Source Files

Beginning in data year 2004, Iowa Hospital Association (IHA) provided their Statewide Outpatient Database to HCUP. This database contains information on all emergency room, ambulatory surgeries, and observation stays. Additionally, IHA provides information on additional outpatient services, such as therapy and lab and radiology. IHA identifies the different types of outpatient records as follows:

• Emergency Room - Any record with a HCPCS code of 99281-99285 or 99291 and with a revenue code 0450, 0451, 0452, 0456, 0459
• Outpatient Surgery - Any record with a revenue code 0360, 0361, 0369, 0480, 0481, 0490, 0499, 0750, 0759.
• Observation - Any record with a revenue code 0760, 0762, 0769.
• Therapy - Any record with a revenue code in the categories 41X-44X or 93X-95X.
• Lab and radiology - Any record with a revenue code in the categories 30X, 32X-35X, 40X, 61X, 73X-74X, or 92X.

The types of outpatient records are designated by the IHA as service markers. Multiple types of service markers may exist on the same record.

Records for patients treated in the ED, and then treated and released from observation care are also included in the ED data.

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 = 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 (valid for data year 2010 and forward):
  • 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; HTLV or HIV antibody, confirmatory test (eg, 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 SEDD

The IHA provides HCUP with one outpatient file in which ED records are included with outpatient surgery and observation stays. All records identified by the IHA as ED are included in the SEDD (HCUP data element STATE_ED=1 based on the service marker for emergency room).

Additionally, any other records with evidence of ED services that are flagged by the variable HCUP_ED (i.e., HCUP_ED>0) during HCUP processing are included in the SEDD. If a record in the SASD also has evidence of ED services based on the HCUP criteria (HCUP data element HCUP_ED not equal to 0), then the SASD record is also included in the SEDD. These records will have the same value for the HCUP data element KEY.

SEDD records with evidence of other types of outpatient services, such as lab or radiology, can be identified by the data element OPService.

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

The IHA collects ED data from member hospital-owned EDs in the State.

A comparison of the number of hospitals included in the SEDD and the number of hospitals reported in the AHA Annual Survey is available starting in data year 2010.

Hospital-owned EDs do not always report data for a full calendar year. Some open or close during the year; others have technical problems that prevent them from reporting data for all months in a year.

Exclusion of Records During HCUP Data Processing

Records with a discharge disposition of "still a patient" are excluded from the HCUP SEDD. Additionally, prior to 2010, records with a discharge disposition of "admitted as an inpatient" were also excluded from the HCUP Iowa SEDD.