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

The Wisconsin Department of Health Services collects data on ambulatory surgery and other outpatient services such as observation services, therapy, laboratory testing, radiology, repetitive services, and emergency department visits. The types of outpatient data collected by Wisconsin include:

• Ambulatory surgery (record type 1)
• Emergency department (record type 2)
• Observation (record type 3)
• Therapies (record type 4)
• Laboratory and radiology (record type 5)
• Other outpatient (record type 6)
• Recurring outpatient services such as chemotherapy (record type 7)
  • Beginning in data year 2018, record type 7 was eliminated. Records involving only minor procedures were no longer collected.

Wisconsin defines an ambulatory surgery record by the outpatient place of service and by one of the following types of revenue codes:

• 0360-0369 Operating room services
  • Beginning in data year 2018, revenue code 0361 was purposely excluded from this range because it captured records involving only minor procedures such as chemotherapy, therapeutic injections, wound care, and dressing changes.
• 0481 Cardiac catheterization lab
• 0490-0499 Ambulatory surgical care
• 0750 Gastrointestinal services.

Wisconsin defines an observation services record by the outpatient place of service and by revenue code 0760 or 0762.

Wisconsin assigns the type of outpatient encounter based on the last place of service. Therefore, if the patient had an ambulatory surgery followed by observation services, the outpatient record is only classified as observation.

Outpatient Data File Provided to HCUP by the Partner

Wisconsin provides only ambulatory surgery, observation, and emergency department records to HCUP from their broader outpatient data set.

Beginning in data year 2014, Wisconsin provides HCUP with separate outpatient and inpatient files.

For data years 2006-2013, Wisconsin provided their outpatient and inpatient records in a combined data file. Outpatient records are clearly identified by record type.

Prior to 2006, Wisconsin provided separate ambulatory surgery data files to HCUP by selecting records with at least one International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedure in the range 01.01-86.99 or Current Procedural Terminology (CPT®) procedure in the range 10000-69999.

Wisconsin masks abortion-related ICD-9-CM and CPT diagnosis and procedure codes to remove the distinction between spontaneous and induced abortions.

Selection of Records for Inclusion in the SASD

The identification of records to include in the SASD varies by data year:

Beginning in 2007, all records marked by Wisconsin as ambulatory surgery are included in the SASD (STATE_AS=1 based on record type 1). Any other nonemergent outpatient records (STATE_ED not equal to 1) also are included in the SASD.

Prior to 2007, all records included in the distinct ambulatory surgery file were 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

Wisconsin Department of Health Services mandates reporting from all hospital-owned and nonhospital-owned ambulatory surgery facilities. Hospital-owned facilities report outpatient data based on revenue center codes. Nonhospital-owned ambulatory surgery facilities are required to report every case.

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.

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.