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Central Distributor SEDD: Description of Data Elements

 
TOTCHG_X - Total charges, as received from data source
 
Documentation Sections:
General Notes
Uniform Values
State Specific Notes
General Notes
 

TOTCHG_X retains the total charge supplied by a data source, including cents and negative values, with the following exceptions:

  • Zero charges are set to missing (.); and
  • Charges that round to zero are set to missing (.).

TOTCHG_X has the same value as TOTCHG just before edit checks on total charges are performed. TOTCHG contains the cleaned total charges. TOTCHG_X contains the original value of total charges.

Generally, total charges (TOTCHG and TOTCHG_X) do not include professional fees and non-covered charges. If the source provides total charges with professional fees, then the professional fees are removed from the charge during HCUP processing. In a small number of HCUP databases, professional fees can not be removed from total charges because the data source cannot provide the information. Please check the state-specific notes for information on which states are affected.

In some cases, only copay amounts, such as $10 or $20, may be in the total charges. There is no documentation as to the prevalence of this practice.

Emergency department charges incurred prior to admission to the hospital may be included in total charges (TOTCHG and TOTCHG_X). Medicare requires a bundled bill for Medicare patients admitted to the hospital through the emergency department. Other payers may or may not have similar requirements.

A few states have a large number of discharges (20%-30%) with total charges less than $25. HCUP edit check TCHG01 sets TOTCHG to inconsistent (.C) on these records. An investigation of this situation reveals no specific pattern. The low values generally occur in all hospitals, but may be more pronounced in a handful of hospitals. The discharges with low total charges are commonly associated with simple diagnoses or procedures (e.g., attention to surgical dressing/suture, otitis media, acute URI, acute pharyngitis, limited or comprehensive interview, and skin suture). They do not occur for one particular payer type and do not appear to be copay amounts. Please consult the state-specific Data Quality Reports available under Summary Statistics.

Emergency department charges incurred prior to admission to the hospital may be included in total charges (TOTCHG and TOTCHG_X). Medicare requires a bundled bill for Medicare patients admitted to the hospital through the emergency department. Other payers may or may not have similar requirements.

 
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Uniform Values
 
VariableDescriptionValueValue Description
TOTCHG_XTotal charges, as received from data source+/- 100 millionTotal charge (with 2 decimal places)
.Missing
.AInvalid (nonnumeric or out of range)
 
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State Specific Notes

Arizona

Beginning in 2008, Arizona provided charge information in addition to total charges. We were able to conclude that charges for professional fees and patient convenience items are included in the Arizona total charges. Any charges for professional fees and convenience items were subtracted from the reported total charges during HCUP processing to make Arizona total charges (TOTCHG and TOTCHG_X) comparable to data from other states.

Prior to 2008, Arizona documentation did not indicate whether charges for professional fees and patient convenience items are included in its total charges for hospital emergency department data.



Florida

In Florida, total charges may include professional fees. In all other HCUP states, either professional fees are not included in the supplied total charges or the professional fees are subtracted from the total during HCUP processing.



Iowa

Iowa includes professional fees in its total charges if the hospital combines hospital and professional bills. Professional fees are subtracted from total charges (TOTCHG and TOTCHG_X) during HCUP processing to make Iowa total charges comparable to data from other states. Due to an error in processing the outpatient data in 2004, professional fees were NOT subtracted from the total charges. Users can correct this by subtracting non-covered charges (CHG16) and professional fees (CHG17) from the total charges (TOTCHG and TOTCHG_X). Beginning in 2005, professional fees and non-covered items are excluded from the total charges (TOTCHG and TOTCHG_X).



Maine

Beginning in 2000, total charges (TOTCHG_X) were collected from the patient summary record and not the detail charge and revenue code array. Prior to 2000, total charges (TOTCHG and TOTCHG_X) were identified by revenue code "001" and extracted from the detail charge and revenue code array.



Maryland

Beginning in 2007, Maryland included the records from all other outpatients, Greenbaum cancer center, and UMMS shock trauma in the unified AS and ED outpatient data file. Total changes associated with some of these new records were smaller than $100. During the HCUP processing, these values were categorized in ā€œInconsistentā€, which resulted in increasing the frequency associated with it.

Beginning in 2006, Maryland stopped providing total charges. This data element is created based on charges associated with revenue code 0001 during the HCUP data processing.

Maryland excluded the following from total charges:

  • Physician charges and
  • Charges not regulated by the Health Services Cost Review Commission (for example, telephone service, television charges or private duty nursing charges).


Massachusetts

Massachusetts included professional fees in its detailed and total charges, if these were included by the hospital. Hospitals are allowed, though not required, to report these professional fees in the charge fields. Individual facilities decide which professional fees are included and where. There is no way to determine which hospitals did or did not include professional fees.



South Carolina

Beginning in 1996, professional fees and charges for patient convenience items were subtracted from the reported total charges during HCUP processing to make South Carolina total charges (TOTCHG and TOTCHG_X) comparable to data from other states.

Prior to 1996, only professional fees were subtracted from the reported total charges because the source did not supply an itemized charge for patient convenience items.

In 2006, total charges were not included on South Carolina SASD or SEDD because of a problem with a major data vendor in the state.



South Dakota

Charges associated with the professional fees and non-covered items (revenue code centers 096X, 097X, 098X, and 099X) have been removed from total charges.



Utah

Beginning in 2002, professional fees were subtracted from the reported total charges during HCUP processing to make Utah total charges (TOTCHG and TOTCHG_X) comparable to data from other states. Utah indicates that for the majority of the discharges, the reported total charge includes professional fees. Utah reports the total charge for the UB-92 revenue code "001" if the hospital provides individual revenue codes to the data organization; otherwise the total charge is the hospital-reported total. For the hospitals that do not provide individual revenue codes, Utah does not have any means of determining whether or not professional charges are included. Prior to 2002, professional fees were not subtracted from the total charges (TOTCHG and TOTCHG_X). To make the total charges comparable to data from other states, professional fees (CHG2) should be subtracted from total charges (TOTCHG and TOTCHG_X). In all years, it is possible that charges for patient convenience items are included in total charges (TOTCHG and TOTCHG_X). There is no means of determining whether these charges are included.



Wisconsin

Prior to 2006, Wisconsin may have included professional fees and convenience items in its total charges. Hospitals are instructed to remove these fees from total charges, but some hospitals do not subtract them and others have had difficulties with their accounting software. There is no way to determine which hospitals did or did not include these items.

Hospitals are not required to report total charges for stays over 100 days.


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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=totchg_x.
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Last modified 9/11/08