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Central Distributor SEDD: Description of Data Elements

 
PRn - ICD-9-CM Procedure
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General 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.

  • Beginning in the 1998 data, invalid and inconsistent procedures are masked directly. Validity flags are not included on the HCUP record. Clinical Classifications Software (CCS) data elements are coded with respect to the procedure.
Invalid Procedure Inconsistent Code
The value of PRn "invl" "incn"
PRCCSn Set to invalid (.A) Set to inconsistent (.C)
  • Prior to 1998 data, invalid and inconsistent procedures are retained on the record. Validity flags (PRVn) indicate invalid, inconsistent procedure codes. Clinical Classifications Software (CCS) data elements use the former name (PCCHPRn). The CCS was formerly known as the Clinical Classifications for Health Policy Research (CCHPRn). The procedure related data element are coded as follows:
Invalid Procedure Inconsistent Code
The value of PRn Unchanged Unchanged
PRVn Set to 1 Set to inconsistent (.C)
PCCHPRn Set to invalid (.A) Retained (values 1-260)


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.

 
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Uniform Values
 
VariableDescriptionValueValue Description
PRnICD-9-CM ProcedurennnnProcedure code
BlankMissing
invlInvalid: beginning with 1998 data, EPR02
incnInconsistent: beginning with EAGE05, EPR03
 
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State Specific Notes

Nebraska

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.



Nebraska

Beginning in 2009, Nebraska no longer provides ICD-9-CM procedure codes.



New York

Beginning with the 2008 data, ICD-9-CM procedure codes were 100% missing and will no longer be available.



South Carolina

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.



Wisconsin

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:

  • Diagnoses with the first three digit of 634, 635, 636, 637, 638 were recoded to 637, while retaining the reported fourth digit,
  • Procedure 6901 was changed to 6902,
  • Procedure 6951 was changed to 6952,
  • Procedure 6993 was changed to 6999,
  • Procedure 7491 was changed to 7499,
  • Procedure 750 was changed to 7599, and
  • Procedures 9641-9649 were changed to 964 (which would be flagged as invalid, PRV=1).

Beginning Q4 2015, the following codes were modified:

  • Diagnosis Z33.2 was changed to Z31.9,
  • Diagnoses O04x and O07x were changed to O03.9,
  • Procedure 10A07ZZ was changed to 10D17ZZ,
  • Procedure 10A08ZZ was changed to 10D18ZZ,
  • Procedure 10A07ZZ was changed to 10D17ZZ,
  • Procedure 10A08ZZ was changed to 10D18ZZ,
  • Procedure 10A07ZW was changed to 0UCB7ZZ,
  • Procedure 10A00ZZ was changed to 10D00Z0,
  • Procedure 10A03ZZ was changed to 0UC93ZZ,
  • Procedure 10A04ZZ was changed to 0UC94ZZ,
  • Procedure 10A07ZX was changed to 3E0P7GC.

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.


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Internet Citation: HCUP Central Distributor SEDD Description of Data Elements - All States. Healthcare Cost and Utilization Project (HCUP). September 2008. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/sedddistnote.jsp?var=prn.
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Last modified 9/11/08