Information Bulletin, March 1999


Year 2000 Update
Proposed SPARCS Edit Change
Web Site Enhancements

Year 2000 Update

SPARCS continues to receive about five percent (5%) of our submissions in the millennium compliant Version 5 format. We encourage all those providers still submitting in Version 4 to start testing Version 5 at your earliest convenience. After December 31, 1999, SPARCS will no longer accept non-millennium ready submissions.

Proposed SPARCS Edit Change

Included below is a proposed edit change in SPARCS. This change would allow, in certain circumstances, a procedure date prior to the date of admission. We encourage submitters and users of the SPARCS data base to review this proposal and submit any comments to the SPARCS Administrative Unit.

Background

Hospitals have indicated that current SPARCS edits make it difficult to report cases where the procedures were done prior to admission because they were performed in the Emergency Room or as part of ambulatory surgery visit at least one day before the inpatient admission. Since these admissions occur within a specified observation time, the charges need to be included on the inpatient bill for some payers, in particular Medicare. Procedures done in the ER or as part of the ambulatory surgery outside of the reported admission and discharge dates currently causes a SPARCS edit exception. To allow these records to pass SPARCS edits and consequently be included in the SPARCS database a change to the SPARCS edits is being proposed. Listed below is a summary of the particular scenario along with the proposed edit change:

Emergency Room Scenario

A patient comes to a hospital emergency room where a procedure is performed, then because of complications the patient moves to inpatient status. The problem occurs when the inpatient admission is after midnight of the day of the ER admission. The proposed edit change would allow a ONE-day prior to admission date variance on the procedure date when the Source of Admission is the Emergency Room. The SPARCS process would create a warning flag to identify the records where this situation has occurred for use by the submitter and user of the data.

Ambulatory Surgery Scenario

A patient comes to a hospital for an ambulatory surgery, then because of complications the patient moves to inpatient status. The problem occurs when the inpatient admission is within 72 hours of the ambulatory surgery admission. The proposed edit change would allow a THREE-day prior to admission date variance on the procedure date when selected ancillary revenue codes for ambulatory services are also reported. The proposed list of these ancillary services is included below. The SPARCS process would create a warning flag to identify the records where this situation has occurred for use by the submitter and user of the data.

Selected UB-92 Ancillary Revenue Codes

25x-----Pharmacy
270-----Medical/Surgical Supplies-Devices (General)
272-----Sterile Supply
276-----Intraocular Lens
36x-----Operating Room Services
37x-----Anesthesia
38x-----Blood
39x-----Blood Storage and Processing
45x-----Emergency Room
49x-----Ambulatory Surgical Care
51x-----Clinic
52x-----Free-Standing Clinic
70x-----Cast Room
71x-----Recovery Room
75x-----Gastro-Intestinal Services
760-----Treatment of Observation Room (General)
761-----Treatment Room
769-----Other Treatment Room
920-----Other Diagnostic Services (General)
929-----Other Diagnostic Services (Other)
940-----Other Therapeutic Services (General)
949-----Other Therapeutic Services (Other)

NOTE: Source of this list is the Medicare Billing Procedures Manual Rev 726, 4-283

Summary

This change in SPARCS edits is being proposed to further class state data collection with current hospital information system requirements in New York State. It is anticipated that this change will ease the reporting burden on New York State providers. For some data users the additional information available about inpatient admissions due to surgical complications will be of great benefit. Other data users, especially those that use a post-op length of stay, may find this change complicates their analysis.

Please forward all comments to the SPARCS Administrative Unit by March 31, 1999.

Web Site Enhancements

As announced in our February 1999 Bulletin, we had planned to modify our existing audit reports to include UNRESOLVED ERROR and UNRESOLVED EXCEPTION counts. As development proceeded we have decided that there is enough additional information to warrant a new report, which summarizes the history of facility submissions for any given year. The counts mentioned above will instead be published as part of a new history report on our Web site by the end of this month.