Section 421.8 - Hospital Discharge Data Creation(a) DSHS records are public records under Government Code, Chapter 552, except as specifically exempted by Health and Safety Code, § 108.010 and § 108.013. Copies of such records may be obtained upon request and upon payment of user fees established by DSHS. The public use data files shall be available for public inspection during normal business hours within ten business days of a written or oral request. Discharge claims in the original format as submitted to DSHS are not available to the public, are not stored at DSHS' office and are exempt from disclosure pursuant to Health and Safety Code, § 108.010 and § 108.013, and shall not be released. Likewise, patient and physician identifying data collected by DSHS through editing of hospital data shall not be released.(b) Creation of codes and identifiers. DSHS shall develop the following codes and identifiers, as listed in paragraphs (1) - (2) of this subsection, required for creation of the public use data file and for other purposes. (1) The executive director shall create a process for assigning uniform patient identifiers, uniform physician identifiers and uniform other health professional identifiers using data elements collected. This process is confidential and not subject to public disclosure. Any documents or records produced describing the process or disclosing the person associated with an identifier are confidential and not subject to public disclosure.(2) The executive director shall create a process for assigning geographic identifiers to each discharge record.(c) Creation of public use data file. DSHS will create a public use data file by creating a single record for each inpatient discharge and adding, modifying or deleting data elements in the following manner as listed in paragraphs (1) - (11) of this subsection: (1) delete patient, and insured name, Social Security Number, address and certificate data elements and any patient identifying information, if submitted; delete patient control and medical record numbers.(2) convert patient birth date to age group;(3) convert admission and discharge dates to a length of stay measured in days and a code for the day of the week of the admission;(4) convert procedure and occurrence dates to day of stay values;(5) delete physician and other health professional names and numbers and assign an alphanumeric uniform physician identifier for the physicians and other health professionals who were reported as "attending" or "operating or other" on discharged patients;(6) assign codes indicating the primary and secondary sources of payment;(7) suppress the record level data elements in a way that the aggregate numbers for a facility or geographic region for that data element is below the number five. Five is the established minimum cell size required by § 108.011(i) of the Health and Safety Code, unless DSHS determines that a higher cell size is required to protect the confidentiality of an individual patient or physician;(8) convert all procedure codes to ICD codes (in the version that is current for the date the data was due to be submitted or the version in effect at the date of service);(9) add risk and severity adjustment scores utilizing an algorithm approved by DSHS;(10) suppress admission source data at patient level when the admission type code represents "Newborn;"(11) include the following data elements in the public use data file, unless the data element needs to be suppressed for patient or physician confidentiality as noted under paragraphs (7), (10), or (12) of this subsection:(A) Discharge Year and Quarter;(B) Provider Name (Facility Name);(C) THCIC Identification Number;(D) Facility Type Indicators;(J) Public Health Region Code;(O) Claim Type Indicator Code;(Q) Encounter Indicator: This indicates whether more than one claim was used to create the encounter;(R) Principal Diagnosis Code (Current version of ICD codes at the time data is submitted);(S) Other Diagnosis Codes (Up to 24 diagnosis codes can be submitted and reported. Current version of ICD codes at the time data is submitted);(T) Principal Procedure code (if applicable) (Current version of ICD codes at the time data is submitted);(U) Other Procedure codes (Up to 24 procedure codes can be submitted and report Current version of ICD codes at the time data is submitted);(V) Admitting Diagnosis (Current version of ICD codes at the time data is submitted);(W) External Cause of Injury (E-codes), (if applicable) (Current version of ICD codes at the time data is submitted) up to 9 E-codes can be submitted and reported;(X) Day of Week Patient is admitted code (Sun. = 1, Mon. = 2, Tues. = 3, Wed. = 4, Thur. = 5, Fri. = 6, Sat. = 7);(Z) Age group of the patient;(AA) Day number of Principal Procedure (Calculated: Principal Procedure Date minus Admission/Start of Care Date);(BB) Day number of Procedure (1) (Calculated: Procedure Date (1) minus Admission/Start of Care Date);(CC) Day number of Procedure (2) (Calculated: Procedure Date (2) minus Admission/Start of Care Date);(DD) Day number of Procedure (3) (Calculated: Procedure Date (3) minus Admission/Start of Care Date);(EE) Day number of Procedure (4) (Calculated: Procedure Date (4) minus Admission/Start of Care Date);(FF) Day number of Procedure (5) (Calculated: Procedure Date (5) minus Admission/Start of Care Date);(GG) Major Diagnostic Category (MDC);(HH) HCFA-DRG Code (Obtained from the 3M HCFA-DRG Grouper);(II) APR-DRG Code (Obtained from 3M APR-DRG Grouper);(JJ) Risk of Mortality Score (Obtained from 3M APR-DRG Grouper);(KK) Severity of Illness Score (Obtained from 3M APR-DRG Grouper);(LL) Uniform Physician Identifier assigned to Attending Physician;(MM) Uniform Physician Identifier assigned to Operating or Other Physician;(NN) Service unit indicator from which the patient received services;(OO) Accommodations Private Room Charges;(PP) Accommodations Semi-Private Charges;(QQ) Accommodations Ward Charges;(RR) Accommodations Intensive Care Charges;(SS) Accommodations Coronary Care Charges;(TT) Ancillary Service - Other Charges;(UU) Ancillary Service - Pharmacy Charges;(VV) Ancillary Service - Medical/Surgical Supply Charges;(WW) Ancillary Service - Durable Medical Equipment Charges;(XX) Ancillary Service - Used Durable Medical Equipment Charges;(YY) Ancillary Service - Physical Therapy Charges;(ZZ) Ancillary Service - Occupational Therapy Charges;(AAA) Ancillary Service - Speech Pathology Charges;(BBB) Ancillary Service - Inhalation Therapy Charges;(CCC) Ancillary Service - Blood Charges;(DDD) Ancillary Service - Blood Administration Charges;(EEE) Ancillary Service - Operating Room Charges;(FFF) Ancillary Service - Lithotripsy Charges;(GGG) Ancillary Service - Cardiology Charges;(HHH) Ancillary Service - Anesthesia Charges;(III) Ancillary Service - Laboratory Charges;(JJJ) Ancillary Service - Radiology Charges;(KKK) Ancillary Service - MRI Charges;(LLL) Ancillary Service - Outpatient Services Charges;(MMM) Ancillary Service - Emergency Service Charges;(NNN) Ancillary Service - Ambulance Charges;(OOO) Ancillary Service - Professional Fees Charges;(PPP) Ancillary Service - Organ Acquisition Charges;(QQQ) Ancillary Service - ESRD Revenue Setting Charges;(RRR) Ancillary Service - Clinic Visit Charges;(SSS) Total Charges - Accommodations;(TTT) Total Charges - Ancillary;(UUU) Total Non-Covered Accommodation Charges;(VVV) Total Non-Covered Ancillary Charges;(XXX) Total Non-Covered Charges;(YYY) Encounter Identifier - a unique number for each encounter for the quarter;(ZZZ) Service Line Revenue Code;(AAAA) Service Line Procedure Code;(BBBB) HCPCS/HIPPS Procedure Code;(CCCC) HCPCS/HIPPS Procedure Modifiers (Up to 4 may be submitted and reported);(DDDD) Service Line Charge Amount;(EEEE) Service Line Unit Code;(FFFF) Service Line Unit Count;(GGGG) Service Line Non-Covered Charge Amount;(HHHH) Patient Country (when address is not in the United States of America and confidentiality can be maintained);(IIII) POA indicator (if applicable); and(JJJJ) Hospital Emergency Department Indicator.(12) The following data elements for records submitted with diagnosis codes that are associated with alcohol or drug use will be modified to protect those patients that may be covered by 42 USC § 290dd-2 and 42 CFR Part 2: (A) Patient ZIP Code shall be reported as "`" (back quote);(B) Patient Country shall be reported as "`" (back quote); and(C) Patient Sex shall be reported as "U" (Unknown).25 Tex. Admin. Code § 421.8
The provisions of this §421.8 adopted to be effective August 19, 1997, 22 TexReg 7490; amended to be effective December 29, 1997, 22 TexReg 12494; amended to be effective July 26, 1998, 23 TexReg 7365; amended to be effective December 24, 2000, 25 TexReg 12430; amended to be effective July 29, 2001, 26 TexReg 5408; amended to be effective April 21, 2002, 27 TexReg 3183; amended to be effective July 6, 2003, 28 TexReg 4915; transferred effective September 1, 2004, as published in the Texas Register September 10, 2004, 29 TexReg 8842; amended to be effective December 27, 2007, 32 TexReg 9683; amended to be effectiveJanuary 9, 2011, 35 TexReg 9743; amended by Texas Register, Volume 39, Number 38, September 19, 2014, TexReg 7584, eff. 12/18/2014; Amended by Texas Register, Volume 42, Number 26, June 30, 2017, TexReg 3375, eff. 7/5/2017; Amended by Texas Register, Volume 44, Number 04, January 25, 2019, TexReg 0430, eff. 1/30/2019