WSR 03-13-029

PERMANENT RULES

DEPARTMENT OF HEALTH


[ Filed June 10, 2003, 10:12 a.m. ]

     Date of Adoption: June 10, 2003.

     Purpose: The establishment of the collection and maintenance of hospital patient discharge data including data necessary for identification of discharge by diagnosis-related groups.

     Citation of Existing Rules Affected by this Order: Amending chapter 246-455 WAC.

     Statutory Authority for Adoption: RCW 43.70.040 and [43.]70.170.

      Adopted under notice filed as WSR 03-09-127 on April 23, 2003.

     Number of Sections Adopted in Order to Comply with Federal Statute: New 0, Amended 0, Repealed 0; Federal Rules or Standards: New 0, Amended 2, Repealed 0; or Recently Enacted State Statutes: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted at Request of a Nongovernmental Entity: New 0, Amended 0, Repealed 0.

     Number of Sections Adopted on the Agency's Own Initiative: New 0, Amended 4, Repealed 0.

     Number of Sections Adopted in Order to Clarify, Streamline, or Reform Agency Procedures: New 0, Amended 6, Repealed 0.

     Number of Sections Adopted Using Negotiated Rule Making: New 0, Amended 0, Repealed 0;      Pilot Rule Making: New 0, Amended 0, Repealed 0; or Other Alternative Rule Making: New 0, Amended 0, Repealed 0.
     Effective Date of Rule: Thirty-one days after filing.

June 3, 2003

M. C. Selecky

Secretary

OTS-6047.5


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-001   Purpose.   This chapter is adopted by the Washington state department of health pursuant to RCW ((70.170.100)) 43.70.040 relating to the collection and maintenance of patient discharge data, including data necessary for identification of discharges by diagnosis-related groups.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-001, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-001, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-010, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-010   Definitions.   As used in this chapter, unless the context requires otherwise,

     (1) "Department" means department of health.

     (2) "Diagnosis-related groups" is a classification system that groups hospital patients according to principal and secondary diagnosis, presence or absence of a surgical procedure, age, presence or absence of significant comorbidities or complications, and other relevant criteria.

     (3) "Hospital" means any health care institution which is required to qualify for a license under RCW 70.41.020(2); or as a psychiatric hospital under chapter 71.12 RCW.

     (4) Uniform Billing "UB-92/UB-02 data set" means the data element specifications developed by the ((Washington state)) National Uniform Billing Committee ((and set forth in the state of Washington UB-92 Procedure Manual, which is available to the public upon request)) which can be found at www.NUBC.org.

     (5) "Patient discharge" means the termination of an inpatient admission or stay, including an admission as a result of a birth, in a Washington hospital.

     (6) "HMO" means a health maintenance organization.

     (7) "SNF" means a skilled nursing facility.

     (8) "HCF" means a health care facility.

     (9) (("ICF" means an intermediate care facility.

     (10))) "HHA" means a home health agency.

     (((11))) (10) "IV" means intravenous.

     (((12))) (11) "UPIN" means unique physician identification number.

     (((13))) (12) "CHARS" means comprehensive hospital abstract reporting system.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-010, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-010, filed 12/27/90, effective 1/31/91. Statutory Authority: RCW 70.39.180. 85-17-020 (Order 85-05, Resolution No. 85-05), § 261-50-020, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-020, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-020   Reporting of UB-92 data set information.   (1) Effective with all hospital patient discharges on or after April 1, 1994, hospitals shall collect and report the following UB-92 or UB-02 data set elements to the department:

     (a) Patient control number

Patient's unique alpha-numeric number assigned by the hospital to facilitate retrieval of individual patient records. This number should be constructed to allow prompt hospital access to the patient's discharge record for data verification.

     (b) Type of bill

This three-digit code requires 1 digit each, in the following sequence form: Type of facility, bill classification, frequency.

Digit #1 must be "1" to indicate a hospital.
Digit #2 must be a "1," a "2" or an "8" to indicate an inpatient.
Digit #3 must be a "1" to indicate admit through discharge claim.
     (c) Medicare provider number

This is the number assigned to the provider by Medicare.

     (d) Patient identifier

The patient identifier shall be composed of the first two letters of the patient's last name, the first two letters of the patient's first name, or one or two initials if no first name is available, or when the last name is a single letter add three letters of first name, and the patient's birthdate.

     (e) ZIP Code

Patient's five or nine digit ZIP Code. In the case of a foreign country, enter the first nine characters of the name.

     (f) Birthdate

The patient's date of birth in MMDDYYYY format.

     (g) Sex

Patient's sex in M/F format.

     (h) Admission date

Admission date in MMDDYY format.

     (i) Type of admission

This field is filled with one of the following codes:


1 Emergency
2 Urgent
3 Elective
4 Newborn

     (j) Source of admission

This field is completed with one of the following codes:


1 Physician referral
2 Clinic referral
3 HMO referral
4 Transfer from another hospital
5 Transfer from a SNF
6 Transfer from another HCF
7 Emergency room
8 Court/law enforcement
9 Other

When type of admission is a "4 newborn," enter one of the following for source of admission:


1 Normal delivery
2 Premature delivery
3 Sick baby
4 Extramural birth
5 Multiple birth

     (k) Patient status

Patient discharge disposition in one of the following codes:


01 Discharged home or self care
02 Discharged to another short-term general hospital
03 Discharged to SNF
04 Discharged to an ICF
05 Discharged to another type institution
06 Discharged to home under care of HHA
07 Left against medical advice
08 Discharged/transferred to home under care of home IV provider
20 Expired

     (l) Statement covers period

This is the beginning and ending dates for which the UB-92 covers.

     (m) Revenue code

The Medicare required revenue code (as defined in the UB-92 Procedure Manual), which identifies a specific accommodation, ancillary service or billing calculation.

     (n) Units of service

The Medicare required units of service (as defined in the UB-92 Procedure Manual) which provide a quantitative measure of services rendered by revenue category to or for the patient. Where no units of service are required by Medicare, the units of service may be those used by the hospital.

     (o) Total charges by revenue code category

Total charges pertaining to the related revenue code.

     (p) Payer identification #1

Enter the three-digit code that identifies the primary payer. The required code options include:


001 for Medicare
002 for Medicaid
004 for health maintenance organizations
006 for commercial insurance
008 for workers' compensation which includes state fund, self-insured employers, and labor and industries crime victims claims
009 for self pay
610 for health care service contractors, e.g., Blue Cross, county medical bureaus, Washington Physicians Service
625 for other sponsored patients, e.g., CHAMPUS, Indian health
630 charity care, as defined in chapter 70.170 RCW

     (q) Payer identification #2

Same requirements as in payer identification #1. This field should only be completed when a secondary payer has been identified.

     (r) Principal diagnosis code

ICD-9-CM code describing the principal diagnosis (the condition established after study to be chiefly responsible for causing the admission of the patient for care).

     (s) Other diagnoses codes

ICD-9-CM codes identifying up to eight additional conditions that coexist at the time of admission, or develop subsequently, and which have an effect on the treatment received or the length of stay).

     (t) Principal procedure code

The ICD-9-CM code that identifies the principal procedure performed during the patient admission.

     (u) Other procedure codes

ICD-9-CM codes identifying up to five significant procedures other than the principal procedure performed during the admission.

     (v) Attending physician identification

The UPIN number of the licensed physician who would normally be expected to certify and recertify the medical necessity of the services rendered and/or who has primary responsibility for the patient's medical care and treatment. For physicians who do not have a UPIN number, the state Medicaid number or the state license number should be used.

     (w) Other physician identification

The UPIN number of the licensed physician who performed the principal procedure. For physicians who do not have a UPIN number, the state Medicaid number or the state license number should be used. If no principal procedure was performed, this field should be left blank.

     (2) The hospital shall report all inpatients discharge data described in WAC 246-455-020. Each patient discharge must carry a separate, unique patient control number on a separate UB-92 record. For example, a mother and her newborn require separate UB-92s, each with a separate, unique patient control number.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-020, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-020, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 87-08-037 (Order 87-02, Resolution No. 87-02), § 261-50-030, filed 3/30/87; 87-04-008 (Order 87-01, Resolution No. 87-01), § 261-50-030, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), § 261-50-030, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), § 261-50-030, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-030, filed 10/1/84.]


AMENDATORY SECTION(Amending Order 121, filed 12/27/90, effective 1/31/91)

WAC 246-455-030   Reporting of E-Codes.   Effective with hospital patient discharges occurring on or after January 1, 1989, hospitals shall collect and report ((up to two)) one ICD-9-CM codes identifying the external cause of injury and poisoning (E-Codes), when applicable.

[Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-030, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), § 261-50-035, filed 7/29/88.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-040   Acceptable media for submission of data.   Hospitals shall submit data in the form prescribed by the department in the CHARS Procedure Manual. A copy of the CHARS Procedure Manual may be obtained by contacting the department or on the department's website.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-040, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-040, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), § 261-50-040, filed 7/29/88; 87-04-008 (Order 87-01, Resolution No. 87-01), § 261-50-040, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), § 261-50-040, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), § 261-50-040, filed 8/13/85. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-040, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-080   Confidentiality of data.   The department and any of its contractors or agents shall maintain the confidentiality of any information which may in any manner identify individual patients((.)) per RCW 70.170.090 and federal Health Insurance Portability and Accountability Act standards.

     The following confidential data elements are not public data: Patient control number, patient identifier, patient birthdate, admission date, discharge day, and nine-digit ZIP Code. The following data elements are public data: Patient's age at admission, discharge month and year, length of stay, and a five-digit ZIP Code.

     Records containing confidential data elements may be disclosed for research purposes after approval from the ((human research)) Washington state institutional review board in accordance with RCW 42.48.020.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-080, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-080, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 84-20-067 (Order 84-06, Resolution No. 84-06), § 261-50-070, filed 10/1/84.]


AMENDATORY SECTION(Amending WSR 94-12-090, filed 6/1/94, effective 7/2/94)

WAC 246-455-100   Penalties for violation.   RCW 70.170.070 describes the penalty for violation of any valid orders, rules, regulations, and reporting requirements. The department may grant extensions of time to file the information((, in which cases)). If such an extension is granted, failure to file the information shall not ((constitute)) be considered a violation until the extension period has expired.

[Statutory Authority: RCW 43.70.040 and chapter 70.170 RCW. 94-12-090, § 246-455-100, filed 6/1/94, effective 7/2/94. Statutory Authority: RCW 43.70.040. 91-02-049 (Order 121), recodified as § 246-455-100, filed 12/27/90, effective 1/31/91. Statutory Authority: Chapter 70.39 RCW. 88-16-043 (Order 88-05, Resolution No. 88-05), § 261-50-090, filed 7/29/88; 87-08-037 (Order 87-02, Resolution No. 87-02), § 261-50-090, filed 3/30/87; 87-04-008 (Order 87-01, Resolution No. 87-01), § 261-50-090, filed 1/23/87. Statutory Authority: RCW 70.39.180. 86-14-081 (Order 86-03, Resolution No. 86-03), § 261-50-090, filed 7/1/86; 85-17-020 (Order 85-05, Resolution No. 85-05), § 261-50-090, filed 8/13/85.]

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