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

The Minnesota Hospital Association (MHA) collects data on ambulatory surgery and other outpatient services. MHA identifies outpatient data by the Uniform Billing Form 04 (UB-04) bill type as specified below:

• Ambulatory Surgery
  • Admit to Discharge Claim (bill type 831)
  • Interim (Last) Claim (bill type 834)
  • Replacement Adjustment Claim (bill type 837)
• Outpatient Stay
  • Admit to Discharge Claim (bill type 131)
  • Interim (Last) Claim (bill type 134)
  • Late Charges (bill type 135)
  • Replacement Adjustment Claim (bill type 137)
• Critical Access Hospital
  • Admit to Discharge Claim (bill type 851)
  • Interim (Last) Claim (bill type 854)
  • Replacement Adjustment Claim (bill type 857).

Beginning in data year 2014, MHA creates four separate indicator flags that identify ambulatory surgery, imaging services, emergency department (ED) visits, and observation services. MHA defines the ambulatory surgery flag using the following criteria:

• Bill Type must be 13x, 83x, or 85x
• Bill type must be xx1, xx4, xx5, or xx7
• Any Current Procedural Terminology (CPT®) procedure code in any of the following ranges:
  • 10021 to 36414
  • 36417 to 69999
  • 93451 to 93462
  • 93501 to 93533
  • G0104
  • G0105
  • G0297
• A corresponding Revenue code in and of the following ranges:
  • 0360 to 0369
  • 0480 to 0481
  • 0490 to 0499
  • 0722
  • 0750 to 0759
  • 0761
  • 0790 to 0799

The assignment of an ambulatory surgery and ED visit record is hierarchical. Specifically, if the Partner-defined ED flag is true, the ambulatory surgery flag is set to false. However, if an ambulatory surgery record also had observation and/or imaging services, all outpatient services will be identified on the record by the respective indicator flags. The same is also true for any ED record with observation and/or imaging services.

From 2012-2013, MHA only created three indicator flags: ambulatory surgery, imaging services, and emergency department services. A flag for observation services was not included.

Outpatient Data File Provided to HCUP by the Partner

Beginning in data year 2012, MHA has provided their complete outpatient file to HCUP. Prior to data year 2012, MHA selected ambulatory and emergency department records from their broader outpatient data set.

Selection of Records for Inclusion in the SASD

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

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

MHA collects data on outpatient services performed in hospital-owned facilities. MHA 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 with 2017 data, records with a discharge disposition of "still a patient" are retained in the HCUP SASD. Prior to 2017 data, these records were excluded. The removal of this exclusion resulted in an increase of roughly 550,000 records.

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.