Outpatient Output Data Elements
NOTE: Bolded and UPPER CASE are IDENTIFYING DATA ELEMENTS [see "Data Protection Review Board" (DPRB)]
(See Below Regarding AIDS/HIV Edits)
Collected and Available for Data Type: AS = Ambulatory Surgery
ED = Emergency Department
OP = Outpatient Services
ALL = All Outpatient Data Types
COMMON DETAIL - Primary Records
Data Sets
Record
Positions
Data Element
1-14
Discharge Sequential Number
Type
NUM
Size
14
De-identified
Limited
Identifiable
BLANK
X
X
Data
Type
Page
No.
Description
All
Discharge year, plus an eight digit sequentially assigned
number by SPARCS
All
Indicates if continuation records exist
0 = no continuation records
1 = continuation record exists
56
15
Continuation Indicator
NUM
1
X
X
X
57
16-18
Record Sequence Number
NUM
3
X
X
X
All
Assigned by SPARCS. Indicates record's position within a set
of records for a particular stay/discharge
Primary Record =001
Continuation Records will be = 002 thru 016
58
19-21
Record Sequence Count
NUM
3
X
X
X
All
Total number of records reported for a particular patient
stay/discharge
59
Type
Size
PATIENT SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
22-23
Filler
24-43
PATIENT CONTROL NUMBER
(UNENCRYPTED)
CHAR
6
(3201-3244)
OUTPATIENT
( PATIENT CONTROL NUMBER
Encrypted)
Identifiable
X
X
X
No Data
X
Patient's unique number assigned by the provider
Page
No.
BLANK
BLANK
(44)
Description
Limited
20
CHAR
Data
Type
De-identified
x
60
All
Page 1
Data Sets
Record
Positions
Data Element
44-60
MEDICAL RECORD NUMBER
Type
Size
De-identified
17
Limited
(3245-3288)
MEDICAL RECORD NUMBER
Encrypted
(44)
X
61-70
UNIQUE PERSONAL IDENTIFIER
10
BLANK
CHAR
BLANK
(3289-3310)
UNIQUE PERSONAL IDENTIFIER
Encrypted
(22)
X
71-89
ENHANCED UNIQUE PERSONAL
IDENTIFIER
19
BLANK
CHAR
Data
Type
Page
No.
Description
BLANK
BLANK
CHAR
Identifiable
BLANK
The number used by the Medical Records Department to
identify patient's permanent medical record file
X
All
X
All
Composed of portions of last name (first2, last2), first name
(first 2), SNN (last 4)
62-63
X
All
Unique Personal Identifier plus date of birth and sex
64-65
X
All
Patient Birth Date (CCYYMMDD)
66
All
Patient's age calculated at time of visit
67
All
Age calculated in days for all records with age of 0 (under
one year of age)
68
Sex of patient as recorded at start of care.
M = Male
F = Female
U = Unknown
69
(3311-3354)
ENHANCED UNIQUE PERSONAL
IDENTIFIER Encrypted
(44)
90-97
PATIENT BIRTH DATE
8
DAY/MO.
BLANK
YYYY
(3355-3376)
PATIENT BIRTH DATE Encrypted
(22)
X
98-100
Age
NUM
3
(BLANK if
Age>90O)
X
X
101-103
Age in Days (for Newborn)
NUM
3
BLANK
X
X
104
Patient Sex
CHAR
1
X
X
X
61
X
YYYY\MM
NUM
X
X
OUTPATIENT
All
Page 2
Record
Positions
105-106
Data Sets
Data Element
Type
Size
De-identified
Patient Race
CHAR
CHAR
2
1
X
Limited
X
70
Code best describing ethnic origin of patient
"1" = Spanish/Hispanic Origin
"2" = Not of Spanish/Hispanic Origin
"9" = Unknown
71
All
Patient's street number, PO Box number, or RFD
72
X
All
Continuation of the mailing address (blank if n/a)
73
X
X
All
City, Town or Village
74
X
X
X
All
Capitalized two-letter abbreviation for the state in which the
patient’s principal residence is located on the day of
admission/visit, including US Territories, Commonwealth and
Canadian Provinces.
75
1st 3 digits
X
X
Postal Service Zip Code (five digit)
76
PATIENT ADDRESS LINE 1
(3377 - 3420)
PATIENT ADDRESS LINE 1
Encrypted
(44)
X
126-143
PATIENT ADDRESS LINE 2
18
BLANK
(3421 – 3464)
PATIENT ADDRESS LINE 2
Encrypted
144-158
Patient City
CHAR
15
BLANK
159-160
Patient State
CHAR
2
161-165
Patient Postal Service Zip Code
CHAR
5
166-169
EXTENSION CODE
(3465 - 3486)
EXTENSION CODE
170-171
Patient County Code
NUM
2
BLANK
172-173
SPARCS Region Code
CHAR
2
BLANK
OUTPATIENT
Code best describing race of patient
"01" = White
"02" = Black or African American
"03" = Native American or Alaskan Native
"04" = Asian
"05" = Native Hawaiian or Other Pacific Islander
"88" = Other Race
"99" = Unknown
X
108-125
X
18
X
BLANK
BLANK
BLANK
(44)
X
4
CHAR
AS
ED
Page
No.
Description
X
Patient Ethnicity
CHAR
X
Data
Type
AS
ED
107
CHAR
Identifiable
All
BLANK
X
All
Zip Code Extension (four digit)
76
X
X
All
Valid two-digit code in accordance with Zip/County Code Edit
Validation Table in Appendix F
77
X
X
Assigned by SPARCS based on county of the facility
78
BLANK
22
X
All
Page 3
NEWBORN SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
174
Newborn Flag
Type
Size
CHAR
1
Type
Size
De-identified
Limited
Identifiable
X
X
X
Data
Type
All
Description
Flag indicating newborn status
“0” = not newborn
“1” = newborn
“2” = one of multiple newborns
Page
No.
79-80
FACILITY SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
175-180
Facility Identifier (previously
SPARCS Identification Number)
CHAR
181
Facility Identifier Check Digit
182-251
De-identified
Limited
Identifiable
6
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
CHAR
1
X
X
X
Facility Name
CHAR
70
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
252
Health Service Area
NUM
1
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
253-254
Facility County
NUM
2
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
255-261
Operating Certificate Number
NUM
7
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
262-271
National Provider ID (previously
Provider Identification Number)
NUM
10
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
OUTPATIENT
Data
Type
Description
Page
No.
Number assigned by the NYSDOH upon certification.
Previously Permanent Facility Identifier (PFI).
81
Follows the Facility Identifier. Assigned by SPARCS
Administrative Unit.
82
Facility Name as maintained by the NYSDOH Division of
Health Facility Planning.
83
Assigned by SPARCS based on county of facility.
See Appendix U.
84
Assigned by SPARCS based upon county of facility
See Appendix U.
85
All
Number assigned by NYSDOH Division of Health Facility
Planning
86
All
Facility’s National Provider ID (NPI)
87
All
All
All
All
Page 4
PHYSICIAN SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
272-279
Attending Provider State License
Number
CHAR
280-287
Operating Physician State License
Number
288 - 295
Other Physician State License
Number
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
8
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
ED
OP
Professional license number, issued by NYS Dept. of Ed.
Identifies health care professional primarily responsible for
patient’s care (Attending Physician ID)
88
CHAR
8
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
AS
ED
Professional license number, issued by NYS Dept. of Ed.
Identifies the health care professional who performed principal
procedure (Operating Physician ID)
89
CHAR
8
BLANK IF
ABORTION
PROC/DIAG
PRESENT
BLANK IF
ABORTION
PROC/DIAG
PRESENT
X
ED
Professional license number, issued by NYS Dept. of Ed.
Identifies other health care professional responsible for
patient’s care. (Other Physician ID)
90
Type
Size
PAYER SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
296 - 300
Source of Payment Typology I
NUM
301 - 305
Source of Payment Typology II
306 - 310
Description
Page
No.
Identifies payer expected to pay the MAJOR portion of the bill.
See Appendix P for values.
91
Identifies secondary payer expected to pay a portion of bill.
See Appendix P for values.
92
All
Identifies third payer expected to pay a portion of bill.
See Appendix P for values.
93
X
All
Code indicating type of payment
94-95
X
X
All
X-12 code indicating type of payment
96-97
X
X
X
X
X
X
De-identified
Limited
Identifiable
5
X
X
X
NUM
5
X
X
X
Source of Payment Typology III
NUM
5
X
X
X
311
Source of Payment 1
CHAR
1
X
X
312-313
Claim Filing Indicator Code 1
CHAR
2
X
314-321
Payer ID Number 1
CHAR
8
322-334
Billing National Provider
Identification NPI 1
CHAR
13
OUTPATIENT
Data
Type
All
All
All
All
NAIC ID Number or Plan Number for Insurance Company
98
Insurance Company's ID for Facility (Facility NPI)
99
Page 5
Data Sets
Record
Positions
Data Element
335
Source of Payment 2
CHAR
336-337
Claim Filing Indicator Code 2
338-345
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
CHAR
2
X
X
X
Payer ID Number 2
CHAR
8
X
X
X
All
NAIC ID Number or Plan Number for Insurance Company
98
346-358
Billing National Provider
Identification NPI 2
CHAR
13
X
X
X
All
Insurance Company's ID for Facility (Facility NPI)
99
359
Source of Payment 3
CHAR
1
X
X
X
All
Code indicating type of payment
94-95
360-361
Claim Filing Indicator Code 3
CHAR
2
X
X
X
X-12 code indicating type of payment
96-97
362-369
Payer ID Number 3
CHAR
8
X
X
X
All
NAIC ID Number or Plan Number for Insurance Company
98
370-382
Billing National Provider
Identification NPI 3
CHAR
13
X
X
X
All
Insurance Company's ID for Facility (Facility NPI)
99
383
Source of Payment 4
CHAR
1
X
X
X
384-385
Claim Filing Indicator Code 4
CHAR
2
X
X
X
386-393
Payer ID Number 4
CHAR
8
X
X
394-406
Billing National Provider
Identification NPI 4
CHAR
13
X
407
Source of Payment 5
CHAR
1
408-409
Claim Filing Indicator Code 5
CHAR
410-417
Payer ID Number 5
CHAR
OUTPATIENT
All
All
All
All
Code indicating type of payment
94-95
X-12 code indicating type of payment
96-97
Code indicating type of payment
94-95
All
X-12 code indicating type of payment
96-97
X
All
NAIC ID Number or Plan Number for Insurance Company
98
X
X
All
Insurance Company's ID for Facility (Facility NPI)
99
X
X
X
All
Code indicating type of payment
94-95
2
X
X
X
All
X-12 code indicating type of payment
96-97
8
X
X
X
All
NAIC ID Number or Plan Number for Insurance Company
98
Page 6
Data Sets
Record
Positions
Data Element
418-430
Billing National Provider
Identification NPI 5
CHAR
431
Source of Payment 6
432-433
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
13
X
X
X
All
Insurance Company's ID for Facility (Facility NPI)
CHAR
1
X
X
X
All
Code indicating type of payment
94-95
Claim Filing Indicator Code 6
CHAR
2
X
X
X
All
X-12 code indicating type of payment
96-97
434-441
Payer ID Number 6
CHAR
8
X
X
X
All
NAIC ID Number or Plan Number for Insurance Company
98
442-454
Billing National Provider
Identification NPI 6
CHAR
13
X
X
X
All
Insurance Company's ID for Facility (Facility NPI)
99
455 - 456
Expected Principal Reimbursement
CHAR
2
X
X
X
AS
ED
Code identifying the payer expected to pay the major portion
of the patient's bill.
100
457-460
Medicaid Rate Code
CHAR
4
X
X
X
The Medicaid Rate Code which identifies the service being
paid. These are used only for claims expected Medicaid
payment (fee-for-service and managed care)
See Appendix OO
101
Type
Size
OP
99
DATA COLLECTION SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
461 - 466
Log Number
NUM
6
De-identified
Limited
Identifiable
X
X
X
Data
Type
All
467
Transaction Code
CHAR
1
X
X
X
All
468 - 475
Date Processed
CHAR
8
X
X
X
All
OUTPATIENT
Page
No.
Description
Assigned by SPARCS. Identifies submission to which the
record belongs.
102
Identifies transaction type for the electronic institutional claims
Code Value
1=
Delete
2=
Add
3=
Correction
103
Date facility created the file to submit to SPARCS.
104
Page 7
Data Sets
Record
Positions
Data Element
476 - 478
SPARCS Collector Code
NUM
479
Claim Type
480
Source File Type
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
All
SPARCS Collector Code
105
CHAR
1
X
X
X
All
Claim Type (I, A, E, O) “O” = Outpatient Services
106
NUM
1
X
X
X
All
File Type (C = Complete / I = Incomplete)
107
Type
Size
MISCELLANEOUS SEGMENT - Primary Records
Record
Positions
Data Sets
Data Element
Deidentified
Limited
Data
Type
Description
Identifiable
Page
No.
481
Residence Indicator
CHAR
1
X
X
X
All
Code indicating Homeless / Non-US Resident.
"H" = HOMELESS Patient
"F" = Non-United States Resident (Foreign Born)
Blank if N/A
482-484
Procedure Time
CHAR
3
X
X
X
AS
Amount of time the procedure took to perform
109
485-486
Accident Hour
CHAR
2
X
X
X
AS
ED
Accident Hour. See Appendix B.
110
487
Emergency Department (ED)
Indicator
CHAR
1
X
X
X
Emergency Department Indicator based on submitted
revenue codes.
E=Revenue Codes with 045x
Blank=No ED revenue code
111
OUTPATIENT
All
108
Page 8
TREATMENT SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
488 - 495
STATEMENT FROM DATE
Type
Size
Deidentified
(3487 - 3508
STATEMENT FROM DATE
Encrypted
(22)
496 - 503
STATEMENT THRU DATE
8
NUM
(3509 - 3530)
STATEMENT THRU DATE
Encrypted
(22)
504 - 511
ADMISSION / START OF CARE
DATE
8
NUM
Identifiable
DAY/MO.
BLANK
(YYYY)
DAY/MO.
BLANK
YYYY)
DAY/MO.
BLANK
(YYYY)
X
X
All
Ending date of the billing period (CCYYMMDD)
X
All
Date of Admission (CCYYMMDD)
114
X
DAY
BLANK
(YYYYMM)
Admit Weekday
CHAR
3
BLANK
X
X
515 - 516
Admission Hour
NUM
2
X
X
X
517 - 524
DISCHARGE DATE
8
DAY/MO.
BLANK
(YYYY)
DAY
BLANK
(YYYYMM)
X
115
X
All
All
Day of week patient was admitted (1st three letters)
116
Hour of visit
117
Date of discharge or death. (CCYYMMDD)
118
Weekday of discharge or death (1st three letters)
119
Hour of discharge or death
120
Flag indicating if patient admitted and discharged same
day.
0 = not same day
1 = same day
121
Code which best identifies the patient's destination or
status upon discharge
122
All
3553 -3574)
DISCHARGE DATE Encrypted
525 - 527
Discharge Weekday
CHAR
3
X
X
X
528 - 529
Discharge Hour
NUM
2
X
X
X
530 - 530
Same Day Discharge Indicator
CHAR
1
X
X
X
531 - 532
Patient Status
CHAR
2
X
X
X
(22)
112-113
DAY
BLANK
(YYYYMM)
512 - 514
OUTPATIENT
Page No.
All
(3531 - 3552)
NUM
Description
Beginning date of the billing period (CCYYMMDD)
X
ADMISSION DATE / START OF
CARE DATE Encrypted
(22)
Data
Type
DAY
BLANK
(YYYYMM)
8
NUM
Limited
X
All
All
All
All
Page 9
Data Sets
Record
Positions
Data Element
533 - 535
Type of Bill
536
Service Category Group
Type
CHAR
Size
3
CHAR
1
Type
Size
De-identified
Limited
Identifiable
X
X
X
BLANK
X
X
Data
Type
Description
Page
No.
All
Three-digit numeric code. Identifies specific bill type .
123
All
Service Category Group of discharge record
1 = Medical
2 = Surgical
3 = Pediatric
4 = Obstetrical
5 = Nursery/Newborn
6 = Psychiatric
124
DIAGNOSIS SEGMENT - Primary Records
Data Sets
Record
Positions
Data Element
537 - 543
Admitting Diagnosis Code
CHAR
544 - 550
Primary Diagnosis Code
551 - 557
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
7
X
X
X
All
Code describing condition at time of admission
CHAR
7
X
X
X
All
Code indicating condition established after study to have
been chiefly responsible for admission
126-127
Other Diagnosis Code 1
CHAR
7
X
X
X
All
Any other condition affecting treatment and /or length of
stay
128-129
558 - 564
Other Diagnosis Code 2
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
565 - 571
Other Diagnosis Code 3
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
572 - 578
Other Diagnosis Code 4
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
579 - 585
Other Diagnosis Code 5
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
586 - 592
Other Diagnosis Code 6
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
593 - 599
Other Diagnosis Code 7
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
OUTPATIENT
125
Page 10
Data Sets
Record
Positions
Data Element
600 - 606
Other Diagnosis Code 8
CHAR
607 - 613
Other Diagnosis Code 9
614 - 620
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
Other Diagnosis Code 10
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
621 - 627
Other Diagnosis Code 11
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
628 - 634
Other Diagnosis Code 12
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
635 - 641
Other Diagnosis Code 13
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
642 - 648
Other Diagnosis Code 14
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
649 - 655
Other Diagnosis Code 15
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
656 - 662
Other Diagnosis Code 16
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
663 - 669
Other Diagnosis Code 17
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
670 - 676
Other Diagnosis Code 18
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
677 - 683
Other Diagnosis Code 19
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
684 - 690
Other Diagnosis Code 20
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
691 - 697
Other Diagnosis Code 21
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
698 - 704
Other Diagnosis Code 22
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
705 - 711
Other Diagnosis Code 23
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
712 - 718
Other Diagnosis Code 24
CHAR
7
X
X
X
All
SEE Other Diagnosis Code 1
128-129
719-721
Clinical Classification Software
(CCS) Diagnosis Category
CHAR
3
X
X
X
All
OUTPATIENT
CCS Diagnosis Category using the reported ICD-9-CM code
130
Page 11
Record
Positions
722 - 723
Data Sets
Data Element
Type
Size
Data Type
De-identified
Accident Related Code
CHAR
2
X
724 - 731
ACCIDENT RELATED DATE
(3575 - 3596)
ACCIDENT RELATED DATE
Encrypted
732 - 738
External Cause of Injury
CHAR
7
X
739 - 745
Place of Injury Code
CHAR
7
X
Type
Size
8
DAY/MO. BLANK
(YYYY)
NUM
22
Limited
X
Page
No.
Description
Identifiable
All
X
DAY
BLANK
(YYYYMM)
Identifies specific event relating to the bill that may affect
payer processing
01 Accident /Medical Coverage
02 No Fault Insurance Involved/ Including Auto
Accident/Other
03 Accident /Tort Liability
04 Accident /Employment Related
05 Accident /No Medical or Liability Coverage
06 Crime Victim
131
X
All
Date corresponds to significant event related to bill that
might affect payer processing (CCYYMMDD)
132
X
X
All
ICD-9-CM code for the external cause of an injury,
poisoning, or adverse effect
133
X
X
All
Identifies place where the corresponding injury was reported
in External Cause-of-Injury Code
134
X
PROCEDURE SEGMENT – Primary Records
Data Sets
Record
Positions
Data Element
746 - 749
Principal Procedure Code
750 - 757
PRINCIPAL PROCEDURE DATE
CHAR
4
Page
No.
Description
Limited
Identifiable
X
X
X
All
Identifies the inpatient principal procedure performed at
claim level during period covered by this event
135
X
All
Date Principal Procedure performed
136
DAY BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Data
Type
De-identified
(3597 - 3618)
PRINCIPAL PROCEDURE DATE
Encrypted
758
Pre-Admit Procedure Indicator 1
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after (+)
Admission Date. Blank if no procedure.
137
759 - 762
Other Procedure Code 1
CHAR
4
X
X
X
All
ICD-9-CM code identifying any significant procedure, other
than principal procedure
138
OUTPATIENT
(22)
X
Page 12
Data Sets
Record
Positions
Data Element
763 - 770
OTHER PROCEDURE DATE 1
Encrypted Location
Type
Size
De-identified
Limited
Data
Type
Description
Page
No.
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
identifiable
X
All
Date Other Procedure performed.
139-140
(3597 - 3618)
OTHER PROCEDURE DATE 1
Encrypted
771
Pre-Admit Procedure Indicator 2
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
772 - 775
Other Procedure Code 2
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
776 - 783
OTHER PROCEDURE DATE 2
X
All
Date Other Procedure performed.
(22)
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
(3619 – 3640)
X
OTHER PROCEDURE DATE 2
Encrypted
(22)
139-140
X
784
Pre-Admit Procedure Indicator 3
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
785 - 788
Other Procedure Code 3
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
789 - 793
OTHER PROCEDURE DATE 3
Encrypted Location
X
All
Date Other Procedure performed.
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
139-140
(3641 – 3662)
OTHER PROCEDURE DATE 3
Encrypted
797
Pre-Admit Procedure Indicator 4
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
798 - 801
Other Procedure Code 4
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
OUTPATIENT
(22)
X
Page 13
Data Sets
Record
Positions
Data Element
802 - 809
OTHER PROCEDURE DATE 4
Type
Size
De-identified
Limited
Data
Type
Description
Page
No.
DAY BLANK
(YYYY)**
8
DAY/MO. BLANK
(YYYY)
NUM
identifiable
X
All
Date Other Procedure performed.
139-140
(3663 – 3706)
OTHER PROCEDURE DATE 4
Encrypted
810
Pre-Admit Procedure Indicator 5
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
811 - 814
Other Procedure Code 5
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
815 - 822
OTHER PROCEDURE DATE 5
Encrypted Location
X
All
Date Other Procedure performed.
(22)
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
139-140
(3707 – 3728)
OTHER PROCEDURE DATE 5
Encrypted
823
Pre-Admit Procedure Indicator 6
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
824 - 827
Other Procedure Code 6
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
828 - 835
OTHER PROCEDURE DATE 6
Encrypted Location
X
All
Date Other Procedure performed.
(22)
X
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
139-140
(3729 – 3750
OTHER PROCEDURE DATE 6
Encrypted
836
Pre-Admit Procedure Indicator 7
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
837 - 840
Other Procedure Code 7
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
OUTPATIENT
(22)
X
Page 14
Data Sets
Record
Positions
Data Element
841 - 848
OTHER PROCEDURE DATE 7
(3751 – 3772)
OTHER PROCEDURE DATE 7
Encrypted
849
Pre-Admit Procedure Indicator 8
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
850 - 853
Other Procedure Code 8
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
854 - 861
OTHER PROCEDURE DATE 8
Type
Size
De-identified
Limited
DAY/MO. BLANK
(YYYY)
(22)
Page
No.
Description
X
All
Date Other Procedure performed.
139-140
X
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
Data
Type
DAY BLANK
(YYYYMM)
8
NUM
Identifiable
X
All
Date Other Procedure performed.
139-140
(3773 – 3794)
OTHER PROCEDURE DATE 8
Encrypted
862
Pre-Admit Procedure Indicator 9
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
863 - 866
Other Procedure Code 9
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
867 - 874
OTHER PROCEDURE DATE 9
(22)
X
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
X
All
Date Other Procedure performed.
139-140
(3795 – 3816)
OTHER PROCEDURE DATE 9
Encrypted
875
Pre-Admit Procedure Indicator 10
CHAR
1
X
X
X
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
876 - 879
Other Procedure Code 10
CHAR
4
X
X
X
All
ICD code identifying any significant procedure, other
than Principal Procedure
138
880 - 887
OTHER PROCEDURE DATE 10
(22)
X
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
X
All
(3817 – 3838)
OTHER PROCEDURE DATE 10
Encrypted
888
Pre-Admit Procedure Indicator 11
CHAR
1
X
X
X
All
889 - 892
Other Procedure Code 11
CHAR
4
X
X
X
All
OUTPATIENT
(22)
Date Other Procedure performed.
139-140
X
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
ICD code identifying any significant procedure, other
than Principal Procedure
138
Page 15
Record
Positions
Data Element
893 - 900
OTHER PROCEDURE DATE 11
Type
Data Sets
Size
De-identified
Limited
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
Identifiable
OTHER PROCEDURE DATE 11
Encrypted
901
Pre-Admit Procedure Indicator 12
CHAR
1
X
X
X
902 - 905
Other Procedure Code 12
CHAR
4
X
X
X
906 - 913
OTHER PROCEDURE DATE 12
DAY/MO. BLANK
(YYYY)
NUM
DAY BLANK
(YYYYMM)
914
Pre-Admit Procedure Indicator 13
CHAR
1
X
X
X
915 - 918
Other Procedure Code 13
CHAR
4
X
X
X
919 - 926
OTHER PROCEDURE DATE 13
DAY BLANK
(YYYYMM)
927
Pre-Admit Procedure Indicator 14
CHAR
1
X
X
X
928 - 931
Other Procedure Code 14
CHAR
4
X
X
X
932 - 939
OTHER PROCEDURE DATE 14
DAY BLANK
(YYYYMM)
940
Pre-Admit Procedure Indicator 15
CHAR
1
X
X
X
941 - 943
Clinical Classification Software
(CCS) Procedure Category
CHAR
3
X
X
X
OUTPATIENT
Method of Anesthesia Used
NUM
2
X
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
ICD code identifying any significant procedure, other
than Principal Procedure
138
Date Other Procedure performed.
139-140
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
ICD code identifying any significant procedure, other
than Principal Procedure
138
Date Other Procedure performed.
139-140
All
X
X
139-140
All
OTHER PROCEDURE DATE 14
Encrypted
944 - 945
All
X
(3905 - 3926)
(22)
138
All
X
DAY/MO. BLANK
(YYYY)
NUM
ICD code identifying any significant procedure, other
than Principal Procedure
All
OTHER PROCEDURE DATE 13
Encrypted
8
137
Date Other Procedure performed.
X
(3883 - 3904)
(22)
All
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
All
X
DAY/MO. BLANK
(YYYY)
NUM
139-140
All
OTHER PROCEDURE DATE 12
Encrypted
8
Date Other Procedure performed.
X
(3861 - 3882)
(22)
Page
No.
All
X
8
Description
All
X
(3839 - 3860)
(22)
Data
Type
X
Indicates if procedure was before (-), on (+), or after
(+) Admission Date. Blank if no procedure.
137
All
CCS Procedure Category based on reported
procedure code
141
All
Type of anesthesia administered during stay.
"00" = No Anesthesia
"10" = Local Anesthesia
"20" = General Anesthesia
"30" = Regional Anesthesia
"40" = Other
142
Page 16
Data Sets
Record
Positions
Data Element
946
Age Warning Flag
CHAR
947
Procedure Date Warning Flag
948
Procedure Coding Method
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
All
Flags a conflict between reported diagnosis and ICD9-CM reference file's age-specific edits.
1 = conflict, blank = no conflict
143
CHAR
1
X
X
X
All
Flags if procedure date conflicts with date of care
"1" = Conflict / blank = No conflict
144
CHAR
1
X
X
X
All
Identifies coding structure used
145
Type
Size
DRG SEGMENT - Primary Records
Record
Positions
949 - 950
Data Sets
Data Element
De-identified
Grouping Claim Processed Flag
CHAR
2
X
Limited
X
Identifiable
X
Data
Type
Description
Page
No.
All
Flags Claims processed with errors or warning
messages
"00" = Errors or warning/messages
"01" = Warning/messages
"02" = Invalid date claim
"03" = Single visit claim action flag
“04” = Blank Pdx
"99" = Fatal error/APG cannot run
146
147
951 - 960
Claim Processed
Warnings/Messages
CHAR
10
X
X
X
All
Issues warning messages for claims:
"00" = No warning messages
"01" = Some visits unassigned
"02" = All visits unassigned
"03" = From Date and Through Date span code
versions
"04" = Non-standard user defined configuration
961 - 963
Number of Visits
CHAR
3
X
X
X
All
The description is maintained within the software
package
148
964 - 975
APG Version Used
CHAR
12
X
X
X
All
3M™ Enhances APG Software 2011 version 4.0
149
976 - 977
APG List Return Code
CHAR
2
X
X
X
All
Identifies which of the lists contains the first offending
element that failed loading
150
978 - 980
APG List Error Location
CHAR
3
X
X
X
All
Identifies error location in the list that triggered the
failure
151
OUTPATIENT
Page 17
Data Sets
Record
Positions
Data Element
981 - 983
Item ID number
CHAR
984 - 986
Error Return Code
987 - 994
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
All
The description is maintained within the software
package
152
CHAR
3
X
X
X
All
Identifies the Error Return Code by a value of 904
when base rate equals zero (NY)
153
Claim APG Payment
CHAR
8
X
X
X
All
Identifies the standard APG-based payment for claim
154
995 - 1002
Claim Transition Visit APG
Payment
CHAR
8
X
X
X
All
The description is maintained within the software
package
155
1003 - 1010
Claim Existing Payment
CHAR
8
X
X
X
All
The description is maintained within the software
package
156
1011 - 1018
Claim Blended Payment
CHAR
8
X
X
X
All
The description is maintained within the software
package
157
1019 - 1026
Claim Add-On Payment
CHAR
8
X
X
X
All
The description is maintained within the software
package
158
1027 - 1034
Total Claim Payment
CHAR
8
X
X
X
All
Identifies the claim payment including the cost outlier
payment, if applicable
159
1035 - 1042
Claim Non-Transition Payment
CHAR
8
X
X
X
All
The description is maintained within the software
package
160
1043 - 1051
Claim Adjusted APG Weight
CHAR
9
X
X
X
All
Identifies the sum of line item adjusted APG weights
161
1052 - 1060
Total Claim Full APG Weight
CHAR
9
X
X
X
All
The description is maintained within the software
package
162
1061 - 1068
Claim Payment
CHAR
8
X
X
X
All
Claim payment including cost outlier payment, if
applicable
163
OUTPATIENT
Page 18
AMI SEGMENT - Primary Records
Data Sets
Record
Positions
1069
1070 - 1072
Data Element
Type
Size
De-identified
AMI Warning Flag
Heart Rate on Arrival
1
3
X
X
X
X
Limited
X
X
Data Type
Description
Page
No.
All
Acute Myocardial Infarction (AMI) Warning Indicator
"1" = AMI code reported
"0" = No AMI code reported.
Data element for six months
164
ED
Patient heart rate in beats per minute (bpm) at first
patient contact after arrival with Principal/Primary
Diagnosis of AMI.
Reported value = Patient Heart Rate on Arrival.
“888” = Undocumented in Medical Chart
“999” = Unknown
blank = Not applicable
165
Identifiable
X
X
1073 - 1075
Systolic BP on Arrival
3
X
X
X
X
ED
1076 - 1078
Diastolic BP on Arrival
3
X
X
X
X
ED
Type
Size
Systolic BP in mg/dl at first patient contact after
arrival with Principal/Primary Diagnosis of AMI
Reported value = Systolic Blood Pressure upon
arrival
“888” = Undocumented in Medical Chart
“999” = Unknown
blank = Not applicable
Diastolic BP in mg/dl at first patient contact after
arrival with Principal/Primary Diagnosis of AMI
Reported value = Diastolic Blood Pressure upon
arrival
“888” = Undocumented in Medical Chart
“999” = Unknown
blank = Not applicable
166
167
HIPAA SEGMENT - Primary Records
Record
Positions
Data Element
Data Sets
Data
Type
De-identified
Limited
Identifiable
Description
1079
AIDS / HIV Flag
CHAR
1
X
X
X
All
Indication of AIDS/HIV in record (Y or N)
1080
Abortion Flag
CHAR
1
X
X
X
All
Indication of abortion in record (Y or N)
OUTPATIENT
Page
No.
168
169
Page 19
CHARGES SEGMENT - Primary Records
Data Sets
Record Positions
Data Element
Type
Size
De-identified
Limited
Identifiable
Data
Type
Page
No.
Description
1081 - 1092
Total Charges
NUM
12
X
X
X
All
Total charges
170
1093 - 1102
Ancillary Total Charges
CHAR
10
X
X
X
All
Total of all Ancillary Charges incurred
171
1103 - 1114
Total Non-Covered Charges
NUM
12
X
X
X
All
Total charges not reimbursable by primary payer
172
1115 - 1124
Total Non-Covered Ancillary
Charges
CHAR
10
X
X
X
All
Total of all Ancillary Non-Covered Charges
173
SERVICE SEGMENT - Primary Records
Record
Positions
1125 - 1128
Data Element
Revenue Code 1
Data Sets
Type
Size
De-identified
Limited
Identifiable
Data Type
Description
Page
No.
CHAR
4
X
X
X
All
Identifies specific accommodations, ancillary service
or unique billing calculations or arrangements.
(Revenue Code)
174-175
1129
Revenue Type 1
CHAR
1
X
X
X
All
Identifies the type of revenue code utilized, and is
grouped into two categories: accommodation codes
and ancillary codes
176
1130 - 1134
HCPCS/CPT Procedure Code 1
CHAR
5
X
X
X
All
Healthcare Common Procedure Coding System
(HCPCS) code and modifiers for outpatient
procedure performed and associated with each line
of service
177
OUTPATIENT
Page 20
Data Sets
Record
Positions
Data Element
1135 - 1136
Procedure Modifier Code #1 - 1
CHAR
1137 - 1138
Procedure Modifier Code #2 - 1
1139 - 1148
Type
Size
Page
No.
De-identified
Limited
Identifiable
Data
Type
2
X
X
X
All
Clarifies or improves the reporting accuracy of the
associated procedure code
178
CHAR
2
X
X
X
All
Clarifies or improves the reporting accuracy of the
associated procedure code
179
Service Charge 1
NUM
10
X
X
X
All
The total amount/sum of revenue charges
(accommodations charges and ancillary charges) of all
submitted charges on each service line segment for this
claim
180
1149 - 1150
Unit Type 1
CHAR
2
X
X
X
All
1151 - 1158
Unit Quantity 1
NUM
8
X
X
X
All
The number of service units that occurred during the bill
period for the patient (Days or Quantity of Units)
182
1159 - 1168
Non-Covered Charge 1
NUM
10
X
X
X
All
The non-covered charges for the primary payer as it
pertains to the associated revenue code.
183
1169 - 1176
SERVICE DATE 1
X
OP
The date the outpatient service was provided
184
The measurement units in which a value is being
expressed
181
DAY BLANK
(YYYYMM)
8
DAY/MO. BLANK
(YYYY)
NUM
Description
(3927 - 3948)
SERVICE DATE 1 Encrypted
1177
Pre-Visit Indicator 1
CHAR
1
X
X
X
OP
Indicates if the procedure occurred before, on or after
the Admission/Start of Care Date
185
1178 - 1180
Line item number 1
CHAR
3
X
X
X
OP
Number between 1 and 999 that is assigned for
differentiation or to reference a line number within a
transaction set
186
OUTPATIENT
(22)
X
Page 21
Data Sets
Record
Positions
Data Element
1181 - 1183
Visit ID 1
CHAR
1184 - 1186
Lines in Visit 1
CHAR
1187 - 1194
VISIT DATE 1
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
3
X
X
X
OP
Identifies the visit in which the line items can be
associated
187
3
X
X
X
OP
Identifies the number of lines in the APG return buffer
with this visit ID
188
X
OP
The earliest date on the claim using the single day visit
option associated with the 3M software. Same as
Service Date.
189
X
OP
Indicates if there were errors during processing
190
191
DAY BLANK
(YYYYMM)
8
NUM
(3949 - 3970)
VISIT DATE 1 Encrypted
1195
Visit Processed Flag 1
1196 - 1205
Visit Processed Warnings/
Messages 1
CHAR
10
X
X
X
OP
Indicates if there were errors during processing
“00” = Visit processed without warning
“01” = Visit processed with some lines unassigned
“02” = Visit processed with all lines unassigned
“03” = Visit processed with multiple per diems assigned
1206 - 1207
Overall Visit Type 1
CHAR
2
X
X
X
OP
The overall visit type based on the service provided
1208 - 1214
Medical Visit Diagnosis 1
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
1215 - 1219
Final APG Assignment 1
CHAR
5
X
X
X
OP
Final APG code assignment
195
1220 - 1221
Final APG Type 1
CHAR
2
X
X
X
OP
Ambulatory Patient Group (APG). Classification of the
procedures which may be performed on an ambulatory
basis
196
1222 - 1223
Final APG Category 1
CHAR
2
X
X
X
OP
Final APG Category number and description
OP
Identifies duplicate costs accrued when multiple
significant procedures, ancillary lab services and/or
ancillary non-lab services are performed during the
same visit. Multiple SPs on the same day are flagged
for same day multiple procedure discounting
1224
OUTPATIENT
Multiple Significant Procedure (MSP)
Discounting Flag 1
(22)
DAY/MO. BLANK
(YYYY)
NUM
CHAR
1
1
X
X
X
X
X
X
192-193
197-198
199
Page 22
Record
Positions
1225
Data Sets
Data Element
Type
Size
De-identified
Repeat Ancillary Discounting Flag 1
CHAR
1
X
Limited
X
Identifiable
X
Data
Type
Description
Page
No.
OP
Identifies duplicate costs accrued when multiple
significant procedures, ancillary lab services and/or
ancillary non-lab services are performed during the
same visit. Multiple ancillary charges on the same day
are flagged with the repeat ancillary discounting flag.
0=None;
1=Repeat Ancillary Discounting applies
200
201
1226
Bilateral Discounting Flag 1
CHAR
1
X
X
X
OP
Indicates that an identical service is performed on the
opposite side of the body at the same session or visit.
00” = None
“01” = Bilateral Discounting applies
“02” = Surgical bilateral discount applies
“03” = Non-surgical bilateral discounting applies
1227
Terminated Procedure Discounting
Flag 1
CHAR
1
X
X
X
OP
Identifies a procedure that is terminated due to medical
complications which would increase the risk to the
patient
202
1228 - 1229
Line Item Unassigned Flag 1
CHAR
2
X
X
X
OP
A single unassigned APG (999) is given to line items
with a corresponding Line Item Unassigned Flag.
203
1230
Packaged Per Diem Flag 1
CHAR
1
X
X
X
OP
Line item packaged as part of a partial hospitalization
per diem or daily mental health service per diem.
“0”=Not Packaged into Per Diem APG
204
OP
Line items that are bundled together, such as
anesthesia, supplies, certain drugs and the use of
recovery and observation rooms.
0= Not Packaged into Per Diem APG
1=Packaged into Per Diem APG
205
206
1231
Packaging Flag 1
CHAR
1
X
X
X
1232
Same Significant Procedure (SSP)
Consolidation Flag 1
CHAR
1
X
X
X
OP
Indicates procedures are consolidated into one for
reimbursement, and applies to multiple instances of the
same significant procedures that are performed at the
same visit.
0=None
1=Same SP Consolidation applies
1233
Clinical Significant Procedure (CSP)
Consolidation Flag 1
CHAR
1
X
X
X
OP
Indicates that multiple instances of the same clinical
significant procedures are consolidated into one for
reimbursement
207
1234 - 1235
Line Item Acuity Flag 1
CHAR
2
X
X
X
OP
Passed from input by the system
208
OUTPATIENT
Page 23
Data Sets
Record
Positions
Data Element
1236 - 1238
Service Item ID number 1
CHAR
1239 - 1246
Line Item APG Payment 1
1247 - 1254
Type
Size
Data
type
Page
No.
Description
De-identified
Limited
Identifiable
3
X
X
X
OP
The description is maintained within the software
package
209
NUM
8
X
X
X
OP
The APG paid amount (Amt_APG_Full_E2246)
multiplied by a percentage based on the APG Blend
Type Code (APG_Blnd_Type_Cd_E2248)
210
Line Item Existing Payment 1
NUM
8
X
X
X
OP
The calculated dollar amount to be paid to the provider
based on a blending rate determined by the State Rate
Setting Agencies
211
1255 - 1262
Line Item Blended Payment 1
NUM
8
X
X
X
OP
Identifies the percentage of the blended rate amount
used in calculating the final APG payment amount.
212
1263 - 1270
Line Item Add-On Payment 1
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
1271 - 1278
Line Item Total Payment 1
NUM
8
X
X
X
OP
Line item payment, including possible cost outlier
payment
214
1279 - 1283
Line Item Blend Percent 1
NUM
5
X
X
X
OP
The percentage, usually in 25 percent increments, used
to calculate the blended amount for calculating payment
215
1284 - 1292
Line Item Adjusted APG Weight 1
NUM
9
X
X
X
OP
The APG weight after the discounting and consolidation
for the line item
216
1293 - 1301
Line Item Full APG Weight 1
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
1302 - 1307
Line Item Payment Percent 1
NUM
6
X
X
X
OP
The APG percentage after discounting and
consolidation
218
OUTPATIENT
Page 24
Data Sets
Record
Positions
Data Element
1308 - 1309
Line Item Payment Action 1
CHAR
1310 - 1316
Line Item Paid Units 1
1317 - 1318
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
2
X
X
X
OP
Identifies if the line was paid fully, consolidated,
discounted, or packaged, based upon the remainder of
the claim
219
CHAR
7
X
X
X
OP
Identifies the number of units paid
220
Line Item Payment Adjustment Flag
1
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
1319 - 1326
Visit APG Payment 1
NUM
8
X
X
X
OP
This is the calculated dollar value that will be paid to a
provider
222
1327 - 1334
Visit Transition APG Payment 1
NUM
8
X
X
X
OP
The amount paid based on the calculated values of both
the existing payment and the blended payment
combined to create the total APG payment specified
phase
223
1335 - 1342
Visit Existing Payment 1
NUM
8
X
X
X
OP
Used for blending purposes and based on a provider's
average per visit reimbursement for services moving to
APGs for calendar year 2007
224
1343 - 1350
Visit Blended Payment 1
NUM
8
X
X
X
OP
The amount that the APG methodology calculates for
the visit based on the coded procedures and diagnosis
225
1351 - 1358
Visit Add-On Payment 1
NUM
8
X
X
X
OP
This is the fixed add-on payment for the visit
226
1359 - 1366
Visit Payment 1
NUM
8
X
X
X
OP
The payment for the visit not including outlier payment
and revenue code add-on
227
1367 - 1374
Visit Non-transition Payment 1
NUM
8
X
X
X
OP
The amount paid based solely on the fully blended
payment (100%) to create the total APG payment during
the specified phase
228
1375 - 1383
Visit Adjusted APG Weight 1
NUM
9
X
X
X
OP
This is the sum of the adjusted APG weights for the visit
229
1384 - 1392
Visit Full APG Weight 1
NUM
9
X
X
X
OP
This is the sum of the APG weights for the visit
230
OUTPATIENT
Page 25
D
SERVICE SEGMENT - Primary Recordsets
Data Sets
Record
Positions
Data Element
1393-1396
Revenue Code 2
CHAR
1397
Revenue Type 2
1398-1402
Type
Size
De-identified
Limited
Identifiable
4
X
X
X
CHAR
1
X
X
X
HCPCS/CPT Procedure Code 2
CHAR
5
X
X
1403-1404
Procedure Modifier Code #1 - 2
CHAR
2
X
1405-1406
Procedure Modifier Code #2 - 2
CHAR
2
1407-1416
Service Charge 2
NUM
1417-1418
Unit Type 2
1419-1426
Data
Type
Page No.
See Description for Revenue Code 1
174-175
All
See Description for Revenue Type 1
176
X
ALL
See Description for HCPCS/CPT Procedure Code 1
177
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
X
X
X
ALL
See Description for Procedure Modifier Code 2 - 1
179
10
X
X
X
All
See Description for Service Charge 1
180
CHAR
2
X
X
X
ALL
See Description for Unit Type 1
181
Unit Quantity 2
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
1427-1436
Non-Covered Charge 2
NUM
10
X
X
X
ALL
See Description for Non-Covered Charge 1
183
1437-1444
SERVICE DATE 2
X
OP
See Description for Service Date 1
184
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
All
Description
(3971 - 3992)
SERVICE DATE 2 Encrypted
1445
Pre-Visit Indicator 2
CHAR
1
X
X
X
OP
See Description for Pre-Visit Indicator 1
185
1446-1448
Line item number 2
CHAR
3
X
X
X
OP
See Description for Line Item Number 1
186
OUTPATIENT
(22)
X
Page 26
Data Sets
Record
Positions
Data Element
1449-1451
Visit ID 2
CHAR
1452-1454
Lines in Visit 2
CHAR
1455-1462
VISIT DATE 2
(3993 - 4014)
VISIT DATE 2 Encrypted
1463
Visit Processed Flag 2
NUM
1
X
1464-1473
Visit Processed Warnings/ Messages
2
CHAR
10
1474-1475
Overall Visit Type 2
CHAR
1476-1482
Medical Visit Diagnosis 2
1483-0487
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 1
187
3
X
X
X
OP
See Description for Lines in Visit 1
188
X
OP
See Description for Visit Date 1
189
X
X
OP
See Description for Visit Processed Flag 1
190
X
X
X
OP
See Description for Visit Processed Warnings/Messages
1
191
2
X
X
X
OP
See Description for Overall Visit Type 1
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
Final APG Assignment 2
CHAR
5
X
X
X
OP
See Description for Final APG Assignment 1
195
1488-1489
Final APG Type 2
CHAR
2
X
X
X
OP
See Description for Final APG Type 1
196
1490-1491
Final APG Category 2
CHAR
2
X
X
X
OP
See Description for Final APG Category 1
1492
Multiple Significant Procedure (SP)
Discounting Flag 2
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
1493
Repeat Ancillary Discounting Flag 2
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag 1
200
DAY/MO.
BLANK (YYYY)
NUM
OUTPATIENT
DAY
BLANK
(YYYYMM)
8
(22)
X
192-193
197-198
Page 27
Data Sets
Record
Positions
Data Element
1494
Bilateral Discounting Flag 2
CHAR
1495
Terminated Procedure Discounting
Flag 2
1496-1497
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 2
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
1498
Packaged Per Diem Flag 2
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
1499
Packaging Flag 2
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
1500
Same Significant Procedure (SP)
Consolidation Flag 2
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
1501
Clinical Significant Procedure (SP)
Consolidation Flag 2
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
1502-1503
Line Item Action Flag 2
CHAR
2
X
X
X
OP
Passed from input by the system
208
1504-1506
Service Item ID number 2
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
1507-1514
Line Item APG Payment 2
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
1515-1522
Line Item Existing Payment 2
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
1523-1530
Line Item Blended Payment 2
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
1531-1538
Line Item Add-on Payment 2
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
1539-1546
Line Item Total Payment 2
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 1
214
OUTPATIENT
Page 28
Data Sets
Record
Positions
Data Element
1547-1551
Line Item Blend Percent 2
NUM
1552-1560
Line Item Adjusted APG Weight 2
1561-1569
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 2
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
1570-1575
Line Item Payment Percent 2
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
1576-1577
Line Item Payment Action 2
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
1578-1584
Line Item Paid Units 2
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
1585-1586
Line Item Payment Adjustment Flag
2
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
1587-1594
Visit APG Payment 2
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
1595-1602
Visit Transition APG Payment 2
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
1603-1610
Visit Existing Payment 2
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
1611-1618
Visit Blended Payment 2
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
1619-1626
Visit Add-on Payment 2
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
1627-1634
Visit Payment 2
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
1635-1642
Visit Non-transition Payment 2
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
1643-1651
Visit Adjusted APG Weight 2
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
1652-1660
Visit Full APG Weight 2
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 29
Data Sets
Record
Positions
Data Element
1661-1664
Revenue Code 3
CHAR
1665
Revenue Type 3
1666-1670
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
4
X
X
X
All
See Description for Revenue Code 1
174-175
CHAR
1
X
X
X
All
See Description for Revenue Type 1
176
HCPCS/CPT Procedure Code 3
CHAR
5
X
X
X
All
See Description for HCPCS/CPT Procedure Code 1
177
1671-1672
Procedure Modifier Code #1 - 3
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
1673-1674
Procedure Modifier Code #2 - 3
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 2 - 1
179
1675-1684
Service Charge 3
NUM
10
X
X
X
All
See Description for Service Charge 1
180
1685-1686
Unit Type 3
CHAR
2
X
X
X
All
See Description for Unit Type 1
181
1687-1694
Unit Quantity 3
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
1695-1704
Non-Covered Charge 3
NUM
10
X
X
X
All
See Description for Non-Covered Charge 1
183
1705-1712
SERVICE DATE 3
X
OP
See Description for Service Date 1
184
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4015-4036)
SERVICE DATE 3 Encrypted
1713
Pre-Visit Procedure Indicator 3
CHAR
1
X
X
X
OP
See Description for Pre-Visit Indicator 1
185
1714-1716
Line item number 3
CHAR
3
X
X
X
OP
See Description for Line Item Number 1
186
OUTPATIENT
(22)
X
Page 30
Data Sets
Record
Positions
Data Element
1717-1719
Visit ID 3
CHAR
1720-1722
Lines in Visit 3
CHAR
1723-1730
VISIT DATE 3
(4037- 4058)
VISIT DATE 3 Encrypted
1731
Visit Processed Flag 3
NUM
1
X
1732-1741
Visit Processed Warnings/ Messages
3
CHAR
10
1742-1743
Overall Visit Type 3
CHAR
1744-1750
Medical Visit Diagnosis 3
1751-1755
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 1
187
3
X
X
X
OP
See Description for Lines in Visit 1
188
X
OP
See Description for Visit Date 1
189
X
X
OP
See Description for Visit Processed Flag 1
190
X
X
X
OP
See Description for Visit Processed
Warnings/Messages 1
191
2
X
X
X
OP
See Description for Overall Visit Type 1
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
Final APG Assignment 3
CHAR
5
X
X
X
OP
See Description for Final APG Assignment 1
195
1756-1757
Final APG Type 3
CHAR
2
X
X
X
OP
See Description for Final APG Type 1
196
1758-1759
Final APG Category 3
CHAR
2
X
X
X
OP
See Description for Final APG Category 1
1760
Multiple Significant Procedure (SP)
Discounting Flag 3
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
1761
Repeat Ancillary Discounting Flag 3
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag
1
200
DAY/MO.
BLANK (YYYY)
NUM
OUTPATIENT
DAY
BLANK
(YYYYMM)
8
(22)
X
192-193
197-198
Page 31
Data Sets
Record
Positions
Data Element
1762
Bilateral Discounting Flag 3
CHAR
1763
Terminated Procedure Discounting
Flag 3
1764-1765
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 3
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
1766
Packaged Per Diem Flag 3
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
1767
Packaging Flag 3
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
1768
Same Significant Procedure (SP)
Consolidation Flag 3
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
1769
Clinical Significant Procedure (SP)
Consolidation Flag 3
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
1770-1771
Line Item Action Flag 3
CHAR
2
X
X
X
OP
Passed from input by the system
208
1772-1774
Item ID number 3
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
1775-1782
Line Item APG Payment 3
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
1783-1790
Line Item Existing Payment 3
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
1791-1798
Line Item Blended Payment 3
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
1799-1806
Line Item Add-on Payment 3
NUM
8
X
X
X
OP
1807-1814
Line Item Total Payment 3
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
See Description for Line Item Total Payment 1
OUTPATIENT
214
Page 32
Data Sets
Record
Positions
Data Element
1815-1819
Line Item Blend Percent 3
NUM
1820-1828
Line Item Adjusted APG Weight 3
1829-1837
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 3
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
1838-1843
Line Item Payment Percent 3
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
1844-1845
Line Item Payment Action 3
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
1846-1852
Line Item Paid Units 3
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
1853-1854
Line Item Payment Adjustment Flag
3
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
1855-1862
Visit APG Payment 3
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
1863-1870
Visit Transition APG Payment 3
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
1871-1878
Visit Existing Payment 3
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
1879-1886
Visit Blended Payment 3
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
1887-1894
Visit Add-on Payment 3
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
1895-1902
Visit Payment 3
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
1903-1910
Visit Non-transition Payment 3
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
1911-1919
Visit Adjusted APG Weight 3
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
1920-1928
Visit Full APG Weight 3
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 33
Record
Positions
Data Element
1929-1932
Revenue Code 4
CHAR
1933
Revenue Type 4
1934-1938
Type
Data Sets
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
4
X
X
X
All
See Description for Revenue Code 1
174-175
CHAR
1
X
X
X
All
See Description for Revenue Type 1
176
HCPCS/CPT Procedure Code 4
CHAR
5
X
X
X
All
See Description for HCPCS/CPT Procedure Code 1
177
1939-1940
Procedure Modifier Code #1 – 4
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
1941-1942
Procedure Modifier Code #2 – 4
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 2 - 1
179
1943-1952
Service Charge 4
NUM
10
X
X
X
All
See Description for Service Charge 1
180
1953-1954
Unit Type 4
CHAR
2
X
X
X
All
See Description for Unit Type 1
181
1955-1962
Unit Quantity 4
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
1963-1972
Non-Covered Charge 4
NUM
10
X
X
X
All
See Description for Non-Covered Charge 1
183
1973-1980
SERVICE DATE 4
X
OP
See Description for Service Date 1
184
See Description for Pre-Visit Indicator 1
185
See Description for Line Item Number 1
186
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4059-4080)
SERVICE DATE 4 Encrypted
1981
Pre-Visit Procedure Indicator 4
CHAR
1
X
X
X
1982-1984
Line Item Number 4
CHAR
3
X
X
X
OUTPATIENT
(22)
X
OP
OP
Page 34
Data Sets
Record
Positions
Data Element
1985-1987
Visit ID 4
CHAR
1988-1990
Lines in Visit 4
CHAR
1991-1998
VISIT DATE 4
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
Data
Type
Description
Page
No.
OP
See Description for Visit ID 1
187
See Description for Lines in Visit 1
188
See Description for Visit Date 1
189
See Description for Visit Processed Flag 1
190
See Description for Visit Processed
Warnings/Messages 1
191
OP
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(22)
X
(4081- 4102)
VISIT DATE 4 Encrypted
1999
Visit Processed Flag 4
NUM
1
X
X
X
2000-2009
Visit Processed Warnings/ Messages
4
CHAR
10
X
X
X
2010-2011
Overall Visit Type 4
CHAR
2
X
X
X
2012-2018
Medical Visit Diagnosis 4
CHAR
7
X
X
X
2019-2023
Final APG Assignment 4
CHAR
5
X
X
X
2024-2025
Final APG Type 4
CHAR
2
X
X
X
2026-2027
Final APG Category 4
CHAR
2
X
X
X
2028
Multiple Significant Procedure (SP)
Discounting Flag 4
CHAR
1
X
X
X
2029
Repeat Ancillary Discounting Flag 4
CHAR
1
X
X
X
OP
X
OP
OP
OP
See Description for Overall Visit Type 1
OP
OP
192-193
The description is maintained within the software
package
194
See Description for Final APG Assignment 1
195
See Description for Final APG Type 1
196
OP
OP
OUTPATIENT
See Description for Final APG Category 1
OP
OP
197-198
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
See Description for Repeat Ancillary Discounting Flag
1
200
Page 35
Data Sets
Record
Positions
Data Element
2030
Bilateral Discounting Flag 4
CHAR
2031
Terminated Procedure Discounting
Flag 4
2032-2033
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 4
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
2034
Packaged Per Diem Flag 4
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
2035
Packaging Flag 4
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
2036
Same Significant Procedure (SP)
Consolidation Flag 4
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
2037
Clinical Significant Procedure (SP)
Consolidation Flag 4
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
2038-2039
Line Item Action Flag 4
CHAR
2
X
X
X
OP
Passed from input by the system
208
2040-2042
Item ID number 4
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
2043-2050
Line Item APG Payment 4
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
2051-2058
Line Item Existing Payment 4
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
2059-2066
Line Item Blended Payment 4
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
2067-2074
Line Item Add-on Payment 4
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
2879-2886
Line Item Total Payment 4
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 1
214
OUTPATIENT
Page 36
Data Sets
Record
Positions
Data Element
2083-2087
Line Item Blend Percent 4
NUM
2088-2096
Line Item Adjusted APG Weight 4
2097-2105
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 4
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
2106-2111
Line Item Payment Percent 4
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
2112-2113
Line Item Payment Action 4
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
2114-2120
Line Item Paid Units 4
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
2121-2122
Line Item Payment Adjustment Flag
4
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
2123-2130
Visit APG Payment 4
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
2131-2138
Visit Transition APG Payment 4
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
2139-2146
Visit Existing Payment 4
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
2147-2154
Visit Blended Payment 4
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
2155-2162
Visit Add-on Payment 4
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
2163-2170
Visit Payment 4
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
2171-2178
Visit Non-transition Payment 4
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
2179-2187
Visit Adjusted APG Weight 4
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
2188-2196
Visit Full APG Weight 4
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 37
Data Sets
Record
Positions
Data Element
2197-2200
Revenue Code 5
CHAR
4
X
X
X
All
See Description for Revenue Code 1
174-175
2201
Revenue Type 5
CHAR
1
X
X
X
All
See Description for Revenue Type 1
176
2202-2206
HCPCS/CPT Procedure Code 5
CHAR
5
X
X
X
All
See Description for HCPCS/CPT Procedure Code 1
177
2207-2208
Procedure Modifier Code #1 - 5
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
2209-2210
Procedure Modifier Code #2 - 5
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 2 - 1
179
2211-2220
Service Charge 5
NUM
10
X
X
X
All
See Description for Service Charge 1
180
2221-2222
Unit Type 5
CHAR
2
X
X
X
All
See Description for Unit Type 1
181
2223-2230
Unit Quantity 5
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
2231-2240
Non-Covered Charge 5
NUM
10
X
X
X
All
See Description for Non-Covered Charge 1
183
2241-2248
SERVICE DATE 5
X
OP
See Description for Service Date 1
184
Type
Size
Deidentified
Limited
Data
Type
Description
Page
No.
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Identifiable
(4103-4124)
SERVICE DATE 5 Encrypted
2249
Pre-Visit Indicator 5
CHAR
1
X
X
X
OP
See Description for Pre-Visit Indicator 1
185
2250-2252
Line item number 5
CHAR
3
X
X
X
OP
See Description for Line Item Number 1
186
OUTPATIENT
(22)
X
Page 38
Data Sets
Record
Positions
Data Element
2253-2255
Visit ID 5
CHAR
2256-5528
Lines in Visit 5
CHAR
2259-2266
VISIT DATE 5
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 1
187
3
X
X
X
OP
See Description for Lines in Visit 1
188
X
OP
See Description for Visit Date 1
189
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4125- 4146)
VISIT DATE 5 Encrypted
2267
Visit Processed Flag 5
NUM
1
X
X
X
OP
See Description for Visit Processed Flag 1
190
2268-2277
Visit Processed Warnings/ Messages 5
CHAR
10
X
X
X
OP
See Description for Visit Processed Warnings/Messages
1
191
2278-2279
Overall Visit Type 5
CHAR
2
X
X
X
OP
See Description for Overall Visit Type 1
2280-2286
Medical Visit Diagnosis 5
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
2287-2291
Final APG Assignment 5
CHAR
5
X
X
X
OP
See Description for Final APG Assignment 1
195
2292-2293
Final APG Type 5
CHAR
2
X
X
X
OP
See Description for Final APG Type 1
196
2294-2295
Final APG Category 5
CHAR
2
X
X
X
OP
See Description for Final APG Category 1
2296
Multiple Significant Procedure (SP)
Discounting Flag 5
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
2297
Repeat Ancillary Discounting Flag 5
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag 1
200
OUTPATIENT
(22)
X
192-193
197-198
Page 39
Data Sets
Record
Positions
Data Element
2298
Bilateral Discounting Flag 5
CHAR
2299
Terminated Procedure Discounting Flag
5
2300-2301
Type
Size
Data
Type
Page
No.
Description
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 5
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
2302
Packaged Per Diem Flag 5
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
2303
Packaging Flag 5
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
2304
Same Significant Procedure (SP)
Consolidation Flag 5
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
2305
Clinical Significant Procedure (SP)
Consolidation Flag 5
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
2306-2307
Line Item Action Flag 5
CHAR
2
X
X
X
OP
Passed from input by the system
208
2308-2310
Item ID number 5
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
2311-2318
Line Item APG Payment 5
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
2319-2326
Line Item Existing Payment 5
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
2327-2334
Line Item Blended Payment 5
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
2335-2342
Line Item Add-on Payment 5
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
2343-2350
Line Item Total Payment 5
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 1
214
OUTPATIENT
Page 40
Data Sets
Record
Positions
Data Element
2351-2355
Line Item Blend Percent 5
NUM
2356-2364
Line Item Adjusted APG Weight 5
2365-2373
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 5
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
2374-2379
Line Item Payment Percent 5
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
2380-2381
Line Item Payment Action 5
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
2382-2388
Line Item Paid Units 5
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
2389-2390
Line Item Payment Adjustment Flag 5
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
2391-2398
Visit APG Payment 5
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
2399-2406
Visit Transition APG Payment 5
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
2407-2414
Visit Existing Payment 5
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
2415-2422
Visit Blended Payment 5
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
2423-2430
Visit Add-on Payment 5
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
2431-2438
Visit Payment 5
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
2439-2446
Visit Non-transition Payment 5
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
2447-2455
Visit Adjusted APG Weight 5
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
2456-2464
Visit Full APG Weight 5
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 41
Record
Positions
Data Sets
Data Element
Type
Size
De-identified
Limited
Identifiable
Data
Type
Description
Page
No.
2465-2468
Revenue Code 6
CHAR
4
X
X
X
All
See Description for Revenue Code 1
174-175
2469
Revenue Type 6
CHAR
1
X
X
X
All
See Description for Revenue Type 1
176
2470-2474
HCPCS/CPT Procedure Code 6
CHAR
5
X
X
X
All
See Description for HCPCS/CPT Procedure Code 1
177
2475-2476
Procedure Modifier Code #1 - 6
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
2477-2478
Procedure Modifier Code #2 - 6
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 2 - 1
179
2479-2488
Service Charge 6
NUM
10
X
X
X
All
See Description for Service Charge 1
180
2489-2490
Unit Type 6
CHAR
2
X
X
X
All
See Description for Unit Type 1
181
2491-2498
Unit Quantity 6
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
2499-2508
Non-Covered Charge 6
NUM
10
X
X
X
All
See Description for Non-Covered Charge 1
183
2509-2516
SERVICE DATE 6
X
OP
See Description for Service Date 1
184
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4147-4168)
SERVICE DATE 6 Encrypted
2517
Pre-Visit Indicator 6
CHAR
1
X
X
X
OP
See Description for Pre-Visit Indicator 1
185
2518-2520
Line item number 6
CHAR
3
X
X
X
OP
See Description for Line Item Number 1
186
OUTPATIENT
(22)
X
Page 42
Data Sets
Record
Positions
Data Element
2521-2523
Visit ID 6
CHAR
2524-2526
Lines in Visit 6
CHAR
2527-2534
VISIT DATE 6
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 1
187
3
X
X
X
OP
See Description for Lines in Visit 1
188
X
OP
See Description for Visit Date 1
189
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4169- 4190)
VISIT DATE 6 Encrypted
2535
Visit Processed Flag 6
NUM
1
X
X
X
OP
See Description for Visit Processed Flag 1
190
2536-2545
Visit Processed Warnings/ Messages 6
CHAR
10
X
X
X
OP
See Description for Visit Processed Warnings/Messages
1
191
2546-2547
Overall Visit Type 6
CHAR
2
X
X
X
OP
See Description for Overall Visit Type 1
2548-2554
Medical Visit Diagnosis 6
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
2555-2559
Final APG Assignment 6
CHAR
5
X
X
X
OP
See Description for Final APG Assignment 1
195
2560-2561
Final APG Type 6
CHAR
2
X
X
X
OP
See Description for Final APG Type 1
196
2562-2563
Final APG Category 6
CHAR
2
X
X
X
OP
See Description for Final APG Category 1
2564
Multiple Significant Procedure (SP)
Discounting Flag 6
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
2565
Repeat Ancillary Discounting Flag 6
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag 1
200
OUTPATIENT
(22)
X
192-193
197-198
Page 43
Data Sets
Record
Positions
Data Element
2566
Bilateral Discounting Flag 6
CHAR
2567
Terminated Procedure Discounting Flag
6
2568-2569
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 6
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
2570
Packaged Per Diem Flag 6
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
2571
Packaging Flag 6
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
2572
Same Significant Procedure (SP)
Consolidation Flag 6
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
2573
Clinical Significant Procedure (SP)
Consolidation Flag 6
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
2574-2575
Line Item Action Flag 6
CHAR
2
X
X
X
OP
Passed from input by the system
208
2576-2578
Item ID number 6
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
2579-2586
Line Item APG Payment 6
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
2587-2594
Line Item Existing Payment 6
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
2595-2602
Line Item Blended Payment 6
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
2603-2610
Line Item Add-on Payment 6
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
2611-2618
Line Item Total Payment 6
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 1
214
OUTPATIENT
Page 44
Data Sets
Record
Positions
Data Element
2619-2623
Line Item Blend Percent 6
NUM
2624-2632
Line Item Adjusted APG Weight 6
2633-2641
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 6
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
2642-2647
Line Item Payment Percent 6
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
2648-2649
Line Item Payment Action 6
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
2650-2656
Line Item Paid Units 6
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
2657-2658
Line Item Payment Adjustment Flag 6
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
2659-2666
Visit APG Payment 6
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
2667-2674
Visit Transition APG Payment 6
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
2675-2682
Visit Existing Payment 6
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
2683-2690
Visit Blended Payment 6
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
2691-2698
Visit Add-on Payment 6
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
2699-2706
Visit Payment 6
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
2707-2714
Visit Non-transition Payment 6
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
2715-2723
Visit Adjusted APG Weight 6
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
2724-2732
Visit Full APG Weight 6
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 45
Data Sets
Record
Positions
Data Element
2733-2736
Revenue Code 7
CHAR
2737
Revenue Type 7
2738-2742
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
4
X
X
X
All
See Description for Revenue Code 1
174-175
CHAR
1
X
X
X
All
See Description for Revenue Type 1
176
HCPCS/CPT Procedure Code 7
CHAR
5
X
X
X
All
See Description for HCPCS/CPT Procedure Code 1
177
2743-2744
Procedure Modifier Code #1 - 7
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 1 - 1
178
2745-2746
Procedure Modifier Code #2 - 7
CHAR
2
X
X
X
All
See Description for Procedure Modifier Code 2 - 1
179
2747-2756
Service Charge 7
NUM
10
X
X
X
All
See Description for Service Charge 1
180
2757-2758
Unit Type 7
CHAR
2
X
X
X
All
See Description for Unit Type 1
181
2759-2766
Unit Quantity 7
NUM
8
X
X
X
All
See Description for Unit Quantity 1
182
2767-2776
Non-Covered Charge 7
NUM
10
X
X
X
All
See Description for Non-Covered Charge 1
183
2777-2784
SERVICE DATE 7
X
OP
See Description for Service Date 1
184
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4191-4212)
SERVICE DATE 7 Encrypted
2785
Pre-Visit Indicator 7
CHAR
1
X
X
X
OP
See Description for Pre-Visit Indicator 1
185
2786-2788
Line item number 7
CHAR
3
X
X
X
OP
See Description for Line Item Number 1
186
OUTPATIENT
(22)
X
Page 46
Data Sets
Record
Positions
Data Element
2789-2791
Visit ID 7
CHAR
2792-2794
Lines in Visit 7
CHAR
2795-2802
VISIT DATE 7
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 1
187
3
X
X
X
OP
See Description for Lines in Visit 1
188
X
OP
See Description for Visit Date 1
189
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(4213- 40234)
VISIT DATE 7 Encrypted
2803
Visit Processed Flag 7
NUM
1
X
X
X
OP
See Description for Visit Processed Flag 1
190
2804-2813
Visit Processed Warnings/ Messages 7
CHAR
10
X
X
X
OP
See Description for Visit Processed
Warnings/Messages 1
191
2814-2815
Overall Visit Type 7
CHAR
2
X
X
X
OP
See Description for Overall Visit Type 1
2816-2822
Medical Visit Diagnosis 7
CHAR
7
X
X
X
OP
The description is maintained within the software
package
194
2823-2827
Final APG Assignment 7
CHAR
5
X
X
X
OP
See Description for Final APG Assignment 1
195
2828-2829
Final APG Type 7
CHAR
2
X
X
X
OP
See Description for Final APG Type 1
196
2830-2831
Final APG Category 7
CHAR
2
X
X
X
OP
See Description for Final APG Category 1
2832
Multiple Significant Procedure (SP)
Discounting Flag 7
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 1
199
2833
Repeat Ancillary Discounting Flag 7
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag
1
200
OUTPATIENT
(22)
X
192-193
197-198
Page 47
Data Sets
Record
Positions
Data Element
2834-2834
Bilateral Discounting Flag 7
CHAR
2835-2835
Terminated Procedure Discounting Flag
7
2836-2837
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
1
X
X
X
OP
See Description for Bilateral Discounting Flag 1
201
NUM
1
X
X
X
OP
See Description for Terminated Procedure Discounting
Flag 1
202
Line Item Unassigned Flag 7
CHAR
2
X
X
X
OP
See Description for Line Item Unassigned Flag 1
203
2838-2838
Packaged Per Diem Flag 7
CHAR
1
X
X
X
OP
See Description for Packaged Per Diem Flag 1
204
2839
Packaging Flag 7
CHAR
1
X
X
X
OP
See Description for Packaging Flag 1
205
2840
Same Significant Procedure (SP)
Consolidation Flag 7
CHAR
1
X
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 1
206
2841
Clinical Significant Procedure (SP)
Consolidation Flag 7
CHAR
1
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 1
207
2842-2843
Line Item Action Flag 7
CHAR
2
X
X
X
OP
Passed from input by the system
208
2844-2846
Item ID number 7
CHAR
3
X
X
X
OP
The description is maintained within the software
package
209
2847-2854
Line Item APG Payment 7
NUM
8
X
X
X
OP
See Description for Line Item APG Payment 1
210
2855-2862
Line Item Existing Payment 7
NUM
8
X
X
X
OP
See Description for Line Item Existing Payment 1
211
2863-2870
Line Item Blended Payment 7
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 1
212
2871-2878
Line Item Add-on Payment 7
NUM
8
X
X
X
OP
The description is maintained within the software
package
213
2879-2886
Line Item Total Payment 7
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 1
214
OUTPATIENT
Page 48
Data Sets
Record
Positions
Data Element
2887-2891
Line Item Blend Percent 7
NUM
2892-2900
Line Item Adjusted APG Weight 7
2901-2909
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
5
X
X
X
OP
See Description for Line Item Blend Percent 1
215
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 1
216
Line Item Full APG Weight 7
NUM
9
X
X
X
OP
The description is maintained within the software
package
217
2910-2915
Line Item Payment Percent 7
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 1
218
2916-2917
Line Item Payment Action 7
CHAR
2
X
X
X
OP
See Description for Line Item Payment Action 1
219
2918-2924
Line Item Paid Units 7
CHAR
7
X
X
X
OP
See Description for Line Item Paid Units 1
220
2925-2926
Line Item Payment Adjustment Flag 7
CHAR
2
X
X
X
OP
The description is maintained within the software
package
221
2927-2934
Visit APG Payment 7
NUM
8
X
X
X
OP
See Description for Visit APG Payment 1
222
2935-2942
Visit Transition APG Payment 7
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 1
223
2943-2950
Visit Existing Payment 7
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 1
224
2951-2958
Visit Blended Payment 7
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 1
225
2959-2966
Visit Add-on Payment 7
NUM
8
X
X
X
OP
See Description for Visit Add-on Payment 1
226
2967-2974
Visit Payment 7
NUM
8
X
X
X
OP
See Description for Visit Payment 1
227
2975-2982
Visit Non-transition Payment 7
NUM
8
X
X
X
OP
See Description for Visit Non-Transition Payment 1
228
2983-2991
Visit Adjusted APG Weight 7
NUM
9
X
X
X
OP
See Description for Visit Adjusted APG Weight 1
229
2992-3000
Visit Full APG Weight 7
NUM
9
X
X
X
OP
See Description for Visit Full APG Weight 1
230
OUTPATIENT
Page 49
Data Sets
Record
Positions
Data Element
1-14
Discharge Sequential Number
NUM
15
Continuation Indicator
16-18
19-21
Type
Size
De-identified
Limited
Identifiable
14
X
X
X
NUM
1
X
X
X
Record Sequence Number
NUM
3
X
X
X
Record Sequence Count
NUM
3
X
X
X
Data
Type
All
Record
Positions
Type
Size
De-identified
22-52
Filler
53 - 56
Revenue Code 8
57
Limited
Identifiable
29
X
X
X
CHAR
4
X
X
X
Revenue Type 8
CHAR
1
X
X
X
58 - 62
HCPCS/CPT Procedure Code 8
CHAR
5
X
X
X
63 - 64
Procedure Modifier Code #1 - 8
CHAR
2
X
X
X
OUTPATIENT
233
All
A code which indicates if continuation records exist for
this discharge and what type of information caused this
overflow
234
All
The number assigned sequentially by SPARCS to
indicate the record's position within a set of records for
a particular patient stay/discharge
235
The total number of records reported for a particular
patient stay/discharge
236
Data
Type
Description
no data
All
Page
No.
The discharge year, plus an eight digit number
sequentially assigned number
All
Data Sets
Data Element
Description
Identifies specific accommodations, ancillary service or
unique billing calculations or arrangements. (Revenue
Code)
Page
No.
237
237-238
Identifies the type of revenue code utilized, and is
grouped into two categories: accommodation codes
and ancillary codes
239
All
Healthcare Common Procedure Coding System
(HCPCS) code and modifiers for outpatient procedure
performed and associated with each line of service
240
All
Clarifies or improves the reporting accuracy of the
associated procedure code
241
All
Page 50
Data Sets
Record
Positions
Data Element
65 - 66
Procedure Modifier Code #2 - 8
CHAR
67 - 76
Service Charge 8
77 - 78
Type
Size
De-identified
Limited
Identifiable
2
X
X
X
NUM
10
X
X
X
Unit Type 8
CHAR
2
X
X
X
79 - 86
Unit Quantity 8
NUM
8
X
X
X
87 - 96
Non-Covered Charge 8
NUM
10
X
X
X
97 - 104
SERVICE DATE 8
8
DAY/MO.
BLANK (YYYY)
NUM
(22)
The total amount/sum of revenue charges
(accommodations charges and ancillary charges) of all
submitted charges on each service line segment for
this claim
243
The measurement units in which a value is being
expressed.
DA=Days
UN=Units
244
OP
The number of service units that occurred during the
bill period for the patient
245
OP
Non-covered charges for the primary payer as it
pertains to the associated revenue code.
246
X
OP
The date the outpatient service was provided
247
OP
Indicates if the procedure occurred before, on or after
the Admission/Start of Care Date
248
OP
Number between 1 and 999 that is assigned for
differentiation or to reference a line number within a
transaction set
249
OP
Identifies the visit in which the line items can be
associated
250
OP
Identifies the number of lines in the APG return buffer
with this visit ID
251
The lowest date on the claim using the single day visit
option associated with the 3M software. Same as
Service Date.
252
Pre-visit Indicator 8
CHAR
1
X
X
X
106 - 108
Line item Number 8
CHAR
3
X
X
X
109 - 111
Visit ID 8
CHAR
3
X
X
X
112 - 114
Lines in Visit 8
CHAR
3
X
X
X
115 - 122
VISIT DATE 8
OUTPATIENT
OP
OP
X
8
DAY/MO.
BLANK (YYYY)
(22)
OP
DAY
BLANK
(YYYYMM)
105
VISIT DATE 8 Encrypted
Page
No.
242
SERVICE DATE 8 Encrypted
(3223 - 3244)
Description
Clarifies or improves the reporting accuracy of the
associated procedure code
(3201 - 3222)
NUM
Data
Type
DAY
BLANK
(YYYYMM)
X
X
OP
Page 51
Data Sets
Record
Positions
Data Element
123
Visit Processed Flag 8
Type
NUM
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
OP
Indicates if there were errors during processing
253
OP
The actual warning message as described by the
software. Up to five values can be returned
“00” = visit processed without warning
“01” = visit processed with some lines unassigned
“02” = visit processed with all lines unassigned
“03” = visit processed with multiple per diems assigned
254
124 - 133
Visit Processed Warnings/ Messages 8
CHAR
10
X
X
X
134 - 135
Overall Visit Type 8
CHAR
2
X
X
X
OP
The overall visit type based on the service provided
136 - 142
Medical Visit Diagnosis 8
CHAR
7
X
X
X
OP
The description is maintained within the software
package
257
143 - 147
Final APG Assignment 8
CHAR
5
X
X
X
OP
Final APG code assignment
258
148 - 149
Final APG Type 8
CHAR
2
X
X
X
OP
Ambulatory Patient Group (APG). Classification of the
procedures which may be performed on an ambulatory
basis
259
150 - 151
Final APG Category 8
CHAR
2
X
X
X
OP
Final APG Category number and description
OP
Identifies duplicate costs accrued when multiple
significant procedures, ancillary lab services and/or
ancillary non-lab services are performed during the
same visit. Multiple SP's on the same day are flagged
for same day multiple procedure discounting
262
OP
Identifies duplicate costs accrued when multiple
significant procedures, ancillary lab services and/or
ancillary non-lab services are performed during the
same visit. Multiple ancillary charges on the same day
are flagged with the repeat ancillary discounting flag.
0=None
1=Repeat Ancillary Discounting applies
263
152
153
OUTPATIENT
Multiple Significant Procedure (SP)
Discounting Flag 8
Repeat Ancillary Discounting Flag 8
CHAR
CHAR
1
1
X
X
X
X
X
X
255-256
260-261
Page 52
Data Sets
Record
Positions
Data Element
Type
Size
De-identified
Limited
Identifiable
Data
Type
Description
Page
No.
154
Bilateral Discounting Flag 8
CHAR
1
X
X
X
OP
Indicates that an identical service is performed on the
opposite side of the body at the same session or visit.
“00” = None
“01” = Bilateral Discounting applies
“02” = Surgical bilateral discount applies
“03” = Non- Surgical bilateral discount applies
155
Terminated Procedure Discounting Flag
8
NUM
1
X
X
X
OP
Identifies a procedure that is terminated due to medical
complications which would increase the risk to the
patient
265
156 - 157
Line Item Unassigned Flag 8
CHAR
2
X
X
X
A single unassigned APG (999) is given to line items
with a corresponding Line Item Unassigned Flag.
266
158
Packaged Per Diem Flag 8
CHAR
1
X
X
X
Line item packaged as part of a partial hospitalization
per diem or daily mental health service per diem.
0=Not Packaged into Per Diem APG
267
Line items that are bundled together, such as
anesthesia, supplies, certain drugs, and the use of
recovery and observation rooms.
0= Not Packaged into Per Diem APG
1=Packaged into Per Diem APG
268
Indicates procedures are consolidated into one for
reimbursement, and applies to multiple instances of the
same significant procedures that are performed at the
same visit.
0=None
1=Same SP Consolidation applies
269
159
Packaging Flag 8
CHAR
1
X
X
X
OP
OP
OP
OP
264
160
Same Significant Procedure (SP)
Consolidation Flag 8
CHAR
1
X
X
X
161
Clinical Significant Procedure (SP)
Consolidation Flag 8
CHAR
1
X
X
X
OP
Indicates that multiple instances of the same clinical
significant procedures are consolidated into one for
reimbursement
270
162 - 163
Line Item Action Flag 8
CHAR
2
X
X
X
OP
Passed from input by the system
271
164 - 166
Service Item ID number 8
CHAR
3
X
X
X
OP
The description is maintained within the software
package
272
OUTPATIENT
Page 53
Data Sets
Record
Positions
Data Element
167 - 174
Line Item APG Payment 8
NUM
175 - 182
Line Item Existing Payment 8
183 - 190
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
8
X
X
X
OP
The APG paid amount (Amt_APG_Full_E2246)
multiplied by a percentage based on the APG Blend
Type Code (APG_Blnd_Type_Cd_E2248)
273
NUM
8
X
X
X
OP
The calculated dollar amount to be paid to the provider
based on a blending rate determined by the State Rate
Setting Agencies
274
Line Item Blended Payment 8
NUM
8
X
X
X
OP
Identifies the percentage of the blended rate amount to
use in calculating the final APG payment amount.
275
191 - 198
Line Item Add-on Payment 8
NUM
8
X
X
X
OP
The description is maintained within the software
package
276
199 - 206
Line Item Total Payment 8
NUM
8
X
X
X
OP
Line item payment, including possible cost outlier
payment
277
207 - 211
Line Item Blend Percent 8
NUM
5
X
X
X
278
OP
The percentage, usually in 25 percent increments,
used to calculate the blended amount for calculating
payment
212 - 220
Line Item Adjusted APG Weight 8
NUM
9
X
X
X
OP
The APG weight after the discounting and
consolidation for the line item
279
221 - 229
Line Item Full APG Weight 8
NUM
9
X
X
X
OP
The description is maintained within the software
package
280
230 - 235
Line Item Payment Percent 8
NUM
6
X
X
X
OP
The APG percentage after discounting and
consolidation
281
236 - 237
Line Item Payment Action 8
CHAR
2
X
X
X
OP
Identifies if the line was paid fully, consolidated,
discounted, or packaged, based upon the remainder of
the claim
282
238 - 244
Line Item Paid Units 8
CHAR
7
X
X
X
OP
Identifies the number of units paid
283
OUTPATIENT
Page 54
Record
Positions
Data Sets
Data Element
Type
Data
Type
Size
De-identified
Limited
Identifiable
Page
No.
OP
The description is maintained within the software
package
284
OP
This is the calculated dollar value that will be paid to a
provider
285
OP
The amount paid based on the calculated values of
both the existing payment and the blended payment
combined to create the total APG payment specified
phase
286
X
OP
Used for blending purposes and is based on a
provider's average per visit reimbursement for services
moving to APGs for calendar year 2007
287
X
X
OP
The amount that the APG methodology calculates for
the visit based on the coded procedures and diagnosis
288
X
X
This is the fixed add-on payment for the visit
289
OP
The payment for the visit not including outlier payment
and revenue code add-on
290
OP
The amount paid based solely on the fully blended
payment (100%) to create the total APG payment
during the specified phase
291
OP
This is the sum of the adjusted APG weights for the
visit
292
OP
This is the sum of the APG weights for the visit
293
245 - 246
Line Item Payment Adjustment Flag 8
CHAR
2
X
X
X
247 - 254
Visit APG Payment 8
NUM
8
X
X
X
255 - 262
Visit Transition APG Payment 8
NUM
8
X
X
X
263 - 270
Visit Existing Payment 8
NUM
8
X
X
271 - 278
Visit Blended Payment 8
NUM
8
X
279 - 286
Visit Add-on Payment 8
NUM
8
X
287 - 294
Visit Payment 8
NUM
8
X
X
X
295 - 302
Visit Non-transition Payment 8
NUM
8
X
X
X
303 - 311
Visit Adjusted APG Weight 8
NUM
9
X
X
X
312 - 320
Visit Full APG Weight 8
NUM
9
X
X
X
OUTPATIENT
Description
OP
Page 55
Record
Positions
Data Sets
Data Element
Type
Size
De-identified
Limited
Identifiable
321 - 324
Revenue Code 9
CHAR
4
X
X
X
325
Revenue Type 9
CHAR
1
X
X
X
326 - 330
HCPCS/CPT Procedure Code 9
CHAR
5
X
X
X
331 - 332
Procedure Modifier Code #1 - 9
CHAR
2
X
X
X
333 - 334
Procedure Modifier Code #2 - 9
CHAR
2
X
X
X
335 - 344
Service Charge 9
NUM
10
X
X
X
345 - 346
Unit Type 9
CHAR
2
X
X
X
347 - 354
Unit Quantity 9
NUM
8
X
X
X
355 - 364
Non-Covered Charge 9
NUM
10
X
365 - 372
SERVICE DATE 9
X
X
Page
No.
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
OP
See Description for Non-Covered Charge 8
246
OP
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
OP
OP
OP
OP
OP
OP
DAY
BLANK
(YYYYMM)
DAY/MO.
BLANK (YYYY)
(22)
X
(3245 - 3266)
SERVICE DATE 9 Encrypted
373
Pre-visit Indicator 9
CHAR
1
X
X
X
374 - 376
Line item Number 9
CHAR
3
X
X
X
OUTPATIENT
Description
See Description for Revenue Code 8
OP
OP
8
NUM
Data
Type
X
OP
OP
Page 56
Data Sets
Record
Positions
Data Element
377 - 379
Visit ID 9
CHAR
380 - 382
Lines in Visit 9
CHAR
383 - 390
VISIT DATE 9
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
OP
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Data
Type
OP
See Description for Visit Date 8
252
OP
See Description for Visit Processed Flag 8
253
OP
See Description for Visit Processed Warnings/
Messages 8
254
(3267 - 3288)
VISIT DATE 9 Encrypted
391
Visit Processed Flag 9
NUM
1
X
X
X
392 - 401
Visit Processed Warnings/ Messages 9
CHAR
10
X
X
X
402 - 403
Overall Visit Type 9
CHAR
2
X
X
X
OP
See Description for Overall Visit Type 8
404 - 410
Medical Visit Diagnosis 9
CHAR
7
X
X
X
OP
The description is maintained within the software
package
257
411 - 415
Final APG Assignment 9
CHAR
5
X
X
X
See Description for Final APG Assignment 8
258
416 - 417
Final APG Type 9
CHAR
2
X
X
X
See Description for Final APG Type 8
259
418 - 419
Final APG Category 9
CHAR
2
X
X
X
420
Multiple Significant Procedure (SP)
Discounting Flag 9
CHAR
1
X
X
X
OUTPATIENT
(22)
X
X
OP
OP
OP
OP
See Description for Final APG Category 8
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
255-256
260-261
262
Page 57
Data Sets
Record
Positions
Data Element
421
Repeat Ancillary Discounting Flag 9
CHAR
422
Bilateral Discounting Flag 9
423
Type
Size
De-identified
Limited
Identifiable
1
X
X
X
CHAR
1
X
X
X
Terminated Procedure Discounting Flag
9
NUM
1
X
X
X
424 - 425
Line Item Unassigned Flag 9
CHAR
2
X
X
X
426
Packaged Per Diem Flag 9
CHAR
1
X
X
X
427
Packaging Flag 9
CHAR
1
X
X
428
Same Significant Procedure (SP)
Consolidation Flag 9
CHAR
1
X
429
Clinical Significant Procedure (SP)
Consolidation Flag 9
CHAR
1
430 - 431
Line Item Action Flag 9
CHAR
432 - 434
Service Item ID number 9
435 - 442
Line Item APG Payment 9
OUTPATIENT
Data
Type
Description
Page
No.
See Description for Repeat Ancillary Discounting Flag
8
263
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
OP
See Description for Packaged Per Diem Flag 8
267
X
OP
See Description for Packaging Flag 8
268
X
X
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
X
X
X
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
2
X
X
X
OP
Passed from input by the system
271
OP
CHAR
3
X
X
X
The description is maintained within the software
package
272
NUM
8
X
X
X
OP
OP
OP
OP
See Description for Line Item APG Payment 8
OP
273
Page 58
Data Sets
Record
Positions
Data Element
443 - 450
Line Item Existing Payment 9
NUM
451 - 458
Line Item Blended Payment 9
459 - 466
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
8
X
X
X
OP
See Description for Line Item Existing Payment 8
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 8
Line Item Add-on Payment 9
NUM
8
X
X
X
OP
The description is maintained within the software
package
276
467 - 474
Line Item Total Payment 9
NUM
8
X
X
X
OP
See Description for Line Item Total Payment 8
277
475 - 479
Line Item Blend Percent 9
NUM
5
X
X
X
OP
See Description for Line Item Blend Percent 8
278
480 - 488
Line Item Adjusted APG Weight 9
NUM
9
X
X
X
OP
See Description for Line Item Adjusted APG Weight 8
279
489 - 497
Line Item Full APG Weight 9
NUM
9
X
X
X
OP
The description is maintained within the software
package
280
498 - 503
Line Item Payment Percent 9
NUM
6
X
X
X
OP
See Description for Line Item Payment Percent 8
281
504 - 505
Line Item Payment Action 9
CHAR
2
X
X
X
See Description for Line Item Payment Action 8
282
506 - 512
Line Item Paid Units 9
CHAR
7
X
X
X
See Description for Line Item Paid Units 8
283
OUTPATIENT
OP
OP
274
275
Page 59
Data Sets
Record
Positions
Data Element
513 - 514
Line Item Payment Adjustment Flag 9
CHAR
515 - 522
Visit APG Payment 9
523 - 530
Type
Size
Data
Type
Description
Page
No.
De-identified
Limited
Identifiable
2
X
X
X
OP
The description is maintained within the software
package
284
NUM
8
X
X
X
OP
See Description for Visit APG Payment 8
285
Visit Transition APG Payment 9
NUM
8
X
X
X
OP
See Description for Visit Transition APG Payment 8
286
531 - 538
Visit Existing Payment 9
NUM
8
X
X
X
OP
See Description for Visit Existing Payment 8
287
539 - 546
Visit Blended Payment 9
NUM
8
X
X
X
OP
See Description for Visit Blended Payment 8
288
547 - 554
Visit Add-on Payment 9
NUM
8
X
X
X
See Description for Visit Add-on Payment 8
289
555 - 562
Visit Payment 9
NUM
8
X
X
X
See Description for Visit Payment 8
290
563 - 570
Visit Non-transition Payment 9
NUM
8
X
X
X
See Description for Visit Non-Transition Payment 8
291
571 - 579
Visit Adjusted APG Weight 9
NUM
9
X
X
X
See Description for Visit Adjusted APG Weight 8
292
580 - 588
Visit Full APG Weight 9
NUM
9
X
X
X
See Description for Visit Full APG Weight 8
293
OP
OP
OP
OP
OUTPATIENT
OP
Page 60
Data Sets
Record
Positions
Data Element
589 - 592
Revenue Code 10
CHAR
593
Revenue Type 10
594 - 598
Type
Size
De-identified
Limited
Identifiable
4
X
X
X
CHAR
1
X
X
X
HCPCS/CPT Procedure Code 10
CHAR
5
X
X
X
599 - 600
Procedure Modifier Code #1 - 10
CHAR
2
X
X
X
601 - 602
Procedure Modifier Code #2 - 10
CHAR
2
X
X
X
603 - 612
Service Charge 10
NUM
10
X
X
X
613 - 614
Unit Type 10
CHAR
2
X
X
X
Data
Type
OP
OP
OP
OP
OP
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
OP
615 - 622
Unit Quantity 10
NUM
8
X
X
X
623 - 632
Non-Covered Charge 10
NUM
10
X
X
X
633 - 640
SERVICE DATE 10
8
DAY/MO.
BLANK
(YYYY)
NUM
(3289 - 3310)
SERVICE DATE 10 Encrypted
641
Pre-visit Indicator 10
(22)
CHAR
1
OP
OP
DAY
BLANK
(YYYYMM)
X
OP
X
X
X
X
OP
642 - 644
OUTPATIENT
Line item Number 10
CHAR
3
X
X
X
OP
Page 61
Data Sets
Record
Positions
Data Element
645 - 647
Visit ID 10
CHAR
648 - 650
Lines in Visit 10
CHAR
651 - 658
VISIT DATE 10
(3311 - 3332)
VISIT DATE 10 Encrypted
659
Visit Processed Flag 10
NUM
1
X
X
X
660 - 669
Visit Processed Warnings/ Messages
10
CHAR
10
X
X
X
670 - 671
Overall Visit Type 10
CHAR
2
X
X
X
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
OP
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Data
Type
(22)
X
X
OP
OP
OP
See Description for Overall Visit Type 8
255-256
OP
672 - 678
Medical Visit Diagnosis 10
CHAR
7
X
X
X
679 - 683
Final APG Assignment 10
CHAR
5
X
X
X
684 - 685
Final APG Type 10
CHAR
2
X
X
X
686 - 687
Final APG Category 10
CHAR
2
X
X
X
688
Multiple Significant Procedure (SP)
Discounting Flag 10
CHAR
1
X
X
X
689
Repeat Ancillary Discounting Flag 10
CHAR
1
X
X
X
OUTPATIENT
OP
OP
OP
OP
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
See Description for Final APG Category 8
260-261
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
OP
See Description for Repeat Ancillary Discounting Flag
8
263
Page 62
Data Sets
Record
Positions
Data Element
690
Bilateral Discounting Flag 10
CHAR
691
Terminated Procedure Discounting Flag
10
NUM
692 - 693
Line Item Unassigned Flag 10
CHAR
2
X
X
X
694
Packaged Per Diem Flag 10
CHAR
1
X
X
X
Type
Size
De-identified
Limited
Identifiable
1
X
X
X
1
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
OP
OP
OP
695
Packaging Flag 10
CHAR
1
X
X
X
696
Same Significant Procedure (SP)
Consolidation Flag 10
CHAR
1
X
X
X
Clinical Significant Procedure (SP)
Consolidation Flag 10
CHAR
698 - 699
Line Item Action Flag 10
CHAR
2
X
X
X
700 - 702
Service Item ID number 10
CHAR
3
X
X
X
697
1
X
X
OP
X
OP
OP
703 - 710
Line Item APG Payment 10
NUM
8
X
X
X
OP
711 - 718
Line Item Existing Payment 10
NUM
8
X
X
X
OP
719 - 726
Line Item Blended Payment 10
NUM
8
X
X
X
727 - 734
Line Item Add-on Payment 10
NUM
8
X
X
X
OP
OP
735 - 742
Line Item Total Payment 10
NUM
8
X
X
X
See Description for Line Item Blended Payment 8
275
The description is maintained within the software
package
276
See Description for Line Item Total Payment 8
277
OP
OUTPATIENT
Page 63
Data Sets
Record
Positions
Data Element
742 - 747
Line Item Blend Percent 10
Type
NUM
Size
5
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Line Item Blend Percent 8
278
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
748 - 756
Line Item Adjusted APG Weight 10
NUM
9
X
757 - 765
Line Item Full APG Weight 10
NUM
9
X
X
X
OP
X
X
OP
766 - 771
Line Item Payment Percent 10
NUM
6
X
X
X
OP
772 - 773
Line Item Payment Action 10
CHAR
2
X
X
X
OP
774 - 780
Line Item Paid Units 10
CHAR
7
X
X
X
OP
781 - 782
Line Item Payment Adjustment Flag 10
CHAR
2
X
X
X
OP
783 - 790
Visit APG Payment 10
NUM
8
X
X
X
OP
791 - 798
Visit Transition APG Payment 10
NUM
8
X
X
X
OP
799 - 806
Visit Existing Payment 10
NUM
8
X
X
X
OP
807 - 814
Visit Blended Payment 10
NUM
8
X
X
X
OP
815 - 822
Visit Add-on Payment 10
NUM
8
X
X
X
OP
823 - 830
Visit Payment 10
NUM
8
X
X
X
OP
831 - 838
Visit Non-transition Payment 10
NUM
8
X
X
X
OP
839 - 847
Visit Adjusted APG Weight 10
NUM
9
X
X
X
OP
848 - 856
Visit Full APG Weight 10
NUM
9
X
X
X
OP
OUTPATIENT
Page 64
Data Sets
Record
Positions
Data Element
857 - 860
Revenue Code 11
CHAR
861
Revenue Type 11
862 - 866
Type
Size
De-identified
Limited
Identifiable
4
X
X
X
CHAR
1
X
X
X
HCPCS/CPT Procedure Code 11
CHAR
5
X
X
X
867 - 868
Procedure Modifier Code #1 - 11
CHAR
2
X
X
X
869 - 870
Procedure Modifier Code #2 - 11
CHAR
2
X
X
X
871 - 880
Service Charge 11
NUM
10
X
X
X
Data
Type
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
OP
See Description for Service Date 8
247
OP
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
OP
OP
OP
OP
OP
OP
881 - 882
Unit Type 11
CHAR
2
X
X
X
883 - 890
Unit Quantity 11
NUM
8
X
X
X
891 - 900
Non-Covered Charge 11
NUM
10
X
901 - 908
SERVICE DATE 11
OP
X
X
DAY/MO.
BLANK
(YYYY)
(22)
X
(3333 - 3354)
SERVICE DATE 11 Encrypted
909
Pre-visit Indicator 11
CHAR
1
X
X
X
910 - 912
Line item Number 11
CHAR
3
X
X
X
OUTPATIENT
OP
DAY BLANK
(YYYYMM)
8
NUM
OP
X
OP
Page 65
Data Sets
Record
Positions
Data Element
913 - 915
Visit ID 11
CHAR
916 - 918
Lines in Visit 11
CHAR
919 - 926
VISIT DATE 11
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
OP
OP
DAY BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Data
Type
(22)
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3355 - 3376)
VISIT DATE 11 Encrypted
927
Visit Processed Flag 11
NUM
1
X
928 - 937
Visit Processed Warnings/ Messages
11
CHAR
10
X
X
X
938 - 939
Overall Visit Type 11
CHAR
2
X
X
X
940 - 946
Medical Visit Diagnosis 11
CHAR
7
X
X
X
X
OP
OP
OP
X
X
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
259
947 - 951
Final APG Assignment 11
CHAR
5
X
952 - 953
Final APG Type 11
CHAR
2
X
X
X
OP
See Description for Final APG Type 8
954 - 955
Final APG Category 11
CHAR
2
X
X
X
OP
See Description for Final APG Category 8
956
Multiple Significant Procedure (SP)
Discounting Flag 11
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
957
Repeat Ancillary Discounting Flag 11
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag
8
263
OUTPATIENT
X
X
OP
260-261
Page 66
Data Sets
Record
Positions
Data Element
958
Bilateral Discounting Flag 11
CHAR
959
Terminated Procedure Discounting Flag
11
NUM
Line Item Unassigned Flag 11
CHAR
960 - 961
Type
Size
De-identified
Limited
Identifiable
1
X
X
X
1
X
X
X
Data
Type
X
X
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
269
OP
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
2
Description
X
OP
962
Packaged Per Diem Flag 11
CHAR
1
X
X
X
OP
963
Packaging Flag 11
CHAR
1
X
X
X
OP
964
965
966 - 967
Same Significant Procedure (SP)
Consolidation Flag 11
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 11
CHAR
Line Item Action Flag 11
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
968 - 970
Service Item ID number 11
CHAR
3
X
X
X
OP
971 - 978
Line Item APG Payment 11
NUM
8
X
X
X
OP
979 - 986
Line Item Existing Payment 11
NUM
8
X
X
X
987 - 994
Line Item Blended Payment 11
NUM
8
X
X
X
995 - 1002
Line Item Add-on Payment 11
NUM
8
X
X
X
1003 - 1010
Line Item Total Payment 11
NUM
8
X
X
X
OUTPATIENT
OP
See Description for Line Item Blended Payment 8
OP
275
OP
The description is maintained within the software
package
276
OP
See Description for Line Item Total Payment 8
277
Page 67
Data Sets
Record
Positions
Data Element
1011 - 1015
Line Item Blend Percent 11
Type
NUM
Size
5
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Line Item Blend Percent 8
278
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
1016 - 1024
Line Item Adjusted APG Weight 11
NUM
9
X
X
X
OP
1025 - 1033
Line Item Full APG Weight 11
NUM
9
X
X
X
OP
1034 - 1039
Line Item Payment Percent 11
NUM
6
X
X
X
OP
1040 - 1041
Line Item Payment Action 11
CHAR
2
X
X
X
OP
1042 - 1048
Line Item Paid Units 11
CHAR
7
X
X
X
OP
1049 - 1050
Line Item Payment Adjustment Flag 11
CHAR
2
X
X
X
OP
1051 - 1058
Visit APG Payment 11
NUM
8
X
X
X
OP
1059 - 1066
Visit Transition APG Payment 11
NUM
8
X
X
X
OP
1067 - 1074
Visit Existing Payment 11
NUM
8
X
X
X
OP
1075 - 1082
Visit Blended Payment 11
NUM
8
X
X
X
OP
1083 - 1090
Visit Add-on Payment 11
NUM
8
X
X
X
OP
1091 - 1098
Visit Payment 11
NUM
8
X
X
X
OP
1099 - 1106
Visit Non-transition Payment 11
NUM
8
X
X
X
OP
1107 - 1115
Visit Adjusted APG Weight 11
NUM
9
X
X
X
OP
1116 - 1124
Visit Full APG Weight 11
NUM
9
X
X
X
OP
OUTPATIENT
Page 68
Data Sets
Record
Positions
Data Element
1125 - 1128
Revenue Code 12
CHAR
1129
Revenue Type 12
CHAR
Type
Size
De-identified
Limited
Identifiable
4
X
X
X
1
X
X
X
Data
Type
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
OP
1130 - 1134
HCPCS/CPT Procedure Code 12
CHAR
5
X
X
X
OP
1135 - 1136
Procedure Modifier Code #1 - 12
CHAR
2
X
X
X
1137 - 1138
Procedure Modifier Code #2 - 12
CHAR
2
X
X
X
OP
OP
1139 - 1148
Service Charge 12
NUM
10
X
X
X
1149 - 1150
Unit Type 12
CHAR
2
X
X
X
OP
See Description for Unit Type 8
244
1151 - 1158
Unit Quantity 12
NUM
8
X
X
X
OP
See Description for Unit Quantity 8
245
1159 - 1168
Non-Covered Charge 12
NUM
10
X
X
X
OP
See Description for Non-Covered Charge 8
246
1169 - 1176
SERVICE DATE 12
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
X
(3377 - 3398)
SERVICE DATE 12 Encrypted
1177
Pre-visit Indicator 12
CHAR
1
X
X
X
1178 - 1180
Line item Number 12
CHAR
3
X
X
X
OUTPATIENT
(22)
OP
X
OP
OP
OP
Page 69
Data Sets
Record
Positions
Data Element
1181 - 1183
Visit ID 12
CHAR
1184 - 1186
Lines in Visit 12
CHAR
1187 - 1194
VISIT DATE 12
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
OP
X
X
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
Data
Type
(22)
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3399 - 3420)
VISIT DATE 12 Encrypted
1195
Visit Processed Flag 12
NUM
1
X
X
X
1196 - 1205
Visit Processed Warnings/ Messages
12
CHAR
10
X
X
X
1206 - 1207
Overall Visit Type 12
CHAR
2
X
X
X
X
OP
OP
See Description for Overall Visit Type 8
255-256
OP
1208 - 1214
Medical Visit Diagnosis 12
CHAR
7
X
X
X
1215 - 1219
Final APG Assignment 12
CHAR
5
X
X
X
1220 - 1221
Final APG Type 12
CHAR
2
X
X
X
1222 - 1223
Final APG Category 12
CHAR
2
X
X
X
1224
Multiple Significant Procedure (SP)
Discounting Flag 12
CHAR
1
X
X
X
1225
Repeat Ancillary Discounting Flag 12
CHAR
1
X
X
X
OUTPATIENT
OP
OP
OP
OP
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
See Description for Final APG Category 8
260-261
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
OP
See Description for Repeat Ancillary Discounting Flag
8
263
Page 70
Data Sets
Record
Positions
Data Element
1226
Bilateral Discounting Flag 12
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
1227
Terminated Procedure Discounting Flag
12
NUM
Line Item Unassigned Flag 12
CHAR
1228 - 1229
1
X
X
X
OP
2
X
X
X
OP
1230
Packaged Per Diem Flag 12
CHAR
1
X
X
X
OP
1231
Packaging Flag 12
CHAR
1
X
X
X
OP
1232
1233
1234 - 1235
Same Significant Procedure (SP)
Consolidation Flag 12
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 12
CHAR
Line Item Action Flag 12
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
1236 - 1238
Service Item ID number 12
CHAR
3
X
X
X
OP
1239 - 1246
Line Item APG Payment 12
NUM
8
X
X
X
OP
1247 - 1254
Line Item Existing Payment 12
NUM
8
X
X
X
1255 - 1262
Line Item Blended Payment 12
NUM
8
X
X
X
1263 - 1270
Line Item Add-on Payment 12
NUM
8
X
X
X
OP
See Description for Line Item Blended Payment 8
OP
OP
1271 - 1278
Line Item Total Payment 12
NUM
8
X
X
X
275
The description is maintained within the software
package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
OP
1279 - 1283
Line Item Blend Percent 12
NUM
5
X
X
X
OP
OUTPATIENT
Page 71
Data Sets
Record
Positions
Data Element
1284 - 1292
Line Item Adjusted APG Weight 12
Type
NUM
Size
9
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
1293 - 1301
Line Item Full APG Weight 12
NUM
9
X
X
X
OP
1302 - 1307
Line Item Payment Percent 12
NUM
6
X
X
X
OP
1308 - 1309
Line Item Payment Action 12
CHAR
2
X
X
X
OP
1310 - 1316
Line Item Paid Units 12
CHAR
7
X
X
X
OP
1317 - 1318
Line Item Payment Adjustment Flag 12
CHAR
2
X
X
X
OP
1319 - 1326
Visit APG Payment 12
NUM
8
X
X
X
OP
1327 - 1334
Visit Transition APG Payment 12
NUM
8
X
X
X
OP
1335 - 1342
Visit Existing Payment 12
NUM
8
X
X
X
OP
1343 - 1350
Visit Blended Payment 12
NUM
8
X
X
X
OP
1351 - 1358
Visit Add-on Payment 12
NUM
8
X
X
X
OP
1359 - 1366
Visit Payment 12
NUM
8
X
X
X
OP
1367 - 1374
Visit Non-transition Payment 12
NUM
8
X
X
X
1375 - 1383
Visit Adjusted APG Weight 12
NUM
9
X
X
X
OP
OP
1384 - 1392
Visit Full APG Weight 12
NUM
9
X
X
X
OP
OUTPATIENT
Page 72
Data Sets
Record
Positions
Data Element
1393 - 1396
Revenue Code 13
CHAR
4
1397
Revenue Type 13
CHAR
1398 - 1402
HCPCS/CPT Procedure Code 13
1403 - 1404
Type
Size
De-identified
Limited
Identifiable
X
X
X
1
X
X
X
CHAR
5
X
X
X
Procedure Modifier Code #1 - 13
CHAR
2
X
X
X
1405 - 1406
Procedure Modifier Code #2 - 13
CHAR
2
X
X
X
1407 - 1416
Service Charge 13
NUM
10
X
X
X
1417 - 1418
Unit Type 13
CHAR
2
X
X
X
1419 - 1426
Unit Quantity 13
NUM
8
X
X
X
1427 - 1436
Non-Covered Charge 13
NUM
10
X
X
X
1437 - 1444
SERVICE DATE 13
DAY/MO.
BLANK (YYYY)
OP
OP
OP
OP
OP
OP
OP
OP
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
(22)
X
OP
See Description for Service Date 8
247
OP
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
(3421 - 3442)
SERVICE DATE 13 Encrypted
1445
Pre-visit Indicator 13
CHAR
1
X
X
X
1446 - 1448
Line item Number 13
CHAR
3
X
X
X
OUTPATIENT
OP
Description
DAY BLANK
(YYYYMM)
8
NUM
Data
Type
X
OP
Page 73
Data Sets
Record
Positions
Data Element
1449 - 1451
Visit ID 13
CHAR
1452 - 1454
Lines in Visit 13
CHAR
1455 - 1462
VISIT DATE 13
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
DAY/MO.
BLANK (YYYY)
(22)
X
(3443 - 3464)
VISIT DATE 13 Encrypted
1463
Visit Processed Flag 13
NUM
1
X
X
X
1464 - 1473
Visit Processed Warnings/ Messages
13
CHAR
10
X
X
X
1474 - 1475
Overall Visit Type 13
CHAR
2
X
X
X
1476 - 1482
Medical Visit Diagnosis 13
CHAR
7
X
X
X
1483 - 1487
Final APG Assignment 13
CHAR
5
X
X
X
1488 - 1489
Final APG Type 13
CHAR
2
X
X
X
1490 - 1491
Final APG Category 13
CHAR
2
X
X
X
1492
Multiple Significant Procedure (SP)
Discounting Flag 13
CHAR
1
X
X
X
1493
Repeat Ancillary Discounting Flag 13
CHAR
1
X
X
X
OUTPATIENT
OP
OP
Description
Page No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
DAY BLANK
(YYYYMM)
8
NUM
Data
Type
OP
X
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
OP
See Description for Final APG Category 8
260-261
OP
See Description for Multiple Significant Procedure
(SP) Discounting Flag 8
262
OP
See Description for Repeat Ancillary Discounting Flag
8
263
Page 74
Data Sets
Record
Positions
Data Element
1494
Bilateral Discounting Flag 13
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
1495
Terminated Procedure Discounting Flag
13
NUM
Line Item Unassigned Flag 13
CHAR
1496 - 1497
1
X
X
X
OP
2
X
X
X
OP
1498
Packaged Per Diem Flag 13
CHAR
1
X
X
X
OP
1499
Packaging Flag 13
CHAR
1
X
X
X
OP
1500
1501
1503
Same Significant Procedure (SP)
Consolidation Flag 13
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 13
CHAR
Line Item Action Flag 13
CHAR
1
X
X
X
OP
1
X
X
X
OP
2
X
X
X
OP
1504 - 1506
Service Item ID number 13
CHAR
3
X
X
X
OP
1507- 1514
Line Item APG Payment 13
NUM
8
X
X
X
OP
1515 - 1522
Line Item Existing Payment 13
NUM
8
X
X
X
OP
1523 - 1530
Line Item Blended Payment 13
NUM
8
X
X
X
1531 - 1538
Line Item Add-on Payment 13
NUM
8
X
X
X
OP
OP
1539 - 1546
Line Item Total Payment 13
NUM
8
X
X
X
See Description for Line Item Blended Payment 8
275
The description is maintained within the software
package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
OP
1547 - 1551
OUTPATIENT
Line Item Blend Percent 13
NUM
5
X
X
X
OP
Page 75
Data Sets
Record
Positions
Data Element
1552 - 1560
Line Item Adjusted APG Weight 13
NUM
1561 - 1569
Line Item Full APG Weight 13
NUM
Type
Data
Type
Size
De-identified
Limited
Identifiable
9
X
X
X
9
X
X
X
OP
OP
1570 - 1575
Line Item Payment Percent 13
NUM
6
X
X
X
Description
Page
No.
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
1576 - 1577
Line Item Payment Action 13
CHAR
2
X
X
X
OP
1578 - 1584
Line Item Paid Units 13
CHAR
7
X
X
X
OP
1585 - 1586
Line Item Payment Adjustment Flag 13
CHAR
2
X
X
X
OP
1587 - 1594
Visit APG Payment 13
NUM
8
X
X
X
OP
1595 - 1602
Visit Transition APG Payment 13
NUM
8
X
X
X
OP
1603 - 1610
Visit Existing Payment 13
NUM
8
X
X
X
OP
1611 - 1618
Visit Blended Payment 13
NUM
8
X
X
X
OP
1619 - 1626
Visit Add-on Payment 13
NUM
8
X
X
X
OP
1627 - 1634
Visit Payment 13
NUM
8
X
X
X
1635 - 1642
Visit Non-transition Payment 13
NUM
8
X
X
X
OP
OP
1643 - 1651
Visit Adjusted APG Weight 13
NUM
9
X
X
X
OP
1652 - 1660
Visit Full APG Weight 13
NUM
9
X
X
X
OP
OUTPATIENT
Page 76
Data Sets
Record
Positions
Data Element
1661 - 1664
Revenue Code 14
CHAR
4
1665
Revenue Type 14
CHAR
1666 - 1670
HCPCS/CPT Procedure Code 14
1671 - 1672
Type
Size
De-identified
Limited
Identifiable
X
X
X
1
X
X
X
CHAR
5
X
X
X
Procedure Modifier Code #1 - 14
CHAR
2
X
X
X
1673 – 1674
Procedure Modifier Code #2 - 14
CHAR
2
X
X
X
1675 - 1684
Service Charge 14
NUM
10
X
X
X
1685 - 1686
Unit Type 14
CHAR
2
X
X
X
1687 - 1694
Unit Quantity 14
NUM
8
X
X
X
1695 - 1704
Non-Covered Charge 14
NUM
10
X
X
X
1705 - 1712
SERVICE DATE 14
DAY BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
OP
OP
OP
OP
OP
OP
OP
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
OP
X
OP
(3465 - 3486)
SERVICE DATE 14 Encrypted
1713
Pre-visit Indicator 14
CHAR
1
X
X
X
1714 - 1716
Line item Number 14
CHAR
3
X
X
X
OUTPATIENT
(22)
Data
Type
X
OP
OP
Page 77
Data Sets
Record
Positions
Data Element
1717 - 1719
Visit ID 14
CHAR
1720 - 1722
Lines in Visit 14
CHAR
1723 - 1730
VISIT DATE 14
Type
Size
Description
Page
No.
De-identified
Limited
Identifiable
3
X
X
X
OP
See Description for Visit ID 8
250
3
X
X
X
OP
See Description for Lines in Visit 8
251
OP
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(22)
X
(3487 - 3508)
VISIT DATE 14 Encrypted
1731
Visit Processed Flag 14
NUM
1
X
X
X
1732 - 1741
Visit Processed Warnings/ Messages
14
CHAR
10
X
X
X
1742 - 1743
Overall Visit Type 14
CHAR
2
X
X
X
1744 - 1750
Medical Visit Diagnosis 14
CHAR
7
X
X
X
1751 - 1755
Final APG Assignment 14
CHAR
5
X
X
X
1756 - 1757
Final APG Type 14
CHAR
2
X
X
X
1758 - 1759
Final APG Category 14
CHAR
2
X
X
X
1760
Multiple Significant Procedure (SP)
Discounting Flag 14
CHAR
1
X
X
X
1761
Repeat Ancillary Discounting Flag 14
CHAR
1
X
X
X
OUTPATIENT
Data
Type
X
OP
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
See Description for Final APG Category 8
260-261
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
OP
See Description for Repeat Ancillary Discounting Flag
8
263
Page 78
Data Sets
Record
Positions
Data Element
1762
Bilateral Discounting Flag 14
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
1763
Terminated Procedure Discounting Flag
14
NUM
Line Item Unassigned Flag 14
CHAR
1764 - 1765
1
X
X
X
OP
2
X
X
X
OP
1766
Packaged Per Diem Flag 14
CHAR
1
X
X
X
OP
1767
Packaging Flag 14
CHAR
1
X
X
X
OP
1768
1769
1770 - 1771
Same Significant Procedure (SP)
Consolidation Flag 14
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 14
CHAR
Line Item Action Flag 14
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
1772 - 1774
Service Item ID number 14
CHAR
3
X
X
X
OP
1775 - 1782
Line Item APG Payment 14
NUM
8
X
X
X
OP
1783 - 1790
Line Item Existing Payment 14
NUM
8
X
X
X
OP
1791 - 1798
Line Item Blended Payment 14
NUM
8
X
X
See Description for Line Item Blended Payment 8
X
275
OP
1799 - 1806
Line Item Add-on Payment 14
NUM
8
X
X
X
1807 - 1814
Line Item Total Payment 14
NUM
8
X
X
X
1815 - 1819
Line Item Blend Percent 14
NUM
5
X
X
X
OUTPATIENT
OP
OP
OP
The description is maintained within the software
package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
Page 79
Data Sets
Record
Positions
Data Element
1820 - 1828
Line Item Adjusted APG Weight 14
Type
NUM
Data
Type
Size
9
De-identified
Limited
Identifiable
X
X
X
Description
Page
No.
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
1829 - 1837
Line Item Full APG Weight 14
NUM
9
X
X
X
OP
1838 - 1843
Line Item Payment Percent 14
NUM
6
X
X
X
OP
1844 - 1845
Line Item Payment Action 14
CHAR
2
X
X
X
OP
1846 - 1852
Line Item Paid Units 14
CHAR
7
X
X
X
OP
1853 - 1854
Line Item Payment Adjustment Flag 14
CHAR
2
X
X
X
OP
1855 - 1862
Visit APG Payment 14
NUM
8
X
X
X
OP
1863 - 1870
Visit Transition APG Payment 14
NUM
8
X
X
X
OP
1871 - 1878
Visit Existing Payment 14
NUM
8
X
X
X
OP
1879 - 1886
Visit Blended Payment 14
NUM
8
X
X
X
OP
1887 - 1894
Visit Add-on Payment 14
NUM
8
X
X
X
OP
1895 - 1902
Visit Payment 14
NUM
8
X
X
X
OP
1903 - 1910
Visit Non-transition Payment 14
NUM
8
X
X
X
OP
1911 - 1919
Visit Adjusted APG Weight 14
NUM
9
X
X
X
OP
1920 - 1928
Visit Full APG Weight 14
NUM
9
X
X
X
OP
OUTPATIENT
Page 80
Data Sets
Record
Positions
Data Element
1929 - 1932
Revenue Code 15
CHAR
4
X
X
X
1933
Revenue Type 15
CHAR
1
X
X
X
1934 - 1938
HCPCS/CPT Procedure Code 15
CHAR
5
X
X
X
1939 - 1940
Procedure Modifier Code #1 - 15
CHAR
2
X
X
X
1941 - 1942
Procedure Modifier Code #2 - 15
CHAR
2
X
X
X
1943 - 1952
Service Charge 15
NUM
10
X
X
X
1953 - 1954
Unit Type 15
CHAR
2
X
X
X
1955 - 1962
Unit Quantity 15
NUM
8
X
X
X
1963 - 1972
Non-Covered Charge 15
NUM
10
X
X
X
1973 - 1980
SERVICE DATE 15
Type
Size
De-identified
Limited
DAY/MO.
BLANK (YYYY)
(22)
X
(3509 - 3530)
SERVICE DATE 15 Encrypted
1981
Pre-visit Indicator 15
CHAR
1
X
X
X
1982 - 1984
Line item Number 15
CHAR
3
X
X
X
OUTPATIENT
Data
Type
OP
OP
OP
OP
OP
OP
OP
OP
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
DAY BLANK
(YYYYMM)
8
NUM
Identifiable
OP
X
OP
OP
Page 81
Data Sets
Record
Positions
Data Element
1985 - 1987
Visit ID 15
CHAR
1988 - 1990
Lines in Visit 15
CHAR
1991 - 1998
VISIT DATE 15
Type
Size
Description
Page No.
Description
3
X
X
X
3
X
OP
X
X
OP
DAY BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
(22)
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3531 - 3552)
VISIT DATE 15 Encrypted
1999
Visit Processed Flag 15
NUM
1
X
2000 - 2009
Visit Processed Warnings/ Messages
15
CHAR
10
X
X
X
2010 - 2011
Overall Visit Type 15
CHAR
2
X
X
X
2012 - 2018
Medical Visit Diagnosis 15
CHAR
7
X
X
X
2019 - 2023
Final APG Assignment 15
CHAR
5
X
X
X
2024 - 2025
Final APG Type 15
CHAR
2
X
X
X
2026 - 2027
Final APG Category 15
CHAR
2
X
X
X
2028
Multiple Significant Procedure (SP)
Discounting Flag 15
CHAR
1
X
X
X
2029
Repeat Ancillary Discounting Flag 15
CHAR
1
X
X
X
OUTPATIENT
Data
Type
X
X
X
OP
OP
OP
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
See Description for Final APG Category 8
260-261
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
See Description for Repeat Ancillary Discounting Flag
8
263
Page 82
Data Sets
Record
Positions
Data Element
2030
Bilateral Discounting Flag 15
Type
CHAR
Size
1
Description
Page No.
Description
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
2031
Terminated Procedure Discounting Flag
15
NUM
1
X
X
X
2032 - 2033
Line Item Unassigned Flag 15
CHAR
2
X
X
X
OP
OP
2034
Packaged Per Diem Flag 15
CHAR
1
X
X
X
2035
Packaging Flag 15
CHAR
1
X
X
X
OP
OP
2036
2037
2038 - 2039
Same Significant Procedure (SP)
Consolidation Flag 15
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 15
CHAR
Line Item Action Flag 15
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
2040 - 2042
Service Item ID number 15
CHAR
3
X
X
X
OP
2043 - 2050
Line Item APG Payment 15
NUM
8
X
X
X
OP
2051 - 2058
Line Item Existing Payment 15
NUM
8
X
X
X
OP
2059 - 2066
Line Item Blended Payment 15
NUM
8
X
X
See Description for Line Item Blended Payment 8
X
275
OP
2067 - 2074
Line Item Add-on Payment 15
NUM
8
X
X
X
OP
2075 - 2082
Line Item Total Payment 15
NUM
8
X
X
X
The description is maintained within the software
package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
OP
2083 - 2087
Line Item Blend Percent 15
NUM
5
X
X
X
OP
OUTPATIENT
Page 83
Data Sets
Record
Positions
Data Element
2088 - 2096
Line Item Adjusted APG Weight 15
Type
NUM
Size
9
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
2097 - 2105
Line Item Full APG Weight 15
NUM
9
X
X
X
OP
2106 - 2111
Line Item Payment Percent 15
NUM
6
X
X
X
OP
2112 - 2113
Line Item Payment Action 15
CHAR
2
X
X
X
OP
2114 - 2120
Line Item Paid Units 15
CHAR
7
X
X
X
2121 - 2122
Line Item Payment Adjustment Flag 15
CHAR
2
X
X
X
OP
OP
2123 - 2130
Visit APG Payment 15
NUM
8
X
X
X
OP
2131 - 2138
Visit Transition APG Payment 15
NUM
8
X
X
X
OP
2139 - 2146
Visit Existing Payment 15
NUM
8
X
X
X
OP
2147 - 2154
Visit Blended Payment 15
NUM
8
X
X
X
OP
2155 - 2162
Visit Add-on Payment 15
NUM
8
X
X
X
OP
2163 - 2170
Visit Payment 15
NUM
8
X
X
X
OP
2171 - 2178
Visit Non-transition Payment 15
NUM
8
X
X
X
2179 - 2187
Visit Adjusted APG Weight 15
NUM
9
X
X
X
2188 - 2196
Visit Full APG Weight 15
NUM
9
X
X
X
OUTPATIENT
OP
OP
OP
Page 84
Record
Positions
Data Sets
Data Element
Type
Size
De-identified
Limited
Identifiable
2197 - 2200
Revenue Code 16
CHAR
4
X
X
X
2201
Revenue Type 16
CHAR
1
X
X
X
2202 - 2206
HCPCS/CPT Procedure Code 16
CHAR
5
X
X
X
2207 - 2208
Procedure Modifier Code #1 - 16
CHAR
2
X
X
X
2209 - 2210
Procedure Modifier Code #2 - 16
CHAR
2
X
X
X
2211 - 2220
Service Charge 16
NUM
10
X
X
X
2221 - 2222
Unit Type 16
CHAR
2
X
X
X
2223 - 2230
Unit Quantity 16
NUM
8
X
X
X
2231 - 2240
Non-Covered Charge 16
NUM
10
X
X
X
2241 - 2248
SERVICE DATE 16
DAY/MO.
BLANK (YYYY)
(22)
X
(3553 - 3574)
SERVICE DATE 16 Encrypted
2249
Pre-visit Indicator 16
CHAR
1
X
X
X
2250 - 2252
Line item Number 16
CHAR
3
X
X
X
OUTPATIENT
OP
OP
OP
OP
OP
OP
OP
OP
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
DAY
BLANK
(YYYYMM)
8
NUM
Data
Type
OP
X
OP
OP
Page 85
Data Sets
Record
Positions
Data Element
2253 - 2255
Visit ID 16
CHAR
2256 - 2258
Lines in Visit 16
CHAR
2259 - 2266
VISIT DATE 16
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3575 - 3596)
VISIT DATE 16 Encrypted
2267
Visit Processed Flag 16
NUM
1
X
X
X
2068 - 2277
Visit Processed Warnings/ Messages
16
CHAR
10
X
X
X
2078 - 2279
Overall Visit Type 16
CHAR
2
X
X
X
2080 - 2286
Medical Visit Diagnosis 16
CHAR
7
X
X
X
2087 - 2291
Final APG Assignment 16
CHAR
5
X
X
X
2092 - 2293
Final APG Type 16
CHAR
2
X
X
X
2094 - 2295
Final APG Category 16
CHAR
2
X
X
X
OP
See Description for Final APG Category 8
2296
Multiple Significant Procedure (SP)
Discounting Flag 16
CHAR
1
X
X
X
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
2297
Repeat Ancillary Discounting Flag 16
CHAR
1
X
X
X
OP
See Description for Repeat Ancillary Discounting Flag
8
263
OUTPATIENT
(22)
Data
Type
X
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
260-261
Page 86
Data Sets
Record
Positions
Data Element
2298
Bilateral Discounting Flag 16
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software
package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
2299
2300 - 2301
Terminated Procedure Discounting
Flag 16
NUM
Line Item Unassigned Flag 16
CHAR
1
X
X
X
OP
2
X
X
X
OP
2302
Packaged Per Diem Flag 16
CHAR
1
X
X
X
OP
2303
Packaging Flag 16
CHAR
1
X
X
X
OP
2304
2305
2306 - 2307
Same Significant Procedure (SP)
Consolidation Flag 16
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 16
CHAR
Line Item Action Flag 16
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
2308 - 2310
Service Item ID number 16
CHAR
3
X
X
X
OP
2311 - 2318
Line Item APG Payment 16
NUM
8
X
X
X
OP
2319 - 2326
Line Item Existing Payment 16
NUM
8
X
X
X
OP
2327 - 2334
Line Item Blended Payment 16
NUM
8
X
X
X
2335 - 2342
Line Item Add-on Payment 16
NUM
8
X
X
X
2343 - 2350
Line Item Total Payment 16
NUM
8
X
X
X
2351 - 2355
Line Item Blend Percent 16
NUM
5
X
X
X
See Description for Line Item Blended Payment 8
OP
275
OP
The description is maintained within the software
package
276
OP
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
OP
OUTPATIENT
Page 87
Data Sets
Record
Positions
Data Element
2356 - 2364
Line Item Adjusted APG Weight 16
Type
NUM
Data
Type
Size
9
De-identified
Limited
Identifiable
X
X
X
Description
Page
No.
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software
package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software
package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
2365 - 2373
Line Item Full APG Weight 16
NUM
9
X
X
X
OP
2374 - 2379
Line Item Payment Percent 16
NUM
6
X
X
X
OP
2380 - 2381
Line Item Payment Action 16
CHAR
2
X
X
X
OP
2382 - 2388
Line Item Paid Units 16
CHAR
7
X
X
X
OP
2389 - 2390
2391 - 2398
Line Item Payment Adjustment Flag
16
CHAR
Visit APG Payment 16
NUM
2
X
X
X
OP
8
X
X
X
OP
2399 - 2406
Visit Transition APG Payment 16
NUM
8
X
X
X
OP
2407 - 2414
Visit Existing Payment 16
NUM
8
X
X
X
OP
2415 - 2422
Visit Blended Payment 16
NUM
8
X
X
X
OP
2423 - 2430
Visit Add-on Payment 16
NUM
8
X
X
X
OP
2431 - 2438
Visit Payment 16
NUM
8
X
X
X
OP
2439 - 2446
Visit Non-transition Payment 16
NUM
8
X
X
X
OP
2447 - 2455
Visit Adjusted APG Weight 16
NUM
9
X
X
X
OP
2456 - 2464
Visit Full APG Weight 16
NUM
9
X
X
X
OP
OUTPATIENT
Page 88
Record
Positions
Data Sets
Data Element
Type
Size
De-identified
Limited
Identifiable
2465 - 2468
Revenue Code 17
CHAR
4
X
X
X
2469
Revenue Type 17
CHAR
1
X
X
X
2470 - 2474
HCPCS/CPT Procedure Code 17
CHAR
5
X
X
X
2475 - 2476
Procedure Modifier Code #1 - 17
CHAR
2
X
X
X
2477 - 2478
Procedure Modifier Code #2 - 17
CHAR
2
X
X
X
2479 - 2488
Service Charge 17
NUM
10
X
X
X
2489 - 2490
Unit Type 17
CHAR
2
X
X
X
2491 - 2498
Unit Quantity 17
NUM
8
X
X
X
2499 - 2508
Non-Covered Charge 17
NUM
10
X
X
X
2509 - 2516
SERVICE DATE 17
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
OP
OP
OP
OP
OP
OP
OP
OP
Description
Page No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
OP
X
OP
(3597 - 3618)
SERVICE DATE 17 Encrypted
2517
Pre-visit Indicator 17
CHAR
1
X
X
X
2518 - 2520
Line item Number 17
CHAR
3
X
X
X
OUTPATIENT
(22)
Data
Type
X
OP
OP
Page 89
Data Sets
Record
Positions
Data Element
2521 - 2523
Visit ID 17
CHAR
2524 - 2526
Lines in Visit 17
CHAR
2527 - 2534
VISIT DATE 17
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3619 - 3640)
VISIT DATE 17 Encrypted
2535
Visit Processed Flag 17
NUM
1
X
X
X
2536 - 2545
Visit Processed Warnings/ Messages
17
CHAR
10
X
X
X
2546 - 2547
Overall Visit Type 17
CHAR
2
X
X
X
2548 - 2554
Medical Visit Diagnosis 17
CHAR
7
X
X
X
2555 - 2559
Final APG Assignment 17
CHAR
5
X
X
X
2560 - 2561
Final APG Type 17
CHAR
2
X
X
X
2562 - 2563
Final APG Category 17
CHAR
2
X
X
X
2564
Multiple Significant Procedure (SP)
Discounting Flag 17
CHAR
1
X
X
X
2565
Repeat Ancillary Discounting Flag 17
CHAR
1
X
X
X
OUTPATIENT
(22)
Data
Type
X
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
OP
See Description for Final APG Category 8
260-261
OP
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
OP
See Description for Repeat Ancillary Discounting Flag
8
263
Page 90
Data Sets
Record
Positions
Data Element
2566
Bilateral Discounting Flag 17
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Page
No.
Description
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
OP
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
OP
Passed from input by the system
271
The description is maintained within the software package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
2567
2568 - 2569
Terminated Procedure Discounting
Flag 17
NUM
Line Item Unassigned Flag 17
CHAR
1
X
X
X
OP
2
X
X
X
OP
2570
Packaged Per Diem Flag 17
CHAR
1
X
X
X
OP
2571
Packaging Flag 17
CHAR
1
X
X
X
OP
2572
2573
2574 - 2575
Same Significant Procedure (SP)
Consolidation Flag 17
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 17
CHAR
Line Item Action Flag 17
CHAR
1
1
2
X
X
X
X
X
X
X
X
X
OP
2576 - 2578
Service Item ID number 17
CHAR
3
X
X
X
OP
2579 - 2586
Line Item APG Payment 17
NUM
8
X
X
X
OP
2587 - 2594
Line Item Existing Payment 17
NUM
8
X
X
X
OP
2595 - 2602
Line Item Blended Payment 17
NUM
8
X
X
See Description for Line Item Blended Payment 8
X
275
OP
2603 - 2610
Line Item Add-on Payment 17
NUM
8
X
X
X
The description is maintained within the software package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
OP
2611 - 2618
Line Item Total Payment 17
NUM
8
X
X
X
OP
2619 - 2623
Line Item Blend Percent 17
NUM
5
X
X
X
OP
OUTPATIENT
Page 91
Data Sets
Record
Positions
Data Element
2624 - 2632
Line Item Adjusted APG Weight 17
Type
NUM
Size
9
De-identified
Limited
Identifiable
X
X
X
Data
Type
Page
No.
Description
See Description for Line Item Adjusted APG Weight 8
279
The description is maintained within the software package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
2633 - 2641
Line Item Full APG Weight 17
NUM
9
X
X
X
OP
2642 - 2647
Line Item Payment Percent 17
NUM
6
X
X
X
OP
2648 - 2649
Line Item Payment Action 17
CHAR
2
X
X
X
OP
2650 - 2656
Line Item Paid Units 17
CHAR
7
X
X
X
OP
2657 - 2658
2659 - 2666
Line Item Payment Adjustment Flag
17
CHAR
Visit APG Payment 17
NUM
2
X
X
X
OP
8
X
X
X
OP
2667 - 2674
Visit Transition APG Payment 17
NUM
8
X
X
X
OP
2675 - 2682
Visit Existing Payment 17
NUM
8
X
X
X
OP
2683 - 2690
Visit Blended Payment 17
NUM
8
X
X
X
OP
2691 - 2698
Visit Add-on Payment 17
NUM
8
X
X
X
OP
2699 - 2706
Visit Payment 17
NUM
8
X
X
X
OP
2707 - 2714
Visit Non-transition Payment 17
NUM
8
X
X
X
OP
2715 - 2723
Visit Adjusted APG Weight 17
NUM
9
X
X
X
OP
2724 - 2732
Visit Full APG Weight 17
NUM
9
X
X
X
OP
OUTPATIENT
Page 92
Record
Positions
Data Sets
Data Element
Type
Size
De-identified
Limited
Identifiable
X
X
2733 - 2736
Revenue Code 18
CHAR
4
X
2737
Revenue Type 18
CHAR
1
X
2738 - 2742
HCPCS/CPT Procedure Code 18
CHAR
5
X
2743 - 2744
Procedure Modifier Code #1 - 18
CHAR
2
X
2745 - 2746
Procedure Modifier Code #2 - 18
CHAR
2
X
2747 - 2756
Service Charge 18
NUM
10
X
2457 - 2758
Unit Type 18
CHAR
2
X
X
X
2759 - 2766
Unit Quantity 18
NUM
8
X
X
X
2767 - 2776
Non-Covered Charge 18
NUM
10
X
X
X
2777 - 2784
SERVICE DATE 18
OP
X
X
OP
X
X
OP
X
X
OP
X
X
OP
X
X
OP
DAY/MO.
BLANK (YYYY)
(22)
X
(3641 - 3662)
SERVICE DATE 18 Encrypted
2785
Pre-visit Indicator 18
CHAR
1
X
X
X
2786 - 2788
Line item Number 18
CHAR
3
X
X
X
OUTPATIENT
OP
OP
OP
Description
Page
No.
See Description for Revenue Code 8
237-238
See Description for Revenue Type 8
239
See Description for HCPCS/CPT Procedure Code 8
240
See Description for Procedure Modifier Code #1-8
241
See Description for Procedure Modifier Code #2-8
242
See Description for Service Charge 8
243
See Description for Unit Type 8
244
See Description for Unit Quantity 8
245
See Description for Non-Covered Charge 8
246
See Description for Service Date 8
247
See Description for Pre-visit Indicator 8
248
See Description for Line Item Number 8
249
DAY
BLANK
(YYYYMM)
8
NUM
Data
Type
OP
X
OP
OP
Page 93
Data Sets
Record
Positions
Data Element
2789 - 2791
Visit ID 18
CHAR
2792 - 2794
Lines in Visit 18
CHAR
2795 - 2802
VISIT DATE 18
Type
Size
De-identified
Limited
Identifiable
3
X
X
X
3
X
X
X
DAY
BLANK
(YYYYMM)
8
DAY/MO.
BLANK (YYYY)
NUM
OP
OP
Description
Page
No.
See Description for Visit ID 8
250
See Description for Lines in Visit 8
251
See Description for Visit Date 8
252
See Description for Visit Processed Flag 8
253
See Description for Visit Processed Warnings/
Messages 8
254
OP
X
(3663 - 3684)
VISIT DATE 18 Encrypted
2803
Visit Processed Flag 18
NUM
1
X
X
X
2804 - 2813
Visit Processed Warnings/ Messages
18
CHAR
10
X
X
X
2814 - 2815
Overall Visit Type 18
CHAR
2
X
X
X
2816 - 2822
Medical Visit Diagnosis 18
CHAR
7
X
X
X
2823 - 2827
Final APG Assignment 18
CHAR
5
X
X
X
2828 - 2829
Final APG Type 18
CHAR
2
X
X
X
2830 - 2831
Final APG Category 18
CHAR
2
X
X
X
2832
Multiple Significant Procedure (SP)
Discounting Flag 18
CHAR
1
X
X
X
2833
Repeat Ancillary Discounting Flag 18
CHAR
1
X
X
X
OUTPATIENT
(22)
Data
Type
X
OP
OP
OP
OP
OP
OP
OP
OP
OP
See Description for Overall Visit Type 8
255-256
The description is maintained within the software
package
257
See Description for Final APG Assignment 8
258
See Description for Final APG Type 8
259
See Description for Final APG Category 8
260-261
See Description for Multiple Significant Procedure (SP)
Discounting Flag 8
262
See Description for Revenue Code 8
263
Page 94
Data Sets
Record
Positions
Data Element
2834
Bilateral Discounting Flag 18
Type
CHAR
Size
1
De-identified
Limited
Identifiable
X
X
X
Data
Type
Page
No.
Description
See Description for Bilateral Discounting Flag 8
264
See Description for Terminated Procedure Discounting
Flag 8
265
See Description for Line Item Unassigned Flag 8
266
See Description for Packaged Per Diem Flag 8
267
See Description for Packaging Flag 8
268
See Description for Same Significant Procedure (SP)
Consolidation Flag 8
269
See Description for Clinical Significant Procedure (SP)
Consolidation Flag 8
270
Passed from input by the system
271
The description is maintained within the software package
272
See Description for Line Item APG Payment 8
273
See Description for Line Item Existing Payment 8
274
OP
2835
2836 - 2837
Terminated Procedure Discounting
Flag 18
NUM
Line Item Unassigned Flag 18
CHAR
1
X
X
X
OP
2
X
X
X
OP
2838
Packaged Per Diem Flag 18
CHAR
1
X
X
X
OP
2839
Packaging Flag 18
CHAR
1
X
X
X
OP
2840
2841
2842 - 2843
Same Significant Procedure (SP)
Consolidation Flag 18
CHAR
Clinical Significant Procedure (SP)
Consolidation Flag 18
CHAR
Line Item Action Flag 18
CHAR
1
X
X
X
OP
1
X
X
X
OP
2
X
X
X
OP
2844 - 2846
Service Item ID number 18
CHAR
3
X
X
X
OP
2847 - 2854
Line Item APG Payment 18
NUM
8
X
X
X
OP
2855 - 2862
Line Item Existing Payment 18
NUM
8
X
X
X
OP
2863 - 2870
Line Item Blended Payment 18
NUM
8
X
X
See Description for Line Item Blended Payment 8
X
275
OP
2871 - 2878
Line Item Add-on Payment 18
NUM
8
X
X
X
The description is maintained within the software package
276
See Description for Line Item Total Payment 8
277
See Description for Line Item Blend Percent 8
278
See Description for Line Item Adjusted APG Weight 8
279
OP
2879 - 2886
Line Item Total Payment 18
NUM
8
X
X
X
OP
2887 - 2891
Line Item Blend Percent 18
NUM
5
X
2892 - 2900
Line Item Adjusted APG Weight 18
NUM
9
X
X
X
OP
X
X
OP
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Data Sets
Record
Positions
Data Element
2901 - 2909
Line Item Full APG Weight 18
Type
NUM
Size
9
De-identified
Limited
Identifiable
X
X
X
Data
Type
Description
Page
No.
The description is maintained within the software package
280
See Description for Line Item Payment Percent 8
281
See Description for Line Item Payment Action 8
282
See Description for Line Item Paid Units 8
283
The description is maintained within the software package
284
See Description for Visit APG Payment 8
285
See Description for Visit Transition APG Payment 8
286
See Description for Visit Existing Payment 8
287
See Description for Visit Blended Payment 8
288
See Description for Visit Add-on Payment 8
289
See Description for Visit Payment 8
290
See Description for Visit Non-Transition Payment 8
291
See Description for Visit Adjusted APG Weight 8
292
See Description for Visit Full APG Weight 8
293
OP
2910 - 2915
Line Item Payment Percent 18
NUM
6
X
X
X
OP
2916 - 2917
Line Item Payment Action 18
CHAR
2
X
X
X
OP
2918 - 2924
Line Item Paid Units 18
CHAR
7
X
X
X
OP
2925 - 2926
2927 - 2934
Line Item Payment Adjustment Flag
18
CHAR
Visit APG Payment 18
NUM
2
X
X
X
OP
8
X
X
X
OP
2935 - 2942
Visit Transition APG Payment 18
NUM
8
X
X
X
OP
2943 - 2950
Visit Existing Payment 18
NUM
8
X
X
X
OP
2951 - 2958
Visit Blended Payment 18
NUM
8
X
X
X
OP
2959 - 2966
Visit Add-on Payment 18
NUM
8
X
X
X
OP
2967 - 2974
Visit Payment 18
NUM
8
X
X
X
OP
2975 - 2982
Visit Non-transition Payment 18
NUM
8
X
X
X
OP
2983 - 2991
Visit Adjusted APG Weight 18
NUM
9
X
X
X
OP
2992 - 3000
Visit Full APG Weight 18
NUM
9
X
X
X
OP
NOTE: AIDS/HIV EDITS - all identifiable data elements are redacted (blank/zeroed out) leaving all other data elements intact. All exact
dates are modified to give only month and year. Birth weights are truncated (rounded down to nearest 100 grams).
OUTPATIENT
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