N.M. Admin. Code § 7.1.4.7

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

Section 7.1.4.7 - DEFINITIONS

In addition to the definitions in the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978, the following terms have the following meaning for purposes of this rule.

A.Admission hour coded in military time (e.g., 2:45 p.m. is represented as 1445).

B.Attending physician NPI 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.

C.Birth weight coded in grams.

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

E.Data source has the meaning given in Section 24-14A-2 of the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978, 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

F.Discharge hour coded in military time (e.g., 2:45 p.m. is represented as 1445).

G.1st E-code means the first code for external causes of injury, poisoning, or adverse effect. If a patient has an injury diagnosis in a range of ICD-9-CM 800-999, e-codes are required.

H.2nd E-code means the second code for external causes of injury, poisoning, or adverse effect. If a patient has an injury diagnosis in a range of ICD-9-CM 800-999, e-codes are required.

I.3rd E-code means the third code for external causes of injury, poisoning, or adverse effect. If a patient has an injury diagnosis in a range of ICD-9-CM 800-999, e-codes are required.

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

K.Health information system or HIS means the health information system established by the Health Information System Act, Section 24-14A-1 et seq. NMSA 1978.

L.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.

M.Medicare provider number means the six digit number assigned by Medicare to the data source providing the reported service(s).

N.National provider identifier (NPI) means the ten digit NPI from the national plan and provider enumeration system (NPPES).

O.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).

P.Operating physician NPI 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.

Q.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.

R.Patient means a person who has received or is receiving health care.

S.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.

T.Patient 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.

U.Patient city means the city of the patient's residence at the time of discharge.

V.Patient county means the county of the patient's residence at the time of discharge.

W.Patient state means the state of the patient's residence at the time of discharge.

X.Patient 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.

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

Z.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.

AA.Patient discharge date means the date the patient was discharged by the provider from the inpatient health care facility. Formatted as "MMDDYYYY".

BB.Patient diagnosis related group (DRG) code means the diagnostic related group code.

CC.Patient EMS ambulance run number means the emergency medical services ambulance run number.

DD.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 Asian and other the race field would be R1R5.

(1) R1 - American Indian.

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

(3) R3 - Black or African American.

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

(5) R5 - White.

(6) R6 - patient refused.

(7) R7 - unknown.

(8) R9 - other race.

EE.Patient ethnicity means the gross classification of a patient's stated ethnicity, coded as follows:

(1) Y - Hispanic or Latino;

(2) N - not Hispanic or Latino.

FF.Patient tribal affiliation means the classification(s) of patient's stated New Mexico tribal affiliation. 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 T1T22:

(1) T1 - Acoma pueblo;

(2) T2 - Cochiti pueblo;

(3) T3 - Isleta pueblo;

(4) T4 - Jemez pueblo;

(5) T5 - Jicarilla Apache nation;

(6) T6 - Kewa/Santo Domingo pueblo;

(7) T7 - Laguna pueblo;

(8) T8 - Mescalero Apache nation;

(9) T9 - Nambe pueblo;

(10) T10 - Ohkay Owingeh pueblo;

(11) T11 - Picuris pueblo;

(12) T12 - Pojoaque pueblo;

(13) T13 - San Felipe pueblo;

(14) T14 - San Ildefonso pueblo;

(15) T15 - Sandia pueblo;

(16) T16 - Santa Ana pueblo;

(17) T17 - Santa Clara pueblo;

(18) T18 - Taos pueblo;

(19) T19 - Tesuque pueblo;

(20) T20 - Zia pueblo;

(21) T21 - Zuni pueblo;

(22) T22 - New Mexico Navajo nation;

(23) T100 - other tribal affiliation;

(24) T200 - patient refused;

(25) T300 - unknown.

GG.Patient first name means the first name of the patient.

HH.Patient 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.

II.Patient middle initial means the middle initial of the patient.

JJ.Patient medicaid number means the patient's unique identification number assigned by medicaid.

KK.Patient medical record number means the medical record number used by the provider to identify the patient.

LL.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, patient 18th diagnosis code means the ICD-9-CM 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.

MM.Patient 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 9^th 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.

(1) Y - yes

(2) N - no

(3) U - no information on the record

(4) W - clinically undetermined

(5) 1 - exempt

NN.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 stay.

OO.Procedure date for patient 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).

PP.Patient social security number means the nine digit social security number provided by the patient, without section separating characters like dashes, hyphens or slashes, for example, "585940323".

QQ.Patient status means the code indicating patient disposition at time of discharge. The codes are:

(1) 01 - discharged to home or self care (routine discharge);

(2) 02 - discharged/transferred to another general hospital;

(3) 03 - discharged/transferred to skilled nursing facility;

(4) 04 - discharged/transferred to intermediate care facility (ICF);

(5) 05 - discharged/transferred to another type of institution;

(6) 06 - discharged/transferred to home under care of organized home health service organization;

(7) 07 - left against medical advice;

(8) 08 - reserved for national assignment;

(9) 09 - admitted as an inpatient to this hospital;

(10) 10 - 19 reserved for national assignment;

(11) 20 - expired;

(12) 21 - discharged/transferred to court/law enforcement (covers patients sent to jail, prison or other detention facilities);

(13) 22 - 29 - reserved for national assignment;

(14) 30 - still patient or expected to return for outpatient services;

(15) 31 - 39 - reserved for national assignment;

(16) 40 - expired at home (hospice claims only);

(17) 41 - expired in a medical facility, such as a hospital, SNF, ICF or freestanding hospice (hospice claims only);

(18) 42 - expired - place unknown (hospice claims only);

(19) 43 - discharged/transferred to a federal health care facility; (effective 03/31/2008) (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 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);

(20) 44 - 49 - reserved for national assignment;

(21) 50 - discharged/transferred to hospice - home;

(22) 51 - discharged/transferred to hospice - medical facility;

(23) 52 - 60 - reserved for national assignment;

(24) 61 - discharged/transferred within this institution to a hospital based medicare approved swing bed;

(25) 62 - Discharged/transferred to an inpatient rehabilitation facility including distinct part units of a hospital;

(26) 63 - discharged/transferred to long term care hospitals;

(27) 64 - discharged/transferred to a nursing facility certified under medicaid but not certified under medicare;

(28) 65 - discharged/transferred to a psychiatric hospital or psychiatric distinct part unit of a hospital;

(29) 66 - discharged/transferred to a critical access hospital (CAH) (effective 03/31/2008);

(30) 67 - 69 reserved for national assignment;

(31) 70 - discharge/transfer to another type of health care institution not defined elsewhere in the code list (effective 03/31/2008);

(32) 71-99 - reserved for national assignment.

RR.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.

(1) 1 Medicare is the primary payer from which the provider might expect some payment.

(2) 2 Medicaid is the primary payer from which the provider might expect some payment.

(3) 3 CHAMPUS/military/VA is the primary payer from which the provider might expect some payment.

(4) 4 IHS/PHS (Indian health service/public health service) is the primary payer from which the provider might expect some payment.

(5) 5 Other government (including corrections/research) is a government entity other than those specifically listed as the primary payer from which the provider might expect some payment.

(6) 6 Private insurance is the primary payer from which the provider might expect some payment.

(7) 7 Workers compensation is the primary payer from which the provider might expect some payment.

(8) 8 Self pay/no insurance means the patient (or the patient's family) is the primary payer from which the provider might expect some payment.

(9) 9 County indigent funds are the primary payer source from which the provider might expect some payment.

(10) 10 Charity care means the provider does not anticipate any payment from any source, including the patient.

(11) 88 Unknown.

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

TT.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):

(1) 1 HMO - health maintenance organization;

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

(3) 3 indemnity plan;

(4) 88 unknown.

UU.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, e.g. 87501 or 875010968.

VV.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.

(1) 1 - Medicare is the secondary payer from which the provider might expect some payment.

(2) 2 - Medicaid is the secondary payer from which the provider might expect some payment.

(3) 3 - CHAMPUS/military/VA is the secondary payer from which the provider might expect some payment.

(4) 4 - IHS/PHS (Indian health service/public health service) is the secondary payer from which the provider might expect some payment.

(5) 5 - Other government (including corrections/research) is a government entity other than those specifically listed as the secondary payer from which the provider might expect some payment.

(6) 6 - Private insurance is the secondary payer from which the provider might expect some payment.

(7) 7 - Workers compensation is the secondary payer from which the provider might expect some.

(8) 8 - Self pay/no insurance means the patient (or the patient's family) is the secondary payer from which the provider might expect some payment.

(9) 9 - County indigent funds are the secondary payer source from which the provider might expect some payment.

(10) 10 - Charity care means the provider does not anticipate any payment from any source, including the patient.

(11) 88 - Unknown.

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

XX.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):

(1) 1 - HMO - health maintenance organization;

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

(3) 3 - indemnity plan;

(4) 88 - unknown.

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

(1) female - F;

(2) male - M;

(3) unknown - U.

ZZ.Point of origin for admission or visit means the source of referral for this admission.

(1)Adults and pediatrics: source of admission codes for adults and pediatrics are:

(a) 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 HMO physician (this includes patients coming from home, a physician's office or workplace;

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

(c) 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);

(d) 5 - transfer from SNF or ICF - the patient was admitted to this facility as a transfer from a skilled nursing facility (SNF) or intermediate care facility (ICF) where he or she was a resident;

(e) 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);

(f) 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);

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

(h) A - reserved for national assignment;

(i) 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;

(j) 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);

(k) 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;

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

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

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

(b) 6 - born outside of this facility - a baby born outside of this facility;

AAA.Total charges means an 11 digit number rounded to the whole dollar for the total charges for all inpatient services reported.

BBB.Traffic crash report number means the six digit number of the traffic crash/accident report form.

CCC.Type of admission means an Inpatient code indicating the priority of the admission. Type of admission codes are:

(1) 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;

(2) 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;

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

(4) 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;

(5) 9--information not available.

N.M. Admin. Code § 7.1.4.7

7.1.4.7 NMAC - Rp, 7.1.4.7 NMAC, 11/14/2008; A, 12/1/2010