Types of Ambulatory Surgery and Other Outpatient Services Collected by the Partner

The Iowa Hospital Association (IHA) has been collecting outpatient data since 2003. This includes ambulatory surgery and other outpatient services such as observation services and emergency department visits. IHA does not collect outpatient clinic data. IHA uses Current Procedural Terminology (CPT®) procedure codes and revenue center codes to identify the following types of outpatient services:

• Ambulatory surgery records are defined as having a revenue code in the range of 0360-0369 for operating room services, 0480 for cardiology, 0481 for cardiac catheterization lab, 0490-0499 for ambulatory surgery care, or 0750-0759 for gastrointestinal services
• Observation service records are defined as having a revenue code of 0760, 0762, or 0769 for observation and treatment room.

Beginning in July 2012, IHA has created five separate indicator flags that identify ambulatory surgery, observation services, outpatient therapy, laboratory and radiology services, and emergency department visits. One outpatient record can indicate multiple types of outpatient services.

Prior to July 2012, IHA used the following hierarchy to mark each outpatient record with an outpatient service code:

• Emergency department services (value 1)
• Ambulatory surgery (value 2)
• Observation services (value 3)
• Therapies (value 4)
• Laboratory and radiology services (value 5)
• Other outpatient services (value 6)

Because of the hierarchical assignment, an encounter that involved ambulatory surgery and observation services is only flagged as ambulatory surgery. However, ambulatory surgery records with evidence of observation services can be identified by HCUP data element HCUP_OS.

Outpatient Data File Provided to HCUP by the Partner

IHA divides their outpatient data into two different files for release based on the type of outpatient services. One file includes records identified as ambulatory surgery, observation, and emergency department visits. This file is provided to HCUP. The second file, which is not provided to HCUP, is specific to records for outpatient therapies, laboratory and radiology services, and other outpatient services.

Beginning in July 2012, the ambulatory surgery flag provided by IHA has been used to set the HCUP data element STATE_AS. The observation services flag is used to set the HCUP data element STATE_OS. The emergency department flag is used to set the HCUP data element STATE_ED. Prior to July 2012, the outpatient service code provided by IHA was used to set these data elements.

Beginning July 1, 2016, previous restrictions on the exclusion of records for (1) behavioral health patients treated in chemical dependency or psychiatric care units of the hospital and (2) patients with HIV infections changed allowing IHA to release this data. However, these records are not included in the data until data year 2017.

Prior to July 1, 2016, IHA was prohibited from releasing these two types of discharge records. These discharges were not included in the source file provided to HCUP and were therefore not included in the HCUP files. The identification of behavioral health patients and HIV patients changed over time.

From 2003-2009, records for behavioral health patients treated in chemical dependency or psychiatric care units of the hospital were defined by:

• CCS Grouping
• 218 = Psychological and psychiatric evaluation and therapy
• 219 = Alcohol and drug rehabilitation/detoxification
• Revenue codes
• 0513 =Psychiatric Clinic
• 090X-091X = Behavioral Health Treatment
• 0900 = General Classification PHYS TREATMENT
• 0901 = Electroshock Treatment ELECTRO SHOCK
• 0902 = Milieu Therapy MILIEU THERAPY
• 0903 = Play Therapy PLAY THERAPY
• 0904 = Activity Therapy ACTIVITY THERAPY
• 0909 = Other Psychiatric/Psychological OTHER PSYCH RX
• 0910 = General Classification - PSYCH SERVICES
• 0911 = Rehabilitation - PSYCH/REHAB
• 0914 = Individual Therapy - PSYCH/INDIV RX
• 0915 = Group Therapy - PSYCH/GROUP RX
• 0916 = Family Therapy - PSYCH/FAMILY RX
• 0917 = Bio Feedback - PSYCH/BIOFEED
• 0918 = Testing - PSYCH/TESTING
• 0919 = Other Psychiatric/Psychological - PSYCH/OTHER
• 0944 = Drug Rehabilitation - DRUG REHAB
• 0945 = Alcohol Rehabilitation - ALCOHOL REHAB
• 0953 = Combined drug and alcohol rehabilitation - COMBO DRUG/ALC REHAB
• 0961 = Professional Fees Psychiatric
• 100X = Behavioral Health Accommodations
• 1000 = General Classification BH R&B
• 1001 = Residential Treatment PSYCHIATRIC
• 1002 = Residential Treatment - CHEMICAL DEPENDENCY
• 1003 = Supervised Living - BH R&B SUP LIVING
• 1004 = Halfway House - BH R&B HALFWAY HOUSE
• 1005 = Group Home - BH R&B GROUP HOME

Beginning in data year 2010, the Iowa Hospital Association added the following to the definition of behavioral health patients treated in chemical dependency or psychiatric care units of the hospital:

• EAPG Grouping:
  • 16 = Mental illness and substance abuse therapies
  • 71 = Mental diseases and disorders
  • 72 = Alcohol/drug use and alcohol/drug induced organic mental disorders
• ICD-9-CM Principal Diagnosis Codes:
  • 290 - 319 = Mental Disorders

Beginning October 2015, the Iowa Hospital Association added the following to the definition of behavioral health patients treated in chemical dependency or psychiatric care units of the hospital:

• ICD-10-CM Principal Diagnosis Codes:
  • F01 - F99 (principal diagnosis) = Mental disorders due to known physiological conditions

Beginning in data year 2003, HIV patients were defined by:

• ICD-9-CM diagnosis codes
  • 042 = Human Immunodeficiency Virus (HIV) Disease
  • V08 = Asymptomatic HIV infection status if the results are positive but the patient is asymptomatic
  • V6544 = Human Immunodeficiency Virus (HIV) Counseling
  • 07953 = Human immunodeficiency virus, type 2 [HIV-2]
  • 79571 = Nonspecific Serologic Evidence of Human Immunodeficiency Virus (HIV)
• CPT/HCPCS Codes:
  • 86689 = Antibody; Human T-cell lymphotropic virus (HTLV) or HIV antibody, confirmatory test (e.g., Western Blot)
  • 86701 = Antibody; HIV-1
  • 86702 = Antibody; HIV-2
  • 86703 = Antibody; HIV-1 and HIV-2, single assay
  • 87390 = Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semi-quantitative, multiple step method; HIV-1
  • 87391 = Infectious agent antigen detection by enzyme immunoassay technique, qualitative or semiquantitative, multiple-step method; HIV-2

Beginning in data year 2010, the Iowa Hospital Association added the following to the definition of HIV patients:

• EAPG Grouping:
  • 76 = Human immunodeficiency virus infections

Beginning October 2015, the Iowa Hospital Association added the following to the definition of HIV patients:

• ICD-10-CM diagnosis codes:
  • B20 = Human immunodeficiency virus (HIV) disease
  • B9735 = Human immunodeficiency virus, type 2 (HIV-2)
  • R75 = Nonspecific Serologic Evidence HIV
  • Z21 = Asymptomatic human immunodeficiency virus (HIV) disease
  • Z717 = Other counseling, human immunodeficiency virus (HIV) disease

Selection of Records for Inclusion in the SASD

All records identified by IHA as ambulatory surgery are included in the SASD (STATE_AS=1 based on the indicator for ambulatory surgery). Any other nonemergent outpatient records (STATE_ED not equal to 1) also are included in the SASD.

Additionally, any record in the SASD that also have evidence of ED services based on the HCUP criteria (HCUP data element HCUP_ED > 0), are also included in the HCUP State Emergency Department Databases (SEDD). These records will have the same value for the HCUP data element KEY.

SASD with evidence of other types of outpatient service, such as observation, can be identified by the data element OPService.

Types of Facilities Included in the Files Provided to HCUP by the Partner

IHA collects data on outpatient services performed in hospital-owned facilities. IHA does not collect data from ambulatory surgery facilities that are not owned by a hospital.

Identification of Hospital-Owned Ambulatory Surgery and Other Types of Outpatient Facilities in the SASD

The designation of a facility as hospital-owned is specific to its financial relationship with a hospital that provides inpatient care and not related to its physical location. Hospital-owned ambulatory surgery and other outpatient care facilities may be contained within the hospital, physically attached to the hospital, or located in a different geographic area. The designation as hospital-owned means that HCUP can identify that the hospital is billing for this service.

Starting in data year 2018, the HCUP data element HOSPITAL_OWNED can be used to identify hospital-owned facilities with ambulatory surgery and possibly other outpatient care data in the SASD. A facility is considered hospital-owned (HOSPITAL_OWNED = 1) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (HOSPITAL_OWNED = 0). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with HOSPITAL_OWNED=0 are hospital-owned.

From data year 1998-2018, the HCUP data element was called FREESTANDING. A facility is considered hospital-owned (FREESTANDING = 0) if any one of the following is true:

• The facility is listed in the American Hospital Association (AHA) Annual Survey Database^TM.
• The facility is not listed in the AHA database, but the facility provides inpatient discharge data to HCUP.
• Documentation provided by the data source clearly indicates that the facility is hospital-owned.

If the facility in the SASD does not meet any of the above criteria, it is marked as not being owned by a hospital (FREESTANDING = 1). Not all hospitals report to the AHA, so there is a possibility that some facilities marked with FREESTANDING=1 are hospital-owned.

Exclusion of Records During HCUP Processing

Beginning in 2017, records with a discharge disposition of "still a patient" are retained in the HCUP SASD. Prior to 2017, these records were excluded.

Beginning in 2010, records with a designation of "admitted as an inpatient" are retained in the SASD, even though this rarely occurs. Prior to 2010, records with a designation of "admitted as an inpatient" were excluded from the files.