future of oshpd data presenters: starla ledbetter ginger cox
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Future of Future of OSHPD DataOSHPD Data
Presenters:Starla Ledbetter
Ginger Cox
Present on AdmissionPrincipal Language SpokenMS-DRGsClinical MeasurementsPatient AddressExternal Cause of InjuryPayer TypologyFacility Summary ReportICD-10 Code Sets
Future EnhancementsFuture Enhancements
Collection: January 1, 1996
THREE Values Y = Yes N = No U = Uncertain
Reported on principal and secondary diagnoses for all inpatient records
Condition Present At Admission
Condition Present At Admission
National Standard: October 1, 2007OSHPD Collection: July 1, 2008
FIVE ValuesY = YesN = NoU = No Information in the RecordW = Clinically UndeterminedBlank = Exempt from POA Reporting
Reported on all diagnoses and external cause of injury codes (E-codes)
Present On Admission (POA)
Present On Admission (POA)
Oct 1, 2007 through Jun 30, 2008
Allowed the reporting of two additional values for POA, with no validation
W = Reported as Clinically Undetermined
1 = Reported as Exempt
Interim Present On Admission
Interim Present On Admission
POA FrequenciesPOA Frequencies
Medicare Severity Diagnosis Related Groups
Transition from DRG Grouper: 500+ DRGs
Jan- Dec 2007
Implement MS-DRG Grouper: 900+ DRGs
Jan – June 2008
MS-DRGsMS-DRGs
Collection: IP, ED, AS data
Collection begins: January 1, 2009
Available to you with 2009 data!
Principal Language Spoken
Principal Language Spoken
HIN – Hindi HUN – Hungarian ITA – Italian JPN – Japanese KOR – Korean LAO – Laotian HMN – Miao, Hmong KHM – Mon-Khmer, Cambodian NAV – NavajoPER – Persian
POL – Polish POR – Portuguese RUS – Russian SCR – Serbo-Croatian SPA – Spanish TGL – Tagalog THA – Thai URD – Urdu VIE – Vietnamese YID – Yiddish 999 – Unknown
Principal Language SpokenPrincipal Language Spoken
ENG – English ARA – Arabic ARM – Armenian CHI – Chinese FRE – French CPF – French Creole GER – German GRE – Greek GUJ – GujarathiHEB – Hebrew
24 spaces for write-in language24 spaces for write-in language
Albumin, serumASTBUNCreatinineHemoglobinINR
Clinical MeasurementsClinical Measurements
Oxygen SaturationpHPlatelet countPotassiumSodiumWhite blood cell count
Business Case
Technical Solution
Three data typesInpatientEmergency DepartmentAmbulatory Surgery
HOME
Patient AddressPatient Address
Codes E870-E876 for misadventures
Codes E878-E879 for abnormal reactions
Proposed date: January 1, 2010
External Cause of InjuryExternal Cause of Injury
Need for comprehensive, mutually exclusive categories and definitions
Developed and maintained by the Public Health Data Standards Consortium
Updated annually each October
http://www.phdsc.org/standards/payer-typology-source.asp
Payer TypologyPayer Typology
01 Medicare02 Medical03 Private Coverage04 Workers Comp05 County Indigent 06 Other Govt.07 Other Indigent08 Self Pay09 Other Payer
1 Managed Care*
(Knox Keene/MCOHS)
2 Managed Care Other
3 Traditional Coverage
*Name of Plan
OSHPD IP Payer CodesOSHPD IP Payer Codes
09 Self-pay11 Other Non-Federal
Programs12 Preferred Provider
Organization (PPO)13 Point of Service (POS)14 Exclusive Provider
Organization (EPO)16 Health Maintenance
Organization (HMO) Medicare Risk
AM Automobile MedicalBL Blue Cross/Blue
Shield
CH Champus
CI Commercial Insurance Company
DS DisabilityHM Health Maintenance
OrganizationMA Medicare Part AMB Medicare Part BMC MedicaidOF Other Federal
ProgramTV Title VVA Veteran Affairs PlanWC Workers’
Compensation 00 Other
OSHPD ED and AS Payer Codes
OSHPD ED and AS Payer Codes
1
2
3
4
5
6
7
8
9
Medicare
Medicaid
Other Government (not Medicare, Medicaid or corrections)
Department of Corrections
Private Health Insurance
Blue Cross/Blue Shield
Managed Care, unspecified
No payment from organization
Miscellaneous/other
Payer Typology: 1st LevelPayer Typology: 1st Level
1 MEDICARE
11 Medicare (Managed Care)
111 Medicare HMO
112 Medicare PPO
113 Medicare POS
119 Medicare Managed Care Other
12 Medicare (Non-managed Care)
121 Medicare FFS
122 Medicare Drug Benefit
123 Medicare Medical Savings Account (MSA)
129 Medicare Non-managed Care Other
19 Medicare Other
Payer Typology: ExpandedPayer Typology: Expanded
8 NO PAYMENT from an Organization/Agency/Program/Private Payer Listed
81 Self-pay
82 No Charge
821 Charity
822 Professional Courtesy
823 Research/Clinical Trial
83 Refusal to Pay/Bad Debt
84 Hill Burton Free Care
85 Research/Donor
89 No Payment, Other
Payer Typology: ExpandedPayer Typology: Expanded
Facility Summary ReportsFacility Summary Reports
Data Distribution ReportImmediate feedback to the reporting facility
Facility Profile ReportWithin 15 days of approval
Revised Facility Summary ReportWithin 15 days of approval
http://www.oshpd.ca.gov/MIRCal/Default.aspxhttp://www.oshpd.ca.gov/MIRCal/Default.aspx
Choose Date Type : ED or AS or IP
Choose Date Type : ED or AS or IP
Select which facilitySelect which facility
Select which report periodSelect which report period
Click on “List Report”Click on “List Report”
ICD-10-CM Diagnosis External cause of injury, poisoning,
adverse effect
ICD-10-PCS Inpatient procedure
Effective date: October 1, 2013
ICD-10-CM and ICD-10-PCS Code Sets
ICD-10-CM and ICD-10-PCS Code Sets
ICD-10-CM FormatICD-10-CM Format
ICD-9-CM 365.83 aqueous misdirection (malignant glaucoma)
ICD-10-CM H40.839 aqueous misdirection (malignant glaucoma)
H40.831 Aqueous misdirection, right eyeH40.832 Aqueous misdirection, left eyeH40.833 Aqueous misdirection, bilateral eyesH40.839 Aqueous misdirection, unspecified eye
ICD-9-CM vs ICD-10-CM Diagnosis
ICD-9-CM vs ICD-10-CM Diagnosis
ICD-10-PCS FormatICD-10-PCS Format
Section
Body
System
Root
Operation
Body
Part
Approach
Device
Extension
1 2 3 4 5 6 7
ICD-9-CM 42.41 Partial esophagectomy
No further breakdown for what part of esophagus was resected
ICD-10-PCS ODT10ZZ Open resection of
upper esophagectomy
4th digit = body part = upper esophagus
ICD-9-CM vs ICD-10-PCS Procedure
ICD-9-CM vs ICD-10-PCS Procedure
Effective Date: October 1, 2013Impact AnalysisBudget PlanningSystem upgradesLimit to basic edits Regulation proposalEducationTestGo LiveContinue updates as usual
Next StepsNext Steps
Any Questions ??Any Questions ??
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