As you are aware, with each new year comes a new set of CPT/HCPCS codes. After extensive review of the new 2020 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 Q1-2020 discharge data which are due May 30, 2020.
Please find the updated, changeversion, definition document here. As you review the document you will see changes to the special inclusion and exclusion lists: codes being removed are highlighted in yellow; and codes being 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 2020 THA ambulatory surgery definition:
38 CPT codes were added to the general surgery range of 10021-69990
52 codes were added and 21 codes were removed from the HCPCS level II selections
16 codes were added to the Category III selections
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 the Remote Discharge Data System (RDDS) 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 2020 CPT/HCPCS codes that are included or excluded in the ambulatory surgery definition.
NOTE: If you have submitted your Q1-2020 data prior to this date, March 27, 2020, you will receive a new verification and edit summary report in your email box over the coming days for your review.
Last October you received the message below following a letter from the TN Department of Health (TDH) requesting a change on the Health Plan ID fields – specifically the primary field, field #168. The TDH wanted to see better data in this field and asked that the field be edited with a fatal error beginning with the Q1-2020 data submissions. THA placed a warning edit on the health plan ID fields for the submission of your Q3 and Q4-19 data. You can read the details in my previous email listed below.
Since then we learned that the Federal Registry rescinded the requirement for health plans to maintain their health plan identification numbers effective December 2019. We had a conversation with the TDH and the state agreed to leave the warning edit on the Primary Health Plan ID (field 168) at this time. The warning edit, # 6204, will not turn into a fatal edit beginning with the Q1-2020 data submissions. We will have further conversation with the state over the coming weeks regarding the health plan ID field edits and will communicate the final outcome.
PREVIOUS MESSAGE: On Friday, October 11, 2019, the Tennessee Department of Health (TDH) emailed all licensed Tennessee hospitals a letter requesting improvement of data in all health plan identification fields (primary, secondary and tertiary). Please find that letter HERE. The specific field numbers in reference are 168-170 in your RDDS UB04 record layout; or reference UB-04 form locators 51A-51C. The letter stated that many hospitals are reporting all 9s in these fields which is not acceptable. The TDH is asking all hospitals to begin submitting more viable data for these fields, specifically the PRIMARY health plan ID field, on or before the Q1-2020 discharge data submission which is due to the Remote Discharge Data System (RDDS) no later than May 30, 2020. The TDH further indicated if the health plan identification field – PRIMARY ONLY – does not contain valid identifiers beginning with the Q1-2020 data submission, this field (field # 168) will be edited and considered a fatal error. This could potentially push your facility above the 2% fatal error threshold which will not allow your data to be submitted to the TDH and making you susceptible to penalties as described in the rules of the state law. Please note: The secondary and tertiary health plan identification fields will remain warning errors beginning with Q1-2020 data submissions. However, you should continue to monitor these fields as well. In order to prepare for the change set by the TDH, The Tennessee Hospital Association (THA) analyzed the 2018 final data and found the TDH facts to be true, many hospitals are submitting all 9s in the indicated primary health plan identification field. In order to meet the requests of the TDH, THA will redesign the existing warning edits by changing the logic and further making the PRIMARY health plan ID field FATAL beginning with your Q1-2020 data submission. The warning edits that have been set in place for the health plan identification fields (RDDS UB04 record layout field numbers 168-170 or UB FLs 51A-51C) are listed below. These are the warnings you should look for and evaluate in your Q3 and Q4-19 data submissions, particularly edit # 6204.
Edit No. New for Q3&Q4-19
Edit Type
Edit Description
Layout Field No.
Layout Field Description
Layout Positions
6204
Warning
Primary health plan number is missing or invalid
168
Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual)
1452-1466
6205
Warning
Secondary health plan number is missing or invalid
169
Payer ID/Health Plan ID – Secondary (pg 75 HDDS Manual)
1467-1481
6206
Warning
Tertiary health plan number is missing or invalid
173
Payer ID/Health Plan ID – Tertiary (pg 76 HDDS Manual)
1482-1496
In order to prepare for the change set by the TDH, the following fatal edit will be active for the PRIMARY health plan ID field beginning with your Q1-2020 discharge data submission to RDDS due May 30, 2020:
Edit No. New for Q1-20
Edit Type
Edit Description
Edit Logic
Layout Field No.
Layout Field Description
Layout Positions
6207
FATAL
Primary health plan number is missing or invalid
Fatal error when the field contains blanks and the primary payer is not equal to 0, P, Z or blank; or the field contains a string of 9s or zeros.
168
Payer ID/Health Plan ID – Primary (pg 74 HDDS Manual)
1452-1466
*Please note, the layout field descriptions and positions can be found in the HDDS manual. If you do not have a copy of the manual, you can find it by logging into RDDS or on our website, THA-HIN.com, by clicking HERE.How can you be prepared? As you submit your Q3-19 (due November 29, 2019) and Q4-19 (due March 1, 2020) discharge data to RDDS, please carefully review your edit summary and edit detail reports in RDDS and look for the existing warning edits, 6204-6206, with special attention to the PRIMARY health plan ID field (edit 6204). This will help you determine if your data needs attention in these particular fields prior to the Q1-2020 data being submitted by May 30, 2020. If you have a >2% of the 6204 warning applied in your reports as you submit your Q3 and Q4-19 data, keep in mind these will turn to fatal errors beginning with your Q1-2020 data submission, in turn, placing your fatal error rate above the 2% threshold allowed by the TDH. THA staff will reach out to your hospital(s) over the coming weeks if we found major issues with these fields while analyzing the 2018 data. We want to better prepare you for 2020 data submissions.
MedPAC’s June 2017 Report to Congress states that there has been significant growth recently in the number of health care facilities located apart from hospitals that are devoted primarily to emergency department services; including both OPPS-eligible off-campus provider-based emergency departments and OPPS-ineligible freestanding emergency departments not affiliated with a hospital.
In order to track this, CMS is, through subregulatory process, requiring that effective January 1, 2019, a HCPCSmodifier “ER” (items and services furnished by a provider-based off-campus emergency department) be reported with every claim linefor outpatient hospital services furnished in an off-campus provider-based emergency department. The modifier would be reported in the UB-04 form for hospital outpatient services.
Summary:
Significant growth in the number of EDs and volume of services in off-campus EDs.
CMS must collect data to assess the extent to which services are shifting to off-campus EDs.
Effective 1/1/2019, modifier, ER, will be required with every claim line for outpatient hospital services furnished in off-campus, provider-based EDs.
Please make the necessary changes to comply with this requirement effective January 1, 2019. THA will analyze the data throughout 2019 and assess the usage of this new modifier, ER, for freestanding EDs. NOTE: As a THA-HIN member, you must continue to report your freestanding ED data to us, at this time, using bill type 078X.
The Tennessee Department of Health (TDH), in collaboration with the Tennessee Hospital Association Health Information Network (THA HIN), has released the 2018 Hospital Discharge Data System (HDDS) User Manual. You can access the manual by visiting THA-HIN.com or by clicking here. If you are a registered user for THA RDDS, you may also access the manual upon logging into the RDDS website.
You will find a historical summary of changes to this manual beginning on page 7. The changes to the current manual include:
Conversion to ICD-10 effective October 1, 2015
Dual coding discontinued for ICD-10 for outpatient claims effective October 1, 2015
New payer codes effective January 1, 2016
No longer accepting provider UPIN identifiers effective with the submission of Q1-18 discharge data
Updated language overall to reflect the Official UB-04 Data Specification Manual published by the National Uniform Billing Committee (NUBC)
The THA Board of Directors met on December 11th, 2015 and approved changes to the THA Data Release Policy that were recommended by the THA Data Policy Committee. These changes were made to more accurately reference sections of the THA HIN Agreement, and to permit THA to release patient names to the Tennessee Department of Health, per the Department’s formal request.
On June 29, 2015, we sent an email regarding changes in payer codes effective with January 1, 2016 discharge data. This notification serves as a reminder as the New Year is quickly approaching! More specifically, the changes are as follows:
Current payer codes “B-Blue Cross/Blue Shield (not managed care)” and “H-Blue Cross Managed Care – HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “B-Blue Cross/Blue Shield.”
There are two additions added to payer code B: (1) Blue Network E and (2) Blue Network M.
Current payer codes “I-Commercial Insurance (not managed care)” and “L-Commercial Managed Care-HMO/PPO/Other Managed Care” have been combined. Both are placed under payer code “L” and renamed to “Commercial – Other.”
The following payers have been removed from being grouped into payer code “L-Commercial-Other” and have been assigned new payer codes:
United Healthcare – payer code 14
Cigna – payer code 15
Aetna – payer code 16
A new payer code has been created for the Community Health Alliance (CHA). The payer code assigned is 17.
Payer code K has been renamed to Medicare Advantage and has three additions: (1) Windsor, (2) CrestPoint and (3) Sterling.
Payer code “13-Access TN” has been removed.
A few other minor changes were made which reflect updated health plan names, etc. Again, the changes outlined above are effective beginning with January 1, 2016 discharges. A reference document is available for download. The changes listed above and reflected in the Excel document should be applied to all three payer code fields (primary, secondary and tertiary payer codes).
Please share this information with each person in your facility who is involved in state required hospital discharge data reporting activities.
On October 3, 2014, the Tennessee Department of Health (TDH) mailed all licensed Tennessee hospitals a letter reinforcing penalty for failure to report. The TDH will begin enforcing the penalties associated with delinquent reports having a Statement Covers Period through Data on or after January 1, 2015. The implementation of this section of the T.C.A. at this date is in hopes to receive more complete and higher quality data. Hospitals that are currently delinquent on the date of implementation will not be charged for the previously delinquent records, but delinquencies after that date will be assessed the penalties. The letter sent by TDH can be viewed by clicking here.
THA has a process set in place to remind you of quarterly data submission deadlines. This process has not changed and will continue as it has in the past. Below are the quarterly reporting due dates for hospital UB discharge data submission:
January – March (Q1) discharge data are due to be submitted no later than May 30th.
April – June (Q2) discharge data are due to be submitted no later than August 29th.
July – September (Q3) discharge data are due to be submitted no later than November 29th.
October – December (Q4) discharge data are due to be submitted no later than March 1st of the following year.
Each quarter Nora Sewell, HIN Data Analyst, sends reporting reminders to hospitals, usually no less than a month before a reporting due date. Once the scheduled due date (as outlined above) has passed, Nora notifies the TDH of those hospitals who have not submitted their UB discharge data by the specified scheduled date. In the future, these hospitals could run the risk of being fined for failure to submit discharge data according to schedule.
There are three main characteristics every data system should strive for: timeliness, accuracy and completeness. Please help us keep the data quality and integrity high as it will only serve you, THA member hospitals, the most precise data possible.
Inpatient Replacement Bill Type 0117 As you are aware, bill type 0117 indicates an inpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0117) will overlay the original record and the bill type will be changed from 0117 to 0111.
Please note: If a replacement bill (0117) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0111.
Outpatient Replacement Bill Type 0137 Similar to the above statement, bill type 0137 indicates an outpatient replacement bill. If this bill type is submitted to the THA RDDS, the system will search the database for a previous claim by comparing key elements. Once the previous claim has been located, the replacement bill (0137) will overlay the original record and the bill type will be changed from 0137 to 0131.
Please note: If a replacement bill (0137) cannot be linked to a previous bill, the replacement bill will become the database record and the bill type will be changed to 0131. Please contact Larissa Lee if you have any questions or need assistance.
The process to submit TEST data through THA RDDS is different from the process used in the past when test data was submitted through HIDI. Please be sure to follow the steps below when submitting TEST data through THA RDDS.
Using RDDS, all TEST files should use discharge records that have not yet been submitted. TEST records should have discharge dates later than records already on RDDS for your hospital. In other words, if you have already submitted Q2 data for your hospital and it is within the fatal error threshold (no more than 2%), any TEST data should be for Q3 or later, or even a smaller submission that includes data for one month, (i.e., July data) would be acceptable to submit as a TEST file.
Once the TEST file has processed and you have checked it to make sure the change you were making is working properly, you MUST DELETE the Batch (by number) that RDDS assigned to the TEST file when it was submitted.
It is also recommended that THA HIN staff be notified in advance if you plan to submit TEST data so we can be aware and communicate this if necessary with the processing system..
Please contact Larissa Lee if you have any questions or need assistance.
