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Note: The U.S. transitioned to the International Classification of Diseases, 10th Revision, Clinical Modification/Procedure Coding System (ICD-10-CM/PCS) coding scheme on October 1, 2015. The HCUP tools for International Classification of Diseases, 9th Revision, Clinical Modification (ICD-9-CM) should only be used with data for discharges before 10/1/15.

The HCUP tools were translated to ICD-10-CM/PCS prior to the availability of ICD-10-CM/PCS-coded data. The translated tools are considered in beta version, until a refined version of the tool can be developed. Preliminary findings suggest some unexpected discontinuities between the tools based on ICD-9-CM and the beta version of tools based on ICD-10-CM/PCS. See the ICD-10-CM/PCS Resources page for details. The tools will continue to undergo refinements over the next several years. You are advised to visit this page regularly to download and apply the most recent version of the HCUP tools for your data throughout your research process.

Utilization Flags for ICD-10-PCS (beta version)

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.


The Utilization Flag for ICD-10-PCS software creates 30 data elements that reveal additional information about use of healthcare services. By combining information from ICD-10-PCS procedure codes and Uniform Billing (UB-04) revenue 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.

Detailed documentation for the ICD-10-PCS Utilization Flag assignments is provided below. The document contains a tale for each flag, including the variable, description, UB-04 revenue codes, and ICD-10-PCS procedure codes.
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The Utilization Flags for ICD-10-PCS 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-10-PCS 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-10-PCS procedure codes, charges to the revenue centers of the hospital in which services were performed, or both.

ICD-10-PCS 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-10-PCS 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-10-PCS procedure codes, and Clinical Classifications Software (CCS) for ICD-10-PCS procedure categories, 30 utilization flags were developed for a range of services. The following table lists the flags by type:

Utilization Flags
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
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
Emergency Department Observation Room
Organ Acquisition  

Detailed Description of the Utilization Flags
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SAS 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

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.
I10_PR1-PRn Array of dimension n of ICD-10-PCS procedure codes, decimals removed. The assignment program allows the user to specify the length of the array. The ICD-10-PCS 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-10-CM procedure codes beginning October 2015.
I10_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-10-PCS procedure array. The program to assign the procedure CCS for ICD-10-PCS is available at
I10_NPR I10_NPR indicates the total number of ICD-10-PCS procedure codes reported on the discharge record. For example, if a discharge record has five procedures reported, then I10_NPR equals five. The value on I10_NPR is never larger than the dimension of the array of ICD-10-PCS 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 SAS program assign the 30 utilization flags, output the resulting data set, and calculate summary and detailed statistics for each flag.
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Shift-click from this Web page: Click on the file name to automatically download the files for the Utilization Flags for ICD-10-CM. Alternately, click on the following links with the right mouse button and select "Save Link As" (Google Chrome) or "Save Target As" (Internet Explorer) to download the ZIP folder to your computer. After downloading the files, extract the ZIP file contents by double clicking on the ZIP folder. The ZIP folder includes the Tool, a load program, and instructions for applying the Tool to your data using the load program. Additionally, the HCUP Tools Loading Tutorial, part of the HCUP Online Tutorials Series, provides step-by-step instructions for downloading, applying, and verifying HCUP Tools.

Software Program Files
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Copies of previous versions of the Utilization Flags for ICD-10-PCS are available for users who need to replace or access the old programs.
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Questions regarding the Utilization Flag software for ICD-10-PCS may be directed to HCUP User Support through the following channels:
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Internet Citation: Utilization Flags for ICD-10-PCS (beta version). Healthcare Cost and Utilization Project (HCUP). November 2018. Agency for Healthcare Research and Quality, Rockville, MD.
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Last modified 11/25/18