1
CMS RIF REPORT
AS OF: 09/15/2008
NAME LENGTH BEG END CONTENTS
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*** Medicare Provider Analysis and Review
560 1 560 REC
THE REPRESENTATION OF A BENEFICIARY STAY IN AN
INPATIENT HOSPITAL OR IN A SKILLED NURSING
FACILITY (SNF) WHICH MAY INCLUDE ONE OR MORE FINAL
ACTION CLAIMS.
THE MEDICARE PROVIDER ANALYSIS AND REVIEW (MEDPAR)
FILE CONTAINS DATA FROM CLAIMS FOR SERVICES PROVIDED
TO MEDICARE BENEFICIARIES ADMITTED TO MEDICARE-
CERTIFIED HOSPITALS AND SKILLED NURSING FACILITIES
(SNF). THE FILE IS CREATED QUARTERLY IN MARCH, JUNE,
SEPTEMBER, AND DECEMBER, AND IS GENERALLY AVAILABLE
TWO WEEKS AFTER THE END OF THE QUARTER. EACH MEDPAR
RECORD REPRESENTS A BENEFICIARY STAY IN AN INPATIENT
HOSPITAL (WHERE DISCHARGED) OR IN A SNF (MAY BE
'STILL A PATIENT'; COMPLETE DISCHARGE DATA NOT ALWAYS
RECEIVED), AND MAY INCLUDE ONE CLAIM OR MULTIPLE
CLAIMS. (APPROXIMATELY 95% OF INPATIENT MEDPAR
RECORDS AND 50% OF SNF MEDPAR RECORDS INVOLVE A
SINGLE CLAIM.)
BEGINNING IN JUNE 2007, THE MEDPAR FILE WAS
REVISED TO IMPLEMENT A POLICY CHANGE THAT CHANGED
HOW THE SSI DAY COUNT IS CALCULATED. THE LENGTH
OF STAY IS NOW USED TO CALCULATE THE SSI DAY COUNT
INSTEAD OF USING COVERED DAYS. OTHER CHANGES TO THE
FILE INCLUDED: (1) ADDING THE NPI FIELD TO THE FILE;
AND (2) FILLER WAS ADDED TO THE DIAGNOSIS AND PROCEDURE
CODE GROUPS AND AT THE END OF THE RECORD.
BEGINNING IN JUNE 1995, THE INPATIENT AND SNF
CLAIMS FROM THE NATIONAL CLAIMS HISTORY (NCH)
100% NEARLINE FILE BECAME THE SOURCE OF MEDPAR.
ALSO EFFECTIVE JUNE, 1995, A MEDPAR RECORD
REPRESENTS FINAL ACTION CLAIMS DATA IN WHICH ALL
ADJUSTMENTS HAVE BEEN RESOLVED (THEREBY ELIMINATING
CREDIT-ONLY SITUATIONS).
(PRIOR TO JUNE 1995, MEDPAR WAS CREATED FROM CLAIMS
FROM THE MEDICARE QUALITY ASSURANCE (MQA) SYSTEM;
A MEDPAR RECORD REPRESENTED AN ACCUMULATION OF
ADJUSTMENT CLAIMS, SOMETIMES INCLUDING CREDIT-ONLY
STAYS.)
EFFECTIVE WITH THE 9/96 UPDATE
THE 1995 MEDPAR WAS CREATED AS FOLLOWS:
1. EACH MONTH INPATIENT AND SNF CLAIMS ARE
ACCUMULATED FROM THE NCH NEARLINE REPOSITORY.
2. AT THE END OF EACH QUARTER, THE MONTHLY FILES ARE
MERGED INTO A DATABASE CONTAINING ALL CLAIMS FOR
THE CURRENT YEAR AND PRIOR TWO YEARS.
THE DATABASE IS PROCESSED THROUGH THE FINAL
ACTION ALGORITHMS.
3. THE FINAL-ACTIONED DATABASE IS SPLIT INTO
TWO SEGMENTS FOR EACH YEAR.
INPATIENT CLAIMS WITH DISCHARGE DATES AND SNF
CLAIMS WITH ADMISSION DATES IN JANUARY THROUGH
SEPTEMBER ARE IN THE FIRST SEGMENT; CLAIMS WITH
DATES IN OCTOBER THROUGH DECEMBER ARE IN THE
SECOND SEGMENT. THIS ALLOWS FOR THE CREATION
OF FISCAL YEAR OR CALENDAR YEAR FILES AS
NEEDED.
4. THE CLAIMS REMAINING FROM THE FINAL
ACTION PROCESSING ARE COLLAPSED BY
CLAIM NUMBER, ADMISSION DATE, AND PROVIDER
NUMBER (ALL IN ASCENDING ORDER) TO CREATE A
STAY RECORD. THE RECORDS ARE FURTHER SORTED BY
CLAIM FROM DATE, CLAIM THRU DATE, (BOTH IN
ASCENDING ORDER), HCFA PROCESS DATE (DESCENDING),
AND QUERY CODE (DESCENDING); AND THE RESULTS ARE
USED TO CREATE MEDPAR.
FOR THE 6/95 THROUGH THE 6/96 UPDATES
THE 1995 MEDPAR WAS CREATED AS FOLLOWS:
* EACH MONTH INPATIENT AND SNF CLAIMS ARE
ACCUMULATED FROM THE NCH NEARLINE REPOSITORY.
* AT THE END OF EACH QUARTER, THE MONTHLY FILES
ARE MERGED INTO A DATABASE CONTAINING ALL CLAIMS FOR
THE CURRENT YEAR AND PRIOR TWO YEARS. THE DATABASE
IS SPLIT INTO TWO SEGMENTS FOR EACH YEAR.
INPATIENT CLAIMS WITH DISCHARGE DATES AND SNF
CLAIMS WITH ADMISSION DATES IN JANUARY THROUGH
SEPTEMBER ARE IN THE FIRST SEGMENT; CLAIMS WITH
DATES IN OCTOBER THROUGH DECEMBER ARE IN THE
SECOND SEGMENT. THIS ALLOWS FOR THE CREATION
OF FISCAL YEAR OR CALENDAR YEAR FILES AS
NEEDED.
* THE SEGMENTS ARE PROCESSED THROUGH THE FINAL
ACTION ALGORITHMS. THE CLAIMS REMAINING FROM
THE FINAL ACTION PROCESSING ARE COLLAPSED BY
CLAIM NUMBER, ADMISSION DATE, AND PROVIDER
NUMBER (ALL IN ASCENDING ORDER) TO CREATE A
STAY RECORD. THE RECORDS ARE FURTHER SORTED BY
CLAIM FROM DATE, CLAIM THRU DATE, (BOTH IN
ASCENDING ORDER), HCFA PROCESS DATE (DESCENDING),
AND QUERY CODE (DESCENDING); AND THE RESULTS ARE
USED TO CREATE MEDPAR.
NOTE: THERE ARE 60%, 20% AND "OTHER" 20% FILES
CREATED QUARTERLY FOR EACH FISCAL YEAR (FY) AND
CALENDAR YEAR (CY) MEDPAR FILES. THESE FILES ARE
DERIVED BASED ON THE FOLLOWING CRITERIA:
60% -- 9TH POS. OF HIC; SELECTION VALUES 1,2,3,6,7,9
20% -- 9TH POS. OF HIC; SELECTION VALUES 0, 5
OTHER 20% -- 9TH POS. OF HIC; SELECTION VALUES 4,8
SYSTEM ALIAS : MEDPR560
LIMITATIONS :
REFER TO :
MEDPAR_MAR_QTRLY_UPDT_LIM
1. MEDPAR Claim Locator Number Group
11 1 11 GRP
This number uniquely identifies the beneficiary.
2. MEDPAR Beneficiary Claim Account Number
9 1 9 CHAR
The number identifying the primary beneficiary under the SSA
or RRB programs submitted.
NOTE: This field comes from the CAN that is present on the
first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CAN
STANDARD ALIAS : MEDPAR_BENE_CLM_ACNT_NUM
LENGTH : 9
SOURCE : NCH
3. MEDPAR Category Equatable Beneficiary Identification Code
2 10 11 CHAR
The code which categorizes groups of BICs representing
similar relationships between the beneficiary and the
primary wage earner.
The equatable BIC module electronically matches two records
that contain different BICs where it is apparent that both
are records for the same beneficiary. It validates the BIC
and returns a base BIC under which to house the record in
the national claims history (NCH) databases. (All records
for a beneficiary are stored under a single BIC.)
NOTE: This field comes from the NCH category base BIC that
is present on the first claim record included in the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : EQ_BIC
STANDARD ALIAS : MEDPAR_CTGRY_EQTBL_BIC_CD
LENGTH : 2
SOURCE : NCH
CODE TABLE : CTGRY_EQTBL_BENE_IDENT_TB
4. MEDPAR BENEFICIARY AGE COUNT
3 12 14 NUM
The beneficiary's age as of date of admission.
DB2 ALIAS : UNDEFINED
STANDARD ALIAS : MEDPAR_BENE_AGE_CNT
LENGTH : 3 SIGNED : N
DERIVATIONS :
This field is derived by subtracting the bene date of
birth from the admission date, present on the first
claim record included in the stay. Exception: If the
resulting age is 64, and the MSC = 10 or 11, the age
is changed to 65.
SOURCE : NCH
5. MEDPAR Beneficiary Sex Code
1 15 15 CHAR
The sex of a beneficiary.
NOTE: This field comes from the sex code that is present
on the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SEX
STANDARD ALIAS : MEDPAR_BENE_SEX_CD
LENGTH : 1
SOURCE : NCH
CODE TABLE : BENE_SEX_IDENT_TB
6. MEDPAR Beneficiary Race Code
1 16 16 CHAR
The race of a beneficiary.
NOTE: This field comes from the race code that is present
on the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : RACE
STANDARD ALIAS : MEDPAR_BENE_RACE_CD
LENGTH : 1
SOURCE : NCH
CODE TABLE : BENE_RACE_TB
7. MEDPAR Beneficiary Medicare Status Code
2 17 18 CHAR
The CWF-derived reason for a beneficiary's entitlement to
Medicare benefits, as of the reference date (CLM_THRU_DT).
DB2 ALIAS : UNDEFINED
SAS ALIAS : MS_CD
STANDARD ALIAS : MEDPAR_BENE_MDCR_STUS_CD
LENGTH : 2
DERIVATIONS :
CWF derives MSC from the following:
1. Date of birth
2. Claim through date
3. Original/Current reasons for entitlement
4. ESRD indicator
5. Beneficiary claim number
Items 1,3,4,5 come from the CWF beneficiary
master record; Item 2 comes from the FI/Carrier
claim record. MSC is assigned as follows:
MSC OASI DIB ESRD AGE BIC
_____ ______ _____ ______ _____ _____
10 YES N/A NO 65 AND OVER N/A
11 YES N/A YES 65 AND OVER N/A
20 NO YES NO UNDER 65 N/A
21 NO YES YES UNDER 65 N/A
31 NO NO YES ANY AGE T.
SOURCE : NCH
CODE TABLE : BENE_MDCR_STUS_TB
8. MEDPAR Beneficiary Residence SSA Standard State Code
2 19 20 CHAR
The SSA standard state code of a beneficiary's residence.
NOTE: This field comes from the state code that is present
on the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : STATE_CD
STANDARD ALIAS : MEDPAR_BENE_RSDNC_SSA_STATE_CD
LENGTH : 2
SOURCE : NCH
CODE TABLE : GEO_SSA_STATE_TB
9. MEDPAR Beneficiary Residence SSA Standard County Code
3 21 23 CHAR
The SSA standard county code of a beneficiary's residence.
NOTE: This field comes from the county code that is present
on the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CNTY_CD
STANDARD ALIAS : MEDPAR_BENE_RSDNC_SSA_CNTY_CD
LENGTH : 3
SOURCE : NCH
10. MEDPAR Beneficiary Mailing Contact Zip Code
5 24 28 CHAR
The zip code of the mailing address where the beneficiary
may be contacted.
NOTE: This field comes from the zip code that is present on
the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BENE_ZIP
STANDARD ALIAS : MEDPAR_BENE_MLG_CNTCT_ZIP_CD
LENGTH : 5
SOURCE : NCH
11. FILLER CHAR
4 29 32
DB2 ALIAS : FILLER
LENGTH : 4
12. MEDPAR Admission Day Code
1 33 33 NUM
The code indicating the day of the week on which the
beneficiary was admitted to a facility.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ADMSNDAY
STANDARD ALIAS : MEDPAR_ADMSN_DAY_CD
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived from the admission date that
is present on the first claim record included in
the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_ADMSN_DAY_TB
13. MEDPAR Beneficiary Discharge Status Code
1 34 34 CHAR
The code used to identify the status of the patient as of
the CLM_THRU_DT.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DSCHRGCD
STANDARD ALIAS : MEDPAR_BENE_DSCHRG_STUS_CD
LENGTH : 1
DERIVATIONS :
This field is derived from the claim status code that is
present on the last claim record included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_BENE_DSCHRG_STUS_TB
14. MEDPAR GHO Paid Code
1 35 35 CHAR
The code indicating whether or not a GHO has paid the
provider for the claim(s).
NOTE: This field comes from the GHO-paid indicator that is
present on the first claim record included in the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : GHOPDCD
STANDARD ALIAS : MEDPAR_GHO_PD_CD
LENGTH : 1
SOURCE : NCH
CODE TABLE : MEDPAR_GHO_PD_TB
15. MEDPAR PPS Indicator Code
1 36 36 CHAR
The code indicating whether or not the facility is being
paid under the prospective payment system (PPS).
DB2 ALIAS : UNDEFINED
SAS ALIAS : PPS_IND
STANDARD ALIAS : MEDPAR_PPS_IND_CD
LENGTH : 1
DERIVATIONS :
If the condition code not equal 65 on all of the claims
included in the stay and the third position of the
provider number is numeric set MEDPAR_PPS_IND_CD to
2 (PPS). Otherwise set it to 0 (Non PPS.)
SOURCE : NCH
CODE TABLE : MEDPAR_PPS_IND_TB
16. MEDPAR Organization NPI Number
10 37 46 CHAR
ON AN INSTITUTIONAL CLAIM, THE NATIONAL PROVIDER
IDENTIFIER (NPI) NUMBER ASSIGNED TO UNIQUELY
IDENTIFY THE INSTITUTIONAL PROVIDER CERTIFIED BY
MEDICARE TO PROVIDE SERVICES TO THE BENEFICIARY.
NOTE: EFFECTIVE MAY 23, 2007, THE NPI BECAME THE
NATIONAL STANDARD IDENTIFIER FOR COVERED HEALTH
CARE PROVIDERS. THE NPI WILL REPLACE CURRENT OSCAR
PROVIDER NUMBERS, UPINS, NSC NUMBERS, AND LOCAL
CONTRACTOR PROVIDER IDENTIFICATION NUMBERS (PINS) ON
STANDARD HIPPA CLAIM TRANSACTIONS.
NOTE1: CMS HAS DETERMINED THAT DUAL PROVIDER
IDENTIFIERS (LEGACY NUMBERS AND NEW NPI) MUST BE
AVAILABLE IN THE NCH. AFTER THE 5/07 NPI IMPLE-
MENTATION, THE STANDARD SYSTEM MAINTAINERS WILL ADD
THE LEGACY NUMBER TO THE CLAIM WHEN IT IS ADJUDICATED.
NOTE: THIS FIELD COMES FROM THE ORGANIZATION NPI
THAT IS PRESENT ON THE FIRST CLAIM RECORD INCLUDED IN
THE STAY.
DB2 ALIAS : UNDEFINED
LENGTH : 10
17. MEDPAR ProviderNumber Group
6 47 52 GRP
18. MEDPAR Provider State Code
2 47 48 NUM
The first two positions of the provider number, identifying
the state of the institutional provider that furnished
services to the beneficiary during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRVSTATE
STANDARD ALIAS : MEDPAR_PRVDR_STATE_CD
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field comes from positions 1 & 2 of the provider
number that is present on the first claim record
included in the stay.
SOURCE : NCH
CODE TABLE : GEO_SSA_STATE_TB
19. MEDPAR Provider Number Third Position Code
1 49 49 CHAR
The third position of the provider number, identifying the
category of institutional provider that furnished services
to the beneficiary during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRVNUM3
STANDARD ALIAS : MEDPAR_PRVDR_NUM_3RD_CD
LENGTH : 1
DERIVATIONS :
This field is position 3 of the provider number
from the first claim record included in the stay
modified as follows:
Where position 3 is an alpha character (S, T,
U, W or Y) move to the MEDPAR provider
special unit code and replace with a '0'.
Where position 3 is an alpha character (M or R)
move to the MEDPAR provider special unit
code and replace with a '1'.
SOURCE : NCH
20. MEDPAR Provider Number Serial Code
3 50 52 CHAR
The last three positions of the provider number, identifying
the specific serial numbers of the institutional provider
that furnished services to the beneficiary during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRVDRSRL
STANDARD ALIAS : MEDPAR_PRVDR_NUM_SRL_CD
LENGTH : 3
DERIVATIONS :
This field comes from positions 4 - 6 of the provider
number on the first claim record included in the stay.
SOURCE : NCH
21. MEDPAR Provider Number Special Unit Code
1 53 53 CHAR
The code identifying the special numbering system for units
of hospitals that are excluded from PPS or hospitals with
SNF swing-bed designation.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SPCLUNIT
STANDARD ALIAS : MEDPAR_PRVDR_NUM_SPCL_UNIT_CD
LENGTH : 1
DERIVATIONS :
If the third position of the provider number from the
first claim record included in the stay equals 'M',
'R', 'S', 'T', 'U', 'W', 'Y' OR 'Z', it is moved
to this field, otherwise it is blank.
SOURCE : NCH
CODE TABLE : MEDPAR_PRVDR_NUM_SPCL_UNIT_TB
22. MEDPAR Short Stay/Long Stay/SNF Indicator Code
1 54 54 CHAR
The code indicating whether the stay is a short stay, long
stay, or SNF.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SSLSSNF
STANDARD ALIAS : MEDPAR_SS_LS_SNF_IND_CD
LENGTH : 1
DERIVATIONS :
This field is derived from the third position of the
provider number that is present on the first claim
record included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_SS_LS_SNF_IND_TB
23. MEDPAR Stay Final Action Claims Count
2 55 56 PACK
The count of the number of claim records (final action)
included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : FACLMCNT
STANDARD ALIAS : MEDPAR_STAY_FINL_ACTN_CLM_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by counting the number of final
action claims used to create the stay.
SOURCE : NCH
24. MEDPAR Latest Claim Accretion Date
4 57 60 PACK
The date the latest claim record included in the stay was
accreted (posted/processed) to the beneficiary master
record at the CWF host).
DB2 ALIAS : UNDEFINED
SAS ALIAS : ACRTNDT
STANDARD ALIAS : MEDPAR_LTST_CLM_ACRTN_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from the highest accretion date that
is present on the claim records included in the stay.
SOURCE : NCH
EDIT RULES :
YYYYDDD
25. MEDPAR Beneficiary Medicare Benefit Exhausted Date
4 61 64 PACK
The last date for which the beneficiary had Medicare
coverage. This field is completed only where benefits were
exhausted before the discharge date and during the period
covered by stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : EXHST_DT
STANDARD ALIAS : MEDPAR_BENE_MDCR_BNFT_EXHST_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from the highest benefits exhausted
date that is present on the claim records included in
the stay.
SOURCE : NCH
EDIT RULES :
YYYYDDD
26. MEDPAR SNF Qualification From Date
4 65 68 PACK
The beginning date of the beneficiary's qualifying stay.
For Inpatient claims, the date relates to the PPS portion of
the inlier for which there is no utilization to benefits.
For SNF claims, the date relates to the qualifying stay from
a hospital that is at least two days in a row if the source
of admission is an 'a', or at least three days in a row if
the source of admission is other than an 'a'.
DB2 ALIAS : UNDEFINED
SAS ALIAS : QLFYFROM
STANDARD ALIAS : MEDPAR_SNF_QUALN_FROM_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from occurrence span code = 70 and
related occurrence span from date, if present on any
of the claim records included in the stay. If more
than one record has an occurrence span code = 70, with
different span dates, teh date from the last claim
record included in the stay is used.
SOURCE : NCH
EDIT RULES :
YYYYDDD
27. MEDPAR SNF Qualification Through Date
4 69 72 PACK
The ending date of the beneficiary's qualifying stay. For
Inpatient claims, the date relates to the PPS portion of the
inlier for which there is no utilization to benefits. For
SNF claims, the date relates to the qualifying stay from a
hospital that is at least two days in a row if the source of
admission is an 'A', or at least three days in a row if the
source of admission is other than an 'A'.
DB2 ALIAS : UNDEFINED
SAS ALIAS : QLFYTHRU
STANDARD ALIAS : MEDPAR_SNF_QUALN_THRU_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from the occurrence span code = 70 and
related occurrence span thru date, if present on any of
the claims included in the stay. If more than one record
has an occurrence span code = 70, with different span
dates, the date from the last claim record included in
the stay is used.
SOURCE : NCH
EDIT RULES :
YYYYDDD
28. MEDPAR Admission Date
4 73 76 PACK
The date the beneficiary was admitted for Inpatient care or
the date that care started.
NOTE: This field comes from the admission date that is
present on the first claim record included in the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ADMSNDT
STANDARD ALIAS : MEDPAR_ADMSN_DT
LENGTH : 7 SIGNED : Y
SOURCE : NCH
EDIT RULES :
YYYYDDD
29. MEDPAR Discharge Date
4 77 80 PACK
The date on which the beneficiary was discharged or died.
NOTE: This field comes from the highest claim thru date
that is present on the claim records included in the stay,
where the claim status code is other than '30' (still
patient) on the last claim record included in the stay.
Inpatient claims will always have a discharge date; SNF
claims could have a zero date.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DSCHRGDT
STANDARD ALIAS : MEDPAR_DSCHRG_DT
LENGTH : 7 SIGNED : Y
SOURCE : NCH
EDIT RULES :
YYYYDDD
30. MEDPAR Covered Level Care Thru Date
4 81 84 PACK
The date on which a covered level of care ended in a SNF.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CVRLVLDT
STANDARD ALIAS : MEDPAR_CVR_LVL_CARE_THRU_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from the date associated with
occurrence code = 22 if present on any of the claims
included in the stay. If multiple dates, the highest
date is used. This field is only applicable to SNF claims.
SOURCE : NCH
EDIT RULES :
YYYYDDD
31. MEDPAR Beneficiary Death Date
4 85 88 PACK
The date the beneficiary died.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DEATHDT
STANDARD ALIAS : MEDPAR_BENE_DEATH_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field comes from the beneficiary death date, if
present on the enrollment database, which is accessed
prior to creation of the quarterly MEDPAR file.
SOURCE : EDB
LIMITATIONS :
REFER TO :
MEDPAR_DOD_LIM
EDIT RULES :
YYYYDDD
32. MEDPAR Beneficiary Death Date Verified Code
1 89 89 CHAR
The code indicating whether the beneficiary's date of death
has been verified (SOURCE: SSA's MBR) or originated from a
claim record.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DEATHCD
STANDARD ALIAS : MEDPAR_BENE_DEATH_DT_VRFY_CD
LENGTH : 1
DERIVATIONS :
This field is derived from the enrollment database's
beneficiary source death date code, or from the presence
of a claim status code = '20' (expired) on the last
claim record included in the stay.
SOURCE : EDB,NCH
CODE TABLE : MEDPAR_BENE_DEATH_DT_VRFY_TB
33. MEDPAR Internal Use SSI Group
5 90 94 GRP
34. MEDPAR Internal Use SSI Indicator Code
1 90 90 CHAR
DB2 ALIAS : UNDEFINED
SAS ALIAS : SSICD
STANDARD ALIAS : MEDPAR_INTRNL_USE_SSI_IND_CD
LENGTH : 1
COMMENTS :
Limited availability; for internal use only; applicable to
Inpatient claims only. Where not available, this field is
blank.
35. MEDPAR Internal Use SSI Day Count
3 91 93 PACK
DB2 ALIAS : UNDEFINED
SAS ALIAS : SSIDAY
LENGTH : 5 SIGNED : Y
COMMENTS :
Limited availability; for internal use; applicable to Inpatient
claims only. Where not available, this field will contain
zeroes.
NOTE: IN JUNE 2007, A CHANGE WAS MADE TO USE THE LENGTH
OF STAY COUNT IN THE CALCULATION OF THE SSI DAY COUNT.
PRIOR TO JUNE 2007, THE UTILIZATION (COVERED) DAY COUNT
WAS USED.
36. FILLER CHAR
1 94 94
DB2 ALIAS : FILLER
LENGTH : 1
37. MEDPAR Length of Stay Day Count
3 95 97 PACK
The count in days of the total length of a beneficiary's
stay in a hospital or SNF.
DB2 ALIAS : UNDEFINED
SAS ALIAS : LOSCNT
STANDARD ALIAS : MEDPAR_LOS_DAY_CNT
LENGTH : 5 SIGNED : Y
DERIVATIONS :
This field is derived by subtracting the date of
discharge (or thru date in SNF cases where beneficiary
is still a patient) from the date of admission. If
difference is '0,' the value becomes a '1.'
SOURCE : NCH
38. MEDPAR Outlier Day Count
2 98 99 PACK
The count of the number of days paid as outliers (either a
day or cost outlier) under PPS beyond the DRG threshold.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OUTLRDAY
STANDARD ALIAS : MEDPAR_OUTLIER_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by checking the MEDPAR utilization
day count against the DRG threshold table (DRG weights
file).
SOURCE : MEDPAR
39. MEDPAR Utilization Day Count
3 100 102 PACK
The count of the number of covered days of care that are
chargeable to Medicare utilization for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : UTIL_DAY
LENGTH : 5 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the utilization day
count that is present on any of the claim records
included in the stay (i.e., the sum of utilization days
reported on the claims that comprise the stay).
SOURCE : NCH
40. MEDPAR Beneficiary Total Coinsurance Day Count
2 103 104 PACK
The count of the total number of coinsurance days involved
with the beneficiary's stay in a facility. For Inpatient
services, the beneficiary is liable for a daily coinsurance
amount after the 60th day and before the 91st day in a
single spell of illness; for SNF services, the beneficiary
is liable for a daily coinsurance amount after the 20th day
and before the 101st day in a single spell of illness.
DB2 ALIAS : UNDEFINED
SAS ALIAS : COIN_DAY
STANDARD ALIAS : MEDPAR_TOT_COINSRNC_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the coinsurance day
count that is present on any of the claim records
included in the stay (i.e., the sum of coinsurance days
reported on the claims that comprise the stay).
SOURCE : NCH
41. MEDPAR Beneficiary LRD Used Count
2 105 106 PACK
The count of the number of lifetime reserve days (LRD) used
by the beneficiary for this stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : LRD_USE
STANDARD ALIAS : MEDPAR_BENE_LRD_USE_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the lifetime
reserve days used count that is present on any of the
claim records included in the stay (i.e., the sum of LRD
reported on the claims that comprise the stay).
SOURCE : NCH
42. FILLER CHAR
12 107 118
DB2 ALIAS : FILLER
LENGTH : 12
43. MEDPAR Beneficiary Part A Coinsurance Liability Amount
4 119 122 PACK
The amount of money (rounded to whole dollars) identified
as the beneficiary's liability for part A coinsurance for
the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : COIN_AMT
STANDARD ALIAS : MEDPAR_BENE_PTA_COINSRNC_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the beneficiary's
part a coinsurance liability amount that is present on
any of the claim records included in the stay (i.e., the
sum of coinsurance amounts reported on the claims that
comprise the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
44. MEDPAR Beneficiary Inpatient Deductible Liability Amount
4 123 126 PACK
The amount of money (rounded to whole dollars) identified as
the beneficiary's liability for the Inpatient deductible for
the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DED_AMT
STANDARD ALIAS : MEDPAR_BENE_IP_DDCTBL_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the beneficiary
Inpatient deductible amount that is present on any of the
claim records included in the stay (i.e., the sum of the
Inpatient deductibles reported on the claims that
comprise the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
Rounded; On-size (overflow) Situation = All nines
45. MEDPAR Beneficiary Blood Deductible Liability Amount
4 127 130 PACK
The amount of money (rounded to whole dollars) identified as
the beneficiary's liability for the blood deductible for the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BLDDEDAM
STANDARD ALIAS : MEDPAR_BENE_BLOOD_DDCTBL_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the beneficiary
blood deductible liability amount that is present on any
of the claim records included in the stay (i.e., the sum
of the blood deductibles reported on the claims
that comprise the stay).
SOURCE : NCH
LIMITATIONS :
REFER TO :
MEDPAR_BLOOD_DDCTBL_AMT_LIM
EDIT RULES :
+$$$$$$$
Rounded; On-size (overflow) Situation = All nines
46. MEDPAR Beneficiary Primary Payer Amount
4 131 134 PACK
The amount of payment (rounded to whole dollars) made on
behalf of the beneficiary by a primary payer other than
Medicare, which has been applied to the covered Medicare
charges for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRPAYAMT
STANDARD ALIAS : MEDPAR_BENE_PRMRY_PYR_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the beneficiary
primary payer payment amount that is present on any of
the claim records included in the stay (i.e., the sum of
the primary payer amounts reported on the claims that
comprise the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
Rounded; On-size (overflow) situation = All nines
47. MEDPAR DRG Outlier Approved Payment Amount
4 135 138 PACK
The amount of additional payment (rounded to whole dollars)
approved due to an outlier situation over the DRG allowance
for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OUTLRAMT
STANDARD ALIAS : MEDPAR_DRG_OUTLIER_PMT_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the DRG outlier
approved payment amount (value code = 17 amount) that is
present on any of the claim records included in the stay
(i.e., the sum of outlier amounts reported on the claims
that comprise the stay).
COMMENTS :
THIS AMOUNT IS ALREADY INCLUDED IN THE MEDPAR
MEDICARE PAYMENT AMOUNT.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
48. MEDPAR Inpatient Disproportionate Share Amount
4 139 142 PACK
The amount paid over the DRG amount (rounded to whole
dollars) for the disproportionate share hospital for the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DISP_SHR
STANDARD ALIAS : MEDPAR_IP_DSPRPRTNT_SHR_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the value amount
associated with value code = 18 that is present on any of
the claim records included in the stay (i.e., the sum of
value code 18 amounts reported on the claims that
comprise the stay).
COMMENTS :
THIS AMOUNT IS ALREADY INCLUDED IN THE MEDPAR
MEDICARE PAYMENT AMOUNT.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
49. MEDPAR Indirect Medical Education (IME) Amount
4 143 146 PACK
The amount of additional payment (rounded to whole dollars)
made to teaching hospitals for IME for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : IME_AMT
STANDARD ALIAS : MEDPAR_IME_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the value amount
associated with value code = 19 that is present on any of
the claim records included in the stay (i.e., the sum of
IME amounts - value code 19 amounts - reported on the
claims that comprise the stay).
COMMENTS :
This amount is already included in the MEDPAR Medicare payment
amount.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
50. MEDPAR DRG Price Amount
4 147 150 PACK
The amount (called the 'DRG price' for purposes of MEDPAR
analysis) that would have been paid if no deductibles,
coinsurance, primary payers, or outliers were involved
(rounded to whole dollars).
DB2 ALIAS : UNDEFINED
SAS ALIAS : DRGPRICE
STANDARD ALIAS : MEDPAR_DRG_PRICE_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the following
amounts: MEDPAR Medicare payment amount, MEDPAR
beneficiary primary payer payment amount, MEDPAR
beneficiary coinsurance liability amount, MEDPAR
beneficiary Inpatient deductible liability amount,
MEDPAR beneficiary blood deductible amount; and then
subtracting from the sum the MEDPAR DRG outlier
approved payment amount.
SOURCE : NCH
LIMITATIONS :
REFER TO :
MEDPAR_DRG_PRICE_AMT_LIM
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
51. MEDPAR Total Pass Through Amount
4 151 154 PACK
The total of all claim pass through amounts (rounded to
whole dollars) for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PASSTHRU
STANDARD ALIAS : MEDPAR_PASS_THRU_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by multiplying the
pass thru per diem amount that is present on the last
claim record included in the stay times the MEDPAR
utilization day count (the sum of the utilization
(covered) days reported on the claims that comprise the
stay).
COMMENTS :
Items reimbursed as pass through include capital-related costs,
direct medical education costs, kidney acquisition costs for
hospitals approved as rtc's, and bad debts (per provider
reimbursement manual, part 1, section 2405.2).
The MEDPAR pass thru amount is not included in the MEDPAR
Medicare payment amount.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
52. MEDPAR Total PPS Capital Amount
4 155 158 PACK
The total amount (rounded to whole dollars) that is payable
for capital PPS (e.g., reimbursement for depreciation, rent,
certain interest, real estate taxes for hospital
buildings/equipment subject to PPS).
DB2 ALIAS : UNDEFINED
SAS ALIAS : PPS_CPTL
STANDARD ALIAS : MEDPAR_TOT_PPS_CPTL_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the total PPS
capital amount that is present on any of the claim
records included in the stay (i.e., the sum of total PPS
capital amounts reported on the claims that comprise the
stay).
COMMENTS :
This field is already included in the MEDPAR Medicare payment
amount.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
53. FILLER CHAR
12 159 170
DB2 ALIAS : FILLER
LENGTH : 12
54. MEDPAR Total Charge Amount
4 171 174 PACK
The total amount (rounded to whole dollars) of all charges
(covered and noncovered) for all services provided to the
beneficiary for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : TOTCHRG
STANDARD ALIAS : MEDPAR_TOT_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the total charge
amount from all claim records included in the stay (i.e.,
the sum of total charges reported on the claims that
comprise the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
55. MEDPAR Total Covered Charge Amount
4 175 178 PACK
The portion of the total charges amount (rounded to whole
dollars) that is covered by Medicare for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CVRCHRG
STANDARD ALIAS : MEDPAR_TOT_CVR_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by calculating the covered charges
from all claim records included in the stay (i.e.,
subtract the revenue center noncovered charge amount from
the revenue center total charge amount for revenue center
code = 0001 that is reported on the claims that comprise
the stay; sum the results). Exception: if there exists
an erroneous condition relative to revenue center code
0001, the calculation will be made for each revenue
center code included on the claims that comprise the
stay with the results summed to create the total.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
56. MEDPAR Medicare Payment Amount
4 179 182 PACK
Amount of payment made from the Medicare trust fund for the
services covered by the claim record. Generally, the amount
is calculated by the fi; and represents what was paid to the
institutional provider, with the exceptions noted below.
**Note: in some situations, a negative claim payment amount
May be present; e.g., (1) when a beneficiary is charged the
full deductible during a short stay and the deductible
exceeded the amount Medicare pays; or (2) when a beneficiary
is charged a coinsurance amount during a long stay and the
coinsurance amount exceeds the amount Medicare pays (most
prevalent situation involves psych hospitals who are paid a
daily per diem rate no matter what the charges are.)
Under ip PPS, Inpatient hospital services are paid based on
a predetermined rate per discharge, using the DRG patient
classification system and the pricer program. On the ip
PPS claim, the payment amount includes the DRG outlier
approved payment amount, disproportionate share (since
5/1/86), in- direct medical education (since 10/1/88), total
PPS capital (since 10/1/91). It does not include the pass
thru amounts (i.e., capital-related costs, direct medical
education costs, kidney acquisition costs, bad debts); or
any beneficiary-paid amounts (i.e., deductibles and
coinsurance); or any other payer remibursement.
Under SNF PPS, SNFs will classify beneficiaries using the
patient classification system known as rugs III. For the
SNF PPS claim, the SNF pricer will calculate/return the rate
for each revenue center line item with revenue center code =
'0022'; multiply the rate times the units count; and then
sum the amount payable for all lines with revenue center
code '0022' to determine the total claim payment amount.
Exceptions: For claims involving demos and bba encounter
data, the amount reported in this field May not just
represent the actual provider payment.
For demo ids '01','02','03','04' -- claims contain
amount paid to the provider, except that special
'differentials' paid outside the normal payment system
are not included.
For demo ids '05','15' -- encounter data 'claims'
contain amount Medicare would have paid under ffs,
instead of the actual pay- ment to the MCO.
For demo ids '06','07','08' -- claims contain actual
provider payment but represent a special negotiated
bundled payment for both part a and part B services.
To identify what the conventional provider part a
payment would have been, check value code = 'y4'.
For bba encounter data (non-demo) -- 'claims' contain
amount Medicare would have paid under ffs, instead of
the actual payment to the bba plan.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PMT_AMT
STANDARD ALIAS : MEDPAR_MDCR_PMT_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the payment amount
that is present on all of the claim records included in
the stay (i.e, the sum of payment (reimbursement)
reported on the claims that comprise the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
57. MEDPAR All Accommodations Total Charge Amount
4 183 186 PACK
The total charge amount (rounded to whole dollars) for all
accommodations (routine hospital room and board charges for
general care, coronary care and/or intensive care units)
related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ACMDTNS
STANDARD ALIAS : MEDPAR_ACMDTNS_TOT_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is the sum of MEDPAR private room charge
amount, MEDPAR semiprivate room charge amount, MEDPAR
ward charge amount, MEDPAR intensive care charge amount,
and MEDPAR coronary care charge amount (i.e., the
accumulation of the revenue center total charge amount
associated with revenue center codes 0100 - 0219 from all
claim records included in the stay).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
58. MEDPAR Departmental Total Charge Amount
4 187 190 PACK
The total charge amount (rounded to whole dollars) for
all ancillary departments (other than routine room and
board, CCU, and ICU) related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DPRTMNTL
STANDARD ALIAS : MEDPAR_DPRTMNTL_TOT_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
0220 - 0999 from all claim records included in the stay
(i.e, the sum of charges for all revenue centers other
than accommodations 0100 - 0219).
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
59. MEDPAR Accomodations Days Group
10 191 200 GRP
60. MEDPAR Private Room Day Count
2 191 192 PACK
The count of the number of private room days used by the
beneficiary for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRVTDAY
STANDARD ALIAS : MEDPAR_PRVT_ROOM_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
unit count associated with accommodation revenue center
codes 011x and 014x from all claim records included in
the stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9033-9044 series.
SOURCE : NCH
61. MEDPAR Semiprivate Room Day Count
2 193 194 PACK
The count of the number of semi-private room days used by
the beneficiary for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SPRVTDAY
STANDARD ALIAS : MEDPAR_SEMIPRVT_ROOM_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
unit count associated with accommodation revenue center
codes 010X, 012X, 013X, 016X - 019X from all claim
records included in the stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9019-9032 series.
SOURCE : NCH
62. MEDPAR Ward Day Count
2 195 196 PACK
The count of the number of ward days used by the beneficiary
for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : WARDDAY
STANDARD ALIAS : MEDPAR_WARD_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
unit count associated with accommodation revenue center
code 015x from all claim records included in the stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9000-9018 series.
SOURCE : NCH
63. MEDPAR Intensive Care Day Count
2 197 198 PACK
The count of the number of intensive care days used by the
beneficiary for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ICARECNT
STANDARD ALIAS : MEDPAR_INTNSV_CARE_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
unit count associated with accommodation revenue center
codes 020X (all 9 subcategories) from all claims
included in the stay.
SOURCE : NCH
LIMITATIONS :
There is approximately a 20% error rate in the revenue
center code category 0206 due to coders misunderstanding
the term 'post ICU' as including any day after an ICU
stay rather than just days in a step-down/lower case
version of an ICU. 'Post' was removed from the
revenue center code 0206 description, effective
10/1/96 (12/96 MEDPAR update). 0206 Is now defined
as 'intermediate ICU'.
64. MEDPAR Coronary Care Day Count
2 199 200 PACK
The count of the number of coronary care days used by the
beneficiary for the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CRNRYDAY
STANDARD ALIAS : MEDPAR_CRNRY_CARE_DAY_CNT
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
unit count associated with accommodation revenue center
code 021x (all six subcategories) from all claim
records included in the stay.
SOURCE : NCH
LIMITATIONS :
There is approximately a 20% error rate in the revenue
center code category 0214 due to coders misunderstanding
the term 'post ccu' as including any day after a ccu
stay rather than just days in a step-down/lower case
version of a ccu. 'Post' was removed from the
revenue center code 0214 description, effective
10/1/96 (12/96 MEDPAR update). 0214 Is now defined
as 'intermediate ccu'.
65. MEDPAR Accomodations Charges Group
20 201 220 GRP
66. MEDPAR Private Room Charge Amount
4 201 204 PACK
The charge amount (rounded to whole dollars) for private
room accommodations related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRVTAMT
STANDARD ALIAS : MEDPAR_PRVT_ROOM_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
011x and 014x from all claim records included in the
stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9033-9044 series.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
67. MEDPAR Semi-Private Room Charge Amount
4 205 208 PACK
The charge amount (rounded to whole dollars) for semi-
private room accommodations related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SPRVTAMT
STANDARD ALIAS : MEDPAR_SEMIPRVT_ROOM_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
010x, 012x, 013x, and 016x - 019x from all claim records
included in the stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9019-9032 series.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
68. MEDPAR Ward Charge Amount
4 209 212 PACK
The charge amount (rounded to whole dollars) for ward
accommodations related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : WARDAMT
STANDARD ALIAS : MEDPAR_WARD_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center
code 015x from all claim records included in the stay.
Exception for SNF rugs demo eff 3/96 SNF update:
field is derived from revenue center codes
in the 9000-9018 series.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
69. MEDPAR Intensive Care Charge Amount
4 213 216 PACK
The charge amount (rounded to whole dollars) for intensive
care accommodations related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ICAREAMT
STANDARD ALIAS : MEDPAR_INTNSV_CARE_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with accommodation revenue
center code 020x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
70. MEDPAR Coronary Care Charge Amount
4 217 220 PACK
The charge amount (rounded to whole dollars) for coronary
care accommodations related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CRNRYAMT
STANDARD ALIAS : MEDPAR_CRNRY_CARE_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with accommodation revenue
center code 021X from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
71. MEDPAR Service Charges Group
100 221 320 GRP
72. MEDPAR Other Service Charge Amount
4 221 224 PACK
The charge amount (rounded to whole dollars) for other
services (revenue centers that do not fit into other
categories) related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OTHRAMT
STANDARD ALIAS : MEDPAR_OTHR_SRVC_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with the 'other' revenue
center codes from all claim records included in the stay.
the 'other' codes include 0002-0099, 022x, 023x, 024x,
052x, 053x, 055x - 060x, 064x - 070x, 076x - 078x, 090x -
095x, and 099x. (Some of these codes are not yet
assigned.)
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
73. MEDPAR Pharmacy Charge Amount
4 225 228 PACK
The charge amount (rounded to whole dollars) for
pharmaceutical costs related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PHRMCAMT
STANDARD ALIAS : MEDPAR_PHRMCY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
025x, 026x, and 063x from all claims records included in
the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
74. MEDPAR Medical/Surgical Supple Charge Amount
4 229 232 PACK
The charge amount (rounded to whole dollars) for
medical/surgical supplies related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SUPLYAMT
STANDARD ALIAS : MEDPAR_MDCL_SUPLY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
027x and 062x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
75. MEDPAR DME Charge Amount
4 233 236 PACK
The charge amount (rounded to whole dollars) for DME
(purchase of new DME and rentals) related to the
beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DME_AMT
STANDARD ALIAS : MEDPAR_DME_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
0290, 0291, 0292, and 0294 - 0299 from all claim records
included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
76. MEDPAR Used DME Charge Amount
4 237 240 PACK
The charge amount (rounded to whole dollars) for used DME
(purchase of used DME) related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : UDME_AMT
STANDARD ALIAS : MEDPAR_USED_DME_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
0293 from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
77. MEDPAR Physical Therapy Charge Amount
4 241 244 PACK
The charge amount (rounded to whole dollars) for physical
therapy services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PHYTHAMT
STANDARD ALIAS : MEDPAR_PHYS_THRPY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
042x from all claims records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
78. MEDPAR Occupational Therapy Charge Amount
4 245 248 PACK
The charge amount (rounded to whole dollars) for
occupational therapy services provided during the
beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OCPTLAMT
STANDARD ALIAS : MEDPAR_OCPTNL_THRPY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
043x from all claims records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
79. MEDPAR Speech Pathology Charge Amount
4 249 252 PACK
The charge amount (rounded to whole dollars) for speech
pathology services (speech, language, audiology) provided
during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SPCH_AMT
STANDARD ALIAS : MEDPAR_SPCH_PTHLGY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
044x and 047x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
80. MEDPAR Inhalation Therapy Charge Amount
4 253 256 PACK
The charge amount (rounded to whole dollars) for inhalation
therapy services (respiratory and pulmonary function)
provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : INHLTAMT
STANDARD ALIAS : MEDPAR_INHLTN_THRPY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
041x and 046x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
81. MEDPAR Blood Charge Amount
4 257 260 PACK
The charge amount (rounded to whole dollars) for blood
provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BLOODAMT
STANDARD ALIAS : MEDPAR_BLOOD_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
038x from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
82. MEDPAR Blood Administration Charge Amount
4 261 264 PACK
The charge amount (rounded to whole dollars) for blood
storage and processing related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BLDADMIN
STANDARD ALIAS : MEDPAR_BLOOD_ADMIN_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
039x from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
83. MEDPAR Operating Room Charge Amount
4 265 268 PACK
The charge amount (rounded to whole dollars) for the
operating room, recovery room, and labor room delivery used
by the beneficiary during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OROOMAMT
STANDARD ALIAS : MEDPAR_OPRTG_ROOM_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
036X, 071X, and 072X from all claim records included in
the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
84. MEDPAR Lithotripsy Charge Amount
4 269 272 PACK
The charge amount (rounded to whole dollars) for lithotripsy
services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : LTHTRPSY
STANDARD ALIAS : MEDPAR_LTHTRPSY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
079X from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
85. MEDPAR Cardiology Charge Amount
4 273 276 PACK
The charge amount (rounded to whole dollars) for cardiology
services and electrocardiogram(s) provided during the
beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CRDLGY
STANDARD ALIAS : MEDPAR_CRDLGY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
048X and 073X from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
86. MEDPAR Anesthesia Charge Amount
4 277 280 PACK
The charge amount (rounded to whole dollars) for anesthesia
services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ANSTHSA
STANDARD ALIAS : MEDPAR_ANSTHSA_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
037X from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
87. MEDPAR Laboratory Charge Amount
4 281 284 PACK
The charge amount (rounded to whole dollars) for laboratory
costs related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : LAB_AMT
STANDARD ALIAS : MEDPAR_LAB_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
030x, 031x, 074x, and 075x from all claim records
included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
88. MEDPAR Radiology Charge Amount
4 285 288 PACK
The charge amount (rounded to whole dollars) for radiology
costs (including oncology, excluding MRI) related to a
beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : RDLGYAMT
STANDARD ALIAS : MEDPAR_RDLGY_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating revenue center
total charge amount associated with revenue center codes
028x, 032x, 033x, 034x, 035x, and 040x from all claim
records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
89. MEDPAR MRI Charge Amount
4 289 292 PACK
The charge amount (rounded to whole dollars) for MRI
services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : MRI_AMT
STANDARD ALIAS : MEDPAR_MRI_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center 061x
from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
90. MEDPAR Outpatient Service Charge Amount
4 293 296 PACK
The charge amount (rounded to whole dollars) for outpatient
services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OPSRVC
STANDARD ALIAS : MEDPAR_OP_SRVC_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
049x and 050x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
91. MEDPAR Emergency Room Charge Amount
4 297 300 PACK
The charge amount (rounded to whole dollars) for emergency
room services provided during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ER_AMT
STANDARD ALIAS : MEDPAR_ER_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
045X from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
92. MEDPAR Ambulance Charge Amount
4 301 304 PACK
The charge amount (rounded to whole dollars) for ambulance
services related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : AMBLNC
STANDARD ALIAS : MEDPAR_AMBLNC_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
054x from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
93. MEDPAR Professional Fees Charge Amount
4 305 308 PACK
The charge amount (rounded to whole dollars) for
professional fees related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PROFFEES
STANDARD ALIAS : MEDPAR_PROFNL_FEES_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
096x, 097x, and 098x from all claims records included in
the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
94. MEDPAR Organ Acquisition Charge Amount
4 309 312 PACK
The charge amount (rounded to whole dollars) for organ
acquisition or other donor bank services related to a
beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ORGNAMT
STANDARD ALIAS : MEDPAR_ORGN_ACQSTN_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
081x and 089x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
95. MEDPAR ESRD Revenue Setting Charge Amount
4 313 316 PACK
The charge amount (rounded to whole dollars) for ESRD
services (other than organ acquisition and other donor bank)
related to a beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ESRDSETG
STANDARD ALIAS : MEDPAR_ESRD_REV_SETG_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center codes
080x, 082x - 088x from all claim records included in the
stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
96. MEDPAR Clinic Visit Charge Amount
4 317 320 PACK
The charge amount (rounded to whole dollars) for clinic
visits (e.g., visits to chronic pain or dental centers or
to clinics providing psychiatric, ob-gyn, pediatric
services) related to the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CLNC_AMT
STANDARD ALIAS : MEDPAR_CLNC_VISIT_CHRG_AMT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the revenue center
total charge amount associated with revenue center code
051x from all claim records included in the stay.
SOURCE : NCH
EDIT RULES :
+$$$$$$$
ROUNDED; ON-SIZE (OVERFLOW) SITUATION = ALL NINES
97. MEDPAR Accommodations/Services Indicator Group
23 321 343 GRP
98. MEDPAR Intensive Care Unit (ICU) Indicator Code
1 321 321 CHAR
The code indicating that the beneficiary has spent time
under intensive care during the stay. It also specifies the
type of ICU.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ICUINDCD
STANDARD ALIAS : MEDPAR_ICU_IND_CD
LENGTH : 1
DERIVATIONS :
This field is derived by checking for the presence of icu
revenue center codes (listed below) on any of the claim
records included in the stay. If more than one of the
revenue center codes listed below are included on these
claims, the code with the highest revenue center total
charge amount is used.
SOURCE : NCH
LIMITATIONS :
There is approximately a 20% error rate in the revenue
center code category 0206 due to coders misunderstanding
the term 'post ICU' as including any day after an ICU
stay rather than just days in a step-down/lower case
version of an ICU. 'Post' was removed from the
revenue center code 0206 description, effective
10/1/96 (12/96 MEDPAR update). 0206 Is now defined
as 'intermediate ICU'.
CODE TABLE : MEDPAR_ICU_IND_TB
99. MEDPAR Coronary Care Indicator Code
1 322 322 CHAR
The code indicating that the beneficiary has spent time
under coronary care during the stay. It also specifies
the type of coronary care unit.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CRNRY_CD
STANDARD ALIAS : MEDPAR_CRNRY_CARE_IND_CD
LENGTH : 1
DERIVATIONS :
This field is derived by checking for the presence of
coronary care revenue center codes (listed below) on any
of the claim records included in the stay. If more than
one of the revenue center codes listed below are included
on these claims, the code with the highest revenue center
total charge amount is used.
SOURCE : NCH
LIMITATIONS :
There is approximately a 20% error rate in the revenue
center code category 0214 due to coders misunderstanding
the term 'post CCU' as including any day after a CCU
stay rather than just days in a step-down/lower case
version of a CCU. 'Post' was removed from the
revenue center code 0214 description, effective
10/1/96 (12/96 MEDPAR update). 0214 Is now defined
as 'intermediate CCU'.
CODE TABLE : MEDPAR_CRNRY_CARE_IND_TB
100. MEDPAR Pharmacy Indicator Code
1 323 323 NUM
The code indicating whether or not the beneficiary received
drugs during the stay. It also specifies the type of drugs.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PHRMCYCD
STANDARD ALIAS : MEDPAR_PHRMCY_IND_CD
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for the presence of
drug-specific revenue center codes (listed below) on any
of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_PHRMCY_IND_TB
101. MEDPAR Transplant Indicator Code
1 324 324 NUM
The code indicating whether or not the beneficiary received
a organ transplant during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : TRNSPLNT
STANDARD ALIAS : MEDPAR_TRNSPLNT_IND_CD
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for the presence of the
transplant revenue center code (listed below) on any of
the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_TRNSPLNT_IND_TB
102. MEDPAR Radiology Indicators Group
6 325 330 GRP
103. MEDPAR Radiology Oncology Indicator Switch
1 325 325 NUM
The switch indicating whether or not the beneficiary
received radiology oncology services during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ONCLGYSW
STANDARD ALIAS : MEDPAR_RDLGY_ONCLGY_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
028X on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_ONCLGY_IND_TB
104. MEDPAR Radiology Diagnostic Indicator Switch
1 326 326 NUM
The switch indicating whether or not the beneficiary
received radiology diagnostic services during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DGNSTCSW
STANDARD ALIAS : MEDPAR_RDLGY_DGNSTC_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
032x on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_DGNSTC_IND_TB
105. MEDPAR Radiology Therapeutic Indicator Switch
1 327 327 NUM
The switch indicating whether or not the beneficiary
received radiology therapeutic services during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : THRPTCSW
STANDARD ALIAS : MEDPAR_RDLGY_THRPTC_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
033X on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_THRPTC_IND_TB
106. MEDPAR Radiology Nuclear Medicine Indicator Switch
1 328 328 NUM
The switch indicating whether or not the beneficiary
received radiology nuclear medicine services during the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : NUCLR_SW
STANDARD ALIAS : MEDPAR_RDLGY_NUCLR_MDCN_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
034x on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_NUCLR_MDCN_IND_TB
107. MEDPAR Radiology CT Scan Indicator Switch
1 329 329 NUM
The switch indicating whether or not the beneficiary
received radiology computed tomographic (CT) scan services
during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : CTSCANSW
STANDARD ALIAS : MEDPAR_RDLGY_CT_SCAN_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
035X on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_CT_SCAN_IND_TB
108. MEDPAR Radiology Other Imaging Indicator Switch
1 330 330 NUM
The switch indicating whether or not the beneficiary
received radiology other imaging services during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : IMGNG_SW
STANDARD ALIAS : MEDPAR_RDLGY_OTHR_IMGNG_IND_SW
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for revenue center code
040X on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_RDLGY_OTHR_IMGNG_IND_TB
109. MEDPAR Outpatient Services Indicator Code
1 331 331 NUM
The code indicating whether or not the beneficiary has
received outpatient services, ambulatory surgical care, or
both.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OPSRVCCD
STANDARD ALIAS : MEDPAR_OP_SRVC_IND_CD
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is derived by checking for the presence of the
outpatient services revenue center codes listed below on
any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_OP_SRVC_IND_TB
110. MEDPAR Organ Acquisition Indicator Code
2 332 333 CHAR
The code indicating the type of organ acquisition received
by the beneficiary during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ORGNCD
STANDARD ALIAS : MEDPAR_ORGN_ACQSTN_IND_CD
LENGTH : 2
DERIVATIONS :
This field is derived by checking for the presence of the
organ acquisition indicator revenue center codes listed
below on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_ORGN_ACQSTN_IND_TB
111. MEDPAR ESRD Setting Indicator Code
2 334 335 CHAR
The code indicating the type of dialysis received by the
beneficiary during the stay. Up to 5 2-position codes may
be present.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ESRDSETG
STANDARD ALIAS : MEDPAR_ESRD_SETG_IND_CD
LENGTH : 2
DERIVATIONS :
This field is derived from the presence of the dialysis
revenue center codes listed below on any of the claim
records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_ESRD_SETG_IND_TB
OCCURS MIN: 5 OCCURS MAX: 0
112.
74 344 417
113. MEDPAR Diagnosis Code Count
2 344 345 NUM
The count of the number of diagnosis codes included in the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DGNSCNT
STANDARD ALIAS : MEDPAR_DGNS_CD_CNT
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field is derived by adding '1' to the count of the
other diagnosis codes reported on the last claim record
included in the stay. The '1' represents the principal
diagnosis code, which is reported separately from the
other diagnosis.
SOURCE : NCH
EDIT RULES :
RANGE: 1 through 10
114. MEDPAR Diagnosis Code
6 346 351 CHAR
The ICD-9-CM code identifying the primary condition or other
coexisting conditions shown in the medical records as
affecting the services provided during the beneficiary's
stay. This element is part of the MEDPAR diagnosis group
which May occur up to 10 times.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DGNS_CD
STANDARD ALIAS : MEDPAR_DGNS_CD
LENGTH : 6
DERIVATIONS :
This field is the actual principal diagnosis code (1st
occurrence) or one of up to 9 other diagnosis codes that
are present on the last claim record included in the stay.
SOURCE : NCH
EDIT RULES :
5 POSITION Diagnosis Code LEFT JUSTIFIED
OCCURS MIN: 10 OCCURS MAX: 0
115. MEDPAR Claim Present on Admission Indicator Code
10 406 415 CHAR
Effective September 1, 2008, with the implementation
of CR#3, the code used to indicate a condition was
present at the time the beneficiary was admitted to
a general acute care facility.
NOTE: In the POA field, there can be up to 9 POA
indicators for each diagnosis code reflected in the
diagnosis trailer. This field will also contain a
1-byte indicator ('Z' or 'X') to identify the end
of the POA codes.
DB2 ALIAS : UNDEFINED
STANDARD ALIAS : MEDPAR_POA_IND_CD
LENGTH : 10
CODE TABLE : CLM_POA_IND_TB
116. FILLER CHAR
2 416 417
DB2 ALIAS : FILLER
LENGTH : 2
117. MEDPAR Surgical Procedure Indicator Switch
1 418 418 CHAR
The switch indicating whether or not there were any surgical
procedures performed during the beneficiary's stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRCDRSW
STANDARD ALIAS : MEDPAR_SRGCL_PRCDR_IND_SW
LENGTH : 1
DERIVATIONS :
This field is derived by checking for the presence of
procedure codes on the last claim record included in the
stay.
SOURCE : NCH
CODE TABLE : MEDPAR_SRGCL_PRCDR_IND_TB
118. MEDPAR Surgical Procedure Group
82 419 500 GRP
119. MEDPAR Surgical Procedure Code Count
2 419 420 NUM
The count of the number of surgical procedure codes included
in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRCDRCNT
STANDARD ALIAS : MEDPAR_SRGCL_PRCDR_CD_CNT
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field is derived by counting the procedure codes
that are reported on the last claim record included in
the stay.
SOURCE : NCH
EDIT RULES :
RANGE: 0 through 6
120. MEDPAR Surgical Procedure Performed Date Count
2 421 422 NUM
The count of the number of dates associated with the
surgical procedures included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRCDTCNT
STANDARD ALIAS : MEDPAR_SRGCL_PRCDR_DT_CNT
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field is derived by counting the surgical procedures
dates that are reported on the last claim record included
in the stay.
SOURCE : NCH
EDIT RULES :
RANGE: 0 THROUGH 6
121. MEDPAR Surgical Procedure Code
7 423 429 CHAR
The ICD-9-CM code identifying the principal or other
surgical procedure performed during the beneficiary's stay.
This element is part of the MEDPAR surgical procedure group.
It May occur up to 6 times.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRCDR_CD
STANDARD ALIAS : MEDPAR_SRGCL_PRCDR_CD
LENGTH : 7
DERIVATIONS :
This field is the actual principal surgical procedure
code (1st occurrence) or one of up to 5 other surgical
procedure codes that May be present on the last claim
record included in the stay.
SOURCE : NCH
EDIT RULES :
4 POSITION Surgical Procedure Code LEFT JUSTIFIED
OCCURS MIN: 6 OCCURS MAX: 0
122. FILLER CHAR
12 465 476
DB2 ALIAS : FILLER
LENGTH : 12
123. MEDPAR Surgical Procedure Performed Date
4 477 480 PACK
The date on which the icd-9-cm surgical procedure was
performed during the beneficiary's stay. This element is
part of the MEDPAR surgical procedure group. It can occur
up to 6 times.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRCDR_DT
STANDARD ALIAS : MEDPAR_SRGCL_PRCDR_PRFRM_DT
LENGTH : 7 SIGNED : Y
DERIVATIONS :
This field is the actual date associated with the
principal or one of up to 5 other surgical procedure
codes that is present on the last claim record
included in the stay.
SOURCE : NCH
EDIT RULES :
+YYYYDDD
OCCURS MIN: 6 OCCURS MAX: 0
124. MEDPAR Blood Pints Furnished Quantity
2 501 502 PACK
The quantity of blood (number of whole pints) furnished to
the beneficiary during the stay. Note: this includes blood
pints replaced as well as not replaced.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BLDFRNSH
STANDARD ALIAS : MEDPAR_BLOOD_PT_FRNSH_QTY
LENGTH : 3 SIGNED : Y
DERIVATIONS :
This field is derived by accumulating the blood pints
furnished quantity from all claim records included in
the stay.
SOURCE : NCH
125. MEDPAR Beneficiary Identification Code
2 503 504 CHAR
The BIC reported on the first claim record included in the
stay, representing the values existing on the CWF
beneficiary master record on the date the CWF host site
processed the claim.
DB2 ALIAS : UNDEFINED
SAS ALIAS : BIC
STANDARD ALIAS : MEDPAR_BENE_IDENT_CD
LENGTH : 2
SOURCE : NCH
CODE TABLE : BENE_IDENT_TB
126. MEDPAR DRG Code
3 505 507 NUM
The code indicating the DRG to which the claims that
comprise the stay belong for payment purposes.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DRG_CD
STANDARD ALIAS : MEDPAR_DRG_CD
LENGTH : 3 SIGNED : N
DERIVATIONS :
This field comes from the actual DRG code that is present
on the last claim record included in the stay.
exception: if the DRG code is not present
(e.g., claims from maryland and PPS-exempt hospital units
do not have a DRG), a valid DRG is obtained using the
grouper software and is moved to this field.
SOURCE : NCH
127. MEDPAR Discharge Destination Code
2 508 509 NUM
The code primarily indicating the destination of the
beneficiary upon discharge from a facility; also denotes
death or SNF/still patient situations.
DB2 ALIAS : UNDEFINED
SAS ALIAS : DSTNTNCD
STANDARD ALIAS : MEDPAR_DSCHRG_DSTNTN_CD
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field comes from the claim status code that is
present on the last claim record included in the stay.
SOURCE : NCH
CODE TABLE : PTNT_DSCHRG_STUS_TB
128. MEDPAR DRG/Outlier Stay Code
1 510 510 NUM
The code identifying (1) for PPS providers if the stay has
an unusually long length (day outlier) or high cost (cost
outlier); or (2) for non-PPS providers the source for
developing the DRG.
DB2 ALIAS : UNDEFINED
SAS ALIAS : OUTLR_CD
STANDARD ALIAS : MEDPAR_DRG_OUTLIER_STAY_CD
LENGTH : 1 SIGNED : N
DERIVATIONS :
This field is the actual DRG outlier stay code that is
present on the last claim record included in the stay.
Applicable to PPS providers:
0 = No Outlier
1 = Day Outlier
2 = Cost Outlier
Applicable to Non-PPS Providers:
6 = Valid DRG Received From Intermediary
7 = HCFA-Developed DRG
8 = HCFA-Developed DRG Using Claim Status Code
9 = Not Groupable
SOURCE : NCH
129. MEDPAR Beneficiary Primary Payer Code
1 511 511 CHAR
The code indicating the type of payer who has primary
responsibility for the payment of the Medicare beneficiary's
claims related to the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : PRPAY_CD
STANDARD ALIAS : MEDPAR_BENE_PRMRY_PYR_CD
LENGTH : 1
DERIVATIONS :
This field comes from the primary payer code that is
present on the first claim record included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_BENE_PRMRY_PYR_TB
130. MEDPAR ESRD Condition Code
2 512 513 NUM
The code indicating if the beneficiary had an ESRD condition
reported during the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : ESRD_CD
STANDARD ALIAS : MEDPAR_ESRD_COND_CD
LENGTH : 2 SIGNED : N
DERIVATIONS :
This field is derived by checking for condition codes 70
- 76 on any of the claim records included in the stay.
SOURCE : NCH
CODE TABLE : MEDPAR_ESRD_COND_TB
131. MEDPAR Source Inpatient Admission Code
1 514 514 CHAR
The code indicating the source of the beneficiary's
admission to an Inpatient facility or, for newborn
admission, the type of delivery.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SRC_ADMS
STANDARD ALIAS : MEDPAR_SRC_IP_ADMSN_CD
LENGTH : 1
DERIVATIONS :
This field comes from the source Inpatient admission code
that is present on the last claim record included in the
stay.
SOURCE : NCH
CODE TABLE : CLM_SRC_IP_ADMSN_TB
132. MEDPAR Inpatient Admission Type Code
1 515 515 CHAR
The code indicating the type and priority of the
beneficiary's admission to a facility for the Inpatient
hospital stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : TYPE_ADM
STANDARD ALIAS : MEDPAR_IP_ADMSN_TYPE_CD
LENGTH : 1
DERIVATIONS :
This field comes from the Inpatient admission type code
that is present on the last claim record included in the
stay.
SOURCE : NCH
133. MEDPAR Fiscal Intermediary/Carrier Identification Number
5 516 520 CHAR
The identification of the intermediary processing the
beneficiary's claims related to the stay.
NOTE: This field comes from the intermediary number that is
present on the first claim record included in the stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : FICARR
STANDARD ALIAS : MEDPAR_FICARR_IDENT_NUM
LENGTH : 5
SOURCE : NCH
134. MEDPAR Admitting Diagnosis Code
5 521 525 CHAR
The ICD-9-CM code indicating the beneficiary's initial
diagnosis at the time of admission.
NOTE: This field comes from the admitting diagnosis code
that is present on the last claim record included in the
stay.
DB2 ALIAS : UNDEFINED
SAS ALIAS : AD_DGNS
STANDARD ALIAS : MEDPAR_ADMTG_DGNS_CD
LENGTH : 5
SOURCE : NCH
135. FILLER CHAR
4 526 529
DB2 ALIAS : FILLER
LENGTH : 4
136. MEDPAR Admission Death Day Count
3 530 532 PACK
The count of the number of days from the date the
beneficiary was admitted to a facility to the beneficiary's
date of death (DOD).
DB2 ALIAS : UNDEFINED
SAS ALIAS : DEATHDAY
STANDARD ALIAS : MEDPAR_ADMSN_DEATH_DAY_CNT
LENGTH : 5 SIGNED : Y
DERIVATIONS :
This field is derived by counting the number of days
between the MEDPAR admission date (the admission date
present on the first claim record included in the stay)
and MEDPAR beneficiary death date (the death date present
on the enrollment database, which is accessed prior to
creation of the quarterly MEDPAR file).
SOURCE : NCH/EDB
LIMITATIONS :
REFER TO :
MEDPAR_ADMSN_DEATH_DAY_CNT_LIM
137. FILLER CHAR
4 533 536
DB2 ALIAS : FILLER
LENGTH : 4
138. MEDPAR Internal Use (By IPSB) Code
3 537 539 NUM
Limited availability; for internal use only. Where not
available, this field will contain zeroes.
DB2 ALIAS : UNDEFINED
SAS ALIAS : IPSBCD
STANDARD ALIAS : MEDPAR_INTRNL_USE_IPSB_CD
LENGTH : 3 SIGNED : N
139. MEDPAR Internal Use File Date Code
1 540 540 NUM
Limited availability; for internal use only to to identify
fiscal year/calendar year segments. Where not available,
this field will contain a zero.
DB2 ALIAS : UNDEFINED
SAS ALIAS : FILDTCD
STANDARD ALIAS : MEDPAR_INTRNL_USE_FIL_DT_CD
LENGTH : 1 SIGNED : N
140. MEDPAR Internal Use Sample Size Code
1 541 541 NUM
Limited availability; for internal use only to identify the
MEDPAR sample size: 20% (HIC 9th digit = 0, 5); 20% (HIC
9th digit = 4, 8; 60% (remainder). Where not available,
this field will contain a zero.
DB2 ALIAS : UNDEFINED
SAS ALIAS : SMPLSIZE
STANDARD ALIAS : MEDPAR_INTRNL_USE_SMPL_SIZE_CD
LENGTH : 1 SIGNED : N
141. MEDPAR Warning Indicators Code
9 542 550 PACK
The codes (commonly called warning indicators) specifying
detailed billing information obtained from the claims
analyzed for the stay process. The purpose of these codes
is to provide additional information for the MEDPAR user;
i.e., let the user know whether or not the stay included
adjustments, a single claim or multiple claims, any error
conditions, etc..
DB2 ALIAS : UNDEFINED
SAS ALIAS : WRNGCD
STANDARD ALIAS : MEDPAR_WRNG_IND_CD
LENGTH : 17 SIGNED : Y
DERIVATIONS :
This field is packed. Each of the digits identify
a specific item of interest to users of the
MEDPAR file. Warning indicators 1 and 6, and the first
two values of indicator 8, are set early in the process -
while processing all claims through the final action
algorithm, prior to the creation of the stay record. The
other indicators are derived from the claims remaining
after the final action processing, which are used to
create the stay record.
SOURCE : MEDPAR
CODE TABLE : MEDPAR_WRNG_IND_TB
142. FILLER CHAR
10 551 560
DB2 ALIAS : FILLER
LENGTH : 10
H3PM.R_RIF_MAIN_Q,Q1,F
*******************************************************
1
TABLE OF CODES APPENDIX MEDPAR_560_NCH_REC
FROM CA REPOSITORY RIF REPORT
BENE_IDENT_TB Beneficiary Identification Code (BIC) Table
Social Security Administration:
A = Primary claimant
B = Aged wife, age 62 or over (1st
claimant)
B1 = Aged husband, age 62 or over (1st
claimant)
B2 = Young wife, with a child in her care
(1st claimant)
B3 = Aged wife (2nd claimant)
B4 = Aged husband (2nd claimant)
B5 = Young wife (2nd claimant)
B6 = Divorced wife, age 62 or over (1st
claimant)
B7 = Young wife (3rd claimant)
B8 = Aged wife (3rd claimant)
B9 = Divorced wife (2nd claimant)
BA = Aged wife (4th claimant)
BD = Aged wife (5th claimant)
BG = Aged husband (3rd claimant)
BH = Aged husband (4th claimant)
BJ = Aged husband (5th claimant)
BK = Young wife (4th claimant)
BL = Young wife (5th claimant)
BN = Divorced wife (3rd claimant)
BP = Divorced wife (4th claimant)
BQ = Divorced wife (5th claimant)
BR = Divorced husband (1st claimant)
BT = Divorced husband (2nd claimant)
BW = Young husband (2nd claimant)
BY = Young husband (1st claimant)
C1-C9,CA-CZ = Child (includes minor, student
or disabled child)
D = Aged widow, 60 or over (1st claimant)
D1 = Aged widower, age 60 or over (1st
claimant)
D2 = Aged widow (2nd claimant)
D3 = Aged widower (2nd claimant)
D4 = Widow (remarried after attainment of
age 60) (1st claimant)
D5 = Widower (remarried after attainment of
age 60) (1st claimant)
D6 = Surviving divorced wife, age 60 or over
(1st claimant)
D7 = Surviving divorced wife (2nd claimant)
D8 = Aged widow (3rd claimant)
D9 = Remarried widow (2nd claimant)
DA = Remarried widow (3rd claimant)
DD = Aged widow (4th claimant)
DG = Aged widow (5th claimant)
DH = Aged widower (3rd claimant)
DJ = Aged widower (4th claimant)
DK = Aged widower (5th claimant)
DL = Remarried widow (4th claimant)
DM = Surviving divorced husband (2nd
claimant)
DN = Remarried widow (5th claimant)
DP = Remarried widower (2nd claimant)
DQ = Remarried widower (3rd claimant)
DR = Remarried widower (4th claimant)
DS = Surviving divorced husband (3rd
claimant)
DT = Remarried widower (5th claimant)
DV = Surviving divorced wife (3rd claimant)
DW = Surviving divorced wife (4th claimant)
DX = Surviving divorced husband (4th
claimant)
DY = Surviving divorced wife (5th claimant)
DZ = Surviving divorced husband (5th
claimant)
E = Mother (widow) (1st claimant)
E1 = Surviving divorced mother (1st
claimant)
E2 = Mother (widow) (2nd claimant)
E3 = Surviving divorced mother (2nd
claimant)
E4 = Father (widower) (1st claimant)
E5 = Surviving divorced father (widower)
(1st claimant)
E6 = Father (widower) (2nd claimant)
E7 = Mother (widow) (3rd claimant)
E8 = Mother (widow) (4th claimant)
E9 = Surviving divorced father (widower)
(2nd claimant)
EA = Mother (widow) (5th claimant)
EB = Surviving divorced mother (3rd
claimant)
EC = Surviving divorced mother (4th
claimant)
ED = Surviving divorced mother (5th
claimant
EF = Father (widower) (3rd claimant)
EG = Father (widower) (4th claimant)
EH = Father (widower) (5th claimant)
EJ = Surviving divorced father (3rd
claimant)
EK = Surviving divorced father (4th
claimant)
EM = Surviving divorced father (5th
claimant)
F1 = Father
F2 = Mother
F3 = Stepfather
F4 = Stepmother
F5 = Adopting father
F6 = Adopting mother
F7 = Second alleged father
F8 = Second alleged mother
J1 = Primary prouty entitled to HIB
(less than 3 Q.C.) (general fund)
J2 = Primary prouty entitled to HIB
(over 2 Q.C.) (RSI trust fund)
J3 = Primary prouty not entitled to HIB
(less than 3 Q.C.) (general fund)
J4 = Primary prouty not entitled to HIB
(over 2 Q.C.) (RSI trust fund)
K1 = Prouty wife entitled to HIB (less than
3 Q.C.) (general fund) (1st claimant)
K2 = Prouty wife entitled to HIB (over 2
Q.C.) (RSI trust fund) (1st claimant)
K3 = Prouty wife not entitled to HIB (less
than 3 Q.C.) (general fund) (1st
claimant)
K4 = Prouty wife not entitled to HIB (over
2 Q.C.) (RSI trust fund) (1st
claimant)
K5 = Prouty wife entitled to HIB (less than
3 Q.C.) (general fund) (2nd claimant)
K6 = Prouty wife entitled to HIB (over 2
Q.C.) (RSI trust fund) (2nd claimant)
K7 = Prouty wife not entitled to HIB (less
than 3 Q.C.) (general fund) (2nd
claimant)
K8 = Prouty wife not entitled to HIB (over
2 Q.C.) (RSI trust fund) (2nd
claimant)
K9 = Prouty wife entitled to HIB (less than
3 Q.C.) (general fund) (3rd claimant)
KA = Prouty wife entitled to HIB (over 2
Q.C.) (RSI trust fund) (3rd claimant)
KB = Prouty wife not entitled to HIB (less
than 3 Q.C.) (general fund) (3rd
claimant)
KC = Prouty wife not entitled to HIB (over
2 Q.C.) (RSI trust fund) (3rd
claimant)
KD = Prouty wife entitled to HIB (less than
3 Q.C.) (general fund) (4th claimant)
KE = Prouty wife entitled to HIB (over 2 Q.C
(4th claimant)
KF = Prouty wife not entitled to HIB (less
than 3 Q.C.)(4th claimant)
KG = Prouty wife not entitled to HIB (over
2 Q.C.)(4th claimant)
KH = Prouty wife entitled to HIB (less than
3 Q.C.)(5th claimant)
KJ = Prouty wife entitled to HIB (over 2
Q.C.) (5th claimant)
KL = Prouty wife not entitled to HIB (less
than 3 Q.C.)(5th claimant)
KM = Prouty wife not entitled to HIB (over
2 Q.C.) (5th claimant)
M = Uninsured-not qualified for deemed HIB
M1 = Uninsured-qualified but refused HIB
T = Uninsured-entitled to HIB under deemed
or renal provisions
TA = MQGE (primary claimant)
TB = MQGE aged spouse (first claimant)
TC = MQGE disabled adult child (first claimant)
TD = MQGE aged widow(er) (first claimant)
TE = MQGE young widow(er) (first claimant)
TF = MQGE parent (male)
TG = MQGE aged spouse (second claimant)
TH = MQGE aged spouse (third claimant)
TJ = MQGE aged spouse (fourth claimant)
TK = MQGE aged spouse (fifth claimant)
TL = MQGE aged widow(er) (second claimant)
TM = MQGE aged widow(er) (third claimant)
TN = MQGE aged widow(er) (fourth claimant)
TP = MQGE aged widow(er) (fifth claimant)
TQ = MQGE parent (female)
TR = MQGE young widow(er) (second claimant)
TS = MQGE young widow(er) (third claimant)
TT = MQGE young widow(er) (fourth claimant)
TU = MQGE young widow(er) (fifth claimant)
TV = MQGE disabled widow(er) fifth claimant
TW = MQGE disabled widow(er) first claimant
TX = MQGE disabled widow(er) second claimant
TY = MQGE disabled widow(er) third claimant
TZ = MQGE disabled widow(er) fourth claimant
T2-T9 = Disabled child (second to ninth
claimant)
W = Disabled widow, age 50 or over (1st
claimant)
W1 = Disabled widower, age 50 or over (1st
claimant)
W2 = Disabled widow (2nd claimant)
W3 = Disabled widower (2nd claimant)
W4 = Disabled widow (3rd claimant)
W5 = Disabled widower (3rd claimant)
W6 = Disabled surviving divorced wife (1st
claimant)
W7 = Disabled surviving divorced wife (2nd
claimant)
W8 = Disabled surviving divorced wife (3rd
claimant)
W9 = Disabled widow (4th claimant)
WB = Disabled widower (4th claimant)
WC = Disabled surviving divorced wife (4th
claimant)
WF = Disabled widow (5th claimant)
WG = Disabled widower (5th claimant)
WJ = Disabled surviving divorced wife (5th
claimant)
WR = Disabled surviving divorced husband
(1st claimant)
WT = Disabled surviving divorced husband
(2nd claimant)
Railroad Retirement Board:
NOTE:
Employee: a Medicare beneficiary who is
still working or a worker who
died before retirement
Annuitant: a person who retired under the
railroad retirement act on or
after 03/01/37
Pensioner: a person who retired prior to
03/01/37 and was included in the
railroad retirement act
10 = Retirement - employee or annuitant
80 = RR pensioner (age or disability)
14 = Spouse of RR employee or annuitant
(husband or wife)
84 = Spouse of RR pensioner
43 = Child of RR employee
13 = Child of RR annuitant
17 = Disabled adult child of RR annuitant
46 = Widow/widower of RR employee
16 = Widow/widower of RR annuitant
86 = Widow/widower of RR pensioner
43 = Widow of employee with a child in her care
13 = Widow of annuitant with a child in her care
83 = Widow of pensioner with a child in her care
45 = Parent of employee
15 = Parent of annuitant
85 = Parent of pensioner
11 = Survivor joint annuitant
(reduced benefits taken to insure benefits
for surviving spouse)
BENE_MDCR_STUS_TB CWF Beneficiary Medicare Status Table
10 = Aged without ESRD
11 = Aged with ESRD
20 = Disabled without ESRD
21 = Disabled with ESRD
31 = ESRD only
BENE_RACE_TB Beneficiary Race Table
0 = Unknown
1 = White
2 = Black
3 = Other
4 = Asian
5 = Hispanic
6 = North American Native
BENE_SEX_IDENT_TB Beneficiary Sex Identification Table
1 = Male
2 = Female
0 = Unknown
CLM_POA_IND_TB Claim Present on Admission (POA) Indicator Table
Y = Present at the time of inpatient admission
N = Not present at the time of inpatient admission
U = Documentation is insufficient to determine if
condition was present on admission
W = Provider is unable to clinically determine
whether condition was present on admission or
not.
1 = Unreported/not used -- exempt from POA reporting --
this code is the equivalent code of a blank,
however, it was determined that blanks were
undesirable when submitting the data
Z = Denotes the end of the POA indicators
X = Denotes the end of the POA indicators in special
data processing situations that may be identified
by CMS in the future.
CLM_SRC_IP_ADMSN_TB Claim Source Of Inpatient Admission Table
**For Inpatient/SNF Claims:**
0 = ANOMALY: invalid value, if present,
translate to '9'
1 = Non-Health Care Facility Point of Origin
(Physician Referral) - The patient was
admitted to this facility upon an order
of a physician.
2 = Clinic referral - The patient was
admitted upon the recommendation of
this facility's clinic physician.
3 = HMO referral - Reserved for national
assignment. (eff. 3/08)
Prior to 3/08, HMO referral - The patient
was admitted upon the recommendation of
an health maintenance organization (HMO)
physician.
4 = Transfer from hospital (Different Facility) -
The patient was admitted to this facility
as a hospital transfer from an acute care
facility where he or she was an inpatient.
5 = Transfer from a skilled nursing
facility (SNF) or Intermediate Care Facility
(ICF) - The patient was admitted to this
facility as a transfer from a SNF or ICF
where he or she was a resident.
6 = Transfer from another health care
facility - The patient was admitted
to this facility as a transfer from
another type of health care facility
not defined elsewhere in this code list
where he or she was an inpatient.
7 = Emergency room - The patient was
admitted to this facility after receiving
services in this facility's emergency
room department.
8 = Court/law enforcement - The patient was
admitted upon the direction of a
court of law or upon the request of
a law enforcement agency's
representative.
9 = Information not available - The means
by which the patient was admitted is
not known.
A = Reserved for National Assignment. (eff. 3/08)
Prior to 3/08 defined as: Transfer from a Critical
Access Hospital - patient was admitted/referred
to this facility as a transfer from a Critical
Access Hospital.
B = Transfer from Another Home Health Agency -
The patient was admitted to this home
health agency as a transfer from another
home health agency.
C = Readmission to Same Home Health Agency -
The patient was readmitted to this home
health agency within the same home health
episode period.
D = Transfer from hospital inpatient in the
same facility resulting in a separate
claim to the payer - The patient was
admitted to this facility as a transfer
from hospital inpatient within this
facility resulting in a separate
claim to the payer.
---------------------------------------
**For Newborn Type of Admission**
1 = Normal delivery - A baby delivered with
out complications.
2 = Premature delivery - A baby delivered
with time and/or weight factors
qualifying it for premature status.
3 = Sick baby - A baby delivered with
medical complications, other than those
relating to premature status.
4 = Extramural birth - A baby delivered in
a nonsterile environment.
5-8 = Reserved for national assignment.
9 = Information not available.
CTGRY_EQTBL_BENE_IDENT_TB Category Equatable Beneficiary Identification Code (BIC) Table
NCH BIC SSA Categories
------- --------------
A = A;J1;J2;J3;J4;M;M1;T;TA
B = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
TB(F);TD(F);TE(F);TW(F)
B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
TD(M);TE(M);TW(M)
B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
W7;TG(F);TL(F);TR(F);TX(F)
B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
TL(M);TR(M);TX(M)
B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
W8;TH(F);TM(F);TS(F);TY(F)
BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
WC;TJ(F);TN(F);TT(F);TZ(F)
BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
WJ;TK(F);TP(F);TU(F);TV(F)
BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
TY(M)
BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
TZ(M)
BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
TV(M)
C1 = C1;TC
C2 = C2;T2
C3 = C3;T3
C4 = C4;T4
C5 = C5;T5
C6 = C6;T6
C7 = C7;T7
C8 = C8;T8
C9 = C9;T9
F1 = F1;TF
F2 = F2;TQ
F3-F8 = Equatable only to itself (e.g., F3 IS
equatable to F3)
CA-CZ = Equatable only to itself. (e.g., CA is
only equatable to CA)
---------------------------------------
RRB Categories
10 = 10
11 = 11
13 = 13;17
14 = 14;16
15 = 15
43 = 43
45 = 45
46 = 46
80 = 80
83 = 83
84 = 84;86
85 = 85
GEO_SSA_STATE_TB State Table
01 = Alabama
02 = Alaska
03 = Arizona
04 = Arkansas
05 = California
06 = Colorado
07 = Connecticut
08 = Delaware
09 = District of Columbia
10 = Florida
11 = Georgia
12 = Hawaii
13 = Idaho
14 = Illinois
15 = Indiana
16 = Iowa
17 = Kansas
18 = Kentucky
19 = Louisiana
20 = Maine
21 = Maryland
22 = Massachusetts
23 = Michigan
24 = Minnesota
25 = Mississippi
26 = Missouri
27 = Montana
28 = Nebraska
29 = Nevada
30 = New Hampshire
31 = New Jersey
32 = New Mexico
33 = New York
34 = North Carolina
35 = North Dakota
36 = Ohio
37 = Oklahoma
38 = Oregon
39 = Pennsylvania
40 = Puerto Rico
41 = Rhode Island
42 = South Carolina
43 = South Dakota
44 = Tennessee
45 = Texas
46 = Utah
47 = Vermont
48 = Virgin Islands
49 = Virginia
50 = Washington
51 = West Virginia
52 = Wisconsin
53 = Wyoming
54 = Africa
55 = California
56 = Canada & Islands
57 = Central America and West Indies
58 = Europe
59 = Mexico
60 = Oceania
61 = Philippines
62 = South America
63 = U.S. Possessions
64 = American Samoa
65 = Guam
66 = Commonwealth of the Northern Marianas Islands
67 = Texas
68 = Florida (eff. 10/2005)
69 = Florida (eff. 10/2005)
70 = Kansas (eff. 10/2005)
71 = Louisiana (eff. 10/2005)
72 = Ohio (eff. 10/2005)
73 = Pennsylvania (eff. 10/2005)
74 = Texas (eff. 10/2005)
80 = Maryland (eff. 8/2000)
97 = Northern Marianas
98 = Guam
99 = With 000 county code is American Samoa;
otherwise unknown
MEDPAR_ADMSN_DAY_TB MEDPAR Admission Day Code Table
1 = Sunday
2 = Monday
3 = Tuesday
4 = Wednesday
5 = Thursday
6 = Friday
7 = Saturday
MEDPAR_BENE_DEATH_DT_VRFY_TB MEDPAR Beneficiary Death Date Verified Code Table
V = Date of death verified (EDB received DOD from SSA's
MBR)
B = Date of death taken from claim (EDB received DOD
from claim)
N = Date of death not verified (neither V or B
applicable, but claim status code indicated death)
Space = No date of death indicated
MEDPAR_BENE_DSCHRG_STUS_TB MEDPAR Beneficiary Discharge Status Code Table
A = Discharged alive (claim status code other than 20 or
30)
B = Discharged dead
C = Still a patient
MEDPAR_BENE_PRMRY_PYR_TB MEDPAR Beneficiary Primary Payer Code Table
A = Working aged bene/spouse with eghp
B = ESRD bene in 18-month coordination period with eghp
C = Conditional Medicare payment; future reimbursement
expected
D = Auto no-fault or any liability insurance
E = Worker's compensation
F = Phs or other federal agency (other than dept of
veterans affairs)
G = Working disabled
H = Black lung
I = Dept of veterans affairs
J = Any liability insurance
Z/BLANK = Medicare is primary payer
MEDPAR_CRNRY_CARE_IND_TB MEDPAR Coronary Care Indicator Code Table
BLANK = No coronary care indication
0 = General (revenue code 0210)
1 = Myocardial (revenue code 0211)
2 = Pulmonary care (revenue code 0212)
3 = Heart transplant (revenue code 0213)
4 = Intermediate CCU (revenue code 0214)
MEDPAR_ESRD_COND_TB MEDPAR ESRD Condition Code Table
00 = No ESRD Condition Codes
70 = Self-Administered Epo
71 = Full Care In Unit
72 = Self-Care In Unit
73 = Self-Care Training
74 = Home Dialysis
75 = Home Dialysis/100% Reimbursement
76 = Backup-In-Facility Dialysis
MEDPAR_ESRD_SETG_IND_TB MEDPAR ESRD Setting Indicator Code Table
00 = Ip renal dialysis-general (revenue code 0800)
01 = Ip renal dialysis-hemodialysis (revenue code 0801)
02 = Ip renal dialysis-peritoneal (non-capd: revenue
code 0802)
03 = Ip renal dialysis-capd (revenue code 0803)
04 = Ip renal dialysis-ccpd (revenue code 0804)
09 = Ip renal dialysis-other (revenue code 0809)
20 = Hemodialysis-op-general (revenue code 0820)
21 = Hemodialysis-op-hemodialysis/composite (revenue code
0821)
22 = Hemodialysis-op-home supplies (revenue code 0822)
23 = Hemodialysis-op-home equipment (revenue code 0823)
24 = Hemodialysis-op-maintenance/100% (revenue code 0824)
25 = Hemodialysis-op-support services (revenue code 0825)
29 = Hemodialysis-op-other (revenue code 0829)
30 = Peritoneal-op/home-general (revenue code 0830)
31 = Peritoneal-op/home-peritoneal/composite (revenue
32 = Peritoneal-op/home-home supplies (revenue code 0832)
33 = Peritoneal-op/home-home equipment (revenue code
0833)
34 = Peritoneal-op/home-maintenance/100% (revenue code
0834)
35 = Peritoneal-op/home-support services (revenue code
0835)
39 = Peritoneal-op/home-other (revenue code 0839)
40 = Capd-op-capd/general (revenue code 0840)
41 = Capd-op-capd/composite (revenue code 0841)
42 = Capd-op-home supplies (revenue code 0842)
43 = Capd-op-home equipment (revenue code 0843)
44 = Capd-op-maintenance/100% (revenue code 0844)
45 = Capd-op-support services (revenue code 0845)
49 = Capd-op-other (revenue code 0849)
50 = Ccpd-op-ccpd/general (revenue code 0850)
51 = Ccpd-op-ccpd/composite (revenue code 0851)
52 = Ccpd-op-home supplies (revenue code 0852)
53 = Ccpd-op-home equipment (revenue code 0853)
54 = Ccpd-op-maintenance/100% (revenue code 0854)
55 = Ccpd-op-support services (revenue code 0855)
59 = Ccpd-op-other (revenue code 0859)
80 = Miscellaneous dialysis-general (revenue code 0880)
81 = Miscellaneous dialysis-ultrafiltration (revenue code
0881)
89 = Miscellaneous dialysis-other (revenue code 0889)
BLANK = No ESRD setting indication
MEDPAR_GHO_PD_TB MEDPAR GHO Paid Code Table
1 = GHO has paid the provider
Blank Or 0 = GHO has not paid the provider
MEDPAR_ICU_IND_TB MEDPAR Intensive Care Unit (ICU) Indicator Code
0 = General (revenue center 0200)
1 = Surgical (revenue center 0201)
2 = Medical (revenue center 0202)
3 = Pediatric (revenue center 0203)
4 = Psychiatric (revenue center 0204)
MEDPAR_OP_SRVC_IND_TB MEDPAR Outpatient Services Indicator Codode Table
0 = No outpatient services/ambulatory surgical care
(revenue code other than 049X, 050X)
1 = Outpatient services (revenue code 050X)
2 = Ambulatory surgical care (revenue code 049X)
3 = Outpatient services and ambulatory surgical care
(revenue codes 049X and 050X)
MEDPAR_ORGN_ACQSTN_IND_TB MEDPAR Organ Acquisition Indicator Code Table
K1 = General classification (revenue code 0810)
K2 = Living donor kidney (revenue code 0811)
K3 = Cadaver donor kidney (revenue code 0812)
K4 = Unknown donor kidney (revenue code 0813)
K5 = Other kidney acquisition (revenue code 0814)
H1 = Cadaver donor heart (revenue code 0815)
H2 = Other heart acquisition (revenue code 0816)
L1 = Donor liver (revenue code 0817)
01 = Other organ acquisition (revenue code 0819)
02 = General acquisition (revenue code 0890)
B1 = Bone donor bank (revenue code 0891)
03 = Organ donor bank other than kidney (revenue code 0892)
S1 = Skin donor bank (revenue code 0893)
04 = Other donor bank (revenue code 0899)
BLANK = No organ acquisition indication
MEDPAR_PHRMCY_IND_TB MEDPAR Pharmacy Indicator Code Table
0 = No drugs (revenue code other than those listed below)
1 = General drugs and/pr IV therapy (revenue code 025x,
026x)
2 = Erythropoietin (epoetin: revenue code 0630, 0635,
0637, 0639)
3 = Blood clotting drugs (revenue code 0636)
4 = General drugs and/or IV therapy; and epoetin
(combination of values 1 and 2)
5 = General drugs and/or IV therapy; and blood clotting
drugs (combination of values 1 and 3)
MEDPAR_PPS_IND_TB MEDPAR PPS Indicator Code Table
0 = Non PPS
2 = PPS
MEDPAR_PRVDR_NUM_SPCL_UNIT_TB MEDPAR Provider Number Special Unit Code
M = PPS-exempt psychiatric unit in CAH
R = PPS-exempt rehabilitation unit in CAH
S = PPS-exempt psychiatric unit
T = PPS-exempt rehabilitation unit
U = Swing-bed short-term/acute care hospital
W = Swing-bed long-term hospital
Y = Swing-bed rehabilitation hospital
Z = Swing-bed rural primary care hospital; eff
10/97 changed to critical access hospitals
Blanks = Not PPS-exempt or swing-bed designation
MEDPAR_RDLGY_CT_SCAN_IND_TB MEDPAR Radiology CT Scan Indicator Switch Code Table
0 = No radiology CT scan (revenue code not 035X)
1 = Yes radiology CT scan (revenue code 035X)
MEDPAR_RDLGY_DGNSTC_IND_TB MEDPAR Radiology Diagnostic Indicator Switch Code Table
0 = No radiology-diagnostic (revenue code not 032x)
1 = Yes radiology-diagnostic (revenue code 032x)
MEDPAR_RDLGY_NUCLR_MDCN_IND_TB MEDPAR Radiology Nuclear Medicine Indicator Switch Code Table
0 = No nuclear medicine (revenue code not 034x)
1 = Yes nuclear medicine (revenue code 034x)
MEDPAR_RDLGY_ONCLGY_IND_TB MEDPAR Radiology Oncology Indicator Switch Code Table
0 = No radiology-oncology (revenue code not 028x)
1 = Yes radiology-oncology (revenue code 028x)
MEDPAR_RDLGY_OTHR_IMGNG_IND_TB MEDPAR Radiology Other Imaging Indicator Code Table
0 = No other imaging services (revenue code not 040x)
1 = Yes other imaging services (revenue code 040x)
MEDPAR_RDLGY_THRPTC_IND_TB MEDPAR Radiology Therapeutic Indicator Code Table
0 = No radiology-therapeutic (revenue code not 033X)
1 = Yes radiology-therapeutic (revenue code 033X)
MEDPAR_SRGCL_PRCDR_IND_TB MEDPAR Surgical Procedure Indicator Switch Code Table
0 = No surgery indicated
1 = Yes surgery indicated
MEDPAR_SS_LS_SNF_IND_TB MEDPAR Short Stay/Long Stay/SNF Indicator Code Table
N = SNF Stay (Prvdr3 = 5, 6, U, W, Y, or Z)
S = Short-Stay (Prvdr3 = 0, M, R, S, T)
L = Long-Stay (All Others)
MEDPAR_TRNSPLNT_IND_TB MEDPAR Transplant Indicator Code Table
0 = No organ or kidney transplant
(revenue code not 0362 or 0367)
2 = Organ transplant other than kidney (revenue code
0362)
7 = Kidney transplant (revenue code 0367)
MEDPAR_WRNG_IND_TB MEDPAR Warning Indicators Code Table
Warning indicator 1 ('adjustment indicator' derived
from the presence of query code values noted below
on any of the claim records included in the analysis):
0 = No adjustment (no query code = 0 or 5)
1 = Credit adjustment (query code = 0)
2 = Debit adjustment (query code = 5)
3 = Credit and debit adjustment (both query code = 0
and 5)
Warning indicator 2 ('error condition' derived from
checking the edit code trailer on the final action
claims(s) that comprise the stay):
0 = No error
1 = Error condition
Warning indicator 3 ('reimbursement/total charge
indicator' derived after summing up fields on the
final action claim(s) that comprise the stay; checks
resulting Medicare payment amount (commonly called
reimbursement), total charge amount, as well as
beneificiary primary payer amount and utilization day
count):
0 = Medicare payment amount and total charge amount >
zeroes
1 = Medicare payment amount and total charge amount <
zeroes
2 = Medicare payment amount is a credit
3 = Total charge amount is a credit
4 = Medicare payment amount, total charge amount,
beneficiary primary payer claim payment amount,
and utilization day count = zeroes
Warning indicator 4 ('utilization day/los day indicator'
derived after summing up fields on the final action
claim(s) that comprise the stay; compares resulting
utilization day count and length-of-stay count):
0 = Utilization day count = los day count
1 = Utilization day count < los day count
2 = Utilization day count > los day count
warning indicator 5 ('single/multiple claim indicator'
derived when the stay record is created by checking
the number of final action claims that comprise the
stay):
0 = Stay includes a single final action claim
1 = Stay includes multiple final action claims
2 = Stay includes multiple final action claims and
beneficiary is still a patient (applicable to
SNF stays only)
Warning indicator 6 ('intermediary cancel indicator'
derived from the presence of the values noted below
for intermediary claim action code and intermediary-
requested claim cancel reason code on any of the claims
included in the analysis. If multiple claims contain
these values, latest claim is used. If both specified
action code and cancel reason code are present, cancel
reason code takes priority.):
0 = No cancel action
1 = Cancel action by credit adjustment (action code =
(2 or 6)
2 = Cancel action only (action code = 4)
3 = Coverage transfer (cancel reason code = C)
4 = Plan transfer (cancel reason code = P)
5 = Scramble (cancel reason code = S)
6 = Duplicate billing (cancel reason code = D)
7 = Other (cancel reason code = H)
8 = Combining 2 spells or 2 beneficiary records
(cancel reason code = L)
Warning indicator 7 ('state/county numeric indicator'
derived from checking the format of the beneficiary
residence SSA state code and beneficiary residence
county code on the final action claim(s) that comprise
the stay; determine if in numeric range):
0 = State and county codes are valid numeric values
1 = State and county codes are not in numeric range
2 = State code is not in numeric range
3 = County code is not in numeric range
Warning indicator 8 ('duplicate indicator' derived from
the presence of two claim records with the same claim
number, admission date, provider number, claim from/
thru date, HCFA process date and query code; death/
admission date indicator derived by comparing the
admission date on the final claim(s) that comprise the
stay to the beneficiary death date):
0 = Do duplicate record
1 = Duplicate record
2 = Death date < admission date
3 = Death date < admission date and duplicate record
Warning indicator 9 ('pass-thru indicator' derived from
the presence of a pass thru per diem amount on the final
action claim(s) that comprise the stay):
0 = No pass thru per diem present (Non-PPS)
1 = Pass thru per diem present on final action claim
Warning indicator 10 (eff 3/96 update) (rugs indicator
applicable to 'nhcmq rugs III SNF demo' stay records
derived from the presence of 9,000 series revenue
center codes.)
0 = No rugs 9,000 series revenue center codes
2 = Rugs 9,000 series revenue center code(s) with
service date 1/1/96 or later
3 = Rugs 9,000 series revenue center code(s) with
service date 7/1/96 or later
4 = Rugs 9,000 series revenue center code(s) with
service date 1/1/97 or later
Warning indicators 11 - 17 (not yet assigned; zeroes
will be present)
PTNT_DSCHRG_STUS_TB Patient Discharge Status Table
01 = Discharged to home/self care (routine
charge).
02 = Discharged/transferred to other short term
general hospital for inpatient care.
03 = Discharged/transferred to skilled
nursing facility (SNF) with Medicare
certification in anticipation of covered
skilled care -- (For hospitals with an
approved swing bed arrangement, use Code
61 - swing bed. For reporting discharges/
transfers to a non-certified SNF, the
hospital must use Code 04 - ICF.
04 = Discharged/transferred to intermediate
care facility (ICF).
05 = Discharged/transferred to another type
of institution for inpatient care (including
distinct parts). NOTE: Effective 1/2005,
psychiatric hospital or psychiatric distinct
part unit of a hospital will no longer be
identified by this code. New code is '65'.
06 = Discharged/transferred to home care of
organized home health service organization.
07 = Left against medical advice or discontinued
care.
08 = Discharged/transferred to home under
care of a home IV drug therapy provider.
(discontinued effective 10/1/05)
09 = Admitted as an inpatient to this
hospital (effective 3/1/91). In situa-
tions where a patient is admitted before
midnight of the third day following the
day of an outpatient service, the out-
patient services are considered inpatient.
20 = Expired (did not recover - Christian
Science patient).
30 = Still patient.
40 = Expired at home (hospice claims only)
41 = Expired in a medical facility such as
hospital, SNF, ICF, or freestanding
hospice. (Hospice claims only)
42 = Expired - place unknown (Hospice claims
only)
43 = Discharged/transferred to a federal hospital
(eff. 10/1/03)
50 = Hospice - home (eff. 10/96)
51 = Hospice - medical facility (eff. 10/96)
61 = Discharged/transferred within this insti-
tution to a hospital-based Medicare
approved swing bed (eff. 9/01)
62 = Discharged/transferred to an inpatient
rehabilitation facility including distinct
parts units of a hospital.
(eff. 1/2002)
63 = Discharged/transferred to a long term care
hospitals. (eff. 1/2002)
64 = Discharged/transferred to a nursing facility
certified under Medicaid but not under
Medicare (eff. 10/2002)
65 = Discharged/Transferred to a psychiatric
hospital or psychiatric distinct unit of a
hospital (these types of hospitals were
pulled from patient/discharge status code
'05' and given their own code). (eff. 1/2005).
66 = Discharged/transferred to a Critical Access
Hospital (CAH) (eff. 1/1/06)
70 = Discharged/transferred to another type of health
care institution not defined elsewhere in code
list.
71 = Discharged/transferred/referred to another
institution for outpatient services as
specified by the discharge plan of care
(eff. 9/01) (discontinued effective 10/1/05)
72 = Discharged/transferred/referred to this
institution for outpatient services as
specified by the discharge plan of care
(eff. 9/01) (discontinued effective 10/1/05)
09/15/2008
H3PM.R_RIF_TOC_RPT_Q,F
******************************************************
1
LIMITATIONS APPENDIX FOR RECORD: MEDPAR_560_NCH_REC
AS OF: 09/26/2008
MEDPAR_ADMSN_DEATH_DAY_CNT_LIM
FULL NAME: MEDPAR Admission Death Day Count Limitation
DESCRIPTION :
MEDPAR Admission Death Day Count calculated incorrectly,
on both the 3/00 and 6/00 MEDPAR updates.
BACKGROUND :
Both the 3/00 and 6/00 MEDPAR updates incorrectly cal-
culated the mortality days; i.e., days between the
admission date and the beneficiary date of death. Users
of the regular unencrypted MEDPAR file, this is not a
problem, as the count can be calculated using the
admission date and the date of death. The problem is
with the encrypted file (the expanded modified MEDPAR)
because the fields needed to calculate the mortality
days are ranged.
CORRECTIVE ACTION :
The problem was corrected with the 12/00 MEDPAR
update. NOTE: For users of the expanded modified
MEDPAR file who needs the mortality days, the 12/00
update of the FY1999 file can be given as a replace-
ment.
SOURCE:
CONTACT : OIS/EDG/DMUDD
MEDPAR_MAR_QTRLY_UPDT_LIM
FULL NAME: MEDPAR March Quarterly Update Limitation
DESCRIPTION :
The 3/01 quarterly update of the FY00 file containing
fewer records than the 12/00 version.
BACKGROUND :
The 3/01 quarterly update of the FY00 file has about
50,000 fewer records than the 12/00 update. The
problem originated from modified programs required to
process Version 'I' input. There was an omission of
a sort step from the modified Version 'I' processing
procedures.
CORRECTIVE ACTION :
The sort sequence was corrected and the 3/01 in-
correct datasets were replaced with new files on
7/17/01.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 04/01/01
END DATE : 07/17/01
CONTACT : OIS/EDG/DMUDD
MEDPAR_BLOOD_DDCTBL_AMT_LIM
FULL NAME: MEDPAR Blood Deductible Amount Limitation
DESCRIPTION :
It was discovered that the blood deductible amounts were
incorrect on the Old MEDPAR Files.
BACKGROUND :
Users of the MEDPAR data were comparing money amounts and
counts present on the new MEDPAR file (created 6/95 using
NCH Nearline File as the source) to that reported on the
old MEDPAR File (created 3/95 and prior from claims from
the Medicare Quality Assurance System) for Fiscal Year
1994. They discovered that the blood deductible amount on
the new MEDPAR was greater than that of the old MEDPAR.
During NCH's investigation it was determined that the old
500-character MEDPAR incorrectly used a different field
to report the blood deductible; specifically the noncovered
charges derived from blood use Revenue Center codes 0380-
0389. The new program correctly used the NCH field,
BENE_BLOOD_DDCTBL_LBLTY_AMT, which is derived from a value
code (CLM_VAL_AMT associated with CLM_VAL_CD = '6').
It is believed that all MEDPAR files created prior to 6/95
in the 500 character version are affected. MEDPAR 500 was
first available with calendar year and fiscal year 9/91
updates for year 1987 forward.
NOTE: This anamoly also impacts the DRG Price Amount on the
old MEDPAR file because it is calculated from a number of
fields including the blood deductible.
SOURCE:
CONTACT : OIS/EDG/DMUDD
MEDPAR_MAR_QTRLY_UPDT_LIM
FULL NAME: MEDPAR March Quarterly Update Limitation
DESCRIPTION :
The 3/01 quarterly update of the FY00 file containing
fewer records than the 12/00 version.
BACKGROUND :
The 3/01 quarterly update of the FY00 file has about
50,000 fewer records than the 12/00 update. The
problem originated from modified programs required to
process Version 'I' input. There was an omission of
a sort step from the modified Version 'I' processing
procedures.
CORRECTIVE ACTION :
The sort sequence was corrected and the 3/01 in-
correct datasets were replaced with new files on
7/17/01.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 04/01/01
END DATE : 07/17/01
CONTACT : OIS/EDG/DMUDD
MEDPAR_DOD_LIM
FULL NAME: MEDPAR Date of Death Limitation
DESCRIPTION :
The Date of Death on the MEDPAR files were not up-to-
date for four cycles.
BACKGROUND :
The MEDPAR process pulls in 10 segments of the HISKEW
file, to get the date of death. The HISKEW file
names were changed with no notification the change
was being made. Because of this, MEDPAR kept using
the HISKEW that was created in June 2000.
The incomplete MEDPAR cycles are: 12/2000, 3/2001,
6/2001 and 9/2001 (9/2000 MEDPAR was not run).
CORRECTIVE ACTION :
Since this anamoly causes no major problem to the
prime user of this data, a rerun will not take place.
NOTE: The 12/01 quarterly update will access up-to-
date information.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 12/01/00
END DATE : 09/30/01
DISCOVERY DATE : 01/16/02
CONTACT : OIS/EDG/DMUDD
MEDPAR_MAR_QTRLY_UPDT_LIM
FULL NAME: MEDPAR March Quarterly Update Limitation
DESCRIPTION :
The 3/01 quarterly update of the FY00 file containing
fewer records than the 12/00 version.
BACKGROUND :
The 3/01 quarterly update of the FY00 file has about
50,000 fewer records than the 12/00 update. The
problem originated from modified programs required to
process Version 'I' input. There was an omission of
a sort step from the modified Version 'I' processing
procedures.
CORRECTIVE ACTION :
The sort sequence was corrected and the 3/01 in-
correct datasets were replaced with new files on
7/17/01.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 04/01/01
END DATE : 07/17/01
CONTACT : OIS/EDG/DMUDD
MEDPAR_DRG_PRICE_AMT_LIM
FULL NAME: MEDPAR DRG Price Amount Limitation
DESCRIPTION :
IT WAS DISCOVERED THAT THE DRG PRICE AMOUNT WSA INCORRECT
ON THE OLD MEDPAR FILES.
BACKGROUND :
Users of the MEDPAR data were comparing money amounts and
counts present on the new MEDPAR file (created 6/95 using
NCH Nearline File as the source) to that reported on the
old MEDPAR File (created 3/95 and prior from claims from
the Medicare Quality Assurance System) for Fiscal Year
1994. They discovered that the DRG price amount on the
new MEDPAR contained incorrect amounts.
NOTE: This anamoly occurs because the DRG price amount is
calculated from a number of fields including the blood
deductible amount, which was discovered to be populated
incorrectly.
During NCH's investigation it was determined that the old
500-character MEDPAR incorrectly used a different field
to report the blood deductible; specifically the noncovered
charges derived from blood use Revenue Center codes 0380-
0389. The new program correctly used the NCH field,
BENE_BLOOD_DDCTBL_LBLTY_AMT, which is derived from a value
code (CLM_VAL_AMT associated with CLM_VAL_CD = '6').
It is believed that all MEDPAR files created prior to 6/95
in the 500 character version were affected. MEDPAR 500 was
first available with calendar year and fiscal year 9/91
updates for year 1987 forward.
SOURCE:
MEDPAR_MAR_QTRLY_UPDT_LIM
FULL NAME: MEDPAR March Quarterly Update Limitation
DESCRIPTION :
The 3/01 quarterly update of the FY00 file containing
fewer records than the 12/00 version.
BACKGROUND :
The 3/01 quarterly update of the FY00 file has about
50,000 fewer records than the 12/00 update. The
problem originated from modified programs required to
process Version 'I' input. There was an omission of
a sort step from the modified Version 'I' processing
procedures.
CORRECTIVE ACTION :
The sort sequence was corrected and the 3/01 in-
correct datasets were replaced with new files on
7/17/01.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 04/01/01
END DATE : 07/17/01
CONTACT : OIS/EDG/DMUDD
MEDPAR_MAR_QTRLY_UPDT_LIM
FULL NAME: MEDPAR March Quarterly Update Limitation
DESCRIPTION :
The 3/01 quarterly update of the FY00 file containing
fewer records than the 12/00 version.
BACKGROUND :
The 3/01 quarterly update of the FY00 file has about
50,000 fewer records than the 12/00 update. The
problem originated from modified programs required to
process Version 'I' input. There was an omission of
a sort step from the modified Version 'I' processing
procedures.
CORRECTIVE ACTION :
The sort sequence was corrected and the 3/01 in-
correct datasets were replaced with new files on
7/17/01.
SOURCE:
ADMINISTRATIVE DATA:
START DATE : 04/01/01
END DATE : 07/17/01
CONTACT : OIS/EDG/DMUDD
H3PM.R_RIF_LIM_RPT_Q,F
09/15/2008
*******************************************************