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Virginia Administrative Code
Title 12. Health
Agency 5. Department of Health
Chapter 217. Regulations of the Patient Level Data System
11/21/2024

12VAC5-217-20. Reporting requirements for patient level data elements.

Every inpatient hospital shall submit a complete filing of each patient level data element listed in the table in this section for each hospital inpatient, including a separate record for each infant, if applicable. Most of these data elements are currently collected from a Uniform Billing Form located in the latest publication of the Uniform Billing Manual prepared by the National Uniform Billing Committee. The Uniform Billing Form and the Uniform Billing Manual are located on the National Uniform Billing Committee's website at www.nubc.org. The Uniform Billing Manual provides a detailed field description and any special instruction pertaining to that element. An asterisk (*) indicates when the required data element is either not on the billing form or in the Uniform Billing Manual. The instructions provided under that particular data element should then be followed. Inpatient hospitals that submit patient level data directly to the board or the nonprofit organization shall submit it in an electronic data format.

Data Element

1. Hospital identifier.*
Enter the six-digit Medicare provider number or a number assigned by the board or its designee.

2. Attending physician identifier.
Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician assigned as the attending physician for an inpatient.

3. Other physician identifier.
Enter the nationally assigned physician identification number, either the Uniform Physician Identification Number (UPIN) or National Provider Identifier (NPI) as approved by the board for the physician identified as the operating physician for the principal procedure reported.

4. Payor identifier.

5. Employer identifier.

6. 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.

7a. Patient sex.

7b. Race code.*
If an inpatient hospital collects information regarding the choices listed below, the appropriate one-digit code reflecting the race of the patient should be entered. If a hospital only collects information for categories 0, 1, or 2, then the appropriate code should be entered from those three selections.

0 = White

1 = Black

2 = Other

3 = Asian

4 = American Indian

5 = White Hispanic

6 = Black Hispanic

7c. Date of birth.

7d. Street address, city or county, and zip code.

7e. Employment status code.

7f. Patient status (i.e., discharge).
Inpatient codes only.

7g. Birth weight (for infants).*
Enter the birth weight of newborns in grams.

8a. Admission type.

8b. Admission source.

8c. Admission date.

8d. Admission hour.

8e. Admission diagnosis code.

9a. Discharge date.
Only enter date of discharge.

10. Principal diagnosis code.
Enter secondary diagnoses (up to eight).
In addition, include diagnoses recorded in the comments section for DX6-DX9.

11. External cause of injury code (E-code).
Record all external cause of injury codes in secondary diagnoses position after recording all treated secondary diagnoses.

12. Co-morbid conditions existing but not treated.

13. Principal procedure code and date.
Enter other procedures and dates (up to five). In addition, include procedures recorded in the comments section for PX4-PX6.

14. Revenue code (up to 23).
Units of service (up to 23).
Units of service charges (up to 23).

15. Total charges (by revenue code category or by HCPCS code).
(R.C. Code 001 is for total charges. See page 47-1.)

Statutory Authority

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

Historical Notes

Former 12VAC25-40-20 derived from VR370-01-003 § 2.1, eff. April 1, 1994; amended and adopted as 12VAC5-217-20, Virginia Register Volume 13, Issue 22, eff. August 20, 1997; Volume 32, Issue 8, eff. February 1, 2016.

Website addresses provided in the Virginia Administrative Code to documents incorporated by reference are for the reader's convenience only, may not necessarily be active or current, and should not be relied upon. To ensure the information incorporated by reference is accurate, the reader is encouraged to use the source document described in the regulation.

As a service to the public, the Virginia Administrative Code is provided online by the Virginia General Assembly. We are unable to answer legal questions or respond to requests for legal advice, including application of law to specific fact. To understand and protect your legal rights, you should consult an attorney.