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

The 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 for International Classification of Diseases, 10th Revision, Procedure Coding System (ICD-10-PCS) creates 30 data elements (i.e., utilization flags) that reveal additional information about use of healthcare services. By combining information from Uniform Billing (UB-04) revenue center codes and ICD-10-PCS procedure 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.

WARNING: The beta version of the Utilization Flags for ICD-10-PCS has not been thoroughly evaluated. 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. The refined version of the CCS for ICD-10-PCS is in progress and will be available in December of 2020. 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. The Utilization Flags tool will be evaluated and revised in 2021.
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The Utilization Flag software was developed originally using 2003 HCUP inpatient and outpatient data with UB-04 revenue center codes. Some of the utilization flags were specific to the inpatient setting (e.g., intensive care and newborn accommodations), and others identified services often performed in an outpatient setting (e.g., lithotripsy and cardiac stress test). Nineteen of the 30 utilization flags used ICD-9-CM procedure codes to augment the revenue center codes. HCPCS procedures codes on outpatient data were not considered. The remaining utilization flags depend only on UB-04 revenue center codes. A detailed description of the development of the original Utilization Flags is included in the HCUP Methods Series Report #2006-04 Development of Utilization Flags for Use with UB-92 Administrative Data (PDF file, 258 KB) and Appendices: A-F (PDF file, 452 KB).

The beta version of the Utilization Flag for ICD-10-PCS was created prior to the availability of ICD-10-PCS coded data by linking ICD-10-PCS codes to ICD-9-CM codes via the General Equivalence Mappings (GEMs) available from the Centers for Medicare & Medicaid Services (CMS) website. When the United States transitioned to the use of ICD-10-PCS on October 1, 2015, only procedures performed in the inpatient setting were reported using ICD-10-PCS codes. Outpatient procedures were reported using HCPCS codes. No adjustment was made to the Utilization Flag software for the HCPCS procedure coding on outpatient data.
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Using a combination of the UB revenue center codes, ICD-10-PCS procedure codes, and beta version of the CCS for ICD-10-PCS procedure categories, 30 utilization flags identify 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  


The document Table of Revenue Codes and Procedure Codes for Utilization Flags for ICD-10-PCS (PDF file, 172 KB) contains the definition of each utilization flag, including the data element name, description, UB revenue center codes, and ICD-10-PCS procedure codes, if used.
 
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A SAS program is available for assigning the utilization flags to administrative databases. The following table lists the data elements expected by the SAS program. Names of data elements are consistent with those used in the HCUP databases.

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. Exit Disclaimer 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 beta version of the Utilization Flag software is valid for ICD-10-PCS codes from October 2015 through September 2020.
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 beta version of the procedure Clinical Classification Software (CCS) for ICD-10-PCS is available at http://www.hcup-us.ahrq.gov/tools_software.jsp. The beta version of the CCS for ICD-10-PCS includes ICD-10-PCS codes valid from October 2015 through September 2020.

The CCS Refined (CCSR) for ICD-10-PCS is in progress and will be available in December of 2020. The Utilization Flags tool will be evaluated and revised in 2021 to use the CCSR for ICD-10-PCS.
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 assigns the 30 utilization flags, outputs the resulting data set, and calculates summary and detailed statistics for each flag.
 
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The ZIP folder includes the Tool, a load program, and instructions for applying the Tool to your data using the load program.

Utilization Flags v2020.1 (beta version): Fiscal Year 2020, Updated October 2019 (valid for ICD-10-PCS codes through September 2020)
WARNING: 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 CCS may be insufficient. The refined version of the CCS for ICD-10-PCS is in progress and will be available in December of 2020. In addition, the utilization flag definitions have not been modified to account for the use of HCPCS procedure codes in outpatient data. The Utilization Flags tool will be evaluated and revised in 2021.
 
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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). August 2020. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/toolssoftware/utilflagsicd10/utilflag_icd10.jsp.
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Last modified 8/20/20