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Future of OSHPD Data Presenters: Starla Ledbetter Ginger Cox.

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Presentation on theme: "Future of OSHPD Data Presenters: Starla Ledbetter Ginger Cox."— Presentation transcript:

1 Future of OSHPD Data Presenters: Starla Ledbetter Ginger Cox

2 Present on Admission Principal Language Spoken MS-DRGs Clinical Measurements Patient Address External Cause of Injury Payer Typology Facility Summary Report ICD-10 Code Sets Future Enhancements

3 Collection: January 1, 1996 THREE Values Y = Yes N = No U = Uncertain Reported on principal and secondary diagnoses for all inpatient records Condition Present At Admission

4 National Standard: October 1, 2007 OSHPD Collection: July 1, 2008 FIVE Values Y = Yes N = No U = No Information in the Record W = Clinically Undetermined Blank = Exempt from POA Reporting Reported on all diagnoses and external cause of injury codes (E-codes ) Present On Admission (POA)

5 Oct 1, 2007 through Jun 30, 2008 Allowed the reporting of two additional values for POA, with no validation W = Reported as Clinically Undetermined 1 = Reported as Exempt Interim Present On Admission

6 POA Frequencies

7 Medicare Severity Diagnosis Related Groups Transition from DRG Grouper: 500+ DRGs Jan- Dec 2007 Implement MS-DRG Grouper: 900+ DRGs Jan – June 2008 MS-DRGs

8 Collection: IP, ED, AS data Collection begins: January 1, 2009 Available to you with 2009 data! Principal Language Spoken

9 HIN – Hindi HUN – Hungarian ITA – Italian JPN – Japanese KOR – Korean LAO – Laotian HMN – Miao, Hmong KHM – Mon-Khmer, Cambodian NAV – Navajo PER – Persian POL – Polish POR – Portuguese RUS – Russian SCR – Serbo-Croatian SPA – Spanish TGL – Tagalog THA – Thai URD – Urdu VIE – Vietnamese YID – Yiddish 999 – Unknown Principal Language Spoken ENG – English ARA – Arabic ARM – Armenian CHI – Chinese FRE – French CPF – French Creole GER – German GRE – Greek GUJ – Gujarathi HEB – Hebrew 24 spaces for write-in language

10 Albumin, serum AST BUN Creatinine Hemoglobin INR Clinical Measurements Oxygen Saturation pH Platelet count Potassium Sodium White blood cell count

11 Business Case Technical Solution Three data types Inpatient Emergency Department Ambulatory Surgery HOME Patient Address

12 Codes E870-E876 for misadventures Codes E878-E879 for abnormal reactions Proposed date: January 1, 2010 External Cause of Injury

13 Need for comprehensive, mutually exclusive categories and definitions Developed and maintained by the Public Health Data Standards Consortium Updated annually each October source.asp Payer Typology

14 01Medicare 02Medical 03Private Coverage 04Workers Comp 05County Indigent 06Other Govt. 07 Other Indigent 08 Self Pay 09Other Payer 1Managed Care * (Knox Keene/MCOHS) 2Managed Care Other 3Traditional Coverage * Name of Plan OSHPD IP Payer Codes

15 09Self-pay 11 Other Non-Federal Programs 12 Preferred Provider Organization (PPO) 13 Point of Service (POS) 14 Exclusive Provider Organization (EPO) 16 Health Maintenance Organization (HMO) Medicare Risk AM Automobile Medical BL Blue Cross/Blue Shield CH Champus CI Commercial Insurance Company DS Disability HM Health Maintenance Organization MA Medicare Part A MB Medicare Part B MC Medicaid OF Other Federal Program TV Title V VA Veteran Affairs Plan WC Workers’ Compensation 00 Other OSHPD ED and AS Payer Codes

16 123456789123456789 Medicare Medicaid Other Government (not Medicare, Medicaid or corrections) Department of Corrections Private Health Insurance Blue Cross/Blue Shield Managed Care, unspecified No payment from organization Miscellaneous/other Payer Typology: 1 st Level

17 1MEDICARE 11 Medicare (Managed Care) 111 Medicare HMO 112 Medicare PPO 113 Medicare POS 119 Medicare Managed Care Other 12 Medicare (Non-managed Care) 121 Medicare FFS 122 Medicare Drug Benefit 123 Medicare Medical Savings Account (MSA) 129 Medicare Non-managed Care Other 19 Medicare Other Payer Typology: Expanded

18 8NO PAYMENT from an Organization/Agency/Program/Private Payer Listed 81 Self-pay 82 No Charge 821 Charity 822 Professional Courtesy 823 Research/Clinical Trial 83 Refusal to Pay/Bad Debt 84 Hill Burton Free Care 85 Research/Donor 89 No Payment, Other Payer Typology: Expanded

19 Facility Summary Reports Data Distribution Report Immediate feedback to the reporting facility Facility Profile Report Within 15 days of approval Revised Facility Summary Report Within 15 days of approval


21 Choose Date Type : ED or AS or IP

22 Select which facility

23 Select which report period

24 Click on “List Report”



27 ICD-10-CM Diagnosis External cause of injury, poisoning, adverse effect ICD-10-PCS Inpatient procedure Effective date: October 1, 2013 ICD-10-CM and ICD-10-PCS Code Sets

28 X99.xxxx X99. Category xxx Etiology, Anatomy Site x Extension ICD-10-CM Format

29 ICD-9-CM 365.83 aqueous misdirection (malignant glaucoma) ICD-10-CM H40.839 aqueous misdirection (malignant glaucoma) H40.831 Aqueous misdirection, right eye H40.832 Aqueous misdirection, left eye H40.833 Aqueous misdirection, bilateral eyes H40.839 Aqueous misdirection, unspecified eye ICD-9-CM vs ICD-10-CM Diagnosis

30 ICD-10-PCS Format Section Body System Root Operation Body Part Approach Device Extension 1 1 2 2 3 3 4 4 5 5 6 6 7 7

31 ICD-9-CM 42.41 Partial esophagectomy No further breakdown for what part of esophagus was resected ICD-10-PCS ODT10ZZ Open resection of upper esophagectomy 4 th digit = body part = upper esophagus ICD-9-CM vs ICD-10-PCS Procedure

32 Effective Date: October 1, 2013 Impact Analysis Budget Planning System upgrades Limit to basic edits Regulation proposal Education Test Go Live Continue updates as usual Next Steps

33 Any Questions ??

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