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 421.68 - Event Data Release

Universal Citation: 25 TX Admin Code § 421.68

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

(a) DSHS records are public records under Government Code, Chapter 552, except as specifically exempted by Health and Safety Code, §§ 108.010, 108.011 and 108.013 or other state or federal law. Copies of such records may be obtained upon request and upon payment of user fees established by DSHS. The public use data files shall be available for public inspection during normal business hours within ten business days of a written or oral request. Event claims in any format as submitted to DSHS are not available to the public and are exempt from disclosure pursuant to Health and Safety Code, §§ 108.010, 108.011 and 108.013, and shall not be released. Likewise, patient and physician identifying data collected by the DSHS through editing of facility data shall not be released.

(b) Creation of codes and identifiers. DSHS shall develop the following codes and identifiers, as listed in paragraphs (1) - (2) of this subsection, required for creation of the public use data file and for other purposes.

(1) DSHS shall create a process for assigning uniform patient identifiers, uniform physician identifiers and uniform other health professional identifiers using data elements collected. This process is confidential and not subject to public disclosure. Any documents or records produced describing the process or disclosing the person associated with an identifier are confidential and not subject to public disclosure.

(2) DSHS shall create a process for assigning geographic identifiers to each event record.

(c) The data elements specified for outpatient event reports in this section do not constitute "Provider Quality Data" as discussed in Health and Safety Code, § 108.010.

(d) Creation of public use data file. DSHS will create a public use data file by creating a single record for each reportable outpatient event and adding, modifying, or deleting data elements in the following manner as listed in this subsection:

(1) delete patient and insured name, Social Security number, address and certificate data elements, any patient identifying information, and patient control and medical record numbers;

(2) convert patient birth date to age;

(3) convert procedure dates to a code for the day of the week;

(4) convert occurrence dates to day values;

(5) delete physician and other health professional names and numbers and assign an alphanumeric uniform physician identifier for the physicians and other health professionals who were reported as "rendering," "operating or other," or "other provider" on patients;

(6) assign codes indicating the primary and secondary sources of payment;

(7) suppress the record level data elements in a way that the aggregate numbers for a facility or geographic region for that data element is below the number five. Five is the established minimum cell size required by Health and Safety Code, § 108.011(i), unless DSHS determines that a higher cell size is required to protect the confidentiality of an individual patient or physician;

(8) convert all procedure codes to HCPCS codes (in the version that is current for the date the data was due to be submitted or the version in effect at the date of service);

(9) add nationally accepted risk and severity adjustment scores utilizing an algorithm approved by DSHS, when available and applicable;

(10) include the following data elements in the public use data file, unless the data element needs to be suppressed for patient or physician confidentiality as noted under paragraphs (7) or (11) of this subsection:

(A) Event Year and Quarter;

(B) Provider Name (Facility Name);

(D) Facility Type Indicators;

(E) Patient Sex/Gender;

(F) Patient ZIP Code;

(G) County Code;

(H) Health Service Region Code;

(I) Patient State;

(J) Patient Race;

(K) Patient Ethnicity;

(L) Claim Type Indicator;

(M) Type of Bill;

(N) Principal Diagnosis Code (Current version of ICD codes at the time data is submitted);

(O) Other Diagnosis Codes (Up to 24 diagnosis codes can be submitted and reported. Current version of ICD codes at the time data is submitted);

(P) Procedure codes (Up to 24 procedure codes can be submitted and reported. Current version of HCPCS codes at the time data is submitted);

(Q) Reason For Visit (Current version of ICD or HCPCS codes at the time data is submitted);

(R) External Cause of Injury (E-codes), (if applicable) (Current version of ICD codes at the time data is submitted. Up to nine (9) E-codes can be submitted and reported);

(S) Related Cause Code, (if applicable) (Up to three (3) codes can be submitted and reported);

(T) Day of Week Patient is provided services code (Sunday = 1, Monday = 2, Tuesday = 3, Wednesday = 4, Thursday = 5, Friday = 6, Saturday = 7);

(U) Age group of the patient;

(V) APG Code (Obtained from 3M APG Grouper) if applicable (Up to 10);

(W) APG Category Code (Obtained from 3M APG Grouper) if applicable (Up to 10);

(X) APG Type Code (Obtained from 3M APG Grouper) if applicable (Up to 10);

(Y) Final APG Assignment Code (Obtained from 3M APG Grouper) if applicable (Up to 10);

(Z) Final APG Category Code (Obtained from 3M APG Grouper) if applicable (Up to 10);

(AA) APC Procedure Code (if applicable) (Up to 10);

(BB) APC Procedure Status Indicator Code (if applicable) (Up to 10);

(CC) APC Diagnosis Edits (if applicable) (Up to 10);

(DD) APC Procedure Code Edits (if applicable) (Up to 10);

(EE) APC Weight (if applicable) (Up to 10);

(FF) APC Base Procedure (if applicable) (Up to 10);

(GG) Clinical Classification Software Category Codes and associated codes, if applicable;

(HH) Uniform Physician Identifier assigned to Rendering Physician or Rendering Other Health Professional;

(II) Uniform Physician Identifier assigned to Operating Physician or Other Physician or Other Health Professional;

(JJ) Uniform Physician Identifier assigned to Other Provider or Other Health Professional;

(KK) Ancillary Service--Other Charges;

(LL) Ancillary Service--Pharmacy Charges;

(MM) Ancillary Service--Medical/Surgical Supply Charges;

(NN) Ancillary Service--Durable Medical Equipment Charges;

(OO) Ancillary Service--Used Durable Medical Equipment Charges;

(PP) Ancillary Service--Physical Therapy Charges;

(QQ) Ancillary Service--Occupational Therapy Charges;

(RR) Ancillary Service--Speech Pathology Charges;

(SS) Ancillary Service--Inhalation Therapy Charges;

(TT) Ancillary Service--Blood Charges;

(UU) Ancillary Service--Blood Administration Charges;

(VV) Ancillary Service--Operating Room Charges;

(WW) Ancillary Service--Lithotripsy Charges;

(XX) Ancillary Service--Cardiology Charges;

(YY) Ancillary Service--Anesthesia Charges;

(ZZ) Ancillary Service--Laboratory Charges;

(AAA) Ancillary Service--Radiology Charges;

(BBB) Ancillary Service--MRI Charges;

(CCC) Ancillary Service--Outpatient Services Charges;

(DDD) Ancillary Service--Emergency Service Charges;

(EEE) Ancillary Service--Ambulance Charges;

(FFF) Ancillary Service--Professional Fees Charges;

(GGG) Ancillary Service--Organ Acquisition Charges;

(HHH) Ancillary Service--ESRD Revenue Setting Charges;

(III) Ancillary Service--Clinic Visit Charges;

(JJJ) Total Charges--Ancillary;

(KKK) Total Non-Covered Ancillary Charges;

(LLL) Total Charges;

(MMM) Total Non-Covered Charges;

(NNN) Encounter Identifier--a unique number for each encounter for the quarter;

(OOO) Service Line Revenue Code;

(PPP) Service Line Procedure Code;

(QQQ) HCPCS/HIPPS Procedure Code;

(RRR) HCPCS/HIPPS Procedure Modifiers (Up to 4 may be submitted and reported);

(SSS) Service Line Charge Amount;

(TTT) Service Line Unit Code;

(UUU) Service Line Unit Count;

(VVV) Service Line Non-Covered Charge Amount;

(WWW) Patient Country (when the address is not in the United States of America and confidentiality can be maintained);

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

(YYY) Patient Status (Hospital Emergency Department Visits only); and

(ZZZ) Hospital Emergency Department Indicator.

(11) The following data elements for records submitted with diagnosis codes that are associated with alcohol or drug use will be modified to protect those patients that maybe covered by 42 USC § 290dd-2 and 42 CFR Part 2:

(A) Patient ZIP Code shall be reported as "`" (back quote);

(B) Patient Country shall be reported as "`" (back quote); and

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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