Author: Larissa Lee

Beginning with Q1-2025 discharge data submissions there will be changes in reporting Medicare Advantage payer classification codes. 

There is a need to analyze more granular Medicare Advantage plans that have been identified as the most utilized Medicare Advantage payers across the state. Currently, all Tennessee hospitals report all Medicare Advantage plans in patient discharge records using payer “K.” Additional Medicare Advantage payer codes, K1 – K7, have been added to the payer classification categories.  

Beginning with your Q1-2025 discharge data submissions, we ask that you make changes to the way you map your Medicare Advantage payer classification codes as described below. This change applies to primary, secondary and tertiary payer name codes (additional details about these data fields can be found in the 2020 HDDS manual on pages 65, 68 and 71). 

The Tennessee Department of Health (TDH) emailed this notice on November 22, 2024. The notice can be found here. Please report the data to THA/HIDINet using the payer classification codes listed above beginning with your Q1-2025 data submissions which are due by May 30, 2025.

THA worked with the Data Policy Committee (DPC) to review
and update the THA Data Release Policy. The main objectives of this effort were
to reflect changes in THA’s data programs by removing outdated uses, clarify
language to ensure consistent interpretation of intended uses and prohibitions,
and explore new external uses for UB discharge data in health planning and
financial disclosures. After a thorough review, the DPC recommended the updated
policy for approval to the THA Board of Directors, which approved it at its
September 2024 meeting.

Enabling these additional UB discharge data uses to support
health planning and financial disclosures requires that THA segregate member
and non-member data for data subscribers and Market Optics users. Going
forward, the non-HIN/non-member data will only be available to subscribers upon
request, and will only be added to Market Optics once the Tennessee Department
of Health (TDH) has made the data publicly available (typically 18 months after
the close of a calendar year). For example, the 2023 data will be accessible in
July 2025.

Please review the updated THA Data Release Policy which is active and replaces any previous copies you may have on file. You can find the document HERE.

As you are aware, with each new year comes a new set of CPT/HCPCS codes.  After extensive review of the new 2024 codes by the Tennessee Hospital Association (THA) and the Tennessee Health Information Management Association (THIMA) professionals, we have determined which codes should be included or excluded from the ambulatory surgery definition beginning with the Q1-2024 discharge data which are due May 30, 2024. 

Please find the updated, change version, definition document here.  As you review the document you will see changes to the special inclusion and exclusion lists:  codes removed are highlighted in yellow and codes added are highlighted in peach.  You may also find the FINAL ambulatory surgery definition document here (this version does not include markups).  Below is a breakdown of changes for 2024 THA ambulatory surgery definition: 

• 23 codes were added, and 9 codes were removed to the general surgery range of 10021-69990 
• 6 codes were added to the select included CPT code list that are not within the general surgery range
• 5 codes were added to the select HCPCS Level II code list
• 26 codes were added, and 12 codes were removed the Category III code list 

This update will continue to be made each year with the release of new CPT/HCPCS codes. 

The THA ambulatory surgery definition document is made available, so you understand how HIDINet flags your outpatient records as an ambulatory surgery record.  Please continue to submit all your outpatient records as you currently do, and the system will continue to define and flag the ambulatory surgery records for you. 

You do not have to make any changes to the way you currently submit your data.  This is only an update to reflect the new 2024 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.  

As you are aware, with each new year comes a new set of CPT/HCPCS codes.  After extensive review of the new 2023 codes by the Tennessee Hospital Association (THA) and the Tennessee Health Information Management Association (THIMA) professionals, we have determined which codes should be included or excluded from the ambulatory surgery definition beginning with the Q1-2023 discharge data which are due May 30, 2023. 

Please find the updated, FINAL ambulatory surgery definition document here.  Below is a breakdown of changes for 2023 THA ambulatory surgery definition: 

• 29 codes were added, and 19 codes were removed to the general surgery range of 10021-69990  (excluding two codes as noted on page 2)
• 4 codes were added to the select included CPT code list that are not within the general surgery range
• 55 codes were added to the select HCPCS Level II code list
• 3 codes were removed, and 7 codes were added to the Category III code list 

This update will continue to be made each year with the release of new CPT/HCPCS codes. 

The THA ambulatory surgery definition document is made available so you understand how HIDINet flags your outpatient records as an ambulatory surgery record.  Please continue to submit all of your outpatient records as you currently do, and the system will continue to define and flag the ambulatory surgery records for you. 

You do not have to make any changes to the way you currently submit your data.  This is only an update to reflect the new 2023 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.