Posted: April 24th, 2025

Health Information

 

In this assignment, you will be working with a data set on patients with CHF. This data has been pulled from a MedPAR dataset. MedPAR is a file that is distributed by CMS (the entity that administers the Medicare program). It contains detailed information on inpatient hospital and SNF stays for Medicare beneficiaries, providing a valuable resource for understanding use and costs in the Medicare system.

Data Dictionary Directions:

1. First, download the CHF Database excel file Download CHF Database excel file. After opening the file, you will see there are two sheets titled Data and Data Dictionary.
2. Open the Data Dictionary sheet (second tab). You will use this sheet as your template to complete the first part of your assignment (Data Dictionary). 
3. Use the MedPAR data dictionary file Download MedPAR data dictionary fileto find and complete the definitions for the coded variables on your template. All cells with an asterisk (*) and a yellow highlighted background need to be filled out (column D, rows 3-62)
4. For cells labeled Description*, you need to write a data definition. It should be similar in format to the definitions provided in the MedPAR file, but it must be in your own words – you cannot copy and paste these definitions. You will not receive any points for definitions that are copied/pasted.

• Example: I need to write my definition for Length of Stay. From the MedPAR file, the definition is, “This field specifies the total length of a patient’s hospital stay from the date of admission to the date of discharge.” I may write something like, “This field specifies the patient’s length of stay from admission to discharge” or “This field specifies the total number of days that the patient was admitted to the hospital.” Similar phrasing is fine, it just cannot be an exact copy/paste.

1. For cells labeled with only an asterick *, you need to use the MedPAR file to locate the definition for the specified values.

• Example: I need to find the definition for one of the values for Age. First, I need to find the data element “age” on the MedPar file (page 11 of the pdf) and then identify what an age value of “2” represents.

1. For the DRG definition (cell D62), you need to come up with your own definition. It should be similar in format to the definitions provided in the file.
2. Once you have completed your data dictionary, save and rename the Excel file in accordance with the format outlined in the assignment directions. You will use this file again in the second part of the assignment.

Data Analysis Directions:

1. Imagine you are explaining a data dictionary to a new intern at your hospital who will be assisting with a research project involving patients with a diagnosis of CHF. In a word document, write a paragraph (150-200 words) explaining what a data dictionary is, its importance, and how it might be used in this upcoming research project.
2. Next, open the CHF Data file and navigate to the first sheet titled Data. Select three patients with the SAME LENGTH OF STAY (LOS). In your word document, describe each patient in a narrative format. When writing your narrative, you need to use your data dictionary to find the actual values for your three patients. (Example: If the age value for the patient is 3, then the patient’s actual age is between 45-64. If the patient has a sex value of 1, they should be described as male. So you would write, “Patient XX is a male between the ages of 45 and 64, with XX diagnoses. His total charges were XX, and the amount reimbursed was XX. He was admitted from…” etc.). Your description should include the following information:

   Patient ID (column A)
   Age (column C)
   Sex (column D)
   Total charges (column H)
   Amount reimbursed (column E)
   Number of diagnoses (column I)
   Admit source (column J)
   Discharge destination (column K)

3. Calculate the difference between the total charges and the amount reimbursed for each patient. Briefly compare the results (2-3 sentences). Are the amounts the same or different? Speculate on the reasons behind similarities and discrepancies. 

 

Data

PatientID
LOS
Age
Sex
AmtReim
TotAccomChg
TotDeptChg
TotChg
NumDxCodes
AdmSrc
DischDest
DrgCode

1
8
4
1
10372
19632
8144
27776
9
4
06
291

2
5
4
2
10306
12270
23259
35529
9
1
01
291

3
2
4
2
10306
4908
12834
17742
9
1
01
291

4
2
5
2
10372
4908
5459
10367
9
7
01
291

5
2
3
2
6200
4908
8893
13801
7
1
01
293

6
5
4
1
6186
12270
25758
38028
6
7
01
293

7
7
6
2
10372
18816
14516
33332
9
7
06
291

8
6
7
2
7224
14724
8105
22829
4
1
01
293

9
4
7
2
6200
9816
22244
32060
9
1
06
293

10
8
7
1
6200
19632
6506
26138
8
4
01
293

11
6
9
1
7328
14724
9108
23832
9
1
06
292

12
7
3
2
7307
18816
17622
36438
9
1
62
292

13
8
3
1
10372
21816
15152
36968
9
7
06
291

14
17
4
2
10306
59718
39275
98993
9
4
06
291

15
3
7
1
6200
7362
23293
30655
9
7
06
293

16
6
8
2
7328
14724
11008
25732
9
1
06
292

17
5
8
2
7328
12270
7951
20221
9
1
06
292

18
3
5
1
9604
8181
6400
14581
9
1
01
291

19
3
3
1
7307
7362
15891
23253
9
1
01
292

20
18
8
2
9348
44172
44636
88808
9
1
62
291

21
8
4
1
10306
22632
16528
39160
9
4
62
291

22
3
9
2
7111
7362
7642
15004
9
6
03
291

23
3
5
1
8352
7362
21648
29010
9
4
01
292

24
6
5
2
7224
14724
13808
28532
7
1
06
293

25
3
3
1
7125
7362
7051
14413
9
7
06
292

26
3
3
1
7307
7362
13726
21088
9
7
01
292

27
7
9
2
7328
17178
11598
28776
9
5
01
292

28
6
9
2
10372
16362
9502
25864
9
7
03
291

29
6
6
1
7224
14724
3841
18565
9
4
01
293

30
7
9
2
10372
17178
11772
28950
9
1
20
291

31
3
9
2
8096
8181
12812
20993
9
5
03
292

32
3
9
2
7224
7362
18325
25687
9
7
62
293

33
7
4
2
10372
17178
25524
42702
9
7
01
291

34
2
3
2
6186
4908
20305
25213
8
7
01
293

35
3
6
1
7156
8181
7851
16032
9
7
06
292

36
13
7
1
10372
31902
38027
69929
9
4
62
291

37
7
6
2
10306
17178
21988
39166
9
4
01
291

38
12
6
1
7307
29448
33959
63407
9
7
06
292

39
7
8
2
10306
17178
7653
24831
9
7
03
291

40
10
8
2
9348
27270
12287
39557
9
5
03
291

41
4
7
2
7224
9816
6545
16361
6
4
62
293

42
10
3
1
7328
27270
51831
79101
9
1
06
292

43
4
8
1
7328
10089
8197
18286
9
1
06
292

44
14
7
2
9314
36290
26885
63175
9
1
63
291

45
5
7
2
7328
12270
7381
19651
9
1
01
292

46
11
6
1
10372
27813
29640
57453
9
6
20
291

47
3
4
1
10306
7362
16110
23472
9
1
01
291

48
4
8
1
8352
10635
16165
26800
9
1
06
292

49
4
8
2
8352
9816
9050
18866
9
5
03
292

50
14
6
1
10372
52356
54000
106356
9
4
63
291

51
4
6
2
7307
9816
19578
29394
9
4
01
292

52
2
7
2
5077
5454
7349
12803
9
7
06
291

53
6
7
2
10372
16089
14907
30996
9
2
03
291

54
6
7
1
6200
14724
7592
22316
9
1
01
293

55
1
8
1
6200
2454
12934
15388
9
7
01
293

56
7
8
1
8352
17178
20868
38046
5
7
06
292

57
2
8
2
6946
4908
5275
10183
7
1
06
293

58
2
8
2
8299
4908
6669
11577
7
1
01
292

59
3
7
2
7091
7362
16887
24249
9
7
06
291

60
4
8
2
8352
9816
19391
29207
9
7
01
292

61
8
4
1
10306
21543
34499
56042
9
1
06
291

62
12
3
1
10372
29721
36984
66705
9
7
06
291

63
5
9
2
9348
12270
14455
26725
9
7
01
291

64
3
4
2
8135
7362
21724
29086
9
4
62
291

65
5
9
1
8352
12270
9817
22087
9
7
06
292

66
9
8
1
7328
22086
12891
34977
9
1
01
292

67
4
5
1
8352
9816
8099
17915
7
1
01
292

68
16
6
2
9389
39264
56077
95341
9
7
20
291

69
4
7
2
8299
9816
6609
16425
9
7
06
292

70
2
7
2
5954
4908
11836
16744
9
7
06
293

71
10
6
2
7307
27270
11076
38346
9
1
62
292

72
6
6
2
9348
16362
8068
24430
9
1
03
291

73
7
7
2
8385
17178
3737
20915
9
1
03
292

74
1
4
1
7307
2454
6343
8797
9
1
01
292

75
4
9
1
8352
9816
9802
19618
9
7
06
292

76
2
5
2
6200
4908
17325
22233
7
1
01
293

77
2
7
1
7328
4908
10749
15657
9
1
01
292

78
18
4
2
8352
49086
23614
72700
9
7
03
292

79
6
4
1
9348
14724
39146
53870
7
1
01
291

80
4
5
1
6186
9816
14517
24333
9
1
01
293

81
5
8
2
6200
12270
10710
22980
9
1
06
293

82
11
3
1
5176
29724
13601
43325
9
7
07
293

83
4
3
1
10104
9816
17515
27331
9
7
06
291

84
6
3
1
9348
14724
8024
22748
9
7
06
291

85
12
6
2
7328
29448
17512
46960
9
7
06
292

86
1
6
2
7307
5454
13419
18873
9
7
20
292

87
1
8
1
7307
2454
7257
9711
9
1
01
292

88
17
7
2
24691
81537
92645
174182
9
5
20
291

89
19
4
2
7307
51813
22010
73823
9
7
06
292

90
8
5
2
9348
19632
28685
48317
9
7
62
291

91
8
5
2
10372
19632
12937
32569
9
6
62
291

92
10
8
2
7328
24540
20389
44929
9
1
03
292

93
3
6
2
7224
7362
4845
12207
8
7
01
293

94
5
8
1
10306
12270
11413
23683
9
4
01
291

95
3
8
1
7111
7635
7573
15208
9
1
06
291

96
8
8
1
7328
19632
9014
28646
9
1
06
292

97
6
9
2
9348
14724
15619
30343
9
7
06
291

98
2
3
1
0
5454
14680
20134
9
1
01
291

99
8
4
1
7178
19632
27023
46655
8
7
06
293

100
7
8
1
6200
17178
15861
33039
9
1
06
293

101
5
3
2
8299
12270
9417
21687
9
1
06
292

102
47
7
1
19293
115897
40341
156238
9
4
50
291

103
6
8
1
9348
14724
16173
30897
9
7
03
291

104
6
8
1
7307
14724
7696
22420
9
1
06
292

105
8
6
1
9348
21816
11337
33153
9
1
06
291

106
3
7
1
6200
7362
4854
12216
6
7
01
293

107
12
7
2
6200
29448
22170
51618
9
7
03
293

108
2
9
1
5077
4908
4975
9883
9
7
06
291

109
13
9
2
8352
35451
22129
57580
9
7
62
292

110
4
6
1
8299
9816
20513
30329
9
7
01
292

111
14
6
1
7224
43356
31181
74537
9
7
62
293

112
5
7
2
8352
13635
7406
21041
9
4
06
292

113
9
5
1
7307
22086
15972
38058
9
7
06
292

114
6
7
1
9348
14724
14957
29681
9
7
06
291

115
13
7
2
7252
31902
15884
47786
9
7
06
293

116
5
3
1
7328
12270
15440
27710
9
1
01
292

117
5
5
2
10372
12270
12367
24637
9
4
06
291

118
6
3
2
9314
14724
9204
23928
9
1
01
291

119
6
4
1
9348
14724
14024
28748
9
1
06
291

120
11
6
1
9314
26994
17687
44681
9
4
06
291

121
25
8
2
13283
70350
61336
131686
9
1
03
291

122
11
9
2
8299
26994
10189
37183
9
7
06
292

123
4
8
2
8299
9816
5602
15418
9
4
03
292

124
4
8
1
10372
9816
6083
15899
9
7
01
291

125
15
8
2
7328
39267
42305
81572
9
7
06
292

126
17
7
1
8352
41718
56768
98486
9
6
65
292

127
8
7
1
7328
19632
21843
41475
9
7
06
292

128
3
7
2
9314
7362
11111
18473
9
7
01
291

129
4
5
1
8352
9816
5931
15747
9
7
06
292

130
6
7
2
9314
13054
35895
48949
9
7
06
291

131
2
8
2
9348
4908
7574
12482
7
1
01
291

132
9
4
1
9389
22086
38094
60180
9
1
01
291

133
10
8
1
8352
24540
14220
38760
9
7
62
292

134
5
8
1
7224
12270
9956
22226
9
6
62
293

135
8
7
1
7307
21816
18192
40008
8
7
62
292

136
7
7
2
10058
18270
21166
39436
9
5
03
291

137
6
7
2
7328
14724
19871
34595
9
7
03
292

138
6
9
2
6200
16362
9560
25922
9
1
06
293

139
4
8
1
7328
9816
8393
18209
9
1
03
292

140
5
8
2
9348
12270
12906
25176
9
1
06
291

141
2
9
2
5088
4908
4317
9225
9
1
06
292

142
11
8
2
9348
26994
37174
64168
9
1
01
291

143
22
7
2
10372
59721
31004
90725
9
1
06
291

144
3
7
2
7224
7362
8213
15575
8
7
06
293

145
7
7
2
6200
17178
21553
38731
9
7
06
293

146
6
7
1
6186
14724
8024
22748
9
7
06
293

147
4
8
2
6200
9816
6995
16811
6
1
06
293

148
7
7
2
9348
17178
14906
32084
9
5
03
291

149
7
7
1
8352
17178
13895
31073
9
1
06
292

150
7
7
1
9348
23178
13867
37045
9
7
06
291

151
10
6
1
0
27270
19106
46376
9
7
06
291

152
4
4
1
7178
13635
13328
26963
9
7
06
293

153
9
4
1
10372
24543
16223
40766
9
7
06
291

154
10
4
1
10372
27270
14859
42129
9
1
06
291

155
5
9
1
7328
13635
22619
36254
9
7
06
292

156
10
8
2
8352
24813
20491
45304
9
1
06
292

157
2
8
2
7224
4908
7530
12438
6
1
01
293

158
3
6
2
8096
7362
8240
15602
9
1
06
292

159
4
7
1
9389
9816
8370
18186
9
7
01
291

160
7
7
2
7328
17178
8819
25997
9
1
06
292

161
6
7
2
10372
20724
19088
39812
9
7
20
291

162
7
7
1
8299
17178
23280
40458
9
7
63
292

163
3
6
1
7224
7362
7926
15288
9
1
06
293

164
4
6
1
9145
9816
7965
17781
9
1
06
291

165
17
6
1
10413
41718
21486
63204
9
1
51
291

166
10
6
2
8352
26451
18721
45172
9
7
03
292

167
4
5
2
6186
9816
11391
21207
8
1
01
293

168
2
4
2
9348
4908
25068
29976
9
5
01
291

169
5
8
2
7328
12270
13065
25335
9
7
01
292

170
1
9
2
8299
5454
14773
20227
9
5
20
292

171
4
8
2
8299
9816
17999
27815
9
7
03
292

172
14
7
2
9348
34356
39941
74297
9
7
03
291

173
15
7
2
10372
36810
35288
72098
9
5
03
291

174
5
7
2
10306
12270
6764
19034
9
7
03
291

175
2
7
1
5077
4908
4450
9358
9
7
06
291

176
4
7
1
10169
9816
12498
22314
9
7
06
291

177
1
7
1
6200
2454
4546
7000
9
7
20
293

178
9
6
1
8299
22086
24650
46736
9
1
06
292

179
18
5
2
10413
49086
24523
73609
9
1
01
291

180
4
8
1
7307
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9
7
06
293

385
24
7
1
11539
58896
61342
120238
9
4
62
291

386
15
4
1
8352
48810
51408
100218
9
4
06
292

387
2
4
2
9348
4908
32164
37072
7
7
50
291

388
12
7
2
7361
29448
29337
58785
9
7
03
292

389
2
3
2
5088
4908
8346
13254
8
4
06
292

390
13
6
1
9314
29787
40885
70672
9
1
06
291

Data Dictionary

Data Element
Definition
Values
Definition
Data Type

Patient ID
Patient ID Number

This field specifies the ID number assigned to the patient by the researcher.
Number

LOS
Length of Stay

Description: *
Number

Age
Patient Age Category

Description: *
Number

1
*

2
*

3
*

4
*

5
*

6
*

7
*

8
*

9
*

Sex
Patient Gender
0
*

1
*

2
*

AmtReim
Amount Paid by Medicare

Description: *
Number

TotAccomChg
Total Accomodation Charges

Description: *
Number

TotDeptChg
Total Departmental Charges

Description: *
Number

NumDxCodes
Number of Diagnosis Codes on Claim

Description: *
Number

admsrc
Admission Source (exclude NB)

Description: *
Number

0
*

1
*

2
*

3
*

4
*

5
*

6
*

7
*

8
*

9
*

A
*

B
*

C
*

D
*

dischdest
Discharge Destination

Description: *
Number

01
*

02
*

03
*

04
*

05
*

06
*

07
*

08
*

09
*

20
*

30
*

40
*

41
*

42
*

43
*

50
*

51
*

61
*

62
*

63
*

64
*

65
*

66
*

71
*

72
*

drgcode
MS-DRG Code

Description: *
Number

1. Data dictionary (30 points)

· Must be an excel file, a 

template

 Download template

has been provided for you

· Rename the file as YourName_CHF_Database prior to uploading (10 points automatic deduction if not properly named)

· Example: I would name my file: ChristineNeubert_CHF_Database

2. Data analysis (20 points)

· Must be a word document or in pdf format

Rubric

CHF Database

6 pts

CHF Database
Criteria	Ratings	Pts
This criterion is linked to a Learning OutcomeData Dictionary	30 to >0.0 pts Satisfied Definitions for specified variables are complete, accurate, and in own words. Points are evenly divided by the number of possible answers. 0 pts Not Submitted Not submitted.	30 pts
This criterion is linked to a Learning OutcomeData Analysis Importance	8 pts Satisfied Accurately explains a data dictionary, its importance, and how it’s used. Explanation is detailed and specific to a CHF research project. 4 pts Needs Improvement Explains importance of data dictionary, but explanation may be vague or general (not specific to CHF research project), or contains minor inaccuracies. 2 pts Not Satisfied Explanation is inaccurate or not relevant. 0 pts Not Submitted Not submitted.	8 pts
This criterion is linked to a Learning OutcomeData Analysis Patient Narrative	6 pts Satisfied Provides required data on 3 patients with same length of stay. Narrative is accurate and the coded data is appropriately translated using the data dictionary. 3 pts Needs Improvement Provides required data on 3 patients with the same length of stay. Coded data is not appropriately translated using the data dictionary; Or narrative may contain minor accuracies. 1 pts Not Satisfied Provides data on less than 3 patients or does not provide all required data; Or patients incorrectly selected; Or narrative contains major inaccuracies. 0 pts Not Submitted Not submitted.		6 pts
This criterion is linked to a Learning OutcomeData Analysis Patient Charges	6 pts Satisfied Correctly calculates the charges/amount reimbursed for 3 patients; Thoroughly compares results and draws a logical conclusion. 3 pts Needs Improvement Incorrectly calculates the charges/amount reimbursed for 3 patients; Attempt is made to compare results and draw a logical conclusion, though may be inaccurate. 1 pts Not Satisfied Incorrectly calculates the charges/amount reimbursed for less than 3 patients; Comparison/conclusion is missing or not logical. 0 pts Not Submitted Not submitted.
Total Points: 50

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EXPANDED MODIFIED MEDPAR FILE

CONTENTS

I. The Expanded Modified MedPAR File

II. Record Format

III. Record Data Descriptions

Attachment A

Medicare Status Code

Attachment B Provider Number Coding

Attachment C State Codes

Attachment D Occurrences in Accommodation Days

Attachment E Occurrences in Accommodation Charges

Attachment F Occurrences in Service Charges

IV. Frequency Tables

Age Group

Sex

Medicare Status Code

State

Quarter of Discharge

Number of Diagnosis Codes

Surgery Indicator

Discharge Destination

DRG Codes

EXPANDED MODIFIED MEDPAR FILE

The Medicare Provider Analysis and Review (MEDPAR) file contains
records for 100 percent of Medicare beneficiaries using hospital
inpatient services. The records are stripped of most data elements
that will permit identification of beneficiaries. The hospital is
identified by the six-position Medicare bill number. The file is
available to persons qualifying under the terms of the routine use
act as outlined in the December 24, 1984, Federal Register, and
amended by the July 2, 1985 notice.

SIGNED DATA RELEASE AGREEMENT REQUIRED. FOR ALL FILES REQUIRING A
SIGNED DATA RELEASE AGREEMENT, PLEASE WRITE OR CALL TO OBTAIN A
BLANK AGREEMENT FORM BEFORE PLACING ORDER.

Two versions of this file are created each year.
l. Notice of Proposed Ruling (NPRM) published in the Federal

Register, usually available by the end of May. This file is
derived from the MEDPAR file with a cutoff of three months after
the end of the fiscal year (December file).

2. Final Rule published in the Federal Register, usually
available by the first week of September. This file is derived
from the MEDPAR file with a cutoff of six months after the end of
the fiscal year (March file).

The file specifications for the Expanded Modified MEDPAR File are
as follows:

Record Length – 562
Blocksize – 27538
Record Format – Fixed
Sort Sequence – Medicare Provider Number (Field 13)
Layout Changes – Addition of DRG Version 24

Addition of Present on Admission Indicator

EXPANDED MODIFIED MEDPAR

RECORD FORMAT

EXPANDED MODIFIED MEDPAR FILE

FIELD COBOL
NUMBER DATA ELEMENT NAME LOCATION PICTURE

1 Filler 1 X(01)
2 Age 2 X(01)
3 Sex 3 X(01)
4 Race 4 X(01)
5 Medicare Status Code (MSC) 5-6 X(02)
6 State 7-8 X(02)
7 Filler 9-11 X(03)
8 Filler 12 X(01)
9 Filler 13 X(01)
10 Day of Admission 14 9(01)
11 Discharge Status 15 X(01)
12 HMO Paid Indicator 16 X(01)
13 PPS Indicator 17 X(01)
14 MEDPAR Provider Number 18-23 X(06)
15 Special Unit Character Code 24 X(01)
16 Stay Indicator 25 X(01)
17 Number of Bills 26-28 9(03)
18 DRG Version 24 29-31 X(03)
19 Filler 32 X(01)
20 Admission Date 33-35 9(03)
21 Discharge Date 36-38 9(03)
22 Filler 39 X(01)
23 Filler 40 X(01)
24 Filler 41 X(01)
25 Filler 42 X(01)
26 Length of Stay 43-47 9(05)
27 Outlier Days 48-50 9(03)
28 Covered Days 51-55 9(05)
29 Coinsurance Days 56-58 9(03)
30 Lifetime Reserve Days 59-61 9(03)
31 Filler 62 X(01)
32 Filler 63 X(01)
33 Filler 64 X(01)

34 Coinsurance Amount 65-71 9(07)
35 Inpatient Deductible 72-78 9(07)
36 Blood Deductible 79-85 9(07)
37 Primary Payer Amount 86-92 9(07)
38 Outlier Amount 93-99 9(07)
39 Disproportionate Share Amt 100-106 9(07)
40 Indirect Med Education Amt 107-113 9(07)
41 DRG Price 114-120 9(07)
42 Bill Total Per Diem 121-127 9(07)
43 PPS Capital Total Amount 128-134 9(07)
44 Filler 135 X(01)
45 Filler 136 X(01)
46 Filler 137-143 X(07)

Expanded Modified MEDPAR
Page 2

FIELD COBOL
NUMBER DATA ELEMENT NAME LOCATION PICTURE

47 Total Charges 144-150 9(07)
48 Covered Charges 151-157 9(07)
49 Reimbursement Amount 158-164 9(07)
50 Total Accommodations Charges 165-171 9(07)
51 Total Departmental Charges 172-178 9(07)
52 Accommodation Days 179-193 9(03)
Occurs 5 times
53 Accommodation Charges 194-228 9(07)
Occurs 5 times
54 Service Charges 229-403 9(07)
Occurs 25 times
55 Intensive Care Indicator 404 X(01)
56 Coronary Care Indicator 405 X(01)
57 Pharmacy Indicator 406 9(01)
58 Transplant Indicator 407 9(01)
59 Radiology Indicator 408-413 9(01)
Occurs 6 times
60 Outpatient Services Indicator 414 9(01)
61 Organ Indicator 415-416 X(02)
62 ESRD Setting Indicator 417-426 X(02)
Occurs 5 times
63 Number of Diagnosis Codes 427-428 9(02)
64 Diagnostic Codes 429-473 X(05)
Occurs 9 times
65 Surgery Indicator 474 X(01)
66 Number of Surgical Codes 475-476 9(02)
67 Filler 477 X(01)
68 Surgical Codes 478-501 X(04)
Occurs 6 times
69 Filler 502 X(01)
70 Blood Furnished 503-505 9(03)
71 Filler 506 X(01)
72 DRG Version 25 507-509 9(03)
73 Discharge Destination 510-511 9(02)
74 Outlier Code/DRG Source 512 9(01)

75 Primary Payer Code 513 X(01)
76 MEDPAR ESRD Condition 514-515 9(02)
77 Source of Admission 516 X(01)
78 Type of Admission 517 X(01)
79 Intermediary Number 518-522 X(05)
80 Admission Diagnosis Code 523-527 X(05)
81 Filler 528 X(01)
82 Filler 529 X(01)
83 Admission To Death Interval 530-534 9(05)
84 DRG Version 26 535-537 9(03)
85 DRG Version 27 538-540 9(03)
86 POA Indicator 541-550 X(10)
87 Filler 551-552 X(2)
88 National Provider ID 553-562 X(10)

EXPANDED MODIFIED MEDPAR

RECORD DATA DESCRIPTIONS

01 FILLER

(FOR FUTURE USE)

02 AGE

Description:

The beneficiary’s age is computed as of day of admission. It is
calculated from the Julian date of birth.

Coding Scheme:

Age is a one-position field with the following code:
1 = less than 25
2 = 25 – 44
3 = 45 – 64
4 = 65 – 69
5 = 70 – 74
6 = 75 – 79
7 = 80 – 84
8 = 85 – 89
9 = 90 and over

Original Source:

SSA and RRB Beneficiary Record Systems

03 SEX

Description:

This field specifies the sex of the beneficiary.

Coding Scheme:

0 – Unknown*
1 – Male
2 – Female

Original Source:

SSA and RRB Beneficiary Record Systems

Limitations:

* Unknown is usually an RRB deficiency in reporting. If the sex
is not indicated on the bill, code the sex as unknown.

04 RACE

Description:

This field specifies the beneficiary’s race.

Coding Scheme:

0 – Unknown
1 – White
2 – Black
3 – Other
4 – Asian
5 – Hispanic
6 – North America Native

Original Source:

SSA and RRB Beneficiary Record Systems

Limitations:

Unknown

05 MEDICARE STATUS CODE (MSC)

Description:

This field specifies the reason for Medicare entitlement as of a
point in time.

Coding Scheme:

10 – Aged without End Stage Renal Disease (ESRD)
11 – Aged with ESRD
20 – Disabled without ESRD
21 – Disabled with ESRD
31 – ESRD only

Original Source:

This field is coded from age, original reason for entitlement,
current reason for entitlement and ESRD indicator (See Attachment
A) contained in the master enrollment (HIMaster) file at the
Central Office at the date of processing.

Limitations:

Unknown

06 STATE

Description:

State is a two-position field which specifies the s tate
of residence of the beneficiary and is based on the mailing address
used for cash benefits or the mailing address used for other
purposes (for example, premium billing). This information is
maintained from change of address notices sent in by the
beneficiaries, and is appended to the record at time of processing
in central office. The coding system is the SSA system, not the
Federal Information Processing Standard (FIPS).

Coding Scheme:

01 – Alabama
53 – Wyoming
54-62 – Foreign Countries
63-64 – US Possessions and American SAMOA
65-66 – Pacific Territories
94-96 – Army Post Offices
97-99 – Pacific Territories

Codes 01 – 53 arrange the 50 states, D.C., Puerto Rico, and the
Virgin Islands alphabetically. See Attachment C for list of state
codes.

Original Source:

SSA and RRB Beneficiary Record Systems. For RRB beneficiaries, the
state is coded in SSA based on mailing address.

Limitations:

Invalid or unknown states are coded “99.”

In some cases, the code may not be the actual state of residence
(for example, if the beneficiary has a representative payee).

The last three positions in this field contain blanks.

07 FILLER

(FOR FUTURE USE)

08 FILLER

(FOR FUTURE USE)

09 FILLER

(FOR FUTURE USE)

10 DAY OF ADMISSION

Description:

This one-position field specifies the day of the week the admission
occurred.

Coding Scheme:

1 – Sunday
2 – Monday
3 – Tuesday
4 – Wednesday
5 – Thursday
6 – Friday
7 – Saturday

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

11 DISCHARGE STATUS

Description:

This field specifies the beneficiary’s condition on the date of
discharge from the hospital.

Coding Scheme:

A – Discharged alive
B – Discharged dead
C – Still a patient

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

12 HMO/PAID INDICATOR

Description:

The code indicating whether or not a GHO has paid the provider for the claim(s).

Coding Scheme:

0 – Not paid by HMO
1 – Paid by HMO

Original Source:

Coded at the Central Office

Limitations:

Unknown

13 PPS Indicator

Description:

This field specifies whether a hospital is being paid under the
Prospective Payment System (PPS).

Coding Scheme:

Code 0 = Not PPS
1 = PPS

Original Source:

The PPS Indicator is set at the Central Office and is coded by the
intermediary. A code other than “65” in the Unibill Condition Code
field indicates that this is a PPS provider.

Limitations:

Experience with the indicator shows that it was unreliable in l983,
l984, and l985.

14 MEDICARE PROVIDER NUMBER

Description:

This field specifies the institution that rendered services to a
beneficiary. This is the unique number issued by the HCFA Regional
Office to a provider of services upon initial certification for
participation in the Medicare program. For a more detailed
description of the provider number, see Attachment B.

Coding Scheme:

SSTPPP where:
SS = State of the provider (SSA standard State Codes) –
See Attachment C.
T = Type of provider
PPP = Provider sequence number

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

The MEDPAR File contains only inpatient hospital records.
Provider numbers are validated against a file of Medicare-certified
providers by the intermediary. However, this process is not
repeated when the MEDPAR file is constructed.

15 SPECIAL UNIT CHARACTER CODE

Description:

This field specifies the PPS-exempt special care units of inpatient
hospitals.

Coding Scheme:

S – Psychiatric unit (PPS-exempt)
T – Rehabilitation unit (PPS-exempt)
U – Short term/acute care swing-bed hospital
W – Long term hospital swing-bed
Y – Rehab hospital swing-bed
Z – Swing-bed rural primary care hospital;
eff. 10/97 changed to critical access hospitals
Blank – Not a PPS-exempt unit or swing-bed designation

Original Source:

This is a unique identifier issued by the HCFA Regional Office to a
provider of service. The non-blank code replaces the third digit
of the provider number on incoming bills.

Limitations:

Effective with provider cost reporting periods beginning on or
after October 1, l987, the Alcohol/Drug units are no longer PPS-
exempt units.

16 STAY INDICATOR

Description:

This field specifies the type of stay.

Coding Scheme:

S – Short stay
L – Long stay
N – SNF

Original Source:

Derived from Uniform Bill, Form HCFA-1450

Limitations:

Unknown

17 NUMBER OF BILLS

Description:

This field specifies the number of bills for a stay.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Generated from the stay record at Central Office

Limitations:

Unknown

18 DRG Version 24

Description:

Each DRG represents broad clinical categories that are based on
body system involvement and disease etiology. Each category is
similar in its use of diagnostic resources and is identified using
specific guidelines. Each category must have been clinically
consistent, had a sufficient number of patients, and covered the
complete range of diagnoses represented in the ICD-9-CM, without
overlap. The categories were developed by a Yale University
research team and revised by Health Services International, Inc.

* Please note: For the purposes of IPPS regulation development, the Present on Admission (POA) indicator
was not considered in the grouping process. The groupings in this file reflect the DRG into which the case
is categorized without incorporating any POA indicators.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Added to the record by the intermediary’s GROUPER software, which
translates variables such as age, sex, diagnosis and surgical codes
into the single applicable DRG.

Limitations:

DRG 469 and DRG 470 are categories that could not be accurately
classified into valid DRGs.

19 FILLER

(FOR FUTURE USE)

20 ADMISSION DATE

Description:

This field specifies the date of the beneficiary’s admission to the
institution translated into the quarter of the year in which the
admission occurred.

Coding Scheme:

QYY where:
1YY = First quarter of year
2YY = Second quarter of year
3YY = Third quarter of year
4YY = Fourth quarter of year

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

21 DISCHARGE DATE

Description:

This field specifies the date on which the beneficiary was
discharged translated into the quarter of the year in which the
discharge occurred.

Coding Scheme:

QYY where:
1YY = First quarter of year
2YY = Second quarter of year
3YY = Third quarter of year
4YY = Fourth quarter of year

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

22 FILLER

(FOR FUTURE USE)

23 FILLER

(FOR FUTURE USE)

24 FILLER

(FOR FUTURE USE)

25 FILLER

(FOR FUTURE USE)

26 LENGTH OF STAY

Description:

This field specifies the total length of a patient’s hospital stay
from the date of admission to the date of discharge.

Coding Scheme:

Length of stay is obtained by subtracting the date of admission
from the date of discharge. If the difference was 0, it was
made 1.

Original Source:

Uniform Bill, Form HCFA-1450

27 OUTLIER DAYS

This field specifies the number of days paid as outliers under PPS
and the days over the threshold for the DRG. The number can be a
day or cost outlier.

Coding Scheme:

Three-position field nnn, where n is a number.

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

28 COVERED DAYS

Description:

This field specifies the number of days of care (including
coinsurance and lifetime reserve days) covered by Medicare which
the beneficiary used during this stay as an inpatient.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

29 COINSURANCE DAYS

Description:

This field specifies the actual number of coinsurance days that the
beneficiary used during this hospital stay. The coinsurance days
are the 61st through the 90th day of the spell of illness, plus the
lifetime reserve days used.

Coding Scheme:

Three-position field nnn, where n is a number.

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

30 LIFETIME RESERVE DAYS

Description:

This field specifies the number of lifetime reserve days used by a
beneficiary during this stay. Each beneficiary has a lifetime
reserve of 60 additional days of Medicare coverage for inpatient
hospital services beginning with the 91st day of care in a spell of
illness.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

31 FILLER

(FOR FUTURE USE)

32 FILLER

(FOR FUTURE USE)

33 FILLER

(FOR FUTURE USE)

34 COINSURANCE AMOUNT

Description:

This field specifies the amount shown, which is the number of
coinsurance days multiplied by the applicable coinsurance rate paid
by the patient.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

35 INPATIENT DEDUCTIBLE

Description:

This field specifies the amount identified by the hospital as the
patient’s liability for inpatient deductible.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

36 BLOOD DEDUCTIBLE

Description:

This field specifies the amount identified by the hospital as the
patient’s liability for blood used.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

37 PRIMARY PAYER AMOUNT

Description:

This field specifies the amount paid by the primary insurer for the
beneficiary’s stay in the hospital.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

38 OUTLIER AMOUNT

Description:

This field specifies the amount paid over the DRG allowance. This
amount is included in the Reimbursement Amount.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary – PPS PRICER Program

Limitations:

Unknown

39 DISPROPORTIONATE SHARE

Description:

This field specifies the amount paid over the DRG for the
disproportionate share hospital. This amount is included in the
Reimbursement Amount.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary – PPS PRICER Program

Limitations:

Unknown

40 MEDPAR IME Amount

Description:

This field specifies the additional amount paid to teaching
hospitals for IME. This amount is included in the Reimbursement
Amount.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary – PPS PRICER Program

Limitations:

Unknown

41 DRG PRICE

Description:

This field specifies the DRG price, which is the sum of the
Reimbursement, Primary Payer Amount, Coinsurance Amount, Inpatient
Deductible, and Blood Deductible non-covered charges, less the
Outlier Amount ((R + P + C + I + B) – O = DRG Price).

Coding Scheme:

Charges are rounded to whole dollars

Original source:

Computed by the Fiscal Intermediary for all discharges

Limitations:

Unknown

42 BILL TOTAL PER DIEM

Description:

This field specifies the total per diem amount derived by
multiplying the per diem from the bill by the number of covered
days. This field includes payments for Graduate Medical Education
(GME), Direct Medical Education (DME), and bad debts.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

43 CAPITAL TOTAL AMOUNT

Description:

This field specifies the total reimbursement for depreciation,
rent, certain interest, and real estate taxes for hospital
buildings and equipment subject to the PPS, effective with hospital
cost reporting periods on or after October, 1991. This amount is
included in the Reimbursement Amount.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

From the Fiscal Intermediary – PPS PRICER Program

Limitations:

Unknown

44 FILLER

(FOR FUTURE USE)

45 FILLER

(FOR FUTURE USE)

46 FILLER

(FOR FUTURE USE)

47 TOTAL CHARGES

Description:

This field specifies the total charges, including non-covered
charges, for the beneficiary reported for this hospital stay.

Coding Scheme:

Total is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450, reported in (Total Charges) and
identified by (Revenue Code 001)

Limitations:

An anomaly has been discovered when discharges contain zeros in the
Total Charges field. At this time, the cause is unknown. Since
these records represent 0.002 percent of the file, users are asked
to delete them as errors.

48 COVERED CHARGES

Description:

This field specifies the portion of total charges covered by
Medicare.

Coding Scheme:

Proportional amount is rounded to whole dollars

Original Source:

This field is derived at the Central Office by subtracting non-
covered charges from total charges.

Limitations:

Unknown

49 REIMBURSEMENT AMOUNT

Description:

This field specifies the amount paid to the provider and/or patient
by Medicare for the services reported on the bill. This amount
includes Outlier, Disproportionate Share, Indirect Medical
Education (IME), and Capital Total amounts, but does not include
Bill Total Per Diem. In addition, it excludes amounts paid by or
on behalf of the patient.

Coding Scheme:

Amount is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

IME was excluded before October, 1989. This field may be zero if
Medicare is not the primary payer.

50 TOTAL ACCOMMODATIONS CHARGES

Description

This field specifies the whole dollar amount of the total charges
fields for all accommodations (private room, semi-private room,
ward, intensive care and coronary care units) reported for the
beneficiary during this hospital stay.

Coding Scheme:

Total is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450, summation of (Total Charges) and
identified by (Revenue Codes 10X through 18X)

Limitations:

Unknown

51 TOTAL DEPARTMENTAL CHARGES

Description:

This field specifies the total of the separate departmental charges
for the beneficiary reported during this hospital stay.

Coding Scheme:

Total is rounded to whole dollars

Original Source:

Uniform Bill, Form HCFA-1450, reported in (Total Charges) and
identified by (Revenue Codes 22X through 99X)

Limitations:

Unknown

52 ACCOMMODATION DAYS

Description:

This field specifies the number of days for all routine
accommodations.

Coding Scheme:

Occur five times (See Attachment D for explanation of each
occurrence.)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

53 ACCOMMODATION CHARGES

Description:

This field specifies the number of charges for all routine
accommodations.

Coding Scheme:

Occur five times (See Attachment E for explanation of each
occurrence.)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

54 SERVICE CHARGES

Description:

This field specifies the number of charges for various services,
e.g., used durable equipment, pharmacy, radiology.

Coding Scheme:

Occur 25 times (See Attachment F for explanation of each
occurrence.)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

55 INTENSIVE CARE INDICATOR

Description:

This field specifies that the beneficiary has spent time under
intensive care and indicates the type of ICU.

Coding Scheme:

0 – General (Revenue Center 0200)
1 – Surgical (Revenue Center 0201)
2 – Medical (Revenue Center 0202)
3 – Pediatric (Revenue Center 0203)
4 – Psychiatric (Revenue Center 0204)
6 – Intermediate IOU; (Revenue Center 0206) prior to 12/96
update was ‘post ICU’
7 – Burn care (Revenue Center 0207)
8 – Trauma (Revenue Center 0208)
9 – Other intensive care (Revenue Code 0209)
Blank – No intensive care indication

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

56 CORONARY CARE INDICATOR

Description:

This field specifies that the beneficiary has spent time under
coronary care and indicates the type of coronary care unit.

Coding Scheme:

0 – General (Revenue Code 0210)
1 – Myocardial infarction (Revenue Code 0211)
2 – Pulmonary care (Revenue Code 0212)
3 – Heart transplant (Revenue Code 0213)
4 – Intermediate CCU (Revenue Code 0214) prior to 12/96
update was ‘post ICU’
9 – Other coronary care (Revenue Code 0219)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

57 PHARMACY INDICATOR

Description:

This field specifies that the beneficiary has received drugs during
a stay.

Coding Scheme:

0 – No drugs (Revenue Code other than those listed below)
1 – General drugs and/or IV therapy (Revenue Code 025X, 026X)
2 – Erythropoietin (Revenue Code 0630, 0635, 0637, 0639)
3 – Blood clotting drugs Revenue Code 0636)
4 – General drugs and/or IV therapy, Erythropoietin
(Combination of values 1 and 2)
5 – General drugs and/or IV therapy, and blood clotting drugs
(Combination of values 1 and 3)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

58 TRANSPLANT INDICATOR

Description:

This field specifies whether the beneficiary has had a transplant.

Coding Scheme:

0 – No organ or kidney transplant(Revenue Code not 0362
or 0367)
2 – Organ transplant other than kidney (Revenue Code 0362)
7 – Kidney transplant (Revenue Code 0367)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

59 RADIOLOGY INDICATORS

Description:

This field specifies the type of radiologic treatment a beneficiary
has received.

Coding Scheme:
Occurs six times

Codes are positional. Whenever 1 appears in the string of six (6)
zeroes, the code will specify a particular radiology treatment.

1st position – Radiology-Oncology (Revenue Code 028X)
2nd position – Radiology-diagnostic (Revenue Code 032X)
3rd position – Radiology-therapeutic (Revenue Code 033X)
4th position – Radiology-Nuclear medicine (Revenue Code
034X)
5th position – Radiology CT scan (Revenue Code 035X)
6th position – Radiology Other imaging services (Revenue
Code 040X)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

60 OUTPATIENT SERVICES INDICATOR

Description:

This field specifies whether the beneficiary has received
outpatient services, ambulatory surgical care, or both.

Coding Scheme:

0 – No outpatient services/Ambulatory Surgical Care )
(Revenue Code other than 049X, 050X)
1 – Outpatient services (Revenue Code 050X)
2 – Ambulatory surgical care (Revenue Code 049X)
3 – Outpatient services and ambulatory surgical care
(Revenue Codes 049X and 050X)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

61 ORGAN INDICATOR

Description:

This field specifies the type of organ transplant.

Coding Scheme:

K1 – General classification (Revenue Code 0810)
K2 – Living donor kidney (Revenue Code 0811)
K3 – Cadaver donor kidney (Revenue Code 0812)
K4 – Unknown donor kidney (Revenue Code 0813)
K5 – Other kidney acquisition (Revenue Code 0814)
H1 – Cadaver donor heart (Revenue Code 0815)
H2 – Other heart acquisition (Revenue Code 0816)
L1 – Donor liver (Revenue Code 0817)
01 – Other organ acquisition (Revenue Code 0819)
02 – General classification Revenue Code 0890)
B1 – Bone donor bank (Revenue Code 0891)
03 – Organ donor bank other than kidney (Revenue code 0892)
S1 – Skin donor bank (Revenue Code 0893)
04 – Other donor bank (Revenue Code 0899)
Blank – no organ acquisition indication

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

62 ESRD SETTING

Description:

This field specifies the type of dialysis used on the beneficiary.

Coding Scheme:

Inpatient Renal Dialysis
00 – General (Revenue Code 0800)
01 – Hemodialysis (Revenue Code 0801)
02 – Peritoneal (non-CAPD: Revenue code 0802)
03 – CAPD (Revenue Code 0803)
04 – CCPD (Revenue Code 0804)
09 – Other (Revenue Code 0809)

Hemodialysis-Outpatient
20 – General (Revenue Code 0820)
21 – Hemodialysis/composite (Revenue Code 0821)
22 – Home supplies (Revenue Code 0822)
23 – Home equipment (Revenue Code 0823)
24 – Maintenance/100% (Revenue Code 0824)
25 – Support services (Revenue Code 0825)
29 – Other (Revenue Code 0829)

Peritoneal Dialysis-Outpatient/Home
30 – General (Revenue Code 0830)
31 – Peritoneal/composite (Revenue Code 0831)
32 – Home supplies (Revenue Code 0832)
33 – Home equipment (Revenue Code 0833)
34 – Maintenance/100% (Revenue Code 0834)
35 – Support services (Revenue Code 0835)
39 – Other (Revenue Code 0839)

CAPD Outpatient
40 – CAPD General (Revenue Code 0840)
41 – CAPD/composite (Revenue Code 0841)
42 – Home supplies (Revenue Code 0842)
43 – Home equipment (Revenue Code 0843)
44 – Maintenance/100% (Revenue Code 0844)
45 – Support services (Revenue Code 0845)
49 – Other (Revenue Code 0849)

62 ESRD SETTING (continued)

CCPD Outpatient
50 – CCPD General (Revenue Code 0850)
51 – CCPD/composite (Revenue Code 0851)
52 – Home supplies (Revenue Code 0852)
53 – Home equipment (Revenue Code 0853)
54 – Maintenance/100% (Revenue Code 0854)
55 – Support services (Revenue Code 0855)
59 – Other (Revenue Code 0859)

Miscellaneous Dialysis
80 – General (Revenue Code 0880)
81 – Ultrafiltration (Revenue Code 0881)
89 – Other (Revenue Code 0889)
Blank – No ESRD setting indication

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

63 NUMBER OF Diagnosis CODES

Description:

This field specifies the number of diagnosis codes present in the
stay record (i.e., the number of fields that are not blank).

Coding Scheme:

Two-position field nn, where n is a number (1-10)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations

Unknown

64 DIAGNOSIS CODE

Description:

This field specifies the principal and other diagnosis codes that
are obtained from the patient’s discharge bill. Principal
diagnosis is defined as the condition established, after study,
that is chiefly responsible for admission of the patient. The
principal diagnosis is reported first, followed by up to eight
additional diagnoses. The order of these eight is at the
discretion of the provider.

Coding Scheme:

Coding is based on International Classification of Diseases 9th
Revision, Clinical Modification (ICD-9-CM). Providers key the ICD-
9-CM code from the bills and report the information to HCFA as part
of the claims tape record. Each code can be up to five characters,
left justified.

Original Source:

Uniform Bill, Form HCFA-1450

Limitations

May contain invalid codes

65 SURGERY INDICATOR

Description:

This field specifies whether or not there were any surgical
procedures performed during the beneficiary’s stay.

Coding Scheme:

0 – No surgery indicated
1 – Yes surgery indicated

Original Source:

This field is derived at the Central Office.

Limitations:

Unknown

66 NUMBER OF SURGICAL CODES

Description:

This field specifies the number of surgical codes reported.

Coding Scheme:

Two-position field nn, where n is a number (0-6)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

67 FILLER

(FOR FUTURE USE)

68 SURGICAL CODE

Description:

This field specifies the ICD-9-CM codes that correspond to the
surgical procedures performed during the beneficiary’s stay.

Coding Scheme:

Occur 6 times

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

69 FILLER

(FOR FUTURE USE)

70 BLOOD FURNISHED

Description:

This field specifies the total number of pints of whole blood or
units of packed red cells furnished, regardless of whether they
were replaced. Blood is reported in complete units rounded
upwards. This entry serves as the basis for counting pints toward
the blood deductible and must, therefore, include both replaced and
unreplaced blood.

Coding Scheme:

Three-position field nn, where n is a number

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Based on an analysis of aggregated records, there appears to be a
misinterpretation by some providers of the format (i.e., the field
is to contain whole units, but it appears, in some cases, to be
reported with tenths of units).

71 FILLER

(FOR FUTURE USE)

72 DRG Version 25

Description:

Each DRG represents broad clinical categories that are based on
body system involvement and disease etiology. Each category is
similar in its use of diagnostic resources and is identified using
specific guidelines. Each category must have been clinically
consistent, had a sufficient number of patients, and covered the
complete range of diagnoses represented in the ICD-9-CM, without
overlap. The categories were developed by a Yale University
research team and revised by Health Services International, Inc.

* Please note: For the purposes of IPPS regulation development, the Present on Admission (POA) indicator
was not considered in the grouping process. The groupings in this file reflect the DRG into which the case
is categorized without incorporating any POA indicators.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Added to the record by the intermediary’s GROUPER software, which
translates variables such as age, sex, diagnosis and surgical codes
into the single applicable DRG.

Limitations:

DRG 998 and DRG 999 are categories that could not be accurately
classified into valid DRGs.

73 DISCHARGE DESTINATION

Description:

This field specifies the destination of the patient after discharge
from the hospital.

Coding Scheme:

01 – Discharged to home/self care (routine charge).
02 – Discharged/transferred to other short term
general hospital for inpatient care.
03 – Discharged/transferred to skilled nursing
facility (SNF) – (For hospitals with an approved
swing-bed arrangement, use Code 61 – swing-bed.
For reporting discharges/transfers to a non-certified
SNF, the hospital must use Code 04 – ICF.
04 – Discharged/transferred to intermediate care facility
(ICF).
05 – Discharged/transferred to another type of
institution for inpatient care (including
distinct parts).
06 – Discharged/transferred to home care of
organized home health service organization.
07 – Left against medical advice or discontinued care.
08 – Discharged/transferred to home under care of a home
IV drug therapy provider.
09 – Admitted as an inpatient to this hospital
(effective 3/1/91). In situations where a patient
is admitted before midnight of the third day
following the day of an outpatient service, the
outpatient services are considered inpatient.
20 – Expired (did not recover -(Christian
Science patient).
30 – Still patient.
40 – Expired at home (hospice claims only).

41 – Expired in a medical facility such as
hospital, SNF, ICF, or freestanding hospice.
(Hospice claims only)
42 – Expired – place unknown (Hospice claims only)
43 – Discharged/transferred to a federal hospital
(eff. 10/1/03)
50 – Hospice – home (eff. 10/96)
51 – Hospice – medical facility (eff. 10/96)
61 – Discharged/transferred within this institution
to a hospital-based Medicare approved swing bed (eff.
9/01)
62 – Discharged/transferred to an inpatient
rehabilitation facility including distinct
parts units of a hospital. (eff. 1/2002)
63 – Discharged/transferred to a long term care
hospital. (eff. 1/2002)
64 – Discharged/transferred to a nursing facility
certified under Medicaid but not under
Medicare.(eff. 10/2002)
65 – Discharged/transferred to a psychiatric
hospital or psychiatric distinct unit of a
hospital.(eff. 1/2005)
66 – Discharged/transferred to a Critical
Access Hospital (CAH). (eff. 1/1/06)
71 – Discharged/transferred/referred to another
institution for outpatient services as
specified by the discharge plan of care.
(eff. 9/2001)
72 – Discharged/transferred/referred to this institution
for outpatient services as specified by the
discharge plan of care.(eff. 9/2001)

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

74 OUTLIER CODE/DRG SOURCE

Description:

This field specifies two mutually exclusive conditions. The first,
for PPS providers (codes 0, 1, and 2), if the stay has an unusually
long length (day outlier) or high cost (cost outlier) or the
second, for non-PPS providers (codes 6, 7, 8, and 9), denotes the
source for developing the DRG.

Coding Scheme:

One-position field showing the Outlier Code/DRG Source.

Codes applicable to PPS Providers:
0 – No outlier
1 – Day outlier
2 – Cost outlier

Codes applicable to non-PPS Providers:
6 – Valid DRG received from the Intermediary
7 – HCFA-developed DRG
8 – HCFA-developed DRG using claim status code
9 – Not groupable

Original Source:

This field is coded at the Central Office.

Limitations:

Unknown

75 PRIMARY PAYER CODE

Description:

This field specifies the payer of this claim.

Coding Scheme:

A – Working aged beneficiary/spouse with
Employer Group Health Plan (EGHP)
B – ESRD beneficiary in eighteen-month coordination
period with EGHP
C – Conditional medicare payment; future reimbursement
expected
D – Automobile no-fault or any liability insurance
E – Worker’s compensation
F – PHS or other Federal agency (other than
Dept. of Veterans Affairs)
G – Working disabled
H – Black Lung
I – Depart of Veterans Affairs
J – Any liability insurance
Z/Blank – Medicare is primary payer

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

76 MEDPAR ESRD CONDITION CODE

Description

This field specifies the ESRD condition codes found on the
beneficiary’s bill. (medpar_ESRD_cond_c)

Coding Scheme:

00 – No ESRD
70 – Self-administered EPO
71 – Full care in unit
72 – Self-care in unit
73 – Self-care training
74 – Home dialysis
75 – Home dialysis/100% reimbursement
76 – Backup-in-facility dialysis

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

77 SOURCE OF ADMISSION

Description:

This field specifies the type of admission for inpatient hospital
stays.

Coding Scheme:

0 – ANOMALY: invalid value, if present,
translate to ‘9’
1 – Physician referral – The patient was admitted
upon the recommendation of personal physician.
2 – Clinic referral – The patient was admitted
upon the recommendation of this facility’s
clinic physician.
3 – HMO referral – The patient was admitted upon the
recommendation of a Health Maintenance Organization
(HMO) physician.
4 – Transfer from hospital – The patient was admitted
as an inpatient transfer from an acute care
facility.
5 – Transfer from a Skilled Nursing Facility (SNF) – The
patient was admitted as an inpatient transfer
from a SNF.

6 – Transfer from another health care facility –
The patient was admitted as a transfer from a health
care facility other than an acute care facility
or SNF.
7 – Emergency room – The patient was admitted upon
the recommendation of this facility’s
emergency room physician.
8 – Court/law enforcement – The patient was
admitted upon the direction of a court of
law or upon the request of a law enforcement
agency’s representative.
9 – Information not available – The means by which

the patient was admitted is not known.
A – Transfer from a Critical Access Hospital – patient was
admitted/referred to this facility as a
transfer from a Critical Access Hospital.
B – Transfer from another Home Health Agency –
The patient was admitted to this home
health agency as a transfer from another
home health agency.
C – Readmission to Same Home Health Agency –
The patient was readmitted to this home
health agency within the same home health
episode period.
D – Transfer from hospital inpatient in the
same facility resulting in a separate
claim to the payer – The patient was
admitted to this facility as a transfer
from hospital inpatient within this
facility resulting in a separate
claim to the payer.

**For Newborn Type of Admission**
.
1 – Normal delivery – A baby delivered without
complications.
2 – Premature delivery – A baby delivered with
time and/or weight factors qualifying it
for premature status.
3 – Sick baby – A baby delivered with medical
complications, other than those relating to
premature status.
4 – Extramural birth – A baby delivered in a
nonsterile environment.
5-8 Reserved for national assignment.
9 – Information not available.

Original Source:

Uniform Bill, Form HCFA-1450

Limitations: Unknown

78 TYPE OF ADMISSION

Description:

This field specifies the basic types of admission for inpatient
hospital stays.

Coding Scheme:

1 The code indicating the type and priority of
an inpatient admission associated with the
service on an intermediary submitted claim.

STANDARD ALIAS: CLM_IP_ADMSN_TYPE_CD
SQL ALIAS: IP_ADMSN_TYPE_CD
SAS ALIAS: TYPE_ADM
TITLE ALIAS: IP_ADMISSION_TYPE

CODES:
0 – Blank
1 – Emergency – The patient required immediate
medical intervention as a result of severe,
life threatening, or potentially disabling
conditions. Generally, the patient was
admitted through the emergency room.
2 – Urgent – The patient required immediate
attention for the care and treatment of
a physical or mental disorder. Generally,
the patient was admitted to the first
available and suitable accommodation.
3 – Elective – The patient’s condition
permitted adequate time to schedule the
availability of suitable accommodations.
4 – Newborn – Necessitates the use of special
source of admission codes.
5-8 Reserved.
9 – Unknown – Information not available.

Original Source:

Xeroxed from NCH

Limitations:

Unknown

79 INTERMEDIARY NUMBER

Description:

This field specifies the identifying number of the intermediary
processing the bill.

Coding Scheme:

For the first two positions:
00 – Blue Cross
nn – Commercial Plan

00010 – Alabama BC – Alabama
00011 – Alabama BC – Iowa
00020 – Arkansas BC
00030 – Arizona BC
00040 – California BC (term. 12/00)
00050 – New Mexico BC/CO (term. 06/89)
00060 – Connecticut BC (term. 06/99)
00070 – Delaware BC -(term.02/98)
00080 – Florida BC -(term. 03/88)
00090 – Florida BC
00101 – Georgia BC
00121 – Illinois – HCSC (term. 08/98)
00123 – Michigan – HCSC (term. 08/98)
00130 – Indiana BC/Administar Federal
00131 – Illinois – Administar
00140 – Iowa – Wellmark (term. 6/2000)
00150 – Kansas BC
00160 – Kentucky/Administar
00180 – Maine BC
00181 – Maine BC – Massachusetts
00190 – Maryland BC
00200 – Massachusetts BC (term. 07/97)
00210 – Michigan BC (term. 09/94)
00220 – Minnesota BC (term. 07/99)
00230 – Mississippi BC
00231 – Mississippi BC/LA (term. 09/92)
00232 – Mississippi BC
00241 – Missouri BC (term. 09/92)
00250 – Montana BC

00260 – Nebraska BC
00270 – New Hampshire/VT BC
00280 – New Jersey BC (term. 08/00)
00290 – New Mexico BC – (term. 11/95)
00308 – New York – Empire BC
00310 – North Carolina BC (term. 01/02)
00320 – North Dakota BC
00332 – Community Mutual Ins Co; Ohio Administar
00340 – Oklahoma BC
00350 – Oregon BC
00351 – Oregon BC/ID (term. 09/88)
00355 – Oregon – CWF
00362 – Independence BC – (term. 08/97)
00363 – Pennsylvania – Veritus
00370 – Rhode Island BC
00380 – South Carolina BC
00390 – Tennessee BC
00400 – Texas BC
00410 – Utah BC (term. 09/00)
00423 – Virginia BC; Trigon (term. 08/99)
00430 – Washington/Alaska BC
00450 – Wisconsin BC – Wisconsin
00452 – Wisconsin BC – Michigan
00453 – Wisconsin BC – Virginia & West Virginia
00454 – Wisconsin BC – California
00460 – Wyoming BC
00468 – N Carolina BC/CPRTIVA
00993 – BC/BS Assoc.
17120 – Hawaii Medical Service (term. 06/99)
50333 – Travelers; Connecticut United Healthcare
(term. – date unknown)
51051 – Aetna California – (term. 06/97)
51070 – Aetna Connecticut – (term. 06/97)
51100 – Aetna Florida – (term. 06/97)
51140 – Aetna Illinois – (term. 06/97)
51390 – Aetna Pennsylvania – (term. 06/97)
52280 – NE – Mutual of Omaha
57400 – Puerto Rico – Cooperativa
61000 – Aetna (term. 06/97)
80883 – Contractor ID for Inpatient & Outpatient
Risk Adjustment Data (data not sent through
CWF; but through Palmetto)

Original Source:

From the Fiscal Intermediary

Limitations:

Unknown

80 ADMISSION DIAGNOSIS

Description:

This field specifies the ICD-9 diagnosis code at the time of
admission.

Coding Scheme:

Five-position field nnnnn, where n is a number

Original Source:

Uniform Bill, Form HCFA-1450

Limitations:

Unknown

81 FILLER

(FOR FUTURE USE)

82 FILLER

(FOR FUTURE USE)

83 ADMISSION TO Death Interval

Description:

This field specifies the number of days from the beneficiary’s
admission to date of death.

Coding Scheme:

Five-position field nnn, where n is a number

Original Source:

MEDPAR

Limitations:

Unknown

84 DRG Version 26

Description:

This field specifies the mapped DRG for this fiscal year. For a
description of DRG, see field Diagnosis Related Group (DRG) Code.

* Please note: For the purposes of IPPS regulation development, the Present on Admission (POA) indicator
was not considered in the grouping process. The groupings in this file reflect the DRG into which the case
is categorized without incorporating any POA indicators.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Evaluates the billed DRG, diagnostic, and procedure codes to
produce a current DRG.

Limitations:

DRG 998 and DRG 999 are categories that could not be accurately
classified into valid DRGs.

85 DRG Version 27

Description:

This field projects DRG codes for the next fiscal year. For a
description of DRG, see field Diagnosis Related Group (DRG) Code.

* Please note: For the purposes of IPPS regulation development, the Present on Admission (POA) indicator
was not considered in the grouping process. The groupings in this file reflect the DRG into which the case
is categorized without incorporating any POA indicators.

Coding Scheme:

Three-position field nnn, where n is a number

Original Source:

Evaluates the current DRG, diagnostic, and procedure codes to
produce a proposed DRG.

Limitations:

DRG 998 and DRG 999 are categories that could not be accurately
classified into valid DRGs.

86 POA Indicator

Description:

Effective September 1, 2008,
the code used to indicate a condition was
present at the time the beneficiary was admitted to
a general acute care facility.

Coding scheme:

Ten-position character field.

In the POA field, there can be up to 9 POA
indicators for each diagnosis code reflected in the
diagnosis trailer. This field will also contain a
1-byte indicator (‘Z’ or ‘X’) to identify the end
of the POA codes.

Y = Present at the time of inpatient admission
N = Not present at the time of inpatient admission
U = Documentation is insufficient to determine if
condition was present on admission
W = Provider is unable to clinically determine
whether condition was present on admission or
not.
1 = Unreported/not used — exempt from POA reporting —
this code is the equivalent code of a blank,
however, it was determined that blanks were
undesirable when submitting the data
Z = Denotes the end of the POA indicators
X = Denotes the end of the POA indicators in special
data processing situations that may be identified
by CMS in the future.

87 FILLER

(FOR FUTURE USE)

88 National Provider ID (NPI)

Description:

Effective May 23, 2007, the National Provider Identifier (NPI)
number is assigned to uniquely identify the institutional
provider certified by Medicare to provide services.

Coding Scheme:

Ten-position character field.

Original Source:

Uniform Bill

Limitations:

The MEDPAR File contains only inpatient hospital records.
Provider numbers are validated against a file of Medicare-certified
providers by the intermediary. However, this process is not
repeated when the MEDPAR file is constructed.

ATTACHMENTS

Attachment A

The Medicare Status Code (MSC) logic used by the Enrollment System
follows:

Step 1 Compute Age-of-Person

Step 2 If Age > 64, enter 10 at Medicare Status Code and
go to Step 4.

Step 3 Generate a Medicare Status Code using the original
reason for entitlement code (OREC) and the current reason
for entitlement code (CREC) and the following table:

OREC & CREC = MS CODE OREC & CREC = MS CODE
0 & 0 = 10 1 & 0 = 20
0 & 1 = 10 1 & 1 = 20
0 & 2 = 10 1 & 2 = 20
0 & 3 = 10 1 & 3 = 20
2 & 0 = 31 3 & 0 = 20
2 & 1 = 20 3 & 1 = 20
2 & 2 = 31 3 & 2 = 20
2 & 3 = 20 3 & 3 = 20

Step 4 If Medicare Status Code = 10 or 20 AND
End Stage Renal Disease Indicator (ESRDI) = A thru G,
add 1 to Medicare Status Code (generate 11 or 21 codes).

Note:

Reason for Entitlement: End Stage Renal Disease Indicator:
0 – OASI 0 – No ESRD
1 – DIB A – MBR
2 – Renal B – HI
3 – DIB & Renal C – NIH
D – MBR & HI

Medicare Status Code: E – MBR & HI
10 – Aged without ESRD F – HI & NIH
11 – Aged with ESRD G – MBR, HI, & NIH
20 – DIB without ESRD H – OAS Clerical
21 – DIB with ESRD I – MBR/OAS Clerical
31 – ESRD only J – HI/OAS Clerical
K – NIH/OAS Clerical
L – MBR/HI/OAS Clerical
M – MBR/NIH/OAS Clerical
N – HI/NIH/OAS Clerical
P – MBR/HI/NIH/OAS Clerical

Attachment B
(Page 1)

Provider Number Coding

– The first two positions are the State code (See Attachment C).

– Position three, and sometimes position four, are used as a
category identifier. The remaining positions are serial numbers.
The following blocks of numbers are reserved for the facilities
indicated:

0001-0879 Short-term (General and Specialty) Hospitals
(where TOB = 11X; ESRD clinic where TOB = 72X)
0880-0899 Reserved for hospitals participating in ORD
demonstration projects where TOB = 11X;
ESRD clinic where TOB =72X
0900-0999 Multiple Hospital Component in a Medical Complex
(Numbers Retired) where TOB =11X;ESRD clinic
where TOB = 72X
1000-1199 Reserved for Future Use
1200-1224 Alcohol/Drug Hospitals (Excluded from PPS –
Numbers Retired)where TOB = 11X; ESRD clinic
where TOB = 72X
1225-1299 Medical Assistance Facilities (MONTANA Project)
ESRD clinic where TOB = 72X
1300-1399 Rural Primary Care Hospital (RPCH) eff. 10/97
changed to Critical Access Hospitals (CAH)
1400-1499 Continuation of 4600-4799 series (CMHC)
1500-1799 Hospices
1800-1989 Federally Qualified Health Centers (FQHC)
where TOB = 73X; SNF (IP P7B) where TOB = 22X;
HHA where TOB = 32X, 33X, 34X eff. 7/00
changed to Religious Non Medical Health
Care Institution (RNHCI)
1990-1999 Christian Science Sanatoria (Hospital Services)
2000-2299 Long-Term Hospitals (Excluded from PPS)
2300-2499 Chronic Renal Disease Facilities (Hospital Based)

2500-2899 Non-Hospital Renal Disease Treatment Centers
2900-2999 Independent Special Purpose Renal Dialysis Facility (1)
3000-3024 Formerly Tuberculosis Hospitals (Numbers Retired)
3025-3099 Rehabilitation Hospitals (Excluded from PPS)
3100-3199 Continuation 7300-7399 (HHA) (3)
(eff. 4/96)
3200-3299 Continuation of 4800-4899 series (CORF)
3300-3399 Children’s Hospitals (Excluded from PPS)
3400-3499 Continuation of Rural Health Clinics
(provider based) (3775-3999)
3500-3699 Renal Disease Treatment Centers (Hospital Satellites)

3700-3799 Hospital Based Special Purpose Renal Dialysis Facility (1)
3800-3974 Rural Health Clinics (Free-Standing)
3975-3999 Rural Health Clinics (Provider Based)
4000-4499 Psychiatric Hospitals (Excluded from PPS)
4500-4599 Comprehensive Outpatient Rehabilitation Facilities
(CORF)
4600-4799 Community Mental Health Centers (CMHC);
9/30/91-3/31/97 used for clinic OPT
where TOB = 74*
4800-4899 Continuation of 4500-4599 series (CORF)
4900-4999 Continuation of 4600-4799 series(CMHC)
9/30/91-3/31/97 used for clinic OPT
5000-6499 Skilled Nursing Facilities
CMHC/outpatient physical etc.
6500-6989 Outpatient Physical Therapy Services

6990-6999 Christian Science Sanatoria (Skilled Nursing Services)
eff. 7/00 Numbers Reserved (formerly CS)
7000-7299 Home Health Agencies (HHA) (2)
7300-7399 Subunits of “Nonprofit” and “Proprietary” Home Health
Agencies (3)
7400-7799 Continuation of 7000-7299 Series

1

Attachment B
(Page 2)

7800-7999 Subunits of State and Local Governmental Home Health
Agencies (3)
8000-8499 Continuation of 7400-7799 series (HHA)
8500-8899 Continuation of Rural Health Center
(provider based) (3400-3499)
8900-8999 Continuation of Rural Health Center
(free standing)(3800-3974)
9000-9499 Continuation of 8000-8499 series (HHA)

9500-9999 (eff. 8/1/98) NOTE: 10/95-7/98 This series was
assigned to HHA’s but rescinded-no HHA’s were
ever assigned a number from this series.
P001-P999 Organ Procurement Organization

(1) These facilities (SPRDFS) will be assigned the same provider
number whenever they are recertified.

(2) The 6400-6499 series of provider numbers in Iowa (16), South
Dakota (43), and Texas (45) have been used in Reducing Acute Care
Costs (RACC) Experiments.

(3) In Virginia (49), the series 7100-7299 has been reserved for
Statewide Subunit Components of the Virginia State Home Health
Agencies.

(4) Parent agency must have a number in the 7000-7299, 7400-7799
or 8000-8499 series.

Exception:
P001-P999 Organ procurement organization

(1) These facilities (SPRDFS) will be assigned the same provider
number whenever they are recertified.
(2) The 6400-6499 series of provider numbers in Iowa (16),
South Dakota (43) and Texas (45) have been used in reducing acute
care costs (RACC) experiments.
(3) In Virginia (49), the series 7100-7299 has been reserved
for statewide subunit components of the Virginia state
home health agencies.
(4) Parent agency must have a number in the 7000-7299, 7400-7799 or
8000-8499 series.

Note:
There is a special numbering system for units of hospitals
that are excluded from Prospective Payment System (PPS)
and hospitals with SNF swing-bed designation. An alpha
character in the third position of the provider number
identifies the type of unit or swing-bed designation as follows:

S = Psychiatric unit (excluded from PPS)
T = Rehabilitation unit (excluded from PPS)
U = Short term/acute care swing-bed hospital
V = Alcohol drug unit (prior to 10/87 only)
W = Long term SNF swing-bed hospital (eff 3/91)
Y = Rehab hospital swing-bed (eff 9/92)
Z = Swing Bed Designation for Critical Access Hospitals

There is also a special numbering system for assigning
emergency hospital identification numbers (non participating
hospitals). The sixth position of the provider number is as
follows:

E = Non-federal emergency hospital
F = Federal emergency hospital

SOURCE:
UNIFORM BILL 82, FORM HCFA-1450,
ITEM 7 (MEDICARE PROVIDER NUMBER).

LIMITATIONS:
THE MEDPAR FILE CONTAINS ONLY INPATIENT HOSPITAL
RECORDS. PROVIDER NUMBERS ARE VALIDATED AGAINST
A FILE OF MEDICARE-CERTIFIED PROVIDERS BY THE

INTERMEDIARY. HOWEVER, THIS PROCESS IS NOT
REPEATED WHEN THE MEDPAR FILE IS CONSTRUCTED.

Attachment C

STATE CODES

01 Alabama 47 Vermont
02 Alaska 48 Virgin Islands
03 Arizona 49 Virginia
04 Arkansas 50 Washington
05,55,75 California 51 West Virginia
06 Colorado 52 Wisconsin
07 Connecticut 53 Wyoming
08 Delaware 54 Africa
09 District of Columbia 56 Canada
10,68,69 Florida 57 Central America
11 Georgia and West Indies
12 Hawaii 58 Europe
13 Idaho 59 Mexico
14,78 Illinois 60 Oceania
15 Indiana 61 Philippines
16,76 Iowa 62 South America
17,70 Kansas 63 U.S.
18 Kentucky Possessions
19,71 Louisiana 64** American Samoa
20 Maine 65** Guam
21,80 Maryland 66** Saipan or Northern
Mariana=
94 Army Post Office
(APO AE)
95 Army Post Office
(APO AA)
96 Army Post Office
(APO AP)

22 Massachusetts 97** Northern

23 Michigan Marianas
24,77 Minnesota 98** Guam
25 Mississippi 99** American Samoa
26 Missouri (with 000
27 Montana county code;
28 Nebraska otherwise
29 Nevada unknown)
30 New Hampshire
31 New Jersey
32 New Mexico
33 New York
34 North Carolina
35 North Dakota
36,72 Ohio
37 Oklahoma
38 Oregon
39,73 Pennsylvania
40 Puerto Rico
41 Rhode Island ** Pacific Territories
42 South Carolina
43 South Dakota
44 Tennessee
45,67,74 Texas
46 Utah

Attachment D

OCCURRENCES IN ACCOMMODATION DAYS:

1st Occurrence (177-179) Private Room

2nd Occurrence (180-182) Semi-Private Room

3rd Occurrence (183-185) Ward

4th Occurrence (186-188) Intensive Care

5th Occurrence (189-191) Coronary Care

1

Attachment E

OCCURRENCES IN ACCOMMODATION CHARGES:

1st Occurrence (192-198) Private Room

2nd Occurrence (199-205) Semi-Private Room

3rd Occurrence (206-212) Ward

4th Occurrence (213-219) Intensive Care

5th Occurrence (220-226) Coronary Care

Attachment F

OCCURRENCES IN SERVICE CHARGES:

1st Occurrence (227-233) is Other.
Revenue Center 002 through 099, 22X, 23X, 24X, 52X, 53X,
55X, 56X, 57X, 58X, 59X, 60X, 64X, 65X, 66X, 67X, 68X, 69X,
70X, 76X, 77X, 78X, 90X, 91X, 92X, 93X, 94X, 95X, 99X.

2nd Occurrence (234-240) is Pharmacy.
Revenue Center 25X, 26X, 63X.

3rd Occurrence (241-247) is Medical/Surgical Supplies.
Revenue Center 27X, 62X.

4th Occurrence (248-254) is Durable Medical Equipment.
Revenue Center 290, 291, 292.

5th Occurrence (255-261) is Used Durable Medical Equipment.
Revenue Center 293.

6th Occurrence (262-268) is Physical Therapy.
Revenue Center 42X.

7th Occurrence (269-275) is Occupational Therapy.
Revenue Center 43X.

8th Occurrence (276-282) is Speech Pathology.
Revenue Center 44X, 47X.

9th Occurrence (283-289) is Inhalation Therapy.
Revenue Center 41X, 46X.

10th Occurrence (290-296) is Blood.
Revenue Center 38X.

11th Occurrence (297-303) is Blood Administration.
Revenue Center 39X.

12th Occurrence (304-310) is Operating Room.
Revenue Center 36X, 71X, 72X.

13th Occurrence (311-317) is Lithotripsy.
Revenue Center 79X.

14th Occurrence (318-324) is Cardiology.
Revenue Center 48X, 73X.

Attachment F
Page 2

15th Occurrence (325-331) is Anesthesia.
Revenue Center 37X.

16th Occurrence (332-338) is Laboratory.
Revenue Center 30X, 31X, 74X, 75X.

17th Occurrence (339-345) is Radiology.
Revenue Center 28X, 32X, 33X, 34X, 35X, 40X.

18th Occurrence (346-352) is MRI.
Revenue Center 61X.

19th Occurrence (353-359) is Outpatient Services.
Revenue Center 49X, 50X.

20th Occurrence (360-366) is Emergency Room.
Revenue Center 45X.

21st Occurrence (367-373) is Ambulance.
Revenue Center 54X.

22nd Occurrence (374-380) is Professional Fees.
Revenue Center 96X, 97X, 98X.

23rd Occurrence (381-387) is Organ Acquisition.
Revenue Center 81X, 89X.

24th Occurrence (388-394) is ESRD Revenue Setting.
Revenue Center 80X, 82X, 83X, 84X, 85X, 86X, 87X, 88X.

25th Occurrence (395-401) is Clinic Visit.
Revenue Center 51X.