Medicare Data Utilities Appendices

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Appendix K NCH Patch Table The following claim-level variables reference this Appendix: ptchcd1 NCH patch code 1 01 = RRB Category Equatable BIC - changed (all claim types) - applied during the Nearline 'G' conversion to claims with NCH weekly process date before 3/91. Prior to Version 'H', patch indicator stored in redefined Claim Edit Group, 3rd occurrence, position 2. 02 = Claim Transaction Code made consistent with NCH payment/edit RIC code (OP and HHA) -- effective 3/94, CWFMQA began patch. During 'H' conversion, patch applied to claims with NCH weekly process date prior to 3/94. Prior to version 'H', patch indicator stored in redefined Claim Edit Group, 4th occurrence, position 1. 03 = Garbage/nonnumeric Claim Total Charge Amount set to zeroes (Instnl) -- during the Version 'G' conversion, error occurred in the derivation of this field where the claim was missing revenue center code = '0001'. In 1994, patch was applied to the OP and HHA SAFs only. (This SAF patch indicator was stored in the redefined Claim Edit Group, 4th occurrence, position 2). During the 'H' ocnversion, patch applied to Nearline claims where garbage or nonnumeric values. 04 = Incorrect bene residence SSA standard county code '999' changed (all claim types) -- applied during the Nearline 'G' conversion and ongoing through 4/21/94, calling EQSTZIP routine to claims with NCH weekly process date prior to 4/22/94. Prior to Version 'H' patch indicator stored in redefined Claim Edit Group, 3rd occurrence, position 4. 05 = Wrong century bene birth date corrected (all claim types) - applied during Nearline 'H' conversion to all history where century greater than 1700 and less than 1850; if century less than 1700, zeroes moved. 06 = Inconsistent CWF bene medicare status code made consistent with age (all claim types) -- applied during Nearline 'H' conversion to all history and patched ongoing. Bene age is calculated to determine the correct value; if greater than 64, 1st position MSC ='1'; if less than 65, 1st position MSC = '2'. 07 = Missing CWF bene mediare status code derived (all claim types) - applied during Nearline 'H' conversion to all history and patched ongoing, except claims with unknown DOB and/or Claim From Date='0' (left blank). Bene age is calculated to determine missing value; if greater than 64, MSC='10'; if less than 65, MSC = '20'. 08 = Invalid NCH primary payer code set to blanks (Instnl) -- applied during Version 'H' conversion to claims with NCH weekly process date 10/1/93-10/30/95, where MSP values = invalid '0', '1', '2', '3' or '4' (caused by erroneous logic in HCFA program code, which was corrected on 11/1/95). 09 = Zero CWF claim accretion date replaced with NCH weekly process date (all claim types) -- applied during Version 'H' conversion to Instnl and DMERC claims; applied during Version 'G' conversion to non-institutional (non-DMERC) claims. Prior to Version 'H', patch indicator stored in redefined claim edit group, 3rd occurrence, position 1.
Appendix L State Table The following claim-level variables reference this Appendix: provno <strong>Medicare</strong> provider number prvstgrp Line NCH provider state code stategrp Residence SSA standard state code The following summary-level variables reference this Appendix: prvstgrp Line NCH provider state code stategrp Residence SSA standard state code 01 = Alabama 02 = Alaska 03 = Arizona 04 = Arkansas 05 = California 06 = Colorado 07 = Connecticut 08 = Delaware 09 = District of Columbia 10 = Florida 11 = Georgia 12 = Hawaii 13 = Idaho 14 = Illinois 15 = Indiana 16 = Iowa 17 = Kansas 18 = Kentucky 19 = Louisiana 20 = Maine 21 = Maryland 22 = Massachusetts 23 = Michigan 24 = Minnesota 25 = Mississippi 26 = Missouri 27 = Montana 28 = Nebraska 29 = Nevada 30 = New Hampshire 31 = New Jersey 32 = New Mexico 33 = New York 34 = North Carolina 35 = North Dakota 36 = Ohio 37 = Oklahoma 38 = Oregon 39 = Pennsylvania 40 = Puerto Rico 41 = Rhode Island 42 = South Carolina 43 = South Dakota 44 = Tennessee 45 = Texas
Page 1 and 2: Medicare Data Utilities Appendices
Page 3 and 4: Appendix C BETOS Table The Berenson
Page 5 and 6: Appendix D Carrier Claim Payment De
Page 7 and 8: Appendix G CMS Provider Specialty T
Page 9 and 10: 8O = Clinical social worker (1991)
Page 11 and 12: 75 = Other medical care (GPPP) (not
Page 13 and 14: Appendix I Line Place of Service Ta
Page 15 and 16: 0406 = (C) MAMMOGRAPHY WITH NO HCPC
Page 17 and 18: 46XB = (C) MULTIPLE COIN VALU CODES
Page 19 and 20: 5500 = (U) FULL DAYS/SNF-HOSP FULL
Page 21 and 22: 6911 = (C) REV CODE 274 ON OUTPAT A
Page 23: 94X5 = (C) BLOOD/MSP CODE/COMPUTED
Page 27 and 28: Appendix M Identification of variab
Page 29 and 30: 48 Thyroid disorders 49 Diabetes me
Page 31 and 32: 159 Urinary tract infections 160 Ca
Page 33 and 34: Appendix O Agency for Healthcare Re
Page 35 and 36: 102 Ureteral catheterization 103 Ne
Page 37 and 38: 216 Respiratory intubation and mech
Page 39 and 40: 0064 AMEBIC LUNG ABSCESS 0065 AMEBI
Page 41 and 42: 01136 TB OF BRONCHUS-OTH TEST 0114
Page 43 and 44: 01326 TUBRCLOMA BRAIN-OTH TEST 0133
Page 45 and 46: 01576 TB OF BONE NEC-OTH TEST 0158
Page 47 and 48: 01726 TB PERIPH LYMPH-OTH TEST 0173
Page 49 and 50: 026 RAT-BITE FEVER* 0260 SPIRILLARY
Page 51 and 52: 04181 MYCOPLASMA 04182 BACILLUS FRA
Page 53 and 54: 05579 MEASLES COMPLICATION NEC 0558
Page 55 and 56: 0771 EPIDEM KERATOCONJUNCTIV 0772 P
Page 57 and 58: 0907 LATE CONGEN SYPH NOS 0909 CONG
Page 59 and 60: 09889 GONOCOCCAL INF SITE NEC 099 O
Page 61 and 62: 1160 BLASTOMYCOSIS 1161 PARACOCCIDI
Page 63 and 64: 1330 SCABIES 1338 ACARIASIS NEC 133
Page 65 and 66: 151 MALIGNANT NEO STOMACH* 1510 MAL
Page 67 and 68: 1712 MAL NEO SOFT TISSUE ARM 1713 M
Page 69 and 70: 1902 MAL NEO LACRIMAL GLAND 1903 MA
Page 71 and 72: 20083 MIXED LYMPHOSARC ABDOM 20084
Page 73 and 74: 20225 SEZARY'S DISEASE INGUIN 20226
Page 75 and 76:
20610 CHR MONO LEUK W/O RMSION 2061
Page 77 and 78:
218 UTERINE LEIOMYOMA* 2180 SUBMUCO
Page 79 and 80:
234 CA IN SITU NEC/NOS* 2340 CA IN
Page 81 and 82:
2469 DISORDER OF THYROID NOS 250 DI
Page 83 and 84:
2592 CARCINOID SYNDROME 2593 ECTOPI
Page 85 and 86:
2766 FLUID OVERLOAD 2767 HYPERPOTAS
Page 87 and 88:
2882 GENETIC ANOMALY LEUKOCYT 2883
Page 89 and 90:
29552 LATENT SCHIZOPHREN-CHR 29553
Page 91 and 92:
2990 INFANTILE AUTISM* 29900 INFANT
Page 93 and 94:
30403 OPIOID DEPENDENCE-REMISS 3041
Page 95 and 96:
30721 TRANSIENT TIC, CHILDHOOD 3072
Page 97 and 98:
3150 SPECIFIC READING DIS* 31500 RE
Page 99 and 100:
33510 SPINAL MUSCL ATROPHY NOS 3351
Page 101 and 102:
34600 CLSC MIGRNE WO NTRC MGRN 3460
Page 103 and 104:
3594 TOXIC MYOPATHY 3595 MYOPATHY I
Page 105 and 106:
3625 DEGENERATION OF MACULA* 36250
Page 107 and 108:
36459 IRIS ATROPHY NEC 3646 ANTERIO
Page 109 and 110:
36731 ANISOMETROPIA 36732 ANISEIKON
Page 111 and 112:
37005 MYCOTIC CORNEAL ULCER 37006 P
Page 113 and 114:
37230 CONJUNCTIVITIS NOS 37231 ROSA
Page 115 and 116:
3752 EPIPHORA* 37520 EPIPHORA NOS 3
Page 117 and 118:
37775 CORTICAL BLINDNESS 3779 OPTIC
Page 119 and 120:
37953 VISUAL DEPRIVATN NYSTAGM 3795
Page 121 and 122:
38421 CENT PERF TYMPANIC MEMB 38422
Page 123 and 124:
38900 CONDUCT HEARING LOSS NOS 3890
Page 125 and 126:
41020 AMI INFEROLATERAL,UNSPEC 4102
Page 127 and 128:
426 CONDUCTION DISORDERS* 4260 ATRI
Page 129 and 130:
438 LATE EFF CEREBROVASC DIS* 4380
Page 131 and 132:
4518 THROMBOPHLEBITIS NEC* 45181 IL
Page 133 and 134:
4741 T & A HYPERTROPHY* 47410 HYPER
Page 135 and 136:
4951 BAGASSOSIS 4952 BIRD-FANCIERS'
Page 137 and 138:
5226 CHR APICAL PERIODONTITIS 5227
Page 139 and 140:
53089 OTHER DSRDERS ESOPHAGUS 5309
Page 141 and 142:
535 GASTRITIS AND DUODENITIS* 5350
Page 143 and 144:
5539 HERNIA NOS 555 REGIONAL ENTERI
Page 145 and 146:
572 SEQUELA OF CHR LIVER DIS* 5720
Page 147 and 148:
5838 NEPHRITIS NOS W OTH LES* 58381
Page 149 and 150:
5997 HEMATURIA 5998 URINARY TRACT D
Page 151 and 152:
6168 FEMALE GEN INFLAM NEC 6169 FEM
Page 153 and 154:
6281 INFERTIL-PITUITARY ORIG 6282 I
Page 155 and 156:
63622 ILLEG AB W PEL DAMG-COMP 6363
Page 157 and 158:
64120 PREM SEPAR PLACEN-UNSPEC 6412
Page 159 and 160:
64613 EDEMA IN PREG-ANTEPARTUM 6461
Page 161 and 162:
64821 ANEMIA-DELIVERED 64822 ANEMIA
Page 163 and 164:
65270 PROLAPSED ARM-UNSPEC 65271 PR
Page 165 and 166:
65501 FETAL CNS MALFORM-DELIV 65503
Page 167 and 168:
65901 FAIL MECH INDUCT-DELIVER 6590
Page 169 and 170:
66221 PROLONG 2ND STAGE-DELIV 66223
Page 171 and 172:
66584 OB TRAUMA NEC-POSTPARTUM 6659
Page 173 and 174:
670 MAJOR PUERPERAL INFECT* 67000 M
Page 175 and 176:
67494 PUERP COMPL NOS-POSTPART 675
Page 177 and 178:
6825 CELLULITIS OF BUTTOCK 6826 CEL
Page 179 and 180:
7038 DISEASES OF NAIL NEC 7039 DISE
Page 181 and 182:
71145 BACT ARTHRITIS-PELVIS 71146 B
Page 183 and 184:
71298 CRY ARTHROP NOS-OTH SITE 7129
Page 185 and 186:
71635 CLIMACT ARTHRITIS-PELVIS 7163
Page 187 and 188:
71830 RECUR DISLOCAT-UNSPEC 71831 R
Page 189 and 190:
71951 JT STIFFNESS NEC-SHLDER 71952
Page 191 and 192:
724 BACK DISORDER NEC & NOS* 7240 S
Page 193 and 194:
72886 NECROTIZING FASCIITIS 72889 M
Page 195 and 196:
7330 OSTEOPOROSIS* 73300 OSTEOPOROS
Page 197 and 198:
7379 CURVATURE OF SPINE NOS 738 OTH
Page 199 and 200:
74405 ANOMALIES OF INNER EAR 74409
Page 201 and 202:
74904 BILAT CLEFT PALATE-INC 7491 C
Page 203 and 204:
75433 CONG HIP SUBLUX, BILAT 75435
Page 205 and 206:
75681 ABSENCE OF MUSCLE/TENDON 7568
Page 207 and 208:
7641 LT-FOR-DATES W FETAL MAL* 7641
Page 209 and 210:
7732 NB HEMOLYT DIS-ISOIM NEC 7733
Page 211 and 212:
7826 PALLOR & FLUSHING* 78261 PALLO
Page 213 and 214:
78900 ABDMNAL PAIN UNSPCF SITE 7890
Page 215 and 216:
7951 ABN PAP SMEAR-OTH SITE 7952 AB
Page 217 and 218:
80090 OP SKL VLT FX/BR INJ NEC 8009
Page 219 and 220:
80230 MANDIBLE FX NOS-OPEN 80231 FX
Page 221 and 222:
80405 CL SKUL/OTH FX-DEEP COMA 8040
Page 223 and 224:
8060 CLOS CERV FX W CORD INJ* 80600
Page 225 and 226:
81011 FX CLAVIC, STERN END-OPN 8101
Page 227 and 228:
8141 FRACTURE CARPAL BONE-OPN* 8141
Page 229 and 230:
82391 FX FIBULA NOS-OPEN 82392 FX T
Page 231 and 232:
836 DISLOCATION OF KNEE* 8360 TEAR
Page 233 and 234:
84213 SPRAIN INTERPHALANGEAL 84219
Page 235 and 236:
85155 OPN CEREBE CONT-DEEP COM 8515
Page 237 and 238:
8540 BRAIN INJURY NEC* 85400 BRAIN
Page 239 and 240:
86412 LIVER LACERAT, MINOR-OPN 8641
Page 241 and 242:
87333 OPEN WND NAS SINUS-COMPL 8733
Page 243 and 244:
8821 OPN WOUND HAND-COMPLICAT 8822
Page 245 and 246:
90242 INJURY RENAL VEIN 90249 INJUR
Page 247 and 248:
9117 FOREIGN BODY TRUNK-INFEC 9118
Page 249 and 250:
92320 CONTUSION OF HAND(S) 92321 CO
Page 251 and 252:
94111 1ST DEG BURN EAR 94112 1ST DE
Page 253 and 254:
94311 1ST DEG BURN FOREARM 94312 1S
Page 255 and 256:
9451 1ST DEGREE BURN LEG* 94510 1ST
Page 257 and 258:
94888 80-89% BDY BRN/80-89% 3D 9489
Page 259 and 260:
9590 FACE AND NECK INJURY NOS* 9590
Page 261 and 262:
9697 POISON-PSYCHOSTIMULANTS 9698 P
Page 263 and 264:
9840 TX EFF INORG LEAD COMPND 9841
Page 265 and 266:
99580 ADULT MALTREATMENT NOS 99581
Page 267 and 268:
9994 ANAPHYLACTIC SHOCK-SERUM 9995
Page 269 and 270:
E8147 MV COLL W PEDEST-PEDEST E8148
Page 271 and 272:
E8250 MV N-TRAFF ACC NEC-DRIV E8251
Page 273 and 274:
E8378 WATERCRAFT EXPL-PERS NEC E837
Page 275 and 276:
E8551 ACC POISN-CNS DEPRES NEC E855
Page 277 and 278:
E8714 POSTENDOSCOPY FORGN BODY E871
Page 279 and 280:
E893 CLOTHING FIRE ACCIDENT* E8930
Page 281 and 282:
E9203 KNIFE/SWORD/DAGGER ACC E9204
Page 283 and 284:
E935 ADV EFF ANALGESICS* E9350 ADV
Page 285 and 286:
E9473 ADV EFF ALCOHOL DETER E9474 A
Page 287 and 288:
E9682 ASSAULT-STRIKING W OBJ E9683
Page 289 and 290:
V0261 HEPATITIS B CARRIER V0262 HEP
Page 291 and 292:
V1062 HX OF MYELOID LEUKEMIA V1063
Page 293 and 294:
V169 FAMILY HX-MALIGNANCY NOS V17 F
Page 295 and 296:
V291 NB OBSRV SUSPCT NEURLGCL V292
Page 297 and 298:
V440 TRACHEOSTOMY STATUS V441 GASTR
Page 299 and 300:
V533 ADJUST CARDIAC PACEMAKER* V533
Page 301 and 302:
V6289 PSYCHOLOGICAL STRESS NEC V629
Page 303 and 304:
V738 SCREEN VRAL CHLM DIS NEC* V738
Page 305 and 306:
Appendix Q International Classifica
Page 307 and 308:
0405 GASSERIAN GANGLIONECTOMY 0406
Page 309 and 310:
0752 PINEAL GLAND INCISION 0753 PAR
Page 311 and 312:
098 NASO-LACRIMAL FISTULIZAT* 0981
Page 313 and 314:
1274 CIL BODY DIMINUTION NOS 1279 G
Page 315 and 316:
161 REMOVE PENETRAT FB EYE 162 ORBI
Page 317 and 318:
2098 IMP/REP MCHAN COCHL PROS 2099
Page 319 and 320:
2499 DENTAL OPERATION NEC 25 OPERAT
Page 321 and 322:
2991 PHARYNGEAL DILATION 2992 DIVIS
Page 323 and 324:
3423 CHEST WALL BIOPSY 3424 PLEURAL
Page 325 and 326:
3631 OPEN CHEST TRANS REVASC 3632 O
Page 327 and 328:
385 VARICOSE LIGAT & STRIP* 3850 VA
Page 329 and 330:
406 THORACIC DUCT OPERATIONS* 4061
Page 331 and 332:
4400 VAGOTOMY NOS 4401 TRUNCAL VAGO
Page 333 and 334:
4624 DELAY OPENING ILEOSTOMY 463 OT
Page 335 and 336:
4939 OTHER DESTRUC ANUS LES 494 HEM
Page 337 and 338:
5196 PERC EXTRAC COM DUC CALC 5198
Page 339 and 340:
5495 PERITONEAL INCISION 5496 INJEC
Page 341 and 342:
5749 TU DESTRUC BLADD LES NEC 575 B
Page 343 and 344:
6091 PERCUT PROSTATIC ASPIRAT 6092
Page 345 and 346:
6525 OTH LAP LOC EXC DEST OVA 6529
Page 347 and 348:
686 RADICAL ABD HYSTERECTOMY 687 RA
Page 349 and 350:
7254 TOT BREECH EXTRAC NEC 726 FORC
Page 351 and 352:
7699 FACIAL BONE/JNT OP NEC 77 INCI
Page 353 and 354:
7802 BONE GRAFT TO HUMERUS 7803 BON
Page 355 and 356:
7909 CLOSED FX REDUCTION NEC 791 CL
Page 357 and 358:
8019 OTHER ARTHROTOMY NEC 802 ARTHR
Page 359 and 360:
8151 TOTAL HIP REPLACEMENT 8152 PAR
Page 361 and 362:
8339 EXC LES SOFT TISSUE NEC 834 OT
Page 363 and 364:
8541 UNILAT SIMPLE MASTECTOMY 8542
Page 365 and 366:
8729 SPINAL X-RAY NEC 873 THORAX SO
Page 367 and 368:
8862 CONTR PHLEBOGRAM-PULMON 8863 T
Page 369 and 370:
901 MICRO EXAM-ENDOCRINE* 9011 BACT
Page 371 and 372:
9151 BACT SMEAR-MUSCULOSKEL 9152 CU
Page 373 and 374:
934 SKELETAL & OTH TRACTION* 9341 S
Page 375 and 376:
9507 DARK ADAPTATION STUDY 9509 EYE
Page 377 and 378:
9723 REPLACE TRACH TUBE 9724 REPLAC
Page 379 and 380:
9927 IONTOPHORESIS 9928 IMMUNOTHERA
Page 381 and 382:
Appendix R Diagnostic Related Group
Page 383 and 384:
104 MDC 05P CARDIAC VALVE & OTH MAJ
Page 385 and 386:
218 MDC 08P LOWER EXTREM & HUMER PR
Page 387 and 388:
332 MDC 11M OTHER KIDNEY & URINARY
Page 389 and 390:
446 MDC 21M TRAUMATIC INJURY AGE 0-
Page 391 and 392:
Appendix S Alpha-Numeric HCPCS Code
Page 393 and 394:
A0425 GROUND MILEAGE, PER STATUTE M
Page 395 and 396:
A4356 EXTERNAL URETHRAL CLAMP OR CO
Page 397 and 398:
A4636 REPLACEMENT, HANDGRIP, CANE,
Page 399 and 400:
A6021 COLLAGEN DRESSING, PAD SIZE 1
Page 401 and 402:
EACH DRESSING A6259 TRANSPARENT FIL
Page 403 and 404:
HOMEMIX B4178 PARENTERAL NUTRITION
Page 405 and 406:
C1047 CATHETER, DIAGNOSTIC, NAVI-ST
Page 407 and 408:
C1134 PACEMAKER, DUAL CHAMBER, SIGM
Page 409 and 410:
SOMNOPLASTY COAGULATING ELECTRODE C
Page 411 and 412:
C1812 ANCHOR, OBL 2.0MM MINI TAC AC
Page 413 and 414:
C2104 CATHETER, ELECTROPHYSIOLOGY,
Page 415 and 416:
C4607 LEAD, PACEMAKER, FINELINE II
Page 417 and 418:
C5601 VASCULAR CLOSURE DEVICE, VASC
Page 419 and 420:
C8513 LEAD, NEUROSTIMULATION, PISCE
Page 421 and 422:
E0147 HEAVY DUTY, MULTIPLE BREAKING
Page 423 and 424:
E0424 STATIONARY COMPRESSED GASEOUS
Page 425 and 426:
E0757 IMPLANTABLE NEUROSTIMULATOR R
Page 427 and 428:
AWAY DETACHABLE FOOTRESTS E1100 SEM
Page 429 and 430:
E1635 COMPACT (PORTABLE) TRAVEL HEM
Page 431 and 432:
PATIENT'S CARE, INTEGRATION OF NEW
Page 433 and 434:
G0115 NETT PULM-REHAB; PSYCHOLOGICA
Page 435 and 436:
INVOLVED IN THE PATIENT’S CARE, I
Page 437 and 438:
J0200 INJECTION, ALATROFLOXACIN MES
Page 439 and 440:
J1364 INJECTION, ERYTHROMYCIN LACTO
Page 441 and 442:
J2512 INJECTION, PENTAGASTRIN, PER
Page 443 and 444:
J7320 HYLAN G-F 20, 16 MG, FOR INTR
Page 445 and 446:
J9000 DOXORUBICIN HCL, 10 MG J9001
Page 447 and 448:
K0034 HEEL LOOP,EACH K0035 HEEL LOO
Page 449 and 450:
K0171 ADMINISTRATION SET, SMALL VOL
Page 451 and 452:
K0462 TEMPORARY REPLACEMENT FOR PAT
Page 453 and 454:
L0340 TLSO, ANTERIOR-POSTERIOR-LATE
Page 455 and 456:
CUSTOM FABRICATED L1686 HIP ORTHOSI
Page 457 and 458:
CUSTOM-FABRICATED L2112 ANKLE FOOT
Page 459 and 460:
L2780 ADDITION TO LOWER EXTREMITY O
Page 461 and 462:
L3640 TRANSFER OF AN ORTHOSIS FROM
Page 463 and 464:
RECLINING, PREFABRICATED, INCLUDES
Page 465 and 466:
SYSTEM, PYLON, NO COVER, SACH FOOT,
Page 467 and 468:
L5697 ADDITION TO LOWER EXTREMITY,
Page 469 and 470:
L6100 BELOW ELBOW, MOLDED SOCKET, F
Page 471 and 472:
L6765 TERMINAL DEVICE, HOOK, DORRAN
Page 473 and 474:
L8020 BREAST PROSTHESIS, MASTECTOMY
Page 475 and 476:
P2029 CONGO RED, BLOOD P2031 HAIR A
Page 477 and 478:
Q0172 CHLORPROMAZINE HYDROCHLORIDE,
Page 479 and 480:
Q9936 INJECTION OF EPO, PER 1000 UN
Page 481 and 482:
S2371 EACH ADDITIONAL INTERSPACE (L
Page 483 and 484:
S9310 NURSING SERVICES AND ALL NECE
Page 485 and 486:
V2212 SPHEROCYLINDER, BIFOCAL, PLUS
Page 487:
V5130 BINAURAL, IN THE EAR V5140 BI
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