for the patient, declines to answer, the facility staff is to use its best judgment to make the correct classification based on available data.

(2) Patient ethnicity - This data element shall be reported at Loop 2300 in the segment K3 as the first numeric value. Acceptable codes are 1 = Hispanic or Latino Origin and 2 = Not of Hispanic or Latino Origin. In order to obtain this data, the facility staff retrieves the patient's response from a written form or asks the patient, or the person speaking for the patient to classify the patient. If the patient, or person speaking for the patient, declines to answer, the facility staff is to use its best judgment to make the correct classification based on available data.

(3) Other E-codes - These additional E-codes (maximum of 9 other E-codes, a total of 10 E-codes may be submitted) shall be reported (if applicable) in the following ANSI 837 Institutional Guide locations: Loop 2300, segments, HI05-2, HI06-2, HI07-2, HI08-2, HI09-2, HI10-2, HI11-2 and HI12-2. (The first E-code is generally reported in Loop 2300 segment HI04-2). E-codes may be submitted in the ANSI 837 Professional Guide in the following locations Loop 2300, data fields: HI02-2, HI03-2, HI04-2, HI05-2, HI06-2, HI07-2 or HI08-2 if applicable preceded by "BN" qualifying code in the respective data field HI02-1, HI03-1, HI04-1, HI05-1, HI06-1, HI07-1 or HI08-1.

(4) THCIC Identification Number - This data element shall be submitted in data segment REF02 (Secondary Identification Number) of one of the following Loops where the patient received the event services:

(A) Loop 2010AA associated with the "Billing Provider"; or

(B) Loop 2010AB associated with the "Pay-to provider"; or

(C) Loop 2310E (ANSI 837 Institutional Guide) or Loop 2310D (ANSI 837 Professional Guide) associated with the "Service Facility Provider".

(d) Facilities shall submit the required minimum data set in the following modified ANSI 837 Institutional Guide format for all patients that are uninsured or considered self-pay or covered by third party payers in which the payer requires the claim be submitted in an ANSI 837 Institutional Guide format or CMS-1450 format for which an event claim is required by this subchapter. The required minimum data set for the modified (as specified in subsection (c) of this section) ANSI 837 Institutional Guide format includes the following data elements as listed in this subsection:

(1) Patient Name:

(A) Patient Last Name;

(B) Patient First Name; and

(2) Patient Address:

(A) Patient Address Line 1;

(B) Patient Address Line 2 (if applicable);

(D) Patient State;

(E) Patient ZIP; and

(F) Patient Country (if address is not in the United States of America, or one of its territories).

(3) Patient Birth Date;

(4) Patient Sex;

(5) Patient Race;

(6) Patient Ethnicity;

(7) Patient Social Security Number;

(8) Patient Account Number;

(9) Patient Medical Record Number;

(10) Claim Filing Indicator Code (primary and secondary);

(11) Payer Name - Primary and secondary (if applicable, for both);

(12) National Plan Identifier - for primary and secondary (if applicable) payers (National Health Plan Identification number, if applicable and when assigned by the Federal Government);

(13) Type of Bill (Facility Type Code plus Claim Frequency Code);

(14) Statement Dates;

(15) Principal Diagnosis;

(16) Patient's Reason for Visit;

(17) External Cause of Injury (E-Code) up to 10 occurrences (if applicable);

(18) Other Diagnosis Codes - up to 24 occurrences (all applicable);

(19) Occurrence Code - up to 24 occurrences (if applicable);

(20) Occurrence Code Associated Date - up to 24 occurrences (if applicable);

(21) Value Code - up to 24 occurrences (if applicable);

(22) Value Code Associated Amount - up to 24 occurrences (if applicable);

(23) Condition Code - up to 24 occurrences (if applicable);

(24) Related Cause Code - up to 3 occurrences (if applicable);

(25) Other Provider or Other Health Professional Name (if applicable):

(A) Other Provider or Other Health Professional Last Name;

(B) Other Provider or Other Health Professional First Name; and

(26) Other Provider or Other Health Professional Primary Identifier (National Provider Identifier) (if applicable);

(27) Other Provider or Other Health Professional Secondary Identifier (Texas state license number) (if applicable);

(28) Operating Physician or Other Health Professional Name (if applicable):

(A) Operating Physician or Other Health Professional Last Name;

(B) Operating Physician or Other Health Professional First Name; and

(29) Operating Physician or Other Health Professional Primary Identifier (National Provider Identifier) (if applicable);

(30) Operating Physician or Other Health Professional Secondary Identifier (Texas state license number) (if applicable);

(31) Total Claim Charges;

(32) Revenue Service Line Details (up to 999 service lines) (all applicable);

(A) Revenue Code;

(B) Procedure Code;

(D) HCPCS Procedure Modifier 2 (applicable to each submitted Procedure code);

(E) HCPCS Procedure Modifier 3 (applicable to each submitted Procedure code);

(F) HCPCS Procedure Modifier 4 (applicable to each submitted Procedure code);

(G) Charge Amount;

(H) Unit Code;

(I) Unit Quantity;

(J) Unit Rate; and

(K) Non-covered Charge Amount.

(33) Service Line Date (effective 90 calendar days after being published in the Texas Register);

(34) Service Provider Name;

(35) Service Provider Primary Identifier - Provider Federal Tax ID (EIN) or National Provider Identifier;

(36) Service Provider Address:

(A) Service Provider Address Line 1;

(B) Service Provider Address Line 2 (if applicable);

(D) Service Provider State; and

(E) Service Provider ZIP; and

(37) Service Provider Secondary Identifier - THCIC 6-digit facility ID assigned to each facility;

(38) Point of Origin (Source of Admission) (Hospital Emergency Department Visits only); and

(39) Patient Status (Hospital Emergency Department Visits only).

(e) Facilities shall submit the following required minimum data set in the following modified ANSI 837 Professional Guide format for all patients for which an event claim is required by a third party payer to be in the ANSI 837 Professional Guide format or CMS-1500 format and required to be submitted under this subchapter. At a facility's option, a facility may choose to submit the required data set listed in subsection (d) of this section. The required minimum data set for the modified (as specified in subsection (c) of this section) ANSI 837 Professional Guide format includes the following data elements as listed in this subsection.

(1) Patient Name.

(A) Patient Last Name;

(B) Patient First Name; and

(2) Patient Address.

(A) Patient Address Line 1;

(B) Patient Address Line 2 (if applicable);

(D) Patient State;

(E) Patient ZIP; and

(F) Patient Country (if address is not in the United States of America or one of its territories);

(3) Patient Birth Date;

(4) Patient Sex;

(5) Patient Race;

(6) Patient Ethnicity;

(7) Patient Social Security Number;

(8) Patient Account Number;

(9) Patient Medical Record Number (if applicable);

(10) Claim Filing Indicator Code (Payer Source - primary and secondary (if applicable for secondary payer source);

(11) Payer Name - Primary and secondary (if applicable, for both);

(12) National Plan Identifier - for primary and secondary (if applicable) payers (National Health Plan Identification number, if applicable and when assigned by the federal government);

(13) Type of Bill (Facility Type Code plus Claim Frequency Code);

(14) Service Date;

(15) Principal Diagnosis;

(16) Other Diagnosis Codes - up to 7 occurrences (all applicable);

(17) Related Cause Code - up to 3 occurrences (if applicable);

(18) Procedure Codes - up to 50 occurrences (all applicable):

(A) HCPCS Procedure Modifier 1 (applicable to each submitted Procedure code);

(B) HCPCS Procedure Modifier 2 (applicable to each submitted Procedure code);

(D) HCPCS Procedure Modifier 4 (applicable to each submitted Procedure code);

(E) Charge Amount;

(F) Unit Code; and

(G) Unit Quantity;

(19) Rendering Provider or Rendering Other Health Professional Name (Up to 2 occurrences):

(A) Rendering Provider or Rendering Other Health Professional Last Name;

(B) Rendering Provider or Rendering Other Health Professional First Name; and

(20) Rendering Provider or Rendering Other Health Professional Primary Identifier (National Provider Identifier) (Up to 2 occurrences);

(21) Rendering Provider or Rendering Other Health Professional Secondary Identifier (Texas state license number) (if primary identifier not available) (Up to 2 occurrences);

(22) Total Claim Charges;

(23) Service Provider Name;

(24) Service Provider Primary Identifier--Provider Federal Tax ID (EIN) or National Provider Identifier;

(25) Service Provider Address:

(A) Service Provider Address Line 1;

(B) Service Provider Address Line 2 (if applicable);

(D) Service Provider State; and

(E) Service Provider ZIP;

(26) Service Provider Secondary Identifier--THCIC 6-digit Hospital ID assigned to each facility.

(f) Facilities shall submit the required minimum data set to DSHS for each patient who has one or more of the following revenue codes in this subsection or one or more of the outpatient surgical or radiological procedures (which are covered by the service and procedure categories listed in subsection (g) of this section) for services rendered to the patient in the facility. Facilities operating in the State of Texas shall submit the required data elements as specified in subsection (d) or (e) of this section relating to the revenue codes in this subsection or the procedure codes covered in the service and procedure categories listed in subsection (g) of this section.

(1) 0320 Radiology--Diagnostic General Classification. (effective 90 calendar days after being published in the Texas Register);

(2) 0321 Radiology--Diagnostic Angiocardiology;

(3) 0322 Radiology--Diagnostic Arthrography;

(4) 0323 Radiology--Diagnostic Arteriography;

(5) 0329 Radiology--Diagnostic Other Radiology - Diagnostic;

(6) 0330 Radiology--Therapeutic General Classification;

(7) 0333 Radiology--Therapeutic Radiation Therapy;

(8) 0339 Radiology--Therapeutic Other Radiology - Therapeutic;

(9) 0340 Nuclear Medicine General Classification;

(10) 0341 Nuclear Medicine Diagnostic;

(11) 0342 Nuclear Medicine Therapeutic;

(12) 0343 Nuclear Medicine Diagnostic Pharmaceuticals;

(13) 0344 Nuclear Medicine Therapeutic Pharmaceuticals;

(14) 0349 Nuclear Medicine Other Nuclear Medicine;

(15) 0350 Computed Tomography (CT) Scan General Classification;

(16) 0351 Computed Tomography (CT)--Head Scan;

(17) 0352 Computed Tomography (CT)--Body Scan;

(18) 0359 Computed Tomography (CT)--Other;

(19) 0360 Operating Room Services General Classification;

(20) 0361 Operating Room Services Minor Surgery;

(21) 0369 Operating Room Services Other Operating Room Services;

(22) 0400 Other Imaging Services General Classification;

(23) 0401 Other Imaging Services Diagnostic Mammography;

(24) 0403 Other Imaging Services Screening Mammography;

(25) 0404 Other Imaging Services Positron Emission Tomography (PET);

(26) 0409 Other Imaging Services Other Imaging Services;

(27) 0481 Cardiology Cardiac Catheterization Lab;

(28) 0483 Cardiology Echocardiology;

(29) 0489 Cardiology Other Cardiology Services;

(30) 0490 Ambulatory Surgical Care General Classification;

(31) 0499 Ambulatory Surgical Care Other Ambulatory Surgical;

(32) 0500 Outpatient Services General Classification;

(33) 0509 Outpatient Services Other Outpatient;

(34) 0610 Magnetic Resonance Technology General Classification;

(35) 0611 Magnetic Resonance Technology Magnetic Resonance Imaging (MRI)--Brain/Brainstem;

(36) 0612 Magnetic Resonance Technology Magnetic Resonance Imaging (MRI)--Spinal Cord/Spine;

(37) 0614 Magnetic Resonance Technology Magnetic Resonance Imaging (MRI)--Other;

(38) 0615 Magnetic Resonance Technology Magnetic Resonance Angiography (MRA)--Head and Neck;

(39) 0616 Magnetic Resonance Technology Magnetic Resonance Angiography (MRA)--Lower Extremities;

(40) 0618 Magnetic Resonance Technology Magnetic Resonance Angiography (MRA)--Other;

(41) 0619 Magnetic Resonance Technology Other Magnetic Resonance Technology;

(42) 0760 Specialty Room--Treatment/Observation Room General Classification;

(43) 0761 Specialty Room--Treatment Room;

(44) 0762 Specialty Room--Observation Room; and

(45) 0769 Specialty Room--Other Specialty Room.

(g) Service and Procedure Categories. The HCPCS code ranges relating to the surgical and radiological or imaging categories to be reported shall be specified by DSHS and published on DSHS' website by November 1st of the year prior to the date on which the services are performed.

(1) Incision or excision of Central Nervous System (CNS);

(2) Insertion, replacement, or removal of extracranial ventricular shunt;

(3) Laminectomy, excision intervertebral disc;

(4) Diagnostic spinal tap;

(5) Insertion of catheter or spinal stimulator and injection into spinal canal;

(6) Decompression of peripheral nerves;

(7) Other diagnostic nervous system procedures (requiring surgical or radiological procedures);

(8) Other operating room therapeutic nervous system surgical procedures;

(9) Thyroidectomy, partial or complete;

(10) Diagnostic endocrine procedures (requiring surgical or radiological procedures);

(11) Other therapeutic endocrine procedures (requiring surgical or radiological procedures);

(12) Corneal transplant;

(13) Glaucoma procedures (requiring surgical or radiological procedures);

(14) Lens and cataract procedures (requiring surgical or radiological procedures);

(15) Repair of retinal tear, detachment (requiring surgical or radiological procedures);

(16) Destruction of lesion of retina and choroid (requiring surgical or radiological procedures);

(17) Diagnostic procedures on eye (requiring surgical or radiological procedures);

(18) Other therapeutic procedures on eyelids, conjunctiva, cornea (requiring surgical or radiological procedures);

(19) Other intraocular therapeutic procedures (requiring surgical or radiological procedures);

(20) Other extraocular muscle and orbit therapeutic procedures (requiring surgical or radiological procedures);

(21) Tympanoplasty;

(22) Myringotomy;

(23) Mastoidectomy;

(24) Diagnostic procedures on ear (requiring surgical or radiological procedures);

(25) Other therapeutic ear procedures (requiring surgical or radiological procedures);

(26) Control of epistaxis (requiring surgical or radiological procedures);

(27) Plastic procedures on nose (requiring surgical or radiological procedures);

(28) Oral and Dental Services (requiring surgical or radiological procedures);

(29) Tonsillectomy or adenoidectomy;

(30) Diagnostic procedures on nose, mouth and pharynx (requiring surgical or radiological procedures);

(31) Other non-operating room therapeutic procedures on nose, mouth and pharynx (requiring surgical procedures);

(32) Other operating room therapeutic procedures on nose, mouth and pharynx (requiring surgical or radiological procedures);

(33) Tracheostomy, temporary and permanent;

(34) Tracheoscopy and laryngoscopy with biopsy;

(35) Lobectomy or pneumonectomy;

(36) Diagnostic bronchoscopy and biopsy of bronchus (requiring surgical or radiological procedures);

(37) Other diagnostic procedures on lung and bronchus (requiring surgical or radiological procedures);

(38) Incision of pleura, thoracentesis, chest drainage;

(39) Other diagnostic procedures of respiratory tract and mediastinum (requiring surgical or radiological procedures);

(40) Other non-operating room therapeutic procedures on respiratory system (requiring surgical procedures);

(41) Other operating room therapeutic procedures on respiratory system (requiring surgical or radiological procedures);

(42) Heart valve procedures;

(43) Coronary artery bypass graft (CABG);

(44) Percutaneous transluminal coronary angioplasty (PTCA);

(45) Coronary thrombolysis (requiring surgical or radiological procedures);

(46) Diagnostic Cardiovascular (Cardiac) catheterization, coronary arteriography;

(47) Insertion, revision, replacement, removal of Cardiovascular (Cardiac) pacemaker or cardioverter/defibrillator (requiring surgical or radiological procedures);

(48) Other operating room heart procedures (requiring surgical or radiological procedures);

(49) Extracorporeal circulation auxiliary to open heart procedures (requiring surgical or radiological procedures);

(50) Endarterectomy, vessel of head and neck;

(51) Aortic resection, replacement or anastomosis;

(52) Varicose vein stripping, lower limb;

(53) Other vascular catheterization, not heart;

(54) Peripheral vascular bypass;

(55) Other vascular bypass and shunt, not heart;

(56) Creation, revision and removal of arteriovenous fistula or vessel-to-vessel cannula for dialysis;

(57) Hemodialysis;

(58) Other operating room procedures on vessels of head and neck (requiring surgical or radiological procedures);

(59) Embolectomy and endarterectomy of lower limbs (requiring surgical or radiological procedures);

(60) Other operating room procedures on vessels other than head and neck (requiring surgical or radiological procedures);

(61) Other diagnostic cardiovascular procedures (requiring surgical or radiological procedures);

(62) Other non-operating room therapeutic cardiovascular procedures (requiring surgical or radiological procedures);

(63) Bone marrow transplant;

(64) Bone marrow biopsy;

(65) Procedures on spleen (requiring surgical or radiological procedures);

(66) Other therapeutic procedures, hemic or lymphatic system (requiring surgical or radiological procedures);

(67) Ligation of esophageal varices;

(68) Esophageal dilatation (requiring surgical or radiological procedures);

(69) Upper gastrointestinal endoscopy, biopsy;

(70) Gastrostomy, temporary or permanent;

(71) Colostomy, temporary or permanent;

(72) Ileostomy and other enterostomy;

(73) Gastrectomy, partial or total;

(74) Small bowel resection;

(75) Colonoscopy or biopsy;

(76) Proctoscopy or anorectal biopsy;

(77) Colorectal resection;

(78) Local excision of large intestine lesion (not endoscopic);

(79) Appendectomy;

(80) Hemorrhoid procedures (requiring surgical or radiological procedures);

(81) Endoscopic retrograde cannulation of pancreas (ERCP);

(82) Biopsy of liver;

(83) Cholecystectomy or common duct exploration (requiring surgical or radiological procedures);

(84) Inguinal or femoral hernia repair (requiring surgical or radiological procedures);

(85) Other hernia repair (requiring surgical or radiological procedures);

(86) Laparoscopy;

(87) Abdominal paracentesis;

(88) Exploratory laparotomy;

(89) Excision, lysis peritoneal adhesions (requiring surgical or radiological procedures);

(90) Other bowel diagnostic procedures (requiring surgical or radiological procedures);

(91) Other non-operating room upper GI therapeutic procedures (requiring surgical or radiological procedures);

(92) Other operating room upper GI therapeutic procedures (requiring surgical or radiological procedures);

(93) Other non-operating room lower GI therapeutic procedures (requiring surgical or radiological procedures);

(94) Other operating room lower GI therapeutic procedures (requiring surgical or radiological procedures);

(95) Other gastrointestinal diagnostic procedures (requiring surgical or radiological procedures);

(96) Other non-operating room gastrointestinal therapeutic procedures (requiring surgical or radiological procedures);

(97) Other operating room gastrointestinal therapeutic procedures (requiring surgical or radiological procedures);

(98) Endoscopy or endoscopic biopsy of the urinary tract;

(99) Transurethral excision, drainage, or removal urinary obstruction (requiring surgical or radiological procedures);

(100) Ureteral catheterization;

(101) Nephrotomy or nephrostomy;

(102) Nephrectomy, partial or complete;

(103) Kidney transplant;

(104) Genitourinary incontinence procedures (requiring surgical or radiological procedures);

(105) Extracorporeal lithotripsy, urinary (requiring surgical or radiological procedures);

(106) Indwelling catheter;

(107) Procedures on the urethra (requiring surgical or radiological procedures);

(108) Other diagnostic procedures of urinary tract (requiring surgical or radiological procedures);

(109) Other non-operating room therapeutic procedures of urinary tract (requiring surgical or radiological procedures);

(110) Other operating room therapeutic procedures of urinary tract (requiring surgical or radiological procedures);

(111) Transurethral resection of prostate (TURP);

(112) Open prostatectomy;

(113) Circumcision;

(114) Diagnostic procedures, male genital (requiring surgical or radiological procedures);

(115) Other non-operating room therapeutic procedures, male genital (requiring surgical or radiological procedures);

(116) Other operating room therapeutic procedures, male genital (requiring surgical or radiological procedures);

(117) Oophorectomy, unilateral or bilateral;

(118) Other operations on ovary (requiring surgical or radiological procedures);

(119) Ligation of fallopian tubes (requiring surgical or radiological procedures);

(120) Removal of ectopic pregnancy (requiring surgical or radiological procedures);

(121) Other operations on fallopian tubes (requiring surgical or radiological procedures);

(122) Hysterectomy, abdominal or vaginal (requiring surgical or radiological procedures);

(123) Other excision of cervix or uterus;

(124) Abortion (termination of pregnancy);

(125) Dilatation and curettage (D&C), aspiration after delivery or abortion (requiring surgical or radiological procedures);

(126) Diagnostic dilatation and curettage (D&C);

(127) Repair of cystocele or rectocele, obliteration of vaginal vault (requiring surgical or radiological procedures);

(128) Other diagnostic procedures, female organs (requiring surgical or radiological procedures);

(129) Other non-operating room therapeutic procedures, female organs (requiring surgical or radiological procedures);

(130) Other operating room therapeutic procedures, female organs (requiring surgical or radiological procedures);

(131) Episiotomy;

(132) Cesarean section;

(133) Forceps, vacuum, or breech delivery (requiring surgical or radiological procedures);

(134) Artificial Rupture of membranes to assist delivery (requiring surgical procedures);

(135) Other procedures to assist delivery (requiring surgical or radiological procedures);

(136) Diagnostic amniocentesis;

(137) Fetal monitoring (requiring surgical or radiological procedures);

(138) Repair of current obstetric laceration;

(139) Other therapeutic obstetrical procedures (requiring surgical or radiological procedures);

(140) Partial excision bone;

(141) Bunionectomy or repair of toe deformities (requiring surgical or radiological procedures);

(142) Treatment, facial fracture or dislocation (requiring surgical or radiological procedures);

(143) Treatment, fracture or dislocation of radius and ulna (requiring surgical or radiological procedures);

(144) Treatment, fracture or dislocation of hip and femur (requiring surgical or radiological procedures);

(145) Treatment, fracture or dislocation of lower extremity (other than hip or femur) (requiring surgical or radiological procedures);

(146) Other fracture and dislocation procedure (requiring surgical or radiological procedures);

(147) Arthroscopy;

(148) Division of joint capsule, ligament or cartilage;

(149) Excision of semilunar cartilage of knee;

(150) Arthroplasty knee;

(151) Hip replacement, total or partial;

(152) Arthroplasty other than hip or knee;

(153) Arthrocentesis;

(154) Injections and aspirations of muscles, tendons, bursa, joints and soft tissue (requiring surgical or radiological procedures);

(155) Amputation of lower extremity;

(156) Spinal fusion (requiring surgical or radiological procedures);

(157) Other diagnostic procedures on musculoskeletal system (requiring surgical or radiological procedures);

(158) Other therapeutic procedures on muscles and tendons (requiring surgical or radiological procedures);

(159) Other operating room therapeutic procedures on bone (requiring surgical or radiological procedures);

(160) Other operating room therapeutic procedures on joints (requiring surgical or radiological procedures);

(161) Other non-operating room therapeutic procedures on musculoskeletal system (requiring surgical or radiological procedures);

(162) Other operating room therapeutic procedures on musculoskeletal system (requiring surgical or radiological procedures);

(163) Breast biopsy or other diagnostic procedures on breast (requiring surgical or radiological procedures);

(164) Lumpectomy, quadrantectomy of breast;

(165) Mastectomy;

(166) Incision and drainage, skin and subcutaneous tissue (requiring surgical or radiological procedures);

(167) Excision of skin lesion;

(168) Suture of skin or subcutaneous tissue;

(169) Skin graft;

(170) Other diagnostic procedures on skin or subcutaneous tissue;

(171) Other non-operating room therapeutic procedures on skin or breast (requiring surgical or radiological procedures);

(172) Other operating room therapeutic procedures on skin or breast (requiring surgical or radiological procedures);

(173) Other organ transplantation;

(174) Computerized axial tomography (CT) scan head;

(175) Computerized axial tomography (CT) scan chest;

(176) Computerized axial tomography (CT) scan abdomen;

(177) Other Computerized axial tomography (CT) scan;

(178) Myelogram;

(179) Mammography;

(180) Routine chest X-ray;

(181) Intraoperative cholangiogram;

(182) Upper gastrointestinal X-ray;

(183) Lower gastrointestinal X-ray;

(184) Intravenous pyelogram;

(185) Cerebral arteriogram;

(186) Contrast aortogram;

(187) Contrast arteriogram of femoral or lower extremity arteries;

(188) Arteriogram or venogram (not heart or head);

(189) Diagnostic ultrasound of head or neck;

(190) Diagnostic ultrasound of heart (echocardiogram);

(191) Diagnostic ultrasound of gastrointestinal tract;

(192) Diagnostic ultrasound of urinary tract;

(193) Diagnostic ultrasound of abdomen or retroperitoneum;

(194) Other diagnostic ultrasound;

(195) Magnetic resonance imaging;

(196) Electroencephalogram (EEG) (requiring surgical or radiological procedures);

(197) Swan-Ganz catheterization for monitoring;

(198) Radioisotope bone scan;

(199) Radioisotope pulmonary scan;

(200) Radioisotope scan or function studies;

(201) Other radioisotope scan;

(202) Therapeutic Radiology;

(203) Traction, splints, or other wound care (requiring surgical or radiological procedures);

(204) Ophthalmologic or otologic diagnosis and treatment (requiring surgical or radiological procedures);

(205) Nasogastric tube (requiring radiological procedures);

(206) Blood transfusion;

(207) Parenteral nutrition (via intravenous methods);

(208) Cancer chemotherapy (requiring surgical or radiological procedures);

(209) Conversion of Cardiovascular (Cardiac) rhythm;

(210) Other diagnostic radiology and related (requiring surgical or radiological procedures);

(211) Other therapeutic procedures (requiring surgical or radiological procedures);

(212) Infertility Services (requiring surgical or radiological procedures);

(213) Medications (Infusions and other forms requiring surgical or radiological procedures); and

(214) Gastric bypass and volume reduction (requiring surgical or radiological procedures).

(h) For patients that are covered by 42 USC § 290dd-2 and 42 CFR Part 2, the hospital shall submit the following patient identifying information or default values in the specified record and field locations as required by subsection (a) of this section:

(1) Patient Account Number - This alphanumeric patient control number shall be reported. This number is unique to the institution and episode of care and will be used by the health care facility to review and certify data.

(2) Last Name--The patient's last name shall be removed and replaced with "Doe."

(3) First Name--The patient's first name shall be removed and replaced with "Jane" if female, or "John" if male, and can include a sequential number (e.g., John1, John2, John3... etc.).

(4) Middle Initial--The patient's middle initial shall be removed and left blank (space filled).

(5) Date of Birth--"January 1" and the patient's year of birth shall be reported.

(6) Address--The patient's residence address shall be removed and replaced with the health care facility's street address.

(7) City--The patient's city of residence shall be removed and replaced with the hospital's city.

(8) State--The patient's state of residence shall be reported.

(9) ZIP Code--The patient's ZIP code of residence shall be removed and replaced with the health care facility's ZIP code.

(10) Medical Record Number--The patient's medical record number shall be reported. This number is unique to the institution and episode of care and will be used by DSHS to process the claim data and for the health care facility to review and certify the patient's data.

(11) Social Security Number--The Patient's Social Security Number shall be removed and replaced with "999999999."

(12) Statement Dates--The month, day, and year of the statement from and statement through dates shall be reported as required. Only the year of service will be retained with record after transfer to the DSHS program administering and completing the processing of the data for the health care data collection system under Health and Safety Code, Chapter 108.

Disclaimer: These regulations may not be the most recent version. Texas 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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