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

The Kentucky Cabinet for Health and Family Services Department for Public Health collects data on ambulatory surgery and other outpatient services such as observation care and emergency department visits.

Starting in 2015, Kentucky began collecting all ambulatory surgery and other outpatient services data from the hospital-owned and nonhospital-owned facilities that report their data, not just the cases where a particular set of CPTs were identified. To more clearly identify the type of outpatient services, Kentucky also created 18 service markers which allowed for a record to be identified by multiple types of outpatient services. The service markers were created using the combination of CPT and UB04 revenue codes and included: outpatient surgery, observation care, emergency department care, mammography, computed tomography (CT) scan, magnetic resonance imaging (MRI), positron emission tomography (PET) scan, radiation therapy, cardiac catheterization, behavioral health, laboratory, restorative services, sleep lab, and other imaging.

Starting in 2014, Kentucky changed their outpatient surgery data collection criteria to include any record with a procedure listed within the surgery section of the CPT manual. The surgical section included minor procedures such as injection, blood draw, intravenous (IV) drip, etc. Kentucky defined the patient type based on the classification of the CPT code. For example, if a patient was treated in the emergency department, received an IV, and was discharged home, the patient type was identified as outpatient surgery (patient type OS) instead of emergency care.

Prior to 2014 data, Kentucky uses the following hierarchy and definitions to mark each outpatient record with a service type:

• Outpatient surgery is defined as any record that contains at least one CPT code in the following range: 10021-69990 or one of the following Healthcare Common Procedure Coding System (HCPCS) codes A4300-A4306, C1725, C1730-C1733, C1885, C1888, C2630, C8931-C8936, C9724-C9728, G0104-G0106, G0120-G0122, G0186, G0219, G0235, G0251-G0252, G0269, G0288-G0291, G0364-G0365, G0392-G0393, L8699, Q1003-Q1005, S8042, V2785V, or V2787-V2788 (patient type OS).
• Observation care is defined as any record that does not qualify as outpatient surgery but has at least one Current Procedural Terminology (CPT®) code in the following range: 99234-99235, 99236, 99217-99220, 99224-99226, or G0378-G0379 (patient type OC).
• Emergency care is defined as any record that does not qualify as outpatient surgery or observation care but has at least one CPT code in the following range: 99281-99288 or G0380-G0384 (patient type ED).
• Mammography is defined as any record that does not qualify as outpatient surgery, observation care, or emergency care but has at least one CPT code in the following range: 77031-77032, 77051-77059, or G0202-G0206 (patient type MA).
• Other outpatient is defined as any record that does not qualify as outpatient surgery, observation care, emergency care, or mammography but has at least one CPT code in the category of computed tomography scan, magnetic resonance image, positron emission tomography scan, radiation therapy, cardiac catheterization, single photon emission computed tomography, and all other procedure codes (patient type OT).

Because of the hierarchical assignment for the patient type, an outpatient encounter that involved ambulatory surgery and observation care was only flagged as outpatient 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

Kentucky provides their complete outpatient file to HCUP.

Starting in 2015, outpatient services are identified by the 18 service markers. These markers are used to assign HCUP data elements STATE_AS (sm_surg=Y indicating an outpatient surgery), STATE_ED (sm_er=Y indicating emergency department care), and STATE_OS (sm_obsv=Y indicating observation services).

Prior to 2015 data, outpatient services are identified by service type. The service type is stored in the HCUP data element OPservice. It is also used to assign the HCUP data elements STATE_AS (service type OS), STATE_ED (service type ED),and STATE_OS (servicetype OC).

Selection of Records for Inclusion in the SASD

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

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

The Kentucky Cabinet for Health and Family Services collects outpatient data from hospital-owned facilities. Beginning in 2009, nonhospital-owned facilities also began submitting outpatient data.

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.