12VAC5-218-20. Reporting requirements for outpatient data elements.

Every reporting entity performing outpatient surgical procedures shall submit each patient level data element listed in the table in this section for each patient for which an outpatient surgical procedure is performed and for which the data element is collected on the standard claim form utilized by the reporting entity. Most of these data elements are currently collected from a Uniform Billing Form (UB-04) located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee or from the Centers for Medicare and Medicaid (CMS) Health Insurance Claim Form (CMS 1500). The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Centers for Medicare and Medicaid Health Insurance Claim Form is available on the CMS website at www.cms.gov. Every reporting entity performing outpatient surgical procedures shall submit in an electronic data format. The nonprofit organization will develop detailed record layouts for use by reporting entities in reporting outpatient surgical data. This detailed record layout will be based upon the type of base electronic or paper-billing form utilized by the reporting entity. Outpatient surgical procedures reported shall be those adopted by the board as referred by the nonprofit organization. The nonprofit organization may recommend changes to the list of procedures to be reported not more than annually.

Data Element Name	Instructions
Hospital Identifier	Hospitals and ambulatory care centers enter the six-digit Medicare provider number, or when adopted by the board, the National Provider Identifier or other number assigned by the board. Physicians, leave blank.
Operating Physician or Oral and Maxillofacial Surgeon Identifier	Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN), National Provider Identifier (NPI) or its successor as approved by the board for the physician identified as the operating physician for the principal procedure reported.
Payor Identifier	Enter the board approved payor designation which will be the nationally assigned PAYERID, its successor, or English description of the payor.
Employer Identifier	Enter the federally approved EIN, or employer name, whichever is adopted by the board.
Patient Identifier	Enter the nine-digit social security number of the patient. If a social security number has not been assigned, leave blank. The nine-digit social security number is not required for patients under four years of age.
Patient Sex
Date of Birth	Enter the code in MM/DD/YYYY format.
Street Address
City or County
Zip Code
Employment Status Code
Status at Discharge
Admission Date	Admission/start of care date
Admission Hour	Hour of admission in military time 00-24
Admission Diagnosis	Code sets- ICD 9 or CPT 4 or their successors to be specified in detailed record layouts.
Principal Diagnoses	Code sets- ICD 9 or CPT 4 or their successors to be specified in detailed record layouts.
Secondary Diagnoses	Code sets- ICD 9 or CPT 4 or their successors to be specified in detailed record layouts.
External Cause of Injury	(E-code). Record all external cause of injury codes in secondary diagnoses position after recording all treated secondary diagnoses.
Co-morbid Condition Existing but not Treated	Enter the code for any co-morbid conditions existing but not treated. Code sets- ICD 9 or CPT 4 or their successors to be specified in detailed record layouts.
Procedures	Code sets- ICD 9 or CPT 4 or their successors to be specified in detailed record layouts.
Procedure Dates
Revenue Center Codes	As specified for UB-04 or its successor completion, not available for CMS 1500 or its successor
Revenue Center Units
Revenue Center Charges
Total Charges

Statutory Authority

§§ 32.1-12 and 32.1-276.6 of the Code of Virginia.

Historical Notes

Derived from Virginia Register Volume 19, Issue 26, eff. October 8, 2003; amended, Virginia Register Volume 31, Issue 22, eff. August 29, 2015.

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