Information Bulletin, April 2005


Emergency Department Reporting
HPN Accounts and Development
Reporting Regulations
X12-837 Format?
Data Quality Initiative
DPRB Schedule
Clarifications on Cardiac Catheterizations submissions
Additional ICD9 Age Edits Updated

Emergency Department Reporting

As a reminder, Section 400.18 of Title 10 (Health) regulations now requires submission of emergency department data within 30 days following the month of patient discharge. All hospitals providing emergency department services are required to submit data for all emergency department visits discharged on or after January 1, 2005.The Emergency Department records are reported with the Outpatient Data set; thus, both ambulatory surgery and emergency department records can be submitted on the same data file to SPARCS.

How do we define Emergency Department records from the data file? To date, the 045X revenue code for EMERGENCY visits is used primarily to define all ED records. Currently, the following codes apply:

'0450'    Emergency Room
'0451'    EMTALA Emergency Medical Screening Services
'0452'    ER Beyond EMTALA Screening
'0456'    Urgent Care
'0459'    Other Emergency Room Care
diagram If there is no 045X code the record is edited as an Ambulatory Surgery (AS) record. Next, we look at "Operating Room (OR) time" on the outpatient file; for records that have NO Operating Room time, they are recorded as "Emergency Department Only". If there is no OR time on an AS record, you will get the outpatient error code M0102, "Operating time not found".If there is no revenue code and no OR time on an ED record, you will also get error code M0102.

Emergency department visits that become an inpatient admission have always been added to the SPARCS Inpatient data file. ED records with OR time are recorded as "Ambulatory Surgery from ED". See the Emergency Department Audit reports at www.health.state.ny.us/statistics/sparcs/audit.htm under "Audit and Submission History Reports".
HPN Accounts and Development

The Health Provider Network (HPN) is the secure intranet site used for submitting and receiving SPARCS reports. Those facilities that have been submitting magnetic tapes or cartridges, must obtain an HPN account. Our plan is to discontinue mailing the SPARCS submission results by June 2005. You may continue to submit using magnetic tapes or cartridges, but you will have to go to the HPN to receive your report. Once requested, all reports are available on the HPN. Your facility HPN Coordinator can request an HPN for you. If you do not have an HPN account or know who your HPN coordinator is, you may contact the SPARCS Administrative Unit at sparcs.submissions@health.ny.gov, or by phone at (518) 473-8144 for assistance.

Reporting Regulations

The reporting regulations for SPARCS are being enforced on a monthly basis. The following schedule should be maintained:

Inpatient:   95% of all discharged patients within 60 days from the end of the month should be submitted. 100 % of the data is due within 180 days from the end of the hospital's fiscal year.

Ambulatory Surgery:   100% of the data shall be submitted within 30 days following the calendar quarter. Corrected data is due within 30 days of the receipt of the error reports.

Emergency Department:   data is due within 30 days following the month of the patient's discharge.
X12-837 Format?

For those facilities that have mastered the change to the new electronic format of the 837 Health Care Claim, called the X12, you are to be congratulated and you can NOW submit SPARCS using the X12 in production mode. For guidance in switching to the X12, please refer to the SPARCS Input Data Dictionary (www.health.state.ny.us/statistics/sparcs/sysdoc/elements_837/index.htm) and the Inpatient 837 Addendum Guide (www.health.state.ny.us/statistics/sparcs/sysdoc/ip837.htm) and/or Outpatient 837 Addendum Guide (www.health.state.ny.us/statistics/sparcs/sysdoc/op837.htm) located on our website.

Data Quality Initiative

During 2005, SPARCS will start a quality initiative with SPARCS data. Our first focus will be on specific data elements: "Other Diagnosis Emergent Indicator", "Race" and "Ethnicity". Facilities that may be reporting these data elements incorrectly will be contacted and asked for a plan of correction.

DPRB 2005 Schedule

The Data Protection Review Board (DPRB) approves the release of SPARCS deniable data elements for inpatient, ambulatory surgery and emergency department data. Any users that need the deniable element data sets must submit an application. The following schedule is for 2005:

     Application Due      Meeting Date
July 13, 2005
October 12, 2005
September 7, 2005
December 7, 2005

Clarification on Cardiac Catheterizations Submissions

Hospitals were sent a letter in December 2004 from the Office of Health Systems Management, Cardiac Services Program requesting them to submit ALL cardiac catheterizations on the outpatient data file to SPARCS. The SPARCS outpatient edit program checks all records for operating room time. If this data element is blank, the record will not be accepted into the SPARCS database. Not all cardiac catheterizations require an operating room, thus, only those procedures that occurred in an operating room can be submitted to SPARCS.

Additional ICD9 Age Edits Updated

SPARCS updates the ICD9 codes and edits associated with those codes annually, based on information provided by the Centers for Medicare and Medicaid Services (CMS) on the Federal Fiscal Year (FFY). The 2005 FFY annual updates are for October 1, 2004 thru Sept. 30, 2005. SPARCS updated these codes for all discharges on or after October 1, 2004. However, this past October 2004, CMS also introduced an additional set of age edits. The changes to the age edits were not available at the time of the release of the 2005 ICD9 file (in October, 2004), but became availabe at a later date, and were implemented into the SPARCS production system on April 13, 2005. These new age edits will also apply to all patients discharged on or after October 1, 2004. If you have any question, please call SPARCS Administrative Unit at 518-473-8144.