N.M. Admin. Code § 7.1.27.7

Current through Register Vol. 35, No. 21, November 5, 2024

Section 7.1.27.7 - DEFINITIONS

In addition to the definitions in the HIS Act, Sections 24-14A-1 to -10, NMSA 1978, the following terms have the following meaning for purposes of this rule.

A. All definitions that begin with the letter A.

(1)Accident state means the two-digit state abbreviation where the accident occurred when services are related to an auto accident.

(2)Admission hour means the hour and minute the patient was admitted as an inpatient, coded in military time (e.g., 2:45 p.m. is represented as 1445).

(3)Aggregate analysis means information in report form that contains data combined in a manner which precludes specific identification of a single patient or health care provider.

(4)Annual permanent database means one calendar year of permanent hospital inpatient discharge data or any other database collected under the HIS Act that is deemed complete by division staff.

(5)Attending physician NPI means the national provider identifier (NPI), a unique, government-issued, standard identification 10-digit number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices.

B. All definitions that begin with the letter B. Birth weight means weight of newborns coded in grams.

C. All definitions that begin with the letter C.

(1)Centers for medicare and medicaid services or CMS means the United States federal agency which administers medicare, medicaid, and the state children's health insurance programs.

(2)1st condition code, 2nd condition code, 3rd condition code, 4th condition code, 5th condition code, 6th condition code, 7th condition code, 8th condition code, 9th condition code, 10th condition code, 11th condition code means the codes used to identify conditions or events relating to the billing claim that may affect processing as defined in the form locators 18-28 of the UB-04 manual. (Usage note: The state requires public health data reporting to indicate that a patient was admitted directly from the facility's emergency room/department. Provider will use the code "P7" to indicate the patient was admitted from the provider facility's emergency room/department).

D. All definitions that begin with the letter D.

(1)Data provider means a data source that has provided data to the health information system on a regular basis.

(2)Data source has the meaning given in Section 24-14A-2 of the HIS Act, and includes those categories of persons or entities that possess health information, including any public or private sector licensed hospital, health care practitioner, primary care clinic, ambulatory surgery center, ambulatory urgent care center, ambulatory dialysis unit, home health agency, long-term care facility, pharmacy, third-party payer, and any public entity that has health information.

(3)Database means a set of data based on individual patient hospital discharge abstract data or any other database collected under the HIS Act.

(4)Department means the New Mexico department of health.

(5)Division means the epidemiology and response division of the department, P.O. Box 26110, Santa Fe, NM 87502-6110.

(6)Discharge hour means the hour and minute the patient was discharged as an inpatient, coded in military time (e.g., 2:45 p.m. is represented as 1445).

(7)Durable medical equipment or DME means medical equipment used in the home to aid in a better quality of living.

E. All definitions that begin with the letter E.

(1)1st e-code means the first code for external causes of injury, poisoning, or adverse effect. (Usage note: If a patient has an injury diagnosis in a range of ICD-9-CM 800-999, an e-code is required. This is the primary (first-listed) external cause of injury).

(2)2nd e-code means the second code for external causes of injury, poisoning, or adverse effect.

(3)3rd e-code means the third code for external causes of injury, poisoning, or adverse effect.

F. All definitions that begin with the letter F. Federal agency means any agency, department, bureau, board, division, institution, or other organization of the United States government.

G. All definitions that begin with the letter G.

H. All definitions that begin with the letter H.

(1)Health care means any care, treatment, service, or procedure to maintain, diagnose or otherwise affect an individual's physical or mental condition.

(2)Health care professional means any individual licensed, certified, or otherwise authorized or permitted by law to provide health care in the practice of a profession.

(3)Health care provider means any individual, corporation, partnership, organization, facility, institution, or other entity licensed, certified, or otherwise authorized or permitted by law to provide health care in the ordinary course of business or practice of a profession.

(4)Health information system or HIS means the health information system established by the Health Information System Act, Sections 24-14A-1 to 24-14A-10, NMSA 1978.

(5)HIS advisory committee means individuals from the division pursuant to Subsection 24-14A-3.1 of the HIS Act.

(6)Health Information System Act (HIS Act) means the Health Information System Act, Sections 24-14A-1 to 24-14A-10, NMSA 1978.

(7)Health insurance prospective payment system (HIPPS) rate code means the three-digit codes that represent specific sets of patient characteristics (or case-mix groups) on which payment determinations are made under several prospective payment systems. Case-mix groups are developed based on research into utilization patterns among various provider types. For the payment systems that use HIPPS codes, clinical assessment data is the basic input used to determine which case-mix group applies to a particular patient. A standard patient assessment instrument is interpreted by case-mix grouping software algorithms, which assign the case mix group. For payment purposes, at least one HIPPS code is defined to represent each case-mix group. These HIPPS codes are reported on claims to insurers and reported in form locator 71 of the UB-04 manual.

I. All definitions that begin with the letter I.

(1)ICD-9-CM is the international classification of disease, ninth revision, clinical modification for clinical diagnosis and procedure coding (October 2011) American medical association.

(2)ICD-10-CM is the international classification of disease, 10th revision, clinical modification for clinical diagnosis coding.

(3)ICD-10-PCS is the international classification of disease, 10th revision, clinical modification for procedure coding.

(4)Identifier means any information that reveals the identity of, or could reasonably be used to reveal the identity of, a single patient, or health care professional, but does not include a number assigned to a single patient for the purpose of conducting longitudinal or linking studies.

(5)Inpatient health care facility means a hospital or other health facility which admits patients for overnight or longer (and therefore is responsible for patients' room and board) for the purpose of providing diagnostic treatment or other health services.

(6)Inpatient rehabilitation facility or IRF is an inpatient rehabilitation hospital or part of a rehabilitation hospital, which provides an intensive rehabilitation program for inpatients.

(7)ISO 3166 is the codes for representation of names of countries issued by the American national standards institute (ANSI) (latest release).

J. All definitions that begin with the letter J.

K. All definitions that begin with the letter K.

L. All definitions that begin with the letter L. Long-term care hospital or LTCH means an acute care hospital certified by the centers for medicare and medicaid services (CMS) that provide rehabilitative, restorative, or on-going skilled nursing care to patients or residents in need of assistance with activities of daily living. Long-term care facilities include nursing homes, rehabilitation facilities, inpatient behavioral health facilities, and long-term chronic care hospitals.

M. All definitions that begin with the letter M. Medicare provider number means the six digit number assigned by medicare to the data source providing the reported service(s).

N. All definitions that begin with the letter N.

(1)National provider identifier (NPI) means the 10-digit NPI from the national plan and provider enumeration system (NPPES).

(2)New Mexico state license number means the four to eight digit license number issued by the New Mexico health department for the data source providing the reported service(s).

(3)National uniform billing committee or NUBC is an entity formed by the American hospital association (AHA) in 1975, which includes participation by all major national provider and payer organizations and develops single billing forms and standard data sets that are used nationwide by institutional providers and payers for handling health care claims.

O. All definitions that begin with the letter O.

(1)Operating physician NPI means the national provider identifier (NPI), a unique, government-issued, standard identification 10-digit number for individual health care providers and provider organizations like clinics, hospitals, schools and group practices.

(2)Outpatient health care facility means a hospital or other health facility that provides ambulatory care to a patient without admitting the patient to the facility or providing lodging services.

P. All definitions that begin with the letter P.

(1)Patient means a person who has received or is receiving health care.

(2)Patient admission date means the date the patient was admitted by the provider for inpatient care. Format as, "mmddyyyy". For example, if the admission date was July 1, 1983, "07011983" would be coded.

(3)Patient admitting diagnosis code, patient principle diagnosis code, patient 2nd diagnosis code, patient 3rd diagnosis code, patient 4th diagnosis code, patient 5th diagnosis code, patient 6th diagnosis code, patient 7th diagnosis code, patient 8th diagnosis code, patient 9^th diagnosis code, patient 10th diagnosis code, patient 11th diagnosis code, patient 12th diagnosis code, patient 13th diagnosis code, patient 14th diagnosis code, patient 15th diagnosis code, patient 16th diagnosis code, patient 17th diagnosis code, and patient 18th diagnosis code means the ICD-9-CM (or ICD-10-CM or subsequent versions of ICD coding) diagnosis codes corresponding to additional conditions that co-exist at the time of admission, or develop subsequently, and which have an effect on the treatment received or the length of stay.

(4)Patient city means the city of the patient's residence at the time of discharge.

(5)Patient control number means the patient's unique alpha-numeric number assigned by the provider.

(6)Patient country code means the two-digit alpha-two codes of the patient's residence at the time of discharge, from Part I of the ISO 3166 as required in form locator 9e of the UB-04 manual. (Usage note: Reported only if other than a United States residence).

(7)Patient county means the county of the patient's residence at the time of discharge.

(8)Patient date of birth means the date of birth of the patient. Required format is "mmddyyyy". Note that all four digits of year are required (e.g., "08191898" is for August 19, 1898).

(9)Patient diagnosis related group (DRG) code means the diagnostic related group code used for the HIPPS code in form locator 71 of the UB-04 manual.

(10)Patient diagnostic code qualifier means the revision number of the international classifications of disease diagnosis codes used to record the diagnoses represented by Paragraph (20) of Subsection P of 7.1.27.7 NMAC.

(a) 9-ICD-9-CM, ninth revision required on claims through September 30, 2013.

(b) 0-ICD-10-CM, 10th revision when implemented.

(c) 1-ICD-11-CM, 11th revision reservation for future reporting requirements.

(11)Patient's discharge date means the date the patient was discharged by the provider from the inpatient health care facility. Formatted as "mmddyyyy" (i.e., an admission date of July 1, 1983, would be coded "07011983").

(12)Patient's emergency medical services (EMS) ambulance run number means the emergency medical services ambulance run number.

(13)Patient's ethnicity means the gross classification of a patient's stated ethnicity, coded as follows:

(a) E1-Hispanic or Latino;

(b) E2-not Hispanic or Latino;

(c) E6-declined;

(d) E7-unknown or unable to obtain.

(14)Patient's first name means the first name of the patient.

(15)Patient's medicaid number means the patient's unique identification number assigned by medicaid.

(16)Patient's medical record number means the medical record number used by the provider to identify the patient.

(17)Patient's middle initial means the middle initial of the patient.

(18)Patient's last name means the last name of patient. Last name should not have a space between a prefix and a name as in "MacBeth", but hyphenated names retain the hyphen as in "Smith-Jones". Titles should not be recorded. If the last name has a suffix, put the last name, a space, and then the suffix as in "Snyder III". Last name does not include abbreviations of academic achievement or profession, such as "M.D.", "Ph.D." etc.

(19)Patient's phone number means the 10 digit phone number provided by the patient, without section separating characters like dashes, hyphens or slashes (i.e., "5051234567").

(20)Patient's principle diagnosis code, present on admission; patient 2nd diagnosis code; present on admission; patient 3rd diagnosis code, present on admission; patient 4th diagnosis code, present on admission; patient 5th diagnosis code, present on admission; patient 6th diagnosis code, present on admission; patient 7th diagnosis code, present on admission; patient 8th diagnosis code, present on admission; patient 9th diagnosis code, present on admission; patient 10th diagnosis code, present on admission; patient 11th diagnosis code, present on admission; patient 12th diagnosis code, present on admission; patient 13th diagnosis code, present on admission; patient 14th diagnosis code, present on admission; patient 15th diagnosis code, present on admission; patient 16th diagnosis code, present on admission; patient 17th diagnosis code, present on admission; patient 18th diagnosis code, present on admission means diagnosis was present at the time the order for inpatient admission occurs-conditions that develop during an outpatient encounter, including emergency room, observation, or outpatient surgery are considered as present on admission.

(a) Y-yes.

(b) N-no.

(c) U-no information on the record.

(d) W-clinically undetermined.

(e) 1-exempt.

(21)Patient principal procedure code, patient 2nd procedure code, patient 3rd procedure code, patient 4th procedure code, patient 5th procedure code, patient 6th procedure code means the codes identifying the significant procedures, performed during the patient's stay.

(22)Patient race means the classification(s) of a patient's stated race to include one or multiple reported classifications, coded as shown below. When reporting multiple classifications do not use spaces or delimiters. For example, if a patient states that he or she is both American Indian and other the race field would be R1R9.

(a) R1-American Indian or Alaska Native.

(b) R2-Asian (including Asian Indian, Chinese, Filipino, Japanese, Korean, and Vietnamese).

(c) R3-Black or African American.

(d) R4-Native Hawaiian or Pacific Islander (including Chamorro and Samoan).

(e) R5-White.

(f) R6-declined.

(g) R7-unknown or unable to obtain.

(h) R9-other race.

(23)Patient's social security number means the nine digit social security number provided by the patient, without section separating characters like dashes, hyphens or slashes (i.e., "123456789").

(24)Patient's state means the two-digit state code of the patient's residence at the time of discharge.

(25)Patient's status means the code indicating patient's disposition at time of discharge. The codes are:

(a) 01-discharged to home or self care (routine discharge); (usage note: includes discharge to home; home on oxygen if DME only; any other DME only; group home; foster care; independent living and other residential care arrangements; outpatient programs, such as partial hospitalization of outpatient chemical dependency programs);

(b) 02-discharged/transferred to a short-term general hospital for inpatient care;

(c) 03-discharged/transferred to skilled nursing facility (SNF) with medicare certification in anticipation of skilled care; (usage note: medicare-indicates that the patient is discharged/transferred to a medicare certified nursing facility; for hospitals with an approved swing bed arrangement, use code 61-swing bed; for reporting other discharges/transfers to nursing facilities see definitions for codes 04 and 64 in accordance with 7.1.27.7 NMAC);

(d) 04-discharged/transferred to a facility that provides custodial or supportive care; (usage note: includes intermediate care facilities (ICF) if specifically designated at the state level; also used to designate patients that are discharged/transferred to a nursing facility with neither medicare nor medicaid certification and for discharges/transfers to assisted living facilities);

(e) 05-discharged/transferred to a designated cancer center of children's hospital;

(f) 06-discharged/transferred to home under care of an organized home health service organization in anticipation of covered skilled care; (usage note: report this code when a patient is discharged/transferred to home with a written plan of care (tailored to the patient's medical needs) for home care services; not used for home health services provided by a DME supplier or from a home IV provider for home IV services);

(g) 07-left against medical advice or discontinued care;

(h) 08-reserved for national assignment by the NUBC;

(i) 09-admitted as an inpatient to this hospital; (usage note: this is for use only on medicare outpatient claims; applies only to those medicare outpatient services that begin greater than three days prior to admission and therefore should not be reported for inpatient discharges);

(j) 10-19 reserved for national assignment by the NUBC;

(k) 20-expired;

(l) 21-discharged/transferred to court/law enforcement (covers patients sent to jail, prison or other detention facilities);

(m) 22-29-reserved for national assignment by the NUBC;

(n) 30-still patient or expected to return for outpatient services; (usage note: used when patient is still within the same facility; typically used when billing for leave of absence days or interim bills);

(o) 31-39-reserved for national assignment by the NUBC;

(p) 40-expired at home (hospice claims only);

(q) 41-expired in a medical facility, such as a hospital, SNF, ICF, or freestanding hospice (hospice claims only);

(r) 42-expired-place unknown (hospice claims only);

(s) 43-discharged/transferred to a federal health care facility; (usage note: discharges and transfers to a government operated health care facility such as a department of defense hospital, a veteran's administration (VA) hospital or a VA nursing facility; to be used whenever the destination at discharge is a federal health care facility, whether the patient lives there or not);

(t) 44-49-reserved for national assignment by the NUBC;

(u) 50-discharged/transferred to hospice-home;

(v) 51-discharged/transferred to hospice-medical facility (certified) providing hospice level of care;

(w) 52-60-reserved for national assignment by the NUBC;

(x) 61-discharged/transferred within this institution to a hospital based medicare approved swing bed; (usage note: medicare-used for reporting patients discharged/transferred to SNF level of care within the hospital's approved swing bed arrangement);

(y) 62-discharged/transferred to an IRF including rehabilitation distinct part units of a hospital;

(z) 63-discharged/transferred to a LTCH; (usage note: for hospitals that meet the medicare criteria for LTCH certification);

(aa) 64-discharged/transferred to a nursing facility certified under medicaid but not certified under medicare;

(bb) 65-discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;

(cc) 66-discharged/transferred to a critical access hospital (CAH);

(dd) 67-69 reserved for national assignment by the NUBC;

(ee) 70-discharge/transfer to another type of health care institution not defined elsewhere in the code list;

(ff) 71-99-reserved for national assignment by the NUBC.

(26)Patient's street address means the mailing address of the patient at the time of discharge including street name and number or post office box number or rural route number.

(27)Patient's tribal affiliation means the classification(s) of patient's stated New Mexico tribal affiliation, if stated race indicates American Indian. Up to five reported affiliations can be reported, coded as shown below. When reporting multiple affiliations do not use spaces or delimiters. For example, if a patient states that he or she has affiliations with both Acoma pueblo and the Navajo nation the tribal affiliation field would be T1T10:

(a) T1-Acoma pueblo;

(b) T2-Cochiti pueblo;

(c) T3-Isleta pueblo;

(d) T4-Jemez pueblo;

(e) T5-Jicarilla Apache nation;

(f) T6-Kewa/Santo Domingo pueblo;

(g) T7-Laguna pueblo;

(h) T8-Mescalero Apache nation;

(i) T9-Nambe pueblo;

(j) T10-Navajo nation;

(k) T11-Ohkay Owingeh pueblo;

(l) T12-Picuris pueblo;

(m) T13-Pojoaque pueblo;

(n) T14-San Felipe pueblo;

(o) T15-San Ildefonso pueblo;

(p) T16-Sandia pueblo;

(q) T17-Santa Ana pueblo;

(r) T18-Santa Clara pueblo;

(s) T19-Taos pueblo;

(t) T20-Tesuque pueblo;

(u) T21-Zia pueblo;

(v) T22-Zuni pueblo;

(w) T100-other tribal affiliation;

(x) T200-declined;

(y) T300-unknown.

(28)Patient's zip code means the zip code of the patient's residence at the time of discharge. Use either five or nine digits (e.g., 87501 or 875010968).

(29)Permanent hospital inpatient discharge data means hospital inpatient discharge data contained in a data set created by the division after submitting data the provider has either (1) reviewed and approved a division statistical report based on the data provider's patient discharges; or (2) been provided a 30-day period to review the division's statistical report.

(30)Point of origin for admission or visit means the source of referral for this admission.

(a)Adults and pediatrics: Source of admission codes for adults and pediatrics are:

(i) 1-non-health care facility point of origin-the patient was admitted to this facility upon the recommendation of his or her personal physician if other than a clinic physician or a health maintenance organization (HMO) physician (this includes patients coming from home, a physician's office, or workplace;

(ii) 2-clinic referral-the patient was admitted to this facility as a transfer from a freestanding or non-freestanding clinic;

(iii) 4-transfer from a hospital-the patient was admitted to this facility as a transfer from an acute care facility where he or she was an inpatient or outpatient (excludes transfers from hospital inpatient in the same facility);

(iv) 5-transfer from SNF or ICF-the patient was admitted to this facility as a transfer from a SNF or ICF where he or she was a resident;

(v) 6-transfer from another health care facility-the patient was admitted to this facility as a transfer from a health care facility not defined elsewhere in this code list (i.e., other than an acute care facility or skilled nursing facility);

(vi) 8-court/law enforcement-the patient was admitted to this facility upon the direction of a court of law, or upon a request of a law enforcement agency representative (includes transfers from incarceration facilities);

(vii) 9-information not available-the means by which the patient was referred to this facility is not known;

(viii) A-reserved for national assignment;

(ix) 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;

(x) E-transfer from ambulatory surgery center-the patient was admitted to this facility from an ambulatory or same-day surgery center (does not include patients admitted from the same facilities' outpatient surgery department);

(xi) F-transfer from hospice and is under a hospice plan of care or enrolled in a hospice program-the patient was admitted to this facility as acute inpatient status and was receiving hospice care;

(xii) G-Z-reserved for national assignment.

(b)Newborns: Newborn codes must be used when the type of admission is code 4. The codes are:

(i) 5-born inside this facility-a baby born inside this facility;

(ii) 6-born outside of this facility-a baby born outside of this facility.

(31)Primary payer category means one of the following broad categories assigned by the data provider to the payment source identified in the primary payer identification name field:

(a) 1-medicare is the primary payer from which the provider might expect some payment;

(b) 2-medicaid is the primary payer from which the provider might expect some payment;

(c) 3-other government (federal/state/local) is the primary payer from which the provider might expect some payment (excluding department of corrections);

(d) 4-department of corrections is the primary payer from which the provider might expect some payment;

(e) 5-private health insurance is the primary payer from which the provider might expect some payment;

(f) 6-blue cross/blue shield is the primary payer from which the provider might expect some payment;

(g) 7-managed care, unspecified is the primary payer from which the provider might expect some payment (to be used only if one cannot distinguish public from private);

(h) 8-no payment from an organization, agency, program or private payer is listed as the primary payer;

(i) 9-miscellaneous/other primary payer source from which the provider might expect some payment.

(32)Primary payer identification name means the name identifying the primary payer from which the provider might expect some payment for the reported service(s).

(33)Primary payer type means the type of primary payer as defined below from which the provider might expect some payment for the reported services(s):

(a) 1-HMO-health maintenance organization;

(b) 2-other managed care-includes provider service networks;

(c) 3-indemnity plan;

(d) 88-unknown.

(34)Procedure code qualifier means the revision number of the international classifications of disease diagnosis codes used to record the procedure represented by Paragraph (21) of Subsection P of 7.1.27.7 NMAC.

(a) 9-ICD-9-PCS, ninth revision required on claims through September 30, 2013.

(b) 0-ICD-10-PCS, 10th revision to take effect October 1, 2013 or such later date as required by the CMS.

(c) 1-ICD-11-PCS, 11th revision reservation for future reporting requirements.

(35)Procedure date for patient's principal procedure code; procedure date for 2nd procedure code; procedure date for 3rd procedure code; procedure date for 4th procedure code; procedure date for 5th procedure code; procedure date for 6th procedure code means the date of the procedure that is reported as it coincides with the procedure code that was performed (mmddyyyy).

(36)Proprietary information means confidential technical information, administrative information, or business methods that are the property of the data provider and are perceived to confer a competitive position in the health care market by not being openly known by competitors.

(37)Provider zip code means the zip code whose boundaries physically contain the facility where the reported service(s) were provided. Use either five or nine digits (i.e., 12345 or 123456789).

Q. All definitions that begin with the letter Q.

R. All definitions that begin with the letter R.

(1)Requestor means a person who makes a request for access to health information system data or reports pursuant to this rule.

(2)Routine report means a report that contains information of use to the general public that is issued by the division on its own initiative and not in response to a specific, individualized request.

(3)1st revenue code, 2nd revenue code, 3rd revenue code, 4th revenue code, 5th revenue code, 6th revenue code, 7th revenue code, 8th revenue code, 9th revenue code, 10th revenue code, 11th revenue code, 12th revenue code, 13th revenue code, 14th revenue code, 15th revenue code, 16th revenue code, 17th revenue code, 18th revenue code, 19th revenue code, 20th revenue code, 21st revenue code, and 22nd revenue code means the four-digt revenue codes that identify the specific accommodation, ancillary service or unique billing calculations, or arrangements made during the patient's stay.

(4)1st revenue description, 2nd revenue description, 3rd revenue description, 4th revenue description, 5th revenue description, 6th revenue description, 7th revenue description, 8th revenue description, 9th revenue description, 10th revenue description, 11th revenue description, 12th revenue description, 13th revenue description, 14th revenue description, 15th revenue description, 16th revenue description, 17th revenue description, 18th revenue description, 19th revenue description, 20th revenue description, 21st revenue description, and 22nd revenue description means the revenue standard abbreviated descriptions that identify the specific accommodation, ancillary service or unique billing calculations, or arrangements made during the patient's stay.

(5)1st revenue line item charges, 2nd revenue line item charges, 3rd revenue line item charges, 4th revenue line item charges, 5th revenue line item charges, 6th revenue line item charges, 7th revenue line item charges, 8th revenue line item charges, 9th revenue line item charges, 10th revenue line item charges, 11th revenue line item charges, 12th revenue line item charges, 13th revenue line item charges, 14th revenue line item charges, 15th revenue line item charges, 16th revenue line item charges, 17th revenue line item charges, 18th revenue line item charges, 19th revenue line item charges, 20th revenue line item charges, 21st revenue line item charges, and 22nd revenue line item charges means the revenue line item charges, rounded to the whole dollar, for the specific accommodation, ancillary service or unique billing calculations, or arrangements made during the patient's stay.

(6)1st revenue non-covered charges, 2nd revenue non-covered charges, 3rd revenue non-covered charges, 4th revenue non-covered charges, 5th revenue non-covered charges, 6th revenue non-covered charges, 7th revenue non-covered charges, 8th revenue non-covered charges, 9th revenue non-covered charges, 10th revenue non-covered charges, 11th revenue non-covered charges, 12th revenue non-covered charges, 13th revenue non-covered charges, 14th revenue non-covered charges, 15th revenue non-covered charges, 16th revenue non-covered charges, 17th revenue non-covered charges, 18th revenue non-covered charges, 19th revenue non-covered charges, 20th revenue non-covered charges, 21st revenue non-covered charges, and 22nd revenue non-covered charges means the revenue non-covered charges, rounded to the whole dollar, for the specific accommodation, ancillary service or unique billing calculations, or arrangements made during the patient's stay.

(7)1st revenue service date, 2nd revenue service date, 3rd revenue service date, 4th revenue service date, 5th revenue service date, 6th revenue service date, 7th revenue service date, 8th revenue service date, 9th revenue service date, 10th revenue service date, 11th revenue service date, 12th revenue service date, 13th revenue service date, 14th revenue service date, 15th revenue service date, 16th revenue service date, 17th revenue service date, 18th revenue service date, 19th revenue service date, 20th revenue service date, 21st revenue service date, and 22nd revenue service date means the revenue service dates that the specific accommodation, ancillary service or unique billing calculations, or arrangements occurred on.

(8)1st revenue service units, 2nd revenue service units, 3rd revenue service units, 4th revenue service units, 5th revenue service units, 6th revenue service units, 7th revenue service units, 8th revenue service units, 9th revenue service units, 10th revenue service units, 11th revenue service units, 12th revenue service units, 13th revenue service units, 14th revenue service units, 15th revenue service units, 16th revenue service units, 17th revenue service units, 18th revenue service units, 19th revenue service units, 20th revenue service units, 21st revenue service units, and 22nd revenue service units means the quantitative measure of services rendered by the revenue category to or for the patient to include items such as number of accommodation dates, miles, pints of blood, renal dialysis treatments, etc.

S. All definitions that begin with the letter S.

(1)Secondary payer category means one of the following broad categories assigned by the data provider to the payment source identified in the secondary payer identification name field:

(a) 1-medicare is the secondary payer from which the provider might expect some payment;

(b) 2-medicaid is the secondary payer from which the provider might expect some payment;

(c) 3-other government (federal/state/local) is the secondary payer from which the provider might expect some payment (excluding department of corrections);

(d) 4-department of corrections is the secondary payer from which the provider might expect some payment;

(e) 5-private health insurance is the secondary payer from which the provider might expect some payment;

(f) 6-blue cross/blue shield is the secondary payer from which the provider might expect some payment;

(g) 7-managed care, unspecified is the secondary payer from which the provider might expect some payment (to be used only if one cannot distinguish public from private);

(h) 8-no payment from an organization, agency, program, or private payer is listed as the secondary payer;

(i) 9-miscellaneous/other secondary payer source from which the provider might expect some payment.

(2)Secondary payer identification name means the name identifying a secondary payer from which the provider might expect some payment for the reported service(s).

(3)Secondary payer type means the type of secondary payer as defined below from which the provider might expect some payment for the reported service(s):

(a) 1-HMO-health maintenance organization;

(b) 2-other managed care-includes provider service networks;

(c) 3-indemnity plan;

(d) 88-unknown.

(4)Secretary means the cabinet secretary of the department of health.

(5)Sex of patient means the sex of the patient as recorded at discharge. Enter the sex of the patient, coded as follows:

(a) F-female;

(b) M-male;

(c) U-unknown.

(6)Skilled nursing facility or SNF means a type of nursing home recognized by the medicare and medicaid systems as meeting long-term health care needs for individuals who the potential to function independently after a limited period of care.

(7)State agency means any agency, department, division, bureau, board, commission, institution, or other organization of a state government, including state educational institutions and political subdivisions. "State agency" does not include any health care facility operated by a state agency.

T. All definitions that begin with the letter T.

(1)Tertiary payer category means one of the following broad categories assigned by the data provider to the payment source identified in the tertiary payer identification name field:

(a) 1-medicare is the tertiary payer from which the provider might expect some payment;

(b) 2-medicaid is the tertiary payer from which the provider might expect some payment;

(c) 3-other government (federal/state/local) is the tertiary payer from which the provider might expect some payment (excluding the department of corrections);

(d) 4-department of corrections is the tertiary payer from which the provider might expect some payment;

(e) 5-private health insurance is the tertiary payer from which the provider might expect some payment;

(f) 6-blue cross/blue shield is the tertiary payer from which the provider might expect some payment;

(g) 7-managed care, unspecified is the tertiary payer from which the provider might expect some payment (to be used only if one cannot distinguish public from private);

(h) 8-no payment from an organization, agency, program, or private payer is listed as the tertiary payer;

(i) 9-miscellaneous/other tertiary payer source from which the provider might expect some payment.

(3)Tertiary payer identification name means the name identifying a tertiary payer from which the provider might expect some payment for the reported service(s).

(4)Tertiary payer type means the type of tertiary payer as defined below from which the provider might expect some payment for the reported service(s):

(a) 1-HMO-health maintenance organization;

(b) 2-other managed care-includes provider service networks;

(c) 3-indemnity plan;

(d) 88-unknown.

(5)Total charges means an 11 digit number rounded to the whole dollar for the total charges for all inpatient services reported. This is the sum of all revenue service line charges.

(6)Traffic crash report number means the six digit number of the traffic crash/accident report form.

(7)Type of admission means an inpatient code indicating the priority of the admission. Type of admission codes are:

(a) 1-emergency-the patient requires immediate medical intervention as a result of severe, life threatening or potentially disabling conditions; generally, the patient is admitted through the emergency room;

(b) 2-urgent-the patient requires immediate medical attention for the care and treatment of a physical or mental disorder; generally, the patient is admitted to the first available and suitable accommodation;

(c) 3-elective-the patient's condition permits adequate time to schedule the availability of a suitable accommodation;

(d) 4-newborn-a baby born within this facility; use of this code necessitates the use of special source of admission codes-see source of admission;

(e) 9-information not available.

(8)Type of bill means the specific type of bill code indicating the type of billing for inpatient services.

U. All definitions that begin with the letter U.

(1)UB-04 manual is the official NUBC data specifications manual for (© AHA) issued by the NUBC.

V. All definitions that begin with the letter V.

W. All definitions that begin with the letter W.

X. All definitions that begin with the letter X.

Y. All definitions that begin with the letter Y.

Z. All definitions that begin with the letter Z.

N.M. Admin. Code § 7.1.27.7

7.1.27.7 NMAC - N, 12/31/2012