CODE TABLES - APPENDIX - MedPAR R2K - FY16 Final Rule   [March 2015]                                                                                                                     
                                                                                                                         
                                                                                                 
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_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                                                                                                      
                 an 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 (Effective 10/1/2007)
		 Inpatient: The patient was admitted to this facility as a transfer 
                 from an ambulatory surgery center.
  		 F = Transfer from Hospice and is Under a Hospice Plan of Care or 
                 Enrolled in a Hospice Program (Effective 10/1/2007)
		 Inpatient: The patient was admitted to this facility as a transfer 
                 from a hospice.
                                                                                                                
                 ---------------------------------------                                                                                                      
                 **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'                                                                                                                          

               
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)                                                                                                                    
                 80 = Maryland (eff. 8/2000)                                                                                                                  
                 97 = Northern Marianas                                                                                                                       
                 98 = Guam                                                                                                                                    
                 99 = With 000 county code is American Samoa;                                                                                                 
                 otherwise unknown                                                                                                                            

               
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             

                 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                                         

                 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                                           

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

               
MEDPAR_MA_TCHNG_IND_TB                                 MEDPAR MA Teaching indicator Code                                                       

                 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 Credit Received from Manu1facturer for Replaced Medical Device Switch             

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

               
MEDPAR_PROD_RPLCMT_RCLL_TB                             MEDPAR Product Replacement for known Recall Switch                                      

                 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 Switch 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 Switch 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 Switch 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 Switch 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  Switch 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)                                                                                                    

                             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.                                                                                                                            

               
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 dischared/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)                                                                                                                 
                 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)             

CLM_POA_IND_TB                                         Claim Present on Admission (POA) Indicator Table             

                 Y = Diagnosis was present at the time of inpatient admission.                                                     
                 CMS will pay the CC/MCC DRG for those selected HACs that                                                          
                 are coded as 'Y' for the POA Indicator.                                                                           
                                                                                                                                   
                 N = Diagnosis was not present at the time of inpatient admission.                                                 
                 CMS will not pay the CC/MCC DRG for those selected HACs that                                                      
                 are coded as 'N' for the POA Indicator.                                                                           
                                                                                                                                   
                 U = Documentation is insufficient to determine if the                                                             
                 condition was present at the time of inpatient admission.                                                         
                 CMS will not pay the CC/MCC DRG for those selected HACs that                                                      
                 are coded as 'U' for the POA Indicator.  NOTE: From 4/15/10 to                                                    
                 12/31/10, the MQR process assigned a 'U' to those POAs that came                                                  
                 in blank.  They did this because of the POA/DGNS issue.                                                           
                                                                                                                                   
                 W = Clinically undetermined. Provider is unable to clinically determine                                           
                 whether condition was present at the time of inpatient admission.                                                 
                 CMS will pay the CC/MCC DRG for those selected HACs that                                                          
                 are coded as 'W' for the POA Indicator.                                                                           
                 NOTE:                                                                                                             
                 Inpatient claims received with a POA exempt ICD-9 code                                                            
                 effective 10/1/11 are currently being returned to provider                                                        
                 requesting a valid POA indicator.   CMS has created a                                                             
                 workaround to resolve this issue by adding a POA indicator 'W'                                                    
                 to the affected ICD-9 code instead of leaving it blank.                                                           
                                                                                                                                   
                 1 = Unreported/not used - diagnosis codes exempt from POA reporting --                                            
                 This code is equivalent to a blank on the UB-04, however, it was 
                 determined that blanks are undesirable when submitting this data 
		 via the 4010A.                                                                                          
                 CMS will not pay the CC/MCC DRG for those selected HACs that                                                      
                 are coded as '1' for the POA Indicator. The '1' POA Indicator                                                     
                 should not be applied to any codes on the HAC list.                                                               
                 Obsolete eff. 1/3/11                                                                                              
                                                                                                                                   
                 0 = This value was created by the NCH front-end system to replace                                                 
                 a blank received in the POA field.                                                                                
                                                                                                                                   
                 Z = Denotes the end of the POA indicators (obsolete 1/2011).                                                      
                                                                                                                                   
                 X = Denotes the end of the POA indicators in special                                                              
                 data processing situations that may be identified                                                                 
                 by CMS in the future (obsolete 1/2011).                                                                           
                                                                                                                                   
                 Blank = identifies diagnosis codes that are exempt from the                                                       
                 POA reporting requirements (replaces the '1'). NOTE:  NCH/NMUD                                                    
                 will carry a '0' in place of a blank.                                                                                  