|PRn - ICD-9-CM Procedure
|State Specific Notes
In data prior to the fourth quarter of 2015, International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) procedures reported on HCUP records are stored in the data elements PRn. Beginning in the fourth quarter of 2015, International Classification of Diseases, Tenth Revision, Clinical Modification (ICD-10-CM) procedures reported on HCUP records are stored in the data elements I10_DXn.
In the HCUP databases, ICD-9-CM procedures are represented as 3- to 4-character numeric codes with implicit decimals (i.e., decimals not included). Prior to data year 2014, the HCUP data elements for ICD-9-CM procedures are length 4; in 2014, they are length 7. The codes are left-justified in the HCUP databases so that prior to 2014 there is one space following a 3-digit procedure code (four spaces, in 2014). For example, the procedure code 37.0 would appear as '370 ' with a trailing blank in HCUP data. Any zeroes at the beginning of the code are significant; they are part of the code. Any zeroes at the beginning of the code are significant; they are part of the code. For example, the ICD-9-CM procedure code 03.1 would be stored in the HCUP databases as '031 ' and the diagnosis 003.1 would be stored as '0031'.
The original value of the ICD-9-CM first-listed procedure (PR1), whether blank or coded, is retained in the first position of the procedure vector. Starting at the first secondary procedure (PR2), the procedures are shifted during HCUP processing to eliminate blank secondary procedures. For example, if PR2 and PR4 contain nonmissing procedures and PR3 is blank, then the value of PR4 is shifted into PR3. Secondary procedures are never shifted into the first listed position (PR1).
Procedures are compared to a list of ICD-9-CM codes valid for the discharge date. Anticipation of or lags in response to official ICD-9-CM coding changes are permitted for discharges occurring within a window of time around the official ICD-9-CM coding changes (usually October 1). Prior to 1998 data, a six months window (three months before and three months after) is allowed. Beginning in the 1998 data, a year window (six months before and six months after) is allowed. If the procedure contains intermittent blank characters or is zero filled, then the procedure will be considered invalid.
Procedures are compared to the sex of the patient (edit check EPR03 beginning in the 1998 data and ED2nn prior to 1998 data) and the patient's age (edit check EAGE05 beginning in the 1998 data and ED5nn prior to 1998 data) for checking the internal consistency of the record.
How invalid and inconsistent codes are handled varies by data year.
The validity flags (PRVn) need to be used in connection with any analysis of the procedures (PRn).
The maximum number of procedures reported varies by state. HCUP retains all procedure fields provided by the data source.
|State Specific Notes
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:
Kentucky supplied procedure codes in a field length of 7. Only the first four characters contained in the left-justified source field were used to assign the HCUP procedure codes.
Maryland supplied procedure codes in a field of length 5. Only the first four characters contained in the left-justified source field were used to assign the HCUP procedure codes.
Beginning in July 2001, ICD-9-CM procedure codes are not collected by Maryland. Only CPT-4 procedure codes are collected on ambulatory surgery records.
Nebraska supplied procedure codes in a field of length 7. Only the first four characters contained in the left-justified source field were used to assign the HCUP procedure codes.
Beginning in 2009, Nebraska no longer provides ICD-9-CM procedure codes.
Beginning with the 2008 data, ICD-9-CM procedure codes were 100% missing and will no longer be available.
Because of an error during HCUP data processing, invalid CPT codes beginning with the letters "W" through "Z" were not identified in the 2003 North Carolina SASD. This error was corrected beginning with the 2004 data.
North Carolina supplied procedure codes in a field length of 6. Only the first four characters contained in the left-justified source field were used to assign the HCUP procedure codes.
In the 2004 outpatient data from South Carolina, there were a number of records with X-filled values in the list of procedures. This data source attempted to translate any CPT procedure codes into ICD-9-CM procedure codes. If this was not possible, the data source masked the CPT code with X's. During HCUP data processing, the X-filled values were discarded, and the procedure array was packed to eliminate the blank entries.
Also in 2004, we suspect that some South Carolina hospitals truncated their CPT codes to four digits instead of masking them with X's. The following hospitals have a large number of invalid ICD-9-CM procedure codes: DSHOSPID 045, 090, 1405, 370, 420, 565, 670. The invalid ICD-9-CM procedure codes look suspiciously like truncated CPT codes. It is also possible that some of the truncated CPT procedure codes were not identified because the 4-digit value was a valid ICD-9-CM code.
Prior to 2000 data, a small number of discharges explicitly included decimals in the procedure field, usually the decimal is implicit. This is problematic because South Carolina supplied procedures in a field of length 4. If decimals were included, then a valid 4-digit code would be truncated. For example, the procedure for a simple mastoidectomy "2041" would be incorrectly reported as "20.4". Prior to 1998, invalid procedure codes are marked by a validity flag (PRVn = 1). Beginning in 1998, invalid procedure codes are masked (PRn = "invl"). Beginning in 2000 data this was no longer a problem; explicit decimals were not included in the procedure codes.
In the 1996 data, the frequency of procedures was greater than expected for PR9 and PR10. Although an upturn in the distribution of procedures is typical at the end of the procedure vector, this increase was much larger than expected and was due to reporting practices of one hospital (DSHOSPID = 480). Certain procedures such as abdominal CAT scan, circumcision, and packed-cell transfusion made up the bulk of procedures for PR9 and PR10.
Please use the 1997 data for DSHOSPID="408" with caution. Based on a cursory review of the hospital's data, the following problems were identified:
In 2001, expect secondary procedures PR14 - PR20 to be blank. No more than 13 procedures were provided by the data source.
It is possible that none of the discharges have all of the procedure fields coded. The Vermont inpatient and outpatient source files come to HCUP in the same layout. To simplify HCUP processing, the number of procedure fields on the Vermont HCUP SID and SASD is the same.
To comply with statutory requirements, Wisconsin modified diagnosis and procedure codes that explicitly referenced induced termination of pregnancy to eliminate distinctions between induced and spontaneous termination. The following codes were modified:
Beginning Q4 2015, the following codes were modified:
Wisconsin supplied ICD-9-CM procedure codes in a field length of 5. Only the first four characters contained in the left-justified source field were used to assign the HCUP procedure codes.
CPT codes submitted in the emergency department and ambulatory surgery files were converted to ICD-9-CM procedure codes by the Wisconsin Hospital Association using the current Thomson Reuters Procedure Conversion Files. When a CPT code does not convert to an ICD-9-CM code, four 'X' (XXXX) characters were placed in the ICD field. These X-filled codes are recoded as missing prior to HCUP processing to prevent them being set to invalid.
For 2013, several facilities unintentionally duplicated the principal procedure in the secondary procedure fields on some records.
Beginning Q4 2015, the Wisconsin Hospital Association will no longer convert CPT procedure codes to ICD procedure codes.
|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=prn.
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|Last modified 4/11/08