Utilization Flags

Utilization Flag software is one in a family of databases and software tools developed as part of the Healthcare Cost and Utilization Project (HCUP), a Federal-State-Industry partnership sponsored by the Agency for Healthcare Research and Quality. HCUP databases, tools, and software inform decision making at the national, State, and community levels.

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The Utilization Flag software creates 30 data elements that reveal additional information about use of healthcare services. By combining information from ICD-9-CM procedure codes and Uniform Billing (UB-04) revenue center codes, it is possible to obtain a more complete picture of utilization of services rendered in healthcare settings such as hospitals, emergency departments, and ambulatory surgery centers.

This documentation provides an overview of the following:
  • The different types of utilization flags
  • Data elements required for assigning the utilization flags
  • Downloadable, electronic files that contain the SAS and SPSS programs to create the utilization flags.
Detailed documentation is available under the HCUP Methods Series Report 2006-04 Development of Utilization Flags for Use with UB-92 Administrative Data (PDF file, 258 KB) and accompanying Appendices: A-F (PDF file, 452 KB). This Methods Series details the initial development of the utilization flags. Revenue code categories are reviewed annually and updated as appropriate.
 
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The Utilization Flags can be employed to study issues such as use of intensive care units and to more reliably examine utilization of diagnostic and therapeutic services, beyond the information that can be gleaned from ICD-9-CM procedure codes. A broad range of services, from simple diagnostic tests to resource-intense procedures, occur in the inpatient and outpatient hospital setting. In administrative healthcare data based on claims, use of services may be reported using ICD-9-CM procedure codes, charges to the revenue centers of the hospital in which services were performed, or both. ICD-9-CM procedure codes provide information on healthcare services, but there is concern about under-reporting certain procedures, such as non-invasive, diagnostic services. In addition, ICD-9-CM codes do not provide information on some services, such as stays in intensive care units (ICU) and psychiatric units. UB-04 revenue codes identify services and accommodations using revenue codes that are accompanied by charge information specific to the revenue center. Detailed charges based on revenue codes provide additional evidence that the patient received a specific service.
 
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Using a combination of the UB-04 revenue codes, ICD-9-CM procedure codes, and Clinical Classifications Software (CCS) procedure categories, 30 utilization flags were developed for a range of services. The following table lists the flags by type:


Utilization Flags
Accommodation
     Intensive Care Unit (ICU) Coronary Care Unit (CCU)
     Newborn Level II Newborn Level III
     Newborn Level IV  
Cardiac Services
     Cardiac Catheterization Lab Cardiac Stress Test
     Echocardiogram Electrocardiogram (EKG)
Imaging and Diagnostic Tests
     Computed Tomography (CT) Scan Chest X-Ray
     Electroencephalogram (EEG) Ultrasound
     Magnetic Resonance Technology (MRT) Nuclear Medicine
Devices
     Pacemaker Other Implants
Therapeutic Services
     Lithotripsy Occupational Therapy
     Physical Therapy Respiratory Therapy
     Therapeutic Radiology and Chemotherapy Renal Dialysis
     Speech-Language Pathology Erythropoietin (EPO)
     Mental Health and Substance Abuse Blood
Other
     Emergency Department Observation Room
     Organ Acquisition  
 
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Both SAS and SPSS programs are available for assigning the utilization flags to administrative databases. The following table lists the required data elements.

Data Elements Required for Assigning the Utilization Flags using ICD-9-CM Procedures

Data Elements Description
KEY Unique record identifier
REVCD1-REVCDn Array of dimension n of four-character UB-04 revenue codes, including the leading zero. The assignment program allows the user to specify the length of the array. UB-04 revenue codes are updated by National Uniform Billing Committee. The Utilization Flag software is valid for revenue codes beginning October 1993.
PR1-PRn Array of dimension n of ICD-9-CM procedure codes, decimals removed. The assignment program allows the user to specify the length of the array. The ICD-9-CM codes are revised every October. New codes are added, existing codes are deleted, and definitions of current codes are changed. The Utilization Flag software is valid for ICD-9-CM procedure codes beginning October 1993.
PRCCS1-PRCCSn Array of dimension n of AHRQ CCS procedure categories. The length of the array must be the same as the length of the ICD-9-CM procedure array. The program to assign the procedure CCS is available at www.hcup-us.ahrq.gov/tools_software.jsp.
NPR NPR indicates the total number of ICD-9-CM procedure codes reported on the discharge record. For example, if a discharge record has five procedures reported, then NPR equals five. The value on NPR is never larger than the dimension of the array of ICD-9-CM procedures.


The SAS utilization flag assignment program allows the revenue codes either to be included in the same file as the procedure codes and CCS, or to be in a separate file. In the HCUP State databases available for purchase through the HCUP Central Distributor, the revenue codes are stored in a separate file. The SPSS version of the program requires that the revenue codes be included in the same file as the procedure codes. The SAS and SPSS programs assign the 30 utilization flags, output the resulting data set, and calculate summary and detailed statistics for each flag.
 
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The following ZIP folders include the CSV mapping file and a mapping program in SAS and SPSS.

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The beta version of the Utilization Flags for ICD-10-PCS was developed prior to ICD-10-PCS data being available and has not been thoroughly evaluated or updated. Preliminary findings show that some utilization flags, such as the one for blood transfusions, may not be consistently reported by ICD-10-PCS codes and the grouping of ICD-10-PCS codes by the beta version of the Clinical Classifications Software (CCS) may be insufficient. In addition, the utilization flag definitions have not been modified to account for the use of Healthcare Common Procedure Coding System (HCPCS) procedure codes in outpatient data.

It is important to note that the available software (v2018.1) has not been updated for ICD-10-PCS codes effective after September 2018. The ZIP folder includes the CSV mapping file, a SAS mapping program, and instructions for adding the utilization flags to your data.
 
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Questions regarding the Utilization Flag software may be directed to HCUP User Support through the following channels:
 
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Internet Citation: Utilization Flags. Healthcare Cost and Utilization Project (HCUP). September 2021. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/util_flags/utilflag.jsp.
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Last modified 9/24/21