|CPTn - CPT-4/HCPCS procedures|
|State Specific Notes|
Healthcare Common Procedure Coding System (HCPCS) Level I (CPT) and Level II procedure codes are frequently used on outpatient bills to report procedures and services performed by physicians, nonphysician practitioners, hospitals, laboratories, and outpatient facilities. The procedures code data elements (CPTn) are provided by the data source. Null values are set to blank. HCPCS codes are compared to a list of codes valid for the discharge date. Anticipation of or lags in response to official coding changes are permitted for discharges occurring within a window of time (six months before and six months after). HCUP validates Level I (numeric) and Level II codes (A0000-V9999) but does not validate the Level III codes (W0000-Z9999). If the HCPCS procedure code is not on the list of valid codes, CPTn is set to invalid.
If the HCPCS procedure code is inconsistent with sex (ECPT02), CPTn is set to inconsistent. We discontinued age edits for HCPCS level I (CPT codes) beginning with data year 2011 and we discontinued age edits for all other HCPCS codes beginning in 2015. The corresponding CPTCCSn, sex, and age values (prior to 2015) were also set to inconsistent.
The original value of the primary CPT-4/HCPCS procedure (CPT1), whether blank or coded, is retained in the first position of the procedure vector. Starting at the first secondary procedure (CPT2), the procedures are shifted during HCUP processing to eliminate blank secondary procedures. For example, if CPT2 and CPT4 contain nonmissing procedures and CPT3 is blank, then the value of CPT4 is shifted into CPT3. Secondary procedures are never shifted into the primary position (CPT1).
|State Specific Notes|
From July 2015 - December 2017, some Maryland hospitals under-reported HCPCS and CPT drug codes (specifically J-codes) and the associated units.
The order of the CPT codes in CPTn does not pertain to the order of the detailed charges (CHGn) and revenue codes (REVCDn).
Maryland does not provide ICD-9-CM procedure codes on outpatient data, so the CPTn vector is placed on the core file.
CPT1 is 100% missing for one hospital in the 2010 MD SASD and SEDD.
The order of the CPT codes in CPTn pertains to the order of the detailed charges (CHGn), revenue codes (REVCDn), and units (UNITn).
New York (SEDD)
Prior to 2008, reporting of CPTs was not mandated; it was a voluntary effort. CPT codes were reported only when the payer required a CPT code to process the claim. New York did not consider the quality of the CPT information to be reliable and did not use CPT codes in their analyses. New York used only the ICD-9-CM codes for analyses.
This data element was provided by Utah for ambulatory surgery (AS) records and not supplied for the emergency department (ED) records. However, when AS records with evidence of ED services were placed in the SEDD during HCUP processing, this data element was also added to the SEDD. Therefore, very few records in the SEDD will contain values for this data element.
Approximately 9% of Vermont's 2005 SID records have invalid values in the first CPT field (CPT1). Almost all of the invalid codes are reported by two hospitals.
|Internet Citation: HCUP NEDS Description of Data Elements. Healthcare Cost and Utilization Project (HCUP). May 2015. Agency for Healthcare Research and Quality, Rockville, MD. www.hcup-us.ahrq.gov/db/vars/cptn/nedsnote.jsp.|
|Are you having problems viewing or printing pages on this website?|
|If you have comments, suggestions, and/or questions, please contact firstname.lastname@example.org.|
|Privacy Notice, Viewers & Players|
|Last modified 5/8/15|