DAR File No. 39415

This rule was published in the June 15, 2015, issue (Vol. 2015, No. 12) of the Utah State Bulletin.


Health, Center for Health Data, Health Care Statistics

Rule R428-11

Health Data Authority Ambulatory Surgical Data Reporting Rule

Notice of Proposed Rule

(Amendment)

DAR File No.: 39415
Filed: 06/01/2015 12:35:12 PM

RULE ANALYSIS

Purpose of the rule or reason for the change:

The purpose of this amendment is to update technical requirements associated with change from ICD-9 to ICD-10, and make appropriate changes to reflect current business practice.

Summary of the rule or change:

Revise the facility review section to coincide with requirements in existing statute and rule; incorporate technical and conforming edits for adherence to ICD-10; and make other changes to reflect current business practice.

State statutory or constitutional authorization for this rule:

  • Title 26, Chapter 33a

Anticipated cost or savings to:

the state budget:

This amendment makes technical changes that improve consistency, clarity, and accuracy of Rule R428-11. The Utah Department of Health (UDOH) determines that these changes will not create any cost or savings impact to the state budget or UDOH's budget, since the changes will not increase workload and can be carried out with existing budget.

local governments:

This filing does not create any direct cost or savings impact to local governments since they are not directly affected by the rule; nor are local governments indirectly impacted because the rule does not create a situation requiring services from local governments.

small businesses:

None--Small businesses will not be impacted by this rule change--as a result, the rule will have no effect on small business budgets for costs or savings.

persons other than small businesses, businesses, or local governmental entities:

Minor technical changes in Rule R428-11 will not create any cost or savings to businesses, individuals, local governments, or persons that are not small businesses.

Compliance costs for affected persons:

There are no compliance costs for persons affected by these changes to Rule R428-11. Although there are several modifications within this amendment, they will not financially impact affected persons.

Comments by the department head on the fiscal impact the rule may have on businesses:

This proposed amendment updates technical reporting requirements due to transition from ICD-9 to ICD-10. The amendment has no cost to business because the changes are technical in nature only.

David Patton, PhD, Executive Director

The full text of this rule may be inspected, during regular business hours, at the Division of Administrative Rules, or at:

Health
Center for Health Data, Health Care Statistics
CANNON HEALTH BLDG
288 N 1460 W
SALT LAKE CITY, UT 84116-3231

Direct questions regarding this rule to:

  • Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at nthurston@utah.gov

Interested persons may present their views on this rule by submitting written comments to the address above no later than 5:00 p.m. on:

07/15/2015

This rule may become effective on:

07/22/2015

Authorized by:

David Patton, Executive Director

RULE TEXT

R428. Health, Center for Health Data, Health Care Statistics.

R428-11. Health Data Authority Ambulatory Surgical Data Reporting Rule.

R428-11-1. Legal Authority.

This rule is promulgated under authority granted by Title 26, Chapter 33a, and in accordance with the Health Data Plan.

 

R428-11-2. Purpose.

This rule establishes the reporting standards for ambulatory surgery data by licensed hospitals and ambulatory surgical facilities. The data will be used to develop and maintain a statewide ambulatory surgical data base.

 

R428-11-3. Source of Ambulatory Surgical Data.

The reporting sources for ambulatory surgery data are Utah licensed general acute care hospitals and ambulatory surgical facilities.

(1) A general acute care hospital shall report discharge data records for each surgical outpatient discharged from its facility.

(2) An ambulatory surgical facility shall report surgical and diagnostic procedure data records for each patient discharged from its facility.

(3) For a patient with multiple discharges, each hospital or ambulatory surgical facility submitting electronic media shall submit a single data record for each discharge. For a patient with multiple billing claims each hospital or ambulatory surgical facility shall consolidate the multiple billings into a single data record for submission after the patient's discharge.

(4) A hospital or ambulatory surgical facility may designate an intermediary or may submit ambulatory surgery data directly to the Office.

(5) Each hospital and ambulatory surgical facility is responsible for compliance with the rule. Use of a designated intermediary does not relieve the hospital or ambulatory surgical facility of its reporting responsibility.

(6) Each hospital and ambulatory surgical facility shall designate a department or other appropriate entity and a person who is responsible for submitting the discharge data records. This person shall also be responsible for communicating with the Office.

(7) The Department of Health may conduct on-site audits to verify the accuracy of all submittals.

 

R428-11-4. Data Submittal Schedule.

(1) Each hospital and ambulatory surgical facility shall submit ambulatory surgery data to the Office[outpatient surgical data according to the schedule shown in Table 1].

(2) Each quarterly submission is due no later than the 15th day of the second month following the last day of a calendar quarter.  The Director of the Office may approve an alternate schedule as long as it meets the needs of the committee.

 

[TABLE


(1) DATA SUBMITTAL SCHEDULE

IF PATIENT'S DATE OF                    DISCHARGE DATA RECORD
DISCHARGE IS BETWEEN:                   IS DUE BY:

January 1 through March 31              May 15
April 1 through June 30                 August 15
July 1 through September 30             November 15
October 1 through December 31           February 15

 

 

]R428-11-5. Data [Element ]Reporting.

(1) Each [data supplier]hospital and ambulatory surgical facility shall submit [to the Office information relating to any patient surgical or diagnostic procedure falling within the types described in Table 2, as defined by the corresponding CPT codes and ICD-9-CM codes. In case of changes in the CPT and/or ICD-9-CM codes in future versions, the most current list shall override the lists in Table 2.]ambulatory surgery data described in the Submittal Manual for Ambulatory Surgery Data.

[(2) Table 3 lists the required data elements. Each data supplier shall collect and submit all data elements shown in Table 3 based on the specifications in the Submittal Manual for Ambulatory Surgery Data.

(3) Each data supplier shall collect patient social security number as a required data element and report the patient social security number with the complete discharge record according to the submittal schedule.

](2) Each hospital and ambulatory surgical facility shall submit data for all fields contained in the Submittal Manual for Ambulatory Surgery Data if the data are available to the hospital and ambulatory surgical facility.

([4]3) The Office shall adopt an encryption method for the patient social security number by creating a record linkage number as the control number.

([5]4) Each [data supplier]hospital and ambulatory surgical facility shall [submit the reported data elements]submit ambulatory surgery data on encrypted electronic media acceptable to the Office or send them electronically through the Utah Health Information Network or another compatible electronic data interchange network or other secure upload or secure email method.

 

[TABLE



  (2) SURGICAL SERVICES TO BE SUBMITTED

DESCRIPTION              CPT CODES      ICD-9-CM CODES
Mastectomy               19120-19396    850-8599
Musculoskeletal          20000-29909    760-8499
Respiratory              30000-32999    300-3499
Cardiovascular           33010-37799    350-3999
Lymphatic                38100-38999    400-4199
Diaphragm                39501-39599
Digestive System         40490-49999    420-5499
Urinary                  50010-53899    550-5999
Male Genital             54000-55899    600-6499
Laparoscopy              56300-56399
Female Genital           56405-58999    650-7199
Endocrine/Nervous        60000-64999    010-0799
Eye                      65091-68899    080-1699
Ear                      69000-69979    180-2099
Heart Catheterization    93501-93660   3721-3723
Nose, Mouth, Pharynx                    210-2999
NOTE (1):  IF PERFORMED IN OPERATING OR PROCEDURE ROOM

 

 

TABLE


(3) REQUIRED DATA ELEMENTS
CATEGORY:        NAME:
Provider
1                Medical care provider identifier
Patient
2                Patient control number
3                Patient's medical chart number
4                Patient's Social Security Number
5                Patient's postal zip code for address
6                Patient's date of birth
7                Patient's gender
Service
8                Admission date
9                Source of admission
10               Patient's status
11               Discharge date
Diagnosis and Treatment
12               Diagnosis codes
13               Procedure codes
14               Date of principal procedure
15               Modifiers for procedure codes
16               ICD9 Procedure Codes
17               Related Diagnosis Codes
Charge
18               Statement covers period
19               Total facility charge
20               Primary, secondary, and third sources of payment
Physician
21               Performing physician ID
22               Additional physicians' IDs
23               Type of bill (for hospital, if applicable)

 

]KEY: health, hospital policy, health planning

Date of Enactment or Last Substantive Amendment: [August 5, 2014]2015

Notice of Continuation: November 14, 2012

Authorizing, and Implemented or Interpreted Law: 26-33a-104; 26-33a-108

 


Additional Information

More information about a Notice of Proposed Rule is available online.

The Portable Document Format (PDF) version of the Bulletin is the official version. The PDF version of this issue is available at https://rules.utah.gov/publicat/bull-pdf/2015/b20150615.pdf. The HTML edition of the Bulletin is a convenience copy. Any discrepancy between the PDF version and HTML version is resolved in favor of the PDF version.

Text to be deleted is struck through and surrounded by brackets ([example]). Text to be added is underlined (example).  Older browsers may not depict some or any of these attributes on the screen or when the document is printed.

For questions regarding the content or application of this rule, please contact Norman Thurston at the above address, by phone at 801-538-7052, by FAX at 801-237-0787, or by Internet E-mail at nthurston@utah.gov.  For questions about the rulemaking process, please contact the Division of Administrative Rules.