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Central Distributor SASD: Description of Data Elements

 
CPTn - CPT-4/HCPCS procedures
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

Healthcare Common Procedure Coding System (HCPCS) Level I (CPT) and Level II procedure codes are frequently used on outpatient bills to report procedures and services performed by physicians, nonphysician practitioners, hospitals, laboratories, and outpatient facilities. The procedures code data elements (CPTn) are provided by the data source. Null values are set to blank. 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). If the HCPCS procedure code is not on the list of valid codes, CPTn is set to invalid.

If the HCPCS procedure code is inconsistent with sex (ECPT02), CPTn is set to inconsistent. We discontinued age edits for HCPCS level I (CPT codes) beginning with data year 2011 and we discontinued age edits for all other HCPCS codes beginning in 2015. The corresponding CPTCCSn, sex, and age values (prior to 2015) were also set to inconsistent.

The original value of the primary CPT-4/HCPCS procedure (CPT1), whether blank or coded, is retained in the first position of the procedure vector. Starting at the first secondary procedure (CPT2), the procedures are shifted during HCUP processing to eliminate blank secondary procedures. For example, if CPT2 and CPT4 contain nonmissing procedures and CPT3 is blank, then the value of CPT4 is shifted into CPT3. Secondary procedures are never shifted into the primary position (CPT1).

 
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Uniform Values
 
VariableDescriptionValueValue Description
CPTnCPT-4/HCPCS procedures5(a)Procedure code
.AInvalid: ECPT01
.CInconsistent: ECPT02; in 2006-2014 data, ECPT03
 
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State Specific Notes

Florida

Beginning with 2003, Florida no longer collects CPT codes in the range 77000-77999 (radiation oncology).



Iowa

In 1996 only, Iowa reported both CPT and ICD-9-CM codes in the procedure code field. During HCUP processing, the CPT codes were assigned to the HCUP variable CPTn and the ICD-9-CM codes were assigned to PRn.

In 1996 only, Iowa reports outpatient discharges for only selected CPT and ICD-9-CM codes:

CPT Code ICD-9-CM Description
66984 13.41, 13.71 Extracapsular cataract removal with lens insertion
66821 13.64 Discission of secondary membranes after cataract
69436 20.01 Myringotomy with tube insertion
64721 04.43 Carpal tunnel release
56340 51.23 Laparoscopic cholecystectomy
42825 28.2 Tonsillectomy less than 12 years of age
42820 28.3 Tonsillectomy with adnoidectomy less than 12 years of age
42830 28.6 Adnoidectomy without tonsillectomy less than 12 years of age
49505 53.00 Unilateral inguinal hernia repair
52281 57.32 Cystourethroscopy with calibration
43239 45.16 EGD with closed biopsy
45385 45.42 Colonoscopy with polypectomy
45378 45.23 Colonoscopy fiberoptic beyond splenic
56300 54.21 Laparoscopy, diagnostic
56301 66.29 Laparoscopy, tubal ligation
58600 66.32 Tubal ligation
27332 80.6 Excision of semilunar cartilage of knee
52204 57.33 Closed biopsy of bladder
31625 33.24 Bronchoscopy with biopsy
45305 48.24 Proctosigmoidoscopy with biopsy
55250 63.73 Vasectomy
58120 69.09 Dilation and curettage, diagnostic or therapeutic
59160 69.02 Dilation and curettage, post delivery
46255 49.46 Hemorroidectomy
19120 85.21 Excision of lesion of breast
19101 85.12 Open biopsy of breast
93510 37.22 Left heart cath with coronary arteriogram and venticulogram
93543 88.56 Same as above
93545 88.53 Same as above
93555 Same as above
93556 Same as above
93526 37.23 Left and right heart cath with coronary arteriogram and venticulogram
93543 88.56 Same as above
93545 88.53 Same as above
93555 Same as above
93556 Same as above
93544 88.42 Same as above, but cardiac catheterization with aortography
93540 Same as above, but cardiac catheterization with check of aorto-coronary bypass graft
62284 87.21 Myelogram
50590 98.21 Lithotripsy


Maryland

From July 2015 - December 2017, some Maryland hospitals under-reported HCPCS and CPT drug codes (specifically J-codes) and the associated units.

The order of the CPT codes in CPTn does not pertain to the order of the detailed charges (CHGn) and revenue codes (REVCDn).

Maryland does not provide ICD-9-CM procedure codes on outpatient data, so the CPTn vector is placed on the core file.

CPT1 is 100% missing for one hospital in the 2010 MD SASD and SEDD.



Missouri

Missouri reports a mixture of ICD-9-CM procedure codes (3-4 digit codes) and CPT-4/HCPCS procedure codes (5 digit codes) in one array in their ambulatory surgery files. The reported procedures are split into the HCUP array that holds ICD-9-CM procedures (PRn) and the HCUP array that holds CPT-4/HCPCS procedures (CPTn), as appropriate.

The principal procedure is retained in the principal position:

  • If the reported principal procedure is less than 5 digits long, then PR1 = the reported principal procedure and CPT1 = blank.
  • If the reported principal procedure is 5 digits long, then CPT1 = the reported principal procedure and PR1 = blank.

The secondary procedures are packed into the secondary procedures so that there are no gaps in the HCUP arrays:

  • If the reported secondary procedure is less than 5 digits long, then the reported secondary procedure is placed in the first open position starting at PR2.
  • If the reported principal procedure is 5 digits long, then the reported secondary procedure is placed in the first open position starting at CPT2.

No secondary procedures are placed into the principal position.

Only the procedure dates for the ICD-9-CM procedures could be retained on the HCUP files in the array PRDATEn. Procedure days (PRDAYn) for the ICD-9-CM procedures are calculated from the reported procedure dates and admission date.



New York

Prior to 2008, reporting of CPTs was not mandated; it was a voluntary effort. CPT codes were reported only when the payer required a CPT code to process the claim. New York did not consider the quality of the CPT information to be reliable and did not use CPT codes in their analyses. New York used only the ICD-9-CM codes for analyses.



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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Internet Citation: HCUP Central Distributor SASD Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). April 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/sasddistnote.jsp?var=cptn.
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Last modified 4/11/08