Information Bulletin, January 2007


SPARCS/AMI Announcement
Acute Myocardial Infarction (AMI) Project Final Format
Heart Rate on Arrival
Systolic Blood Pressure on Arrival
Diastolic Blood Pressure on Arrival
Frequently Asked Questions on SPARCS/AMI Project

SPARCS/AMI Announcement

SPARCS announced a new project in August 2006 for the collection of clinical data elements pertaining to Acute Myocardial Infarction (AMI): heart rate upon arrival, blood pressure upon arrival and duration of ischemic symptoms. These elements were chosen for inclusion in the SPARCS Data Set based on the NYSDOH's Cardiac Services Program and their 2004 AMI Pilot Project.

During September - November 2006, SPARCS held a number of discussion groups with the hospitals and health care associations. In addition, SPARCS received comments and concerns on this project about the collection of these data elements.

The SPARCS/AMI project will continue with the collection of heart rate on arrival and blood pressure on arrival for primary diagnoses of 410.0x-410.9x (Acute Myocardial Infarction) beginning with July 2007 discharges for inpatient and emergency department visits.

Duration of ischemic symptoms is undergoing further review and WILL NOT be collected at this time.

The data specifications needed for the new data elements of Heart Rate and Blood Pressure are included in this bulletin. Please forward these to the appropriate personnel within your facility or to your vendor(s) to aid in making the required changes and modifications to your system(s).

In addition, the SPARCS-837 Windows PC application has been developed to assist you with the creation, editing, translation and submission of your SPARCS data. This application supports the submission and retrieval of the new SPARCS/AMI elements. SPARCS-837 is available for download from the Health Provider Network (HPN) at:   https://commerce.health.state.ny.us/hpn/ctrldocs/subsparc/request837.html

The Department of Health would like to thank all the participants of our SPARCS/AMI Project discussion groups and presentations, the New York Health Information Management Association (NYHIMA), HANYS, and GNYHA for your constructive critique, insight and suggestions for the project.

STATEWIDE PLANNING AND RESEARCH COOPERATIVE SYSTEM
ACUTE MYOCARDIAL INFARCTION (AMI) PROJECT
FINAL FORMAT
2300 NTE SEGMENT DEFINITION IN THE X12-837 FORMAT
4050 Data Reporting

Inpatient NTE
      Description Position Length Format
Expected Principal Reimbursement 1 - 2 2 A/N
Expected Reimbursement Other 1 3 - 4 2 A/N
Expected Reimbursement Other 2 5 - 6 2 A/N
Method of Anesthesia 7 - 8 2 A/N
Exempt Unit Indicator 9 - 11 3 A/N
Patient's Race 12 - 13 2 A/N  (These positions should contain spaces if reporting
Patient's Ethnicity 14 - 14 1 A/N   Patient Race and Ethnicity in the DMG05 segment.)
Heart Rate 15 - 17 3 A/N
Blood Pressure - Systolic 18 - 20 3 A/N
Blood Pressure - Diastolic 21 - 23 3 A/N

Examples in version 4010 using the NTE segment:  
All data elements reported:  NTE*UPI*06100120ALR012072125080~

Patient Race and Ethnicity not reported:  NTE*UPI*06100120ALR   072125080~

Outpatient NTE
      Description Position Length Format
Expected Principal Reimbursement 1 - 2 2 A/N
Method of Anesthesia 3 - 4 2 A/N
Patient's Race 5 - 6 2 A/N  (These positions should contain spaces if reporting
Patient's Ethnicity 7 - 7 1 A/N   Patient Race and Ethnicity in the DMG05 segment.)
Heart Rate 8 - 10 3 A/N
Blood Pressure - Systolic 11 - 13 3 A/N
Blood Pressure - Diastolic 14 - 16 3 A/N

Examples of NTE segment:  
All data elements reported:  NTE*UPI*0620012072125080~

Patient Race and Ethnicity not reported:  NTE*UPI*0620   072125080~

Note:   Spaces equaling the data element length must be used if a data element cannot be supplied. Below are NTE segments examples:


Data Element Name: Heart Rate on Arrival
Format-Length: A/N - 3 Required For: ED, IP

X12 Loop

X12 Seg

Seg. Ele. (Ref)

Composite

Element ID

Code

Description
2300 NTE 01 n/a 363 UPI Note Reference Code
02 n/a 352 n/a Claim Note Text
IP Position:  15 - 17
OP Position:  8 - 10

Effective Date:

7/1/07

Revision Date:


Definition:

The patient heart rate in beats per minute (bpm) taken at first patient contact after arrival at this hospital for patients with a primary/principal diagnosis of Acute Myocardial Infarction (AMI) 410.0x - 410.9x. For patients that are transferred from the emergency department to the inpatient setting, this measurement would be taken from the first contact in the emergency department and sent on the inpatient record.

Codes and Values:
  1. If this field is not applicable, (i.e., not in the principal diagnosis range of 410.0x - 410.9x.) it must contain blanks.
  2. Must be greater than or equal to zero.
  3. Must be right justified and zero filled.
  4. "888" = Undocumented in Medical Chart
  5. "999" = Unknown (To be used only in circumstances where patient can not have reading taken at time of arrival)
Edit Applications:
  1. Must be a valid entry.
  2. Must be reported when principal diagnosis code equals 410.0x - 410.9x.
  3. Warning message generated on records with Principal Diagnosis 410.0x - 410.9x for records that contain blank or missing information in the "Heart Rate on Arrival" data element from January 1, 2007 - December 31, 2007 for a transitional time period of data collection. (After December 31, 2007 AMI records will be rejected if this data element is not completed.)

Data Element Name: Systolic Blood Pressure on Arrival
Format-Length: A/N - 3 Required For: ED, IP

X12 Loop

X12 Seg

Seg. Ele. (Ref)

Composite

Element ID

Code

Description
2300 NTE 01 n/a 363 UPI Note Reference Code
02 n/a 352 n/a Claim Note Text
IP Position:  18 - 20
OP Position:  11 - 13

Effective Date:

7/1/07

Revision Date:


Definition:

The patient systolic blood pressure in mg/dl, taken at first patient contact after arrival at this hospital, for patients with a primary/principal diagnosis of Acute Myocardial Infarction (AMI) 410.0x - 410.9x. For patients that are transferred from the emergency department to the inpatient setting, this measurement would be taken from the first contact in the emergency department and sent on the inpatient record.

Codes and Values:
  1. If this field is not applicable, (i.e., not in the principal diagnosis range of 410.0x - 410.9x.) it must contain blanks.
  2. Must be greater than or equal to zero.
  3. Must be right justified and zero filled.
  4. "888" = Undocumented in Medical Chart
  5. "999" = Unknown (To be used only in circumstances where patient can not have reading taken at time of arrival)
Edit Applications:
  1. Must be a valid entry.
  2. Must be reported when principal diagnosis code equals 410.0x - 410.9x.
  3. Warning message generated on records with Principal Diagnosis 410.0x - 410.9x for records that contain blank or missing information in the "Systolic Blood Pressure on Arrival" data element from January 1, 2007 - December 31, 2007 for a transitional time period of data collection. (After December 31, 2007 AMI records will be rejected if this data element is not completed.)

Data Element Name: Diastolic Blood Pressure on Arrival
Format-Length: A/N - 3 Required For: ED, IP

X12 Loop

X12 Seg

Seg. Ele. (Ref)

Composite

Element ID

Code

Description
2300 NTE 01 n/a 363 UPI Note Reference Code
02 n/a 352 n/a Claim Note Text
IP Position:  21 - 23
OP Position:  14 - 16

Effective Date:

7/1/07

Revision Date:


Definition:

The patient diastolic blood pressure in mg/dl, taken at first patient contact after arrival at this hospital, for patients with a primary/principal diagnosis of Acute Myocardial Infarction (AMI) 410.0x - 410.9x. For patients that are transferred from the emergency department to the inpatient setting, this measurement would be taken from the first contact in the emergency department and sent on the inpatient record.

Codes and Values:
  1. If this field is not applicable, (i.e., not in the principal diagnosis range of 410.0x - 410.9x.) it must contain blanks.
  2. Must be greater than or equal to zero.
  3. Must be right justified and zero filled.
  4. "888" = Undocumented in Medical Chart
  5. "999" = Unknown (To be used only in circumstances where patient can not have reading taken at time of arrival).
Edit Applications:
  1. Must be a valid entry.
  2. Must be reported when principal diagnosis code equals 410.0x - 410.9x.
  3. Warning message generated on records with Principal Diagnosis 410.0x - 410.9x for records that contain blank or missing information in the "Diastolic Blood Pressure on Arrival" data element from January 1, 2007 - December 31, 2007 for a transitional time period of data collection. (After December 31, 2007 AMI records will be rejected if this data element is not completed.)
Frequently Asked Questions on SPARCS/AMI Project
  1. Q:  Do I have to submit the new clinical elements in the X12-837 Format?

    A:  Yes. UDS Version 5/6 does not support collection of the new data elements.

  2. Q:  Can I submit these clinical data elements before the July 1, 2007 implementation? (I have collected the data for 2007 discharges prior to July)

    A:  Yes. (Excellent work.) However, we can only accept the new data elements in the X12-837 format. SPARCS has been accepting X12-837 submissions. You can only use the X12-837 format to submit the three new clinical data elements.

  3. Q:  Will I be able to submit the heart rate, and blood pressure elements with the new PC application, SPARCS-837?

    A:  Yes. The new PC Application, SPARCS-837, is designed to import a UDS Version 5/6 file and output an X12-837 file. Data can be imported into SPARCS-837 in UDS Version 5/6 or X12-837 format and modified to include the new SPARCS/AMI elements by using the input screens. New records can also be created from "scratch" using the input screens. Records, which now include the new SPARCS/AMI elements, can be exported in X12-837 format and submitted to SPARCS.

  4. Q:  If my patient arrives by ambulance, do I use the blood pressure and heart rate taken by the ambulance staff?

    A:  No. Use the first occurrence of blood pressure and heart rate taken at YOUR facility. This information will help assess the care given at your hospital.

  5. Q:  Who should record the blood pressure and heart rate in the medical chart?

    A:  We have learned that each hospital has different points of patient contact; it would be best to continue with the same process at YOUR facility, but be definitive for who's responsibility it will be to record the information accurately in the medical chart. We have learned that in most Emergency Department visits the triage nurse is the first point of patient contact where the first occurrence of blood pressure and heart rate is taken. For inpatient visits, this can vary from the admittance area to the appropriate staff nurse.

  6. Q:  For patients transferred from the ED to the inpatient at my facility, which blood pressure and heart rate should be sent to SPARCS: the ED or inpatient?

    A:  The blood pressure and heart rate taken at the ED should be sent to SPARCS. This is the first patient contact at your facility. You will have to train the outpatient coders to abstract this information for your inpatient records.