CODE TABLES - APPENDIX - MedPAR L3K                                                                                                                   
                                                                                                                         
                                                                                                 
MEDPAR Beneficiary Age  

                                                     Age is grouped by the following values:   
         						 	 1 = less than 25                             
           							 2 = 25 - 44                                  
          					 		 3 = 45 - 64                                  
           							 4 = 65 - 69                                  
           							 5 = 70 - 74                                  
           							 6 = 75 - 79                                  
           							 7 = 80 - 84                                  
         							 8 = 85 - 89                                  
           							 9 = 90 and over                              

                                                    The beneficiary's age as of date of admission.
                                                             
                                                                                                                                                              
 BENE_MDCR_STUS_TB                       CWF Beneficiary Medicare Status Table

       10 = Aged without ESRD
       11 = Aged with ESRD
       20 = Disabled without ESRD
       21 = Disabled with ESRD
       31 = ESRD only



 BENE_RACE_TB                            Beneficiary Race Table

       0 = Unknown
       1 = White
       2 = Black
       3 = Other
       4 = Asian
       5 = Hispanic
       6 = North American Native



 BENE_SEX_IDENT_TB                       Beneficiary Sex Identification Table

       1 = Male
       2 = Female
       0 = Unknown



 CLM_ADMTG_DGNS_VRSN_TB                  Claim Admitting Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_CARE_IMPRVMT_MODEL_TB               Claim Care Improvement Model Table


      61 = CLAIM CARE IMPROVEMENT MODEL 1
      62 = CLAIM CARE IMPROVEMENT MODEL 2
      63 = CLAIM CARE IMPROVEMENT MODEL 3
      64 = CLAIM CARE IMPROVEMENT MODEL 4



 CLM_DGNS_VRSN_TB                        Claim Diagnosis Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_HRR_PRTCPNT_IND_TB                  Claim HRR Participant Indicator Code Table

      0 = Not participating
      1 = Participating and not equal to 1.0000
      2 = Participating and equal to 1.0000



 CLM_PRCDR_VRSN_TB                       Claim Procedure Version Code Table

      Valid Values:
      9 = ICD-9
      0 = ICD-10



 CLM_PTNT_RLTNSHP_TB                     Claim Patient Relationship Table

       01 = Spouse
       04 = Grandparent
       05 = Grandchild
       07 = Niece/Nephew
       10 = Foster child
       15 = Ward of the court
       17 = Step child
       18 = Patient is insured
       19 = Natural child/insured financial responsibility
       20 = Employee
       21 = Unknown
       22 = Handicapped dependent
       23 = Sponsored dependent
       24 = Minor dependent of a minor dependent
       32 = Mother
       33 = Father
       39 = Organ donor
       40 = Cadaver donor
       41 = Injured plaintiff
       43 = Natural child/insured does not have financial responsibility



 CLM_SRC_IP_ADMSN_TB                     Claim Source Of Inpatient Admission Table

              **For Inpatient/SNF Claims:**


       0 = ANOMALY: invalid value, if present,
           translate to '9'
       1 = Non-Health Care Facility Point of Origin
           (Physician Referral) - The patient was
           admitted to this facility upon an order
           of a physician.
       2 = Clinic referral - The patient was
           admitted upon the recommendation of
           this facility's clinic physician.
       3 = HMO referral - Reserved for national
           assignment. (eff. 3/08)
           Prior to 3/08, HMO referral - The patient
           was admitted upon the recommendation of
           a health maintenance organization (HMO)
           physician.
       4 = Transfer from hospital (Different Facility) -
           The patient was admitted to this facility
           as a hospital transfer from an acute care
           facility where he or she was an inpatient.
       5 = Transfer from a skilled nursing
           facility (SNF) or Intermediate Care Facility
           (ICF) - The patient was admitted to this
           facility as a transfer from a SNF or ICF
           where he or she was a resident.
       6 = Transfer from another health care
           facility - The patient was admitted
           to this facility as a transfer from
           another type of health care facility
           not defined elsewhere in this code list
           where he or she was an inpatient.
       7 = Emergency room - The patient was
           admitted to this facility after receiving
           services in this facility's emergency
           room department. Obsolete - eff. 7/1/10
       8 = Court/law enforcement - The patient was
           admitted upon the direction of a
           court of law or upon the request of
           a law enforcement agency's representative.
           Includes transfers from incarceration facilities.
       9 = Information not available -  The means
           by which the patient was admitted is
           not known.
       A = Reserved for National Assignment. (eff. 3/08)
           Prior to 3/08 defined as: Transfer from a Critical
           Access Hospital - patient was admitted/referred
           to this facility as a transfer from a Critical
           Access Hospital.
       B = Transfer from Another Home Health Agency -
           The patient was admitted to this home
           health agency as a transfer from another
           home health agency.(Discontinued July 1,2010-
           See Condition Code 47)
       C = Readmission to Same Home Health Agency -
           The patient was readmitted to this home
           health agency within the same home health
           episode period. (Discontinued July 1,2010)
       D = Transfer from hospital inpatient in the
           same facility resulting in a separate
           claim to the payer - The patient was
           admitted to this facility as a transfer
           from hospital inpatient within this
           facility resulting in a separate
           claim to the payer.
       E = Transfer from Ambulatory Surgery Center -
           The patient was admitted to this facility as
           a transfer from an ambulatory surgery center.
           (eff. 10/1/2007)
       F = Transfer from Hospice and is under a Hospice
           Plan of Care or Enrolled in a Hospice Program -
           The patient was admitted to this facility as a
           transfer from a hospice.
           (eff. 10/1/2007)
         ---------------------------------------
            **For Newborn Type of Admission**

       1 = Normal delivery - A baby delivered with
           out complications.  Obsolete eff. 10/1/07
       2 = Premature delivery - A baby delivered
           with time and/or weight factors
           qualifying it for premature status.
           Obsolete eff. 10/1/07
       3 = Sick baby - A baby delivered with
           medical complications, other than those
           relating to premature status. Obsolete eff. 10/1/07
       4 = Extramural birth - A baby delivered in
           a nonsterile environment.  Obsolete eff. 10/1/07
       5 = Born Inside this Hospital - eff. 10/1/07
       6 = Born Outside of this Hospital - eff. 10/1/07
       7-9 = Reserved for national assignment.



 CLM_VBP_PRTCPNT_IND_TB                  Claim VBP Participant Indicator Table

       Y = Participating in Hospital Value Based Purchasing
       N = Not participating in Hospital Value Based Purchasing
       Blank = same as 'N'



 CTGRY_EQTBL_BENE_IDENT_TB               Category Equatable Beneficiary Identification Code (BIC) Table

       NCH BIC              SSA Categories
       -------              --------------

       A  = A;J1;J2;J3;J4;M;M1;T;TA
       B  = B;B2;B6;D;D4;D6;E;E1;K1;K2;K3;K4;W;W6;
            TB(F);TD(F);TE(F);TW(F)
       B1 = B1;BR;BY;D1;D5;DC;E4;E5;W1;WR;TB(M)
            TD(M);TE(M);TW(M)
       B3 = B3;B5;B9;D2;D7;D9;E2;E3;K5;K6;K7;K8;W2
            W7;TG(F);TL(F);TR(F);TX(F)
       B4 = B4;BT;BW;D3;DM;DP;E6;E9;W3;WT;TG(M)
            TL(M);TR(M);TX(M)
       B8 = B8;B7;BN;D8;DA;DV;E7;EB;K9;KA;KB;KC;W4
            W8;TH(F);TM(F);TS(F);TY(F)
       BA = BA;BK;BP;DD;DL;DW;E8;EC;KD;KE;KF;KG;W9
            WC;TJ(F);TN(F);TT(F);TZ(F)
       BD = BD;BL;BQ;DG;DN;DY;EA;ED;KH;KJ;KL;KM;WF
            WJ;TK(F);TP(F);TU(F);TV(F)
       BG = BG;DH;DQ;DS;EF;EJ;W5;TH(M);TM(M);TS(M)
            TY(M)
       BH = BH;DJ;DR;DX;EG;EK;WB;TJ(M);TN(M);TT(M)
            TZ(M)
       BJ = BJ;DK;DT;DZ;EH;EM;WG;TK(M);TP(M);TU(M)
            TV(M)
       C1 = C1;TC
       C2 = C2;T2
       C3 = C3;T3
       C4 = C4;T4
       C5 = C5;T5
       C6 = C6;T6
       C7 = C7;T7
       C8 = C8;T8
       C9 = C9;T9
       F1 = F1;TF
       F2 = F2;TQ
       F3-F8 = Equatable only to itself (e.g., F3 IS
               equatable to F3)
       CA-CZ = Equatable only to itself.  (e.g., CA is
               only equatable to CA)

            ---------------------------------------
                       RRB Categories

       10 = 10
       11 = 11
       13 = 13;17
       14 = 14;16
       15 = 15
       43 = 43
       45 = 45
       46 = 46
       80 = 80
       83 = 83
       84 = 84;86
       85 = 85



 GEO_SSA_STATE_TB                        State Table

        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
        46 = Utah
        47 = Vermont
        48 = Virgin Islands
        49 = Virginia
        50 = Washington
        51 = West Virginia
        52 = Wisconsin
        53 = Wyoming
        54 = Africa
        55 = California
        56 = Canada & Islands
        57 = Central America and West Indies
        58 = Europe
        59 = Mexico
        60 = Oceania
        61 = Philippines
        62 = South America
        63 = U.S. Possessions
        64 = American Samoa
        65 = Guam
        66 = Commonwealth of the Northern Marianas Islands
        67 = Texas
        68 = Florida (eff. 10/2005)
        69 = Florida (eff. 10/2005)
        70 = Kansas (eff. 10/2005)
        71 = Louisiana (eff. 10/2005)
        72 = Ohio (eff. 10/2005)
        73 = Pennsylvania (eff. 10/2005)
        74 = Texas (eff. 10/2005)
        75 = California
        76 = Iowa
        77 = Minnesota
        78 = Illinois
        79 = Missouri
        80 = Maryland (eff. 8/2000)
        81 = Connecticut
        82 = Massachusetts
        83 = New Jersey
        84 = Puerto Rico
        85 = Georgia
        86 = North Carolina
        87 = South Carolina
        88 = Tennessee
        90 = Oklahoma
        91 = Colorado
        92 = California
        93 = Oregon
        94 = Washington
        95 = Louisiana
        96 = New Mexico
        97 = Texas
        98 = Hawaii
        99 = With 000 county code is AS (American Samoa);
             otherwise - unknown
        The following state codes are provider state codes that
        have been assigned as part of the CMS Certification
        Number(CCN) coding system assignment process.
        A0 = California (eff. 4/2019)
        A1 = California (eff. 4/2019)
        A2 = Florida (eff. 4/2019)
        A3 = Louisiana (eff. 4/2019)
        A4 = Michigan (eff. 4/2019)
        A5 = Mississippi (eff. 4/2019)
        A6 = Ohio (eff. 4/2019)
        A7 = Pennsylvania (eff. 4/2019)
        A8 = Tennessee (eff. 4/2019)
        A9 = Texas (eff. 4/2019)
        B0 = Kentucky (eff. 4/2020)
        B1 = West Virginia (eff. 4/2020)
        B2 = California (eff. 4/2020)
        B3 = California (eff. 10/2022)
	B4 = California (eff. 10/2022)
	B5 = California (eff. 10/2022)
	B6 = North Carolina (eff. 4/2023)
	B7 = Alabama (eff. 4/2023)
	B8 = Northern Mariana Islands  (eff. 4/2023)
	B9 = Delaware (eff. 4/2023)
	C0 = District of Columbia (eff. 4/2023)
	C1 = Florida (eff. 4/2023)
	C2 = Georgia (eff. 4/2023)
	C3 = Guam (eff. 4/2023)
	C4 = Illinois (eff. 4/2023)
	C5 = Indiana (eff. 4/2023)
	C6 = Maine (eff. 4/2023)
	C7 = Michigan (eff. 4/2023)
	C8 = Mississippi (eff. 4/2023)
	C9 = Missouri (eff. 4/2023)
	D0 = Nebraska (eff. 4/2023)
	D1 = New York 	(eff. 4/2023)
	D2 = Ohio (eff. 4/2023)
	D3 = Pennsylvania (eff. 4/2023)
	D4 = South Carolina (eff. 4/2023)
        D5 = Virginia (eff. 4/2023)
        D6 = California
        D7 = California
        D8 = California
        D9 = Arizona
        E1 = Nevada
        E2 = Texas
        E3 = Texas



 MEDPAR_ADMSN_DAY_TB                     MEDPAR Admission Day Code Table

      1 = Sunday
      2 = Monday
      3 = Tuesday
      4 = Wednesday
      5 = Thursday
      6 = Friday
      7 = Saturday



 MEDPAR_BENE_DEATH_DT_VRFY_TB            MEDPAR Beneficiary Death Date Verified Code Table

      V = Date of death verified (EDB received DOD from SSA's
          MBR)
      B = Date of death taken from claim (EDB received DOD
          from claim)
      N = Date of death not verified (neither V or B
          applicable, but claim status code indicated death)
      Space = No date of death indicated



 MEDPAR_BENE_DSCHRG_STUS_TB              MEDPAR Beneficiary Discharge Status Code Table

      A = Discharged alive (claim status code other than 20 or
          30)
      B = Discharged dead
      C = Still a patient



 MEDPAR_BENE_PRMRY_PYR_TB                MEDPAR Beneficiary Primary Payer Code Table

      A = Working aged bene/spouse with eghp
      B = ESRD bene in 18-month coordination period with eghp
      C = Conditional Medicare payment; future reimbursement
       expected
      D = Auto no-fault or any liability insurance
      E = Worker's compensation
      F = Phs or other federal agency (other than dept of
      veterans affairs)
      G = Working disabled
      H = Black lung
      I = Dept of veterans affairs
      J = Any liability insurance
      Z/BLANK = Medicare is primary payer



 MEDPAR_CRED_RCVD_RPLCD_DVC_TB           MEDPAR Credit Received from Manufacturer for Replaced Medical Device Switch Table

      Y = The claim involved a credit from
          the device manufacturer for a
          Replaced Medical Device.
      N = The claim did not involve a credit from
          the device manufacturer for a
          Replaced Medical Device.



 MEDPAR_CRNRY_CARE_IND_TB                MEDPAR Coronary Care Indicator Code Table

      BLANK = No coronary care indication
      0 = General (revenue code 0210)
      1 = Myocardial (revenue code 0211)
      2 = Pulmonary care (revenue code 0212)
      3 = Heart transplant (revenue code 0213)
      4 = Intermediate CCU (revenue code 0214)



 MEDPAR_ESRD_COND_TB                     MEDPAR ESRD Condition Code Table

      00 = No ESRD Condition Codes
      70 = Self-Administered Epo
      71 = Full Care In Unit
      72 = Self-Care In Unit
      73 = Self-Care Training
      74 = Home Dialysis
      75 = Home Dialysis/100% Reimbursement
      76 = Backup-In-Facility Dialysis



 MEDPAR_ESRD_SETG_IND_TB                 MEDPAR ESRD Setting Indicator Code Table

      00 = Ip renal dialysis-general (revenue code 0800)
      01 = Ip renal dialysis-hemodialysis (revenue code 0801)
      02 = Ip renal dialysis-peritoneal (non-capd: revenue
      code 0802)
      03 = Ip renal dialysis-capd (revenue code 0803)
      04 = Ip renal dialysis-ccpd (revenue code 0804)
      09 = Ip renal dialysis-other (revenue code 0809)
      20 = Hemodialysis-op-general (revenue code 0820)
      21 = Hemodialysis-op-hemodialysis/composite (revenue code
       0821)
      22 = Hemodialysis-op-home supplies (revenue code 0822)
      23 = Hemodialysis-op-home equipment (revenue code 0823)
      24 = Hemodialysis-op-maintenance/100% (revenue code 0824)
      25 = Hemodialysis-op-support services (revenue code 0825)
      29 = Hemodialysis-op-other (revenue code 0829)
      30 = Peritoneal-op/home-general (revenue code 0830)
      31 = Peritoneal-op/home-peritoneal/composite (revenue
      32 = Peritoneal-op/home-home supplies (revenue code 0832)
      33 = Peritoneal-op/home-home equipment (revenue code
       0833)
      34 = Peritoneal-op/home-maintenance/100% (revenue code
      0834)
      35 = Peritoneal-op/home-support services (revenue code
       0835)
      39 = Peritoneal-op/home-other (revenue code 0839)
      40 = Capd-op-capd/general (revenue code 0840)
      41 = Capd-op-capd/composite (revenue code 0841)
      42 = Capd-op-home supplies (revenue code 0842)
      43 = Capd-op-home equipment (revenue code 0843)
      44 = Capd-op-maintenance/100% (revenue code 0844)
      45 = Capd-op-support services (revenue code 0845)
      49 = Capd-op-other (revenue code 0849)
      50 = Ccpd-op-ccpd/general (revenue code 0850)
      51 = Ccpd-op-ccpd/composite (revenue code 0851)
      52 = Ccpd-op-home supplies (revenue code 0852)
      53 = Ccpd-op-home equipment (revenue code 0853)
      54 = Ccpd-op-maintenance/100% (revenue code 0854)
      55 = Ccpd-op-support services (revenue code 0855)
      59 = Ccpd-op-other (revenue code 0859)
      80 = Miscellaneous dialysis-general (revenue code 0880)
      81 = Miscellaneous dialysis-ultrafiltration (revenue code
       0881)
      89 = Miscellaneous dialysis-other (revenue code 0889)
      BLANK = No ESRD setting indication



 MEDPAR_GHO_PD_TB                        MEDPAR GHO Paid Code Table

      1 = GHO has paid the provider
      Blank Or 0 = GHO has not paid the provider



 MEDPAR_ICU_IND_TB                       MEDPAR Intensive Care Unit (ICU) Indicator Code Table

      0 = General (revenue center 0200)
      1 = Surgical (revenue center 0201)
      2 = Medical (revenue center 0202)
      3 = Pediatric (revenue center 0203)
      4 = Psychiatric (revenue center 0204)



 MEDPAR_INFRMTL_ENCTR_IND_TB             MEDPAR Informational Encounter Indicator Code Table

      Y = Beneficiary enrolled in MCO
      N = Beneficiary not enrolled in MCO



 MEDPAR_MA_TCHNG_IND_TB                  MEDPAR MA Teaching Indicator Code Table

      Y = Claim includes request for supplemental
          IME/DGME/N&AH payment.
      N = Claim does not include request for supplemental
          IME/DGME/N&AH payment.



 MEDPAR_OBSRVTN_TB                       MEDPAR Observation Switch Table

      Y = The claim involved treatment or observation in
          an observation room.
      N = The claim did not involve treatment or
          observation in an observation room.



 MEDPAR_OP_SRVC_IND_TB                   MEDPAR Outpatient Services Indicator Code Table

      0 = No outpatient services/ambulatory surgical care
          (revenue code other than 049X, 050X)
      1 = Outpatient services (revenue code 050X)
      2 = Ambulatory surgical care (revenue code 049X)
      3 = Outpatient services and ambulatory surgical care
          (revenue codes 049X and 050X)



 MEDPAR_ORGN_ACQSTN_IND_TB               MEDPAR Organ Acquisition Indicator Code Table

      K1 = General classification (revenue code 0810)
      K2 = Living donor kidney (revenue code 0811)
      K3 = Cadaver donor kidney (revenue code 0812)
      K4 = Unknown donor kidney (revenue code 0813)
      K5 = Other kidney acquisition (revenue code 0814)
      H1 = Cadaver donor heart (revenue code 0815)
      H2 = Other heart acquisition (revenue code 0816)
      L1 = Donor liver (revenue code 0817)
      01 = Other organ acquisition (revenue code 0819)
      02 = General acquisition (revenue code 0890)
      B1 = Bone donor bank (revenue code 0891)
      03 = Organ donor bank other than kidney (revenue code 0892)
      S1 = Skin donor bank (revenue code 0893)
      04 = Other donor bank (revenue code 0899)
      BLANK = No organ acquisition indication



 MEDPAR_PHRMCY_IND_TB                    MEDPAR Pharmacy Indicator Code Table

      0 = No drugs (revenue code other than those listed below)
      1 = General drugs and/pr IV therapy (revenue code 025x,
          026x)
      2 = Erythropoietin (epoetin:  revenue code 0630, 0635,
          0637, 0639)
      3 = Blood clotting drugs (revenue code 0636)
      4 = General drugs and/or IV therapy; and epoetin
          (combination of values 1 and 2)
      5 = General drugs and/or IV therapy; and blood clotting
          drugs (combination of values 1 and 3)



 MEDPAR_PPS_IND_TB                       MEDPAR PPS Indicator Code Table

      0 = Non PPS
      2 = PPS



 MEDPAR_PROD_RPLCMT_LIFECYC_TB           MEDPAR Product Replacement within Lifecycle Switch

      Y = Claim involves the replacement of a product
          earlier than scheduled due to apparent malfunction.
      N = Claim does not involve the replacement of a product
          earlier than scheduled due to apparent malfunction.



 MEDPAR_PROD_RPLCMT_RCLL_TB              MEDPAR Product Replacement for known Recall Switch Table

      Y = Claim involves the replacement of a product
          due to a recall of the product by the manufacturer
          or by the FDA.
      N = Claim does not involve the replacement of a product
          due to a recall of the product by the manufacturer
          or by the FDA.



 MEDPAR_PRVDR_NUM_SPCL_UNIT_TB           MEDPAR Provider Number Special Unit Code

      M = PPS-exempt psychiatric unit in CAH
      R = PPS-exempt rehabilitation unit in CAH
      S = PPS-exempt psychiatric unit
      T = PPS-exempt rehabilitation unit
      U = Swing-bed short-term/acute care hospital
      W = Swing-bed long-term hospital
      Y = Swing-bed rehabilitation hospital
      Z = Swing-bed rural primary care hospital; eff
      10/97 changed to critical access hospitals
      Blanks = Not PPS-exempt or swing-bed designation



 MEDPAR_RDLGY_CT_SCAN_IND_TB             MEDPAR Radiology CT Scan Indicator Code Table

      0 = No  radiology CT scan (revenue code not 035X)
      1 = Yes radiology CT scan (revenue code 035X)



 MEDPAR_RDLGY_DGNSTC_IND_TB              MEDPAR Radiology Diagnostic Indicator Code Table

      0 = No  radiology-diagnostic (revenue code not 032x)
      1 = Yes radiology-diagnostic (revenue code 032x)



 MEDPAR_RDLGY_NUCLR_MDCN_IND_TB          MEDPAR Radiology Nuclear Medicine Indicator Code Table

      0 = No  nuclear medicine (revenue code not 034x)
      1 = Yes nuclear medicine (revenue code 034x)



 MEDPAR_RDLGY_ONCLGY_IND_TB              MEDPAR Radiology Oncology Indicator Code Table

      0 = No  radiology-oncology (revenue code not 028x)
      1 = Yes radiology-oncology (revenue code 028x)



 MEDPAR_RDLGY_OTHR_IMGNG_IND_TB          MEDPAR Radiology Other Imaging Indicator Code Table

      0 = No  other imaging services (revenue code not 040x)
      1 = Yes other imaging services (revenue code 040x)



 MEDPAR_RDLGY_THRPTC_IND_TB              MEDPAR Radiology Therapeutic Indicator Code Table

      0 = No  radiology-therapeutic (revenue code not 033X)
      1 = Yes radiology-therapeutic (revenue code 033X)



 MEDPAR_SRGCL_PRCDR_IND_TB               MEDPAR Surgical Procedure Indicator Code Table

      0 = No  surgery indicated
      1 = Yes surgery indicated



 MEDPAR_SS_LS_SNF_IND_TB                 MEDPAR Short Stay/Long Stay/SNF Indicator Code Table

      N = SNF Stay (Prvdr3 = 5, 6, U, W, Y, or Z)
      S = Short-Stay (Prvdr3 = 0, M, R, S, T)
      L = Long-Stay (All Others)



 MEDPAR_TRNSPLNT_IND_TB                  MEDPAR Transplant Indicator Code Table

      0 = No organ or kidney transplant
          (revenue code not 0362 or 0367)
      2 = Organ transplant other than kidney (revenue code
          0362)
      7 = Kidney transplant (revenue code 0367)



 MEDPAR_WRNG_IND_TB                      MEDPAR Warning Indicators Code Table

      Warning indicator 1 ('adjustment indicator' derived
      from the presence of query code values noted below
      on any of the claim records included in the analysis):
      0 = No adjustment (no query code = 0 or 5)
      1 = Credit adjustment (query code = 0)
      2 = Debit adjustment (query code = 5)
      3 = Credit and debit adjustment (both query code = 0
      and 5)

      Warning indicator 2 ('error condition' derived from
      checking the edit code trailer on the final action
      claims(s) that comprise the stay):
      0 = No error
      1 = Error condition

      Warning indicator 3 ('reimbursement/total charge
      indicator' derived after summing up fields on the
      final action claim(s) that comprise the stay; checks
      resulting Medicare payment amount (commonly called
      reimbursement), total charge amount, as well as
      beneficiary primary payer amount and utilization day
      count):

      0 = Medicare payment amount and total charge amount >
      zeroes
      1 = Medicare payment amount and total charge amount <
      zeroes
      2 = Medicare payment amount is a credit
      3 = Total charge amount is a credit
      4 = Medicare payment amount, total charge amount,
      beneficiary primary payer claim payment amount,
      and utilization day count = zeroes

      Warning indicator 4 ('utilization day/los day indicator'
      derived after summing up fields on the final action
      claim(s) that comprise the stay; compares resulting
      utilization day count and length-of-stay count):

      0 = Utilization day count = los day count
      1 = Utilization day count < los day count
      2 = Utilization day count > los day count

      warning indicator 5 ('single/multiple claim indicator'
      derived when the stay record is created by checking
      the number of final action claims that comprise the
      stay):

      0 = Stay includes a single final action claim
      1 = Stay includes multiple final action claims
      2 = Stay includes multiple final action claims and
      beneficiary is still a patient (applicable to
      SNF stays only)

      Warning indicator 6 ('intermediary cancel indicator'
      derived from the presence of the values noted below
      for intermediary claim action code and intermediary-
      requested claim cancel reason code on any of the claims
      included in the analysis.   If multiple claims contain
      these values, latest claim is used.  If both specified
      action code and cancel reason code are present, cancel
      reason code takes priority.):

      0 = No cancel action
      1 = Cancel action by credit adjustment (action code =
      (2 or 6)
      2 = Cancel action only (action code = 4)
      3 = Coverage transfer (cancel reason code = C)
      4 = Plan transfer (cancel reason code = P)
      5 = Scramble (cancel reason code = S)
      6 = Duplicate billing (cancel reason code = D)
      7 = Other (cancel reason code = H)
      8 = Combining 2 spells or 2 beneficiary records
      (cancel reason code = L)

      Warning indicator 7 ('state/county numeric indicator'
      derived from checking the format of the beneficiary
      residence SSA state code and beneficiary residence
      county code on the final action claim(s) that comprise
      the stay; determine if in numeric range):

      0 = State and county codes are valid numeric values
      1 = State and county codes are not in numeric range
      2 = State code is not in numeric range
      3 = County code is not in numeric range

      Warning indicator 8 ('duplicate indicator' derived from
      the presence of two claim records with the same claim
      number, admission date, provider number, claim from/
      thru date, HCFA process date and query code; death/
      admission date indicator derived by comparing the
      admission date on the final claim(s) that comprise the
      stay to the beneficiary death date):

      0 = Do duplicate record
      1 = Duplicate record
      2 = Death date < admission date
      3 = Death date < admission date and duplicate record

      Warning indicator 9 ('pass-thru indicator' derived from
      the presence of a pass thru per diem amount on the final
      action claim(s) that comprise the stay):

      0 = No pass thru per diem present (Non-PPS)
      1 = Pass thru per diem present on final action claim

      Warning indicator 10 (eff 3/96 update) (rugs indicator
      applicable to 'nhcmq rugs III SNF demo' stay records
      derived from the presence of 9,000 series revenue
      center codes.)

      0 = No rugs 9,000 series revenue center codes
      2 = Rugs 9,000 series revenue center code(s) with
      service date 1/1/96 or later
      3 = Rugs 9,000 series revenue center code(s) with
      service date 7/1/96 or later
      4 = Rugs 9,000 series revenue center code(s) with
      service date 1/1/97 or later

      Warning indicators 11 - 17 (not yet assigned; zeroes
      will be present)



 NCH_CLM_TYPE_TB                         NCH Claim Type Table

       10 = HHA claim
       20 = Non swing bed SNF claim
       30 = Swing bed SNF claim
       40 = Outpatient claim
       50 = Hospice claim
       60 = Inpatient claim
       61 = Inpatient 'Full-Encounter' claim
       62 = Medicare Advantage IME/GME Claims
       63 = Medicare Advantage (no-pay) claims
       64 = Medicare Advantage (paid as FFS) claims
       71 = RIC O local carrier non-DMEPOS claim
       72 = RIC O local carrier DMEPOS claim
       81 = RIC M DMERC non-DMEPOS claim
       82 = RIC M DMERC DMEPOS claim

      NOTE:  In the data element NCH_CLM_TYPE_CD
      (derivation rules) the numbers for these claim
      types need to be changed - dictionary reflects
      61 for all three.



 NG_ACO_IND_TB                           Next Generation (NG) Accountable Care Organization (ACO) Indicator Code Table


      0 = Base record (no enhancements)
      1 = Population Based Payments (PBP)
      2 = Telehealth
      3 = Post Discharge Home Health Visits
      4 = 3-Day SNF Waiver
      5 = Capitation
      6 = CEC Telehealth
      7 = Care Management Home Visits
      8 = Primary Care Capitation (PCC)
      9 = Home Health Benefit Enhancement - eff. 4/2021
      A = Diabetic Shoes (eff. 10/2023)
      B = Concurrent Care for Beneficiaries that Elect the
          Medicare Hospice Benefit - eff. 4/2021
      C = Kidney Disease Education (KDE) eff. 4/2021
      D = Seriously Ill Population (SIP)
      E = Flat Visit Fee (FVF)
      F = Quarterly Capitation Payment (QCP) eff. 4/2021
      G = Performance Based Adjustment (PBA) (eff. 7/2022)
      H = Home Infusion Therapy (eff. 10/2023)
      I = Medical Nutrition Therapy (eff. 10/2023)
      J = Hospice Care (eff. 10/2023)
      K = Cardiac and Pulmonary Rehabilitation (eff. 10/2023)
      L = Making Care Primary (MCP) Benefit Enhancement Indicator Track 1
      M = Making Care Primary (MCP) Benefit Enhancement Indicator Track 2
      N = Making Care Primary (MCP) Benefit Enhancement Indicator Track 3
      O = GUIDE Model Beneficiary covering all services
      Z0 = PACE straddle claim



 PTNT_DSCHRG_STUS_TB                     Patient Discharge Status Table

       01 = Discharged to home/self care (routine
            charge).
       02 = Discharged/transferred to other short term
            general hospital for inpatient care.
       03 = Discharged/transferred to skilled
            nursing facility (SNF) with Medicare
            certification in anticipation of covered
            skilled care -- (For hospitals with an
            approved swing bed arrangement, use Code
            61 - swing bed.  For reporting discharges/
            transfers to a non-certified SNF, the
            hospital must use Code 04 - ICF.
       04 = Discharged/transferred to a facility that
            provides custodial or supportive care (includes
            intermediate care facilities (ICF).  Also used
            to designate patients that are discharged/trans-
            ferred to a nursing facility with neither
            Medicare nor Medicaid certification and for
            discharges/transfers to Assisted Living Facilities.
       05 = Discharged/transferred to a designated cancer
            center or children's hospital (eff. 10/09). Prior
            to 10/1/09, discharged/transferred to another type
            of institution for inpatient care (including
            distinct parts).  NOTE:  Effective 1/2005,
            psychiatric hospital or psychiatric distinct
            part unit of a hospital will no longer be
            identified by this code.  New code is '65'.
       06 = Discharged/transferred to home care of
            organized home health service organization
            in anticipation of covered skilled care.
       07 = Left against medical advice or discontinued
            care.
       08 = Discharged/transferred to home under
            care of a home IV drug therapy provider.
            (discontinued effective 10/1/05)
       09 = Admitted as an inpatient to this
            hospital (effective 3/1/91).  In situa-
            tions  where a patient is admitted before
            midnight of the third day following the
            day of an outpatient service, the out-
            patient services are considered inpatient.
       20 = Expired
       21 = Discharged/transferred to Court/Law
            Enforcement.
       30 = Still patient.
       40 = Expired at home (Hospice claims only).
       41 = Expired in a medical facility such as
            hospital, SNF, ICF, or freestanding
            hospice. (Hospice claims only)
       42 = Expired - place unknown (Hospice claims
            only)
       43 = Discharged/transferred to a federal hospital
            (eff. 10/1/03). Discharges and transfers to a
            government operated health facility such as a
            Department of Defense hospital, a Veteran's
            Administration hospital or a Veteran's Administration
            nursing facility. To be used whenever the destination
            at discharge is a federal health care facility,
            whether the patient lives there or not.
       50 = Hospice - home (eff. 10/96)
       51 = Hospice - medical facility (certified) providing
            hospice level of care
       61 = Discharged/transferred within this insti-
            tution to a hospital-based Medicare
            approved swing bed (eff. 9/01)
       62 = Discharged/transferred to an inpatient
            rehabilitation facility including distinct
            parts units of a hospital.
            (eff. 1/2002)
       63 = Discharged/transferred to a Medicare certified
            long term care hospital. (eff. 1/2002)
       64 = Discharged/transferred to a nursing facility
            certified under Medicaid but not certified under
            Medicare (eff. 10/2002)
       65 = Discharged/Transferred to a psychiatric
            hospital or psychiatric distinct unit of a
            hospital (these types of hospitals were
            pulled from patient/discharge status code
            '05' and given their own code). (eff. 1/2005).
       66 = Discharged/transferred to a Critical Access
            Hospital (CAH) (eff. 1/1/06)
       69 = Discharge/transfers to a Designated Disaster
            Alternative Care site (eff. 10/2013)
       70 = Discharged/transferred to another type of health
            care institution not defined elsewhere in code
            list.
       71 = Discharged/transferred/referred to another
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       72 = Discharged/transferred/referred to this
            institution for outpatient services as
            specified by the discharge plan of care
            (eff. 9/01) (discontinued effective 10/1/05)
       81 = Discharged to home or self-care with a planned
            acute care hospital inpatient (eff. 10/2013)
       82 = Discharged/transferred to a short term general hospital
            for inpatient care readmission (eff. 10/2013)
       83 = Discharged/transferred to a skilled nursing facility
            (SNF) with Medicare (eff. 10/2013)
       84 = Discharged/transferred to a facility that provides
            custodial supportive care with a planned acute
            care hospital inpatient readmission certification
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       85 = Discharged/transferred to a designated cancer center or
            children's hospital with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       86 = Discharged/transferred to home under care of organized
            home health service organization with a planned acute
            care hospital inpatient readmission (eff. 10/2013)
       87 = Discharged/transferred to court/law enforcement with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       88 = Discharged/transferred to a Federal health care facility
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       89 = Discharged/transferred to a hospital-based Medicare approved
            swing bed with a planned acute care hospital inpatient
            readmission (eff. 10/2013)
       90 = Discharged/transferred to an inpatient rehabilitation
            facility (IRF) including rehabilitation distinct units of
            a hospital with a planned acute care hospital inpatient
            readmission (eff. 10/2013)
       91 = Discharged/transferred to a Medicare certified Long Term
            Care Hospital (LTCH) with a planned acute care hospital
            inpatient readmission (eff. 10/2013)
       92 = Discharged/transferred to a nursing facility certified
            under Medicaid but not certified under Medicare with a
            planned acute care hospital inpatient readmission (eff.
            10/2013)
       93 = Discharged/transferred to a psychiatric hospital or
            psychiatric distinct part unit of a hospital with a
            planned acute care hospital inpatient readmission
            (eff. 10/2013)
       94 = Discharged/transferred to a critical access hospital (CAH)
            with a planned acute care hospital inpatient readmission
            (eff. 10/2013)
       95 = Discharged/transferred to another type of health care
            institution not defined elsewhere in this code list with a
            planned acute care hospital inpatient readmission. (eff. 10/2013)



 RP_IND_TB                               Claim Representative Payee (RP) Indicator Code Table

      R = bypass representative payee
      Space



 RSDL_PMT_IND_TB                         Claim Residual Payment Indicator Code Table

      X = Residual Payment
      Space

                                                           QUERY: RIFQQ11, RIFQQ21 ON DB1V
                                  *******END OF TOC APPENDIX FOR RECORD: MEDPAR_3000_REC********


1
 LIMITATIONS APPENDIX FOR RECORD: MEDPAR_3000_REC,  STATUS: PROD, VERSION: 24009
  PRINTED: 08/28/2024,  USER: BDYG,  DATA SOURCE: CA REPOSITORY ON DB1V


  CARR_LINE_DME_CVRG_STRT_LIM
                                   FULL NAME: Carrier Line DME Coverage Period Start Date Limitation
                                   DESCRIPTION :
                                     When the revised DME processing was implemented
                                     (phased in between 10/93-6/94), this field was not
                                     included on the new DMERC claim; it is being
                                     reported on the certificate of medical necessity
                                     (CMN) transaction.  HCFA does not receive CMN
                                     transaction from CWF.
                                   SOURCE:
  CARR_LINE_DME_NCSTY_LIM
                                   FULL NAME: Carrier Line DME Medical Necessity Month Count Limitation
                                   DESCRIPTION :
                                     When the revised DME processing was implemented
                                     (phased in between 10/93-6/94), this field was not
                                     included on the new DMERC claim; it is being
                                     reported on the certificate of medical necessity
                                     (CMN) transaction.  HCFA does not receive CMN
                                     transaction from CWF.
                                   SOURCE:
  CLM_ACNT_NUM_LIM
                                   FULL NAME: Beneficiary Claim Account Number Limitation
                                   DESCRIPTION :
                                     RRB-issued numbers contain an overpunch in
                                     the first position that may appear as a plus
                                     zero or A-G.   RRB-formatted numbers may
                                     cause matching problems on non-IBM machines.
                                   SOURCE:
  MEDPAR_ADMSN_DEATH_DAY_CNT_LIM
                                   FULL NAME: MEDPAR Admission Death Day Count Limitation
                                   DESCRIPTION :
                                     MEDPAR Admission Death Day Count calculated incorrectly,
                                     on both the 3/00 and 6/00 MEDPAR updates.
                                   BACKGROUND    :
                                     Both the 3/00 and 6/00 MEDPAR updates incorrectly cal-
                                     culated the mortality days; i.e., days between the
                                     admission date and the beneficiary date of death. Users
                                     of the regular unencrypted MEDPAR file, this is not a
                                     problem, as the count can be calculated using the
                                     admission date and the date of death.  The problem is
                                     with the encrypted file (the expanded modified MEDPAR)
                                     because the fields needed to calculate the mortality
                                     days are ranged.
                                   CORRECTIVE ACTION :
                                     The problem was corrected with the 12/00 MEDPAR
                                     update.  NOTE:  For users of the expanded modified
                                     MEDPAR file who needs the mortality days, the 12/00
                                     update of the FY1999 file can be given as a replace-
                                     ment.
                                   SOURCE:
                                     CONTACT         :  OIS/EDG/DMUDD
  MEDPAR_BLOOD_DDCTBL_AMT_LIM
                                   FULL NAME: MEDPAR Blood Deductible Amount Limitation
                                   DESCRIPTION :
                                     It was discovered that the blood deductible amounts were
                                     incorrect on the old MEDPAR Files.
                                   BACKGROUND    :
                                     Users of the MEDPAR data were comparing money amounts and
                                     counts present on the new MEDPAR file (created 6/95 using
                                     NCH Nearline File as the source) to that reported on the
                                     old MEDPAR File (created 3/95 and prior from claims from
                                     the Medicare Quality Assurance System) for Fiscal Year
                                     1994.  They discovered that the blood deductible amount on
                                     the new MEDPAR was greater than that of the old MEDPAR.

                                     During NCH's investigation it was determined that the old
                                     500-character MEDPAR incorrectly used a different field
                                     to report the blood deductible; specifically the noncovered
                                     charges derived from blood use Revenue Center codes 0380-
                                     0389.  The new program correctly used the NCH field,
                                     BENE_BLOOD_DDCTBL_LBLTY_AMT, which is derived from a value
                                     code (CLM_VAL_AMT associated with CLM_VAL_CD = '6').

                                     It is believed that all MEDPAR files created prior to 6/95
                                     in the 500 character version are affected. MEDPAR 500 was
                                     first available with calendar year and fiscal year 9/91
                                     updates for year 1987 forward.

                                     NOTE:  This anomoly also impacts the DRG Price Amount on the
                                     old MEDPAR file because it is calculated from a number of
                                     fields including the blood deductible.
                                   SOURCE:
                                     CONTACT         :  OIS/EDG/DMUDD
  MEDPAR_DOD_LIM
                                   FULL NAME: MEDPAR Date of Death Limitation
                                   DESCRIPTION :
                                     The Date of Death on the MEDPAR files were not up-to-
                                     date for four cycles.
                                   BACKGROUND    :
                                     The MEDPAR process pulls in 10 segments of the HISKEW
                                     file, to get the date of death.  The HISKEW file
                                     names were changed with no notification the change
                                     was being made.  Because of this, MEDPAR kept using
                                     the HISKEW that was created in June 2000.

                                     The incomplete MEDPAR cycles are: 12/2000, 3/2001,
                                     6/2001 and 9/2001 (9/2000 MEDPAR was not run).
                                   CORRECTIVE ACTION :
                                     Since this anomoly causes no major problem to the
                                     prime user of this data, a rerun will not take place.
                                     NOTE:  The 12/01 quarterly update will access up-to-
                                     date information.
                                   SOURCE:
                                   ADMINISTRATIVE DATA:
                                     START DATE      : 12/01/00
                                     END DATE        : 09/30/01
                                     DISCOVERY DATE  : 01/16/02
                                     CONTACT         :  OIS/EDG/DMUDD
  MEDPAR_DRG_PRICE_AMT_LIM
                                   FULL NAME: MEDPAR DRG Price Amount Limitation
                                   DESCRIPTION :
                                     IT WAS DISCOVERED THAT THE DRG PRICE AMOUNT WAS INCORRECT
                                     ON THE OLD MEDPAR FILES.
                                   BACKGROUND    :
                                     Users of the MEDPAR data were comparing money amounts and
                                     counts present on the new MEDPAR file (created 6/95 using
                                     NCH Nearline File as the source) to that reported on the
                                     old MEDPAR File (created 3/95 and prior from claims from
                                     the Medicare Quality Assurance System) for Fiscal Year
                                     1994.  They discovered that the DRG price amount on the
                                     new MEDPAR contained incorrect amounts.

                                     NOTE:  This anomoly occurs because the DRG price amount is
                                     calculated from a number of fields including the blood
                                     deductible amount, which was discovered to be populated
                                     incorrectly.

                                     During NCH's investigation it was determined that the old
                                     500-character MEDPAR incorrectly used a different field
                                     to report the blood deductible; specifically the noncovered
                                     charges derived from blood use Revenue Center codes 0380-
                                     0389.  The new program correctly used the NCH field,
                                     BENE_BLOOD_DDCTBL_LBLTY_AMT, which is derived from a value
                                     code (CLM_VAL_AMT associated with CLM_VAL_CD = '6').

                                     It is believed that all MEDPAR files created prior to 6/95
                                     in the 500 character version were affected. MEDPAR 500 was
                                     first available with calendar year and fiscal year 9/91
                                     updates for year 1987 forward.
                                   SOURCE:
  MEDPAR_MAR_QTRLY_UPDT_LIM
                                   FULL NAME: MEDPAR March Quarterly Update Limitation
                                   DESCRIPTION :
                                     The 3/01 quarterly update of the FY00 file containing
                                     fewer records than the 12/00 version.
                                   BACKGROUND    :
                                     The 3/01 quarterly update of the FY00 file has about
                                     50,000 fewer records than the 12/00 update.  The
                                     problem originated from modified programs required to
                                     process Version 'I' input.  There was an omission of
                                     a sort step from the modified Version 'I' processing
                                     procedures.
                                   CORRECTIVE ACTION :
                                     The sort sequence was corrected and the 3/01 in-
                                     correct datasets were replaced with new files on
                                     7/17/01.
                                   SOURCE:
                                   ADMINISTRATIVE DATA:
                                     START DATE      : 04/01/01
                                     END DATE        : 07/17/01
                                     CONTACT         :  OIS/EDG/DMUDD


                                                           QUERY: RIFQQ41 ON DB1V
                       *******END OF LIMITATION APPENDIX FOR RECORD: MEDPAR_3000_REC*******