Ill. Admin. Code tit. 77, pt. 1010, app E
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 14 secondary codes
8. Principal procedure code and up to 9 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. Primary health plan type
24. Secondary health plan type
25. Tertiary health plan type
26. Patient county
27. Patient planning area
28. Patient Health Service Area
29. Hospital Health Service Area
30. Patient age (in whole years or days if less than one year)
31. Admission date (CCYYMMD)
32. Patient zip code (zip may be masked when hospital/zip cell size less than 10)
33. Newborn birth weight in grams
34. Do Not Resuscitate (DNR) (inpatient only)
35. Hospitalization employment related
36. Admitting diagnosis code
37. Diagnosis present at admission for each diagnosis code (inpatient only)
38. Ecodes (when present)
39. Number of days between admission and primary procedure (inpatient only) (if present)
40. Row ID (when necessary: provides linkage to Revenue Code Dataset)
Ill. Admin. Code tit. 77, pt. 1010, app E