Ill. Admin. Code tit. 77, pt. 1010, app D
1. Facility identifier (federal tax identification number/Department assigned/NPI)
2. Patient sex
3. Admission/visit type
4. Admission/visit source
5. Length of stay (in whole days; inpatient only)
6. Patient discharge status
7. Principal diagnosis code and up to 24 secondary codes
8. Principal procedure code and up to 24 secondary codes
9. DRG (or successor category grouping) code inpatient/APC outpatient
10. MDC (or successor) code inpatient/body system outpatient
11. Total charges
12. Room/board charges (inpatient only)
13. Ancillary charges
14. Anesthesiology charges
15. Pharmacy charges
16. Radiology charges
17. Clinical lab charges
18. Labor/delivery charges (inpatient only)
19. Operating room charges
20. Oncology charges
21. Other charges
22. Combined bill indicator (inpatient only)
23. Patient county
24. Patient planning area
25. Patient Health Service Area
26. Hospital Health Service Area
27. Patient date of birth (CCYYMMDD)
28. Admission date (CCYYMMDD) and time (HH)
29. Discharge Date (CCYYMMDD) and time (HH)
30. Primary, secondary and tertiary payer IDs and health plan names (when available)
31. Patient zip code in every record
32. Primary surgical procedure date (if present)
33. Patient race
34. Patient ethnicity
35. Newborn birth weight in grams
36. Do Not Resuscitate (DNR) (inpatient only)
37. Condition employment related
38. Accident employment related
39. Crime victim
40. Admitting diagnosis code/reason for visit code
41. Diagnosis present at admission for each diagnosis code (inpatient only)
42. Ecodes (when present)
43. Row ID (when necessary: provides linkage to Revenue Code Dataset)
Ill. Admin. Code tit. 77, pt. 1010, app D