Central Distributor SASD: Description of Data Elements

CPTHCPCS - Line item CPT or HCPCS procedure code as received from source

Documentation Sections:

General Notes

Uniform Values

State Specific Notes

General Notes

Healthcare Common Procedure Coding System (HCPCS) Level I (CPT) and Level II or HCPCS procedure codes are frequently used on outpatient bills to report procedures and services performed by physicians, nonphysician practitioners, hospitals, laboratories, and outpatient facilities. The procedure code pertains to a specified revenue code and line item charge. Line item CPT or HCPCS procedure codes (CPTHCPCS) are provided by the data source. HCPCS codes are compared to a list of codes valid for the discharge date. Anticipation of or lags in response to official coding changes are permitted for discharges occurring within a window of time (six months before and six months after). HCUP validates Level I (numeric) and Level II codes (A0000-V9999) but does not validate the Level III codes (W0000-Z9999). Beginning in data year 2019, if the line item CPT or HCPCS procedure code is not on the list of valid HCPCS codes, CPTHCPCS is set to invalid. Also, in data year 2019, if the line item CPT or HCPCS procedure code is inconsistent with sex (ECPT02), CPTHCPCS is set to inconsistent.

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Uniform Values

Variable Description Value Value Description CPTHCPCS Line item CPT or HCPCS procedure code as received from source 5(a) CPT or HCPCS Procedure Code Blank Missing .A Invalid: beginning in data year 2019, ECPT01 .C Inconsistent: beginning in data year 2019, ECPT02

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State Specific Notes

Iowa Beginning with 2005, Iowa provides the information of CPT and HCPCS on the line item charge detail instead of the discharge record. Because Iowa provides line item charge detail, there may be multiple observations with the same CPT/HCPCS code for a discharge record in the Iowa charge file. The HCUP variable KEY which uniquely identifies a discharge can be used to merge the CPT/HCPCS onto the discharge record in the Core file. Kentucky In early 2010, the Kentucky Cabinet for Health and Family Services transitioned to a new data collection entity. During that transition, it was identified that the previous data vendor did not always obtain CPT and Revenue code information. As a result, there are more missing values in 2009 for line item CPTs, Revenue codes, units, charges, and service dates than in previous years. Maryland From July 2015 - December 2017, some Maryland hospitals under-reported HCPCS and CPT drug codes (specifically J-codes) and the associated units. Minnesota Minnesota provided the information of CPT and HCPCS on the line item charge detail instead of the discharge record. Because Minnesota provided line item charge detail, there may be multiple observations with the same CPT/HCPCS code for a discharge record in the Minnesota charge file. The HCUP variable KEY which uniquely identifies a discharge can be used to merge the CPT/HCPCS onto the discharge record in the Core file. Wisconsin Wisconsin provided both an array of CPT\HCPCS codes (CPTn) as well as Line item CPT\HCPCS procedure codes (CPTHCPCS), and we kept both during processing. Some surgery codes are only in the CPTn array, while other CPT\HCPCS codes are only in the Line item CPT\HCPCS procedure codes (CPTHCPCS). Therefore, the CPTn array on the Core File and the CPTHCPCS data element from the Charge Detail File should be used together to get a complete set of CPT\HCPCS codes for each discharge.

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