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APPENDIX V-Edited Inpatient Output File Description

FILE NAME:  Edited Inpatient Output File Description DATE:  March 2010
FILE SORT SEQUENCE:  Master Key RECORD LENGTH:  2000
SOURCE OF DATA:  Inpatient Input
POSITION FIELD
DATA ELEMENT NAME FROM TO SIZE TYPE
Record Length 1 2000 2000 REC
Master Key 1 64 64 GRP
SPARCS Region 1 2 2 A/N
SPARCS Identification Number 3 7 5 A/N
Patient Control Number 8 27 20 A/N
Medical Record Number 28 44 17 A/N
Admission Date/Start Of Care (CCYYMMDD) 45 52 8 NUM
Discharge Date (CCYYMMDD) 53 60 8 NUM
Record Sequence Number 61 62 2 NUM
Record Sequence Count 63 64 2 NUM
Patient Sex 65 65 1 A/N
Patient Birth Date (CCYYMMDD) 66 73 8 NUM
Type of Admission 74 74 1 A/N
Source of Admission 75 75 1 A/N
Admission Hour 76 77 2 NUM
Statement Covers Period From Date (CCYYMMDD) 78 85 8 NUM
Statement Covers Period Thru Date (CCYYMMDD) 86 93 8 NUM
Discharge Hour 94 95 2 NUM
Type of Alternate Care Required 96 96 1 A/N
Date Alternate Care Required (CCYYMMDD) 97 104 8 NUM
Total Alternate Level of Care Days 105 108 4 NUM
Neonate Birth Weight (Grams) 109 112 4 NUM
New York State Patient Status or Disposition 113 114 2 A/N
Mother's Medical Record Number For Newborn Child 115 131 17 A/N
Filler 132 139 8 A/N
Patient Race 140 141 2 A/N
Patient Ethnicity 142 142 1 A/N
Unscheduled/Scheduled Admission 143 143 1 A/N
Expected Principal Reimbursement 144 145 2 A/N
Expected Reimbursement Other 1 146 147 2 A/N
Expected Reimbursement Other 2 148 149 2 A/N
Patient Residence Address - Address Line 1 150 167 18 A/N
Patient Residence Address - Address Line 2 168 185 18 A/N
Patient City 186 200 15 A/N
Patient County Code 201 202 2 NUM
Patient State 203 204 2 A/N
Patient's Postal Service Zip Code and Extension Code 205 213 9 A/N
Source of Payment Information Group Definition (Occurs 6) 214 609 396 A/N
Source of Payment Code 214 214 1 A/N
Policy Number 215 233 19 A/N
Payer Identification Number 234 238 5 A/N
X12 Source of Payment Code 239 240 2 A/N
Filler 241 250 10 A/N
Covered Days 251 254 4 NUM
Non-Covered Days 255 258 4 NUM
Provider Identification Number 259 271 13 A/N
Alternate Level of Care Days 272 275 4 NUM
Leave of Absence Days 276 279 4 NUM
Total Leave of Absence Days 610 613 4 NUM
Type of Bill 614 616 3 A/N
Transaction Code 617 617 1 A/N
Accident Related Code 618 619 2 A/N
Accident Related Date (CCYYMMDD) 620 627 8 A/N
Special Program (DIS) 628 628 1 A/N
Special Program (FP) 629 629 1 A/N
Special Program (PHC) 630 630 1 A/N
Special Program (SFP) 631 631 1 A/N
Worker's Comp/No-Fault Indicator 632 633 2 A/N
Worker's Comp/No-Fault Amount 634 642 9 NUM
Surplus, Catastrophic, or Recurring Monthly Income Code 643 643 1 A/N
Surplus, Catastrophic, or Recurring Monthly Income Amount 644 652 9 NUM
Blood Furnished Amount 653 661 9 NUM
Accommodations Information Group Definition (Occurs 5) 662 846 185 A/N
Accommodations Rate 662 670 9 NUM
Accommodations Days 671 674 4 NUM
Accommodations Total Charges 675 684 10 NUM
Accommodations Total Non-Covered Charges 685 694 10 NUM
UB-92 Accommodation Code 695 698 4 A/N
Inpatient Ancillary Services Information Group Definition (Occurs 20) 847 1326 480 A/N
Inpatient Ancillary Revenue Code 847 850 4 NUM
Inpatient Ancillary Total Charges 851 860 10 NUM
Inpatient Ancillary Total Non-Covered Charges 861 870 10 NUM
Principal/Primary Diagnosis Code 1327 1332 6 A/N
Other Diagnosis Information Group Definition (Occurs 14) 1333 1444 112 A/N
Other Diagnosis Code (1-14) 1333 1338 6 A/N
Present on Admission Indicator (1-14) 1339 1339 1 A/N
After Anesthesia Indicator ( 1-14) 1340 1340 1 A/N
Principal Procedure Code 1445 1451 7 A/N
Principal Procedure Date (CCYYMMDD) 1452 1459 8 A/N
Other Procedure Information Group Definition (Occurs 14) 1460 1669 210 A/N
Other Procedure Code (1-14) 1460 1466 7 A/N
Other Procedure Date (1-14) (CCYYMMDD) 1467 1474 8 A/N
Admitting Diagnosis Code/Patient's Reason for Visit 1670 1675 6 A/N
External Cause-of-Injury Code 1676 1681 6 A/N
Place-of-Injury Code 1682 1687 6 A/N
Procedure Coding Method 1688 1688 1 A/N
Method of Anesthesia Used 1689 1690 2 A/N
Exempt Unit Indicator 1691 1693 3 A/N
Placement of Bed Indicator 1694 1696 3 A/N
Total Acute Certified Days 1697 1700 4 NUM
Attending/Emergency Dept Physician 1 State License Number 1701 1708 8 A/N
Operating/Emergency Dept Physician 2 State License Number 1709 1716 8 A/N
Other/Emergency Dept Physician 3 State License Number 1717 1724 8 A/N
Total Accommodations Charges 1725 1734 10 NUM
Total Accommodations Non-Covered Charges 1735 1744 10 NUM
Total Ancillary Charges 1745 1754 10 NUM
Total Ancillary Non-Covered Charges 1755 1764 10 NUM
Total Charges 1765 1776 12 NUM
Total Non-Covered Charges 1777 1788 12 NUM
Length of Stay 1789 1792 4 NUM
Age 1793 1795 3 NUM
DRG (Current Federal) 1796 1798 3 NUM
MDC (Current Federal) 1799 1800 2 NUM
DRG (Current New York) 1801 1803 3 NUM
MDC (Current New York) 1804 1805 2 NUM
DRG (Prior Federal) 1806 1808 3 NUM
MDC (Prior Federal) 1809 1810 2 NUM
DRG (Prior New York) 1811 1813 3 NUM
MDC (Prior New York) 1814 1815 2 NUM
DRG (New Federal) 1816 1818 3 NUM
MDC (New Federal) 1819 1820 2 NUM
DRG (New New York) 1821 1823 3 NUM
MDC (New New York) 1824 1825 2 NUM
Date Processed (CCYYMMDD) 1826 1833 8 NUM
Log Number 1834 1839 6 A/N
SPARCS Collector Code 1840 1842 3 A/N
DRG Number Billed 1843 1846 4 A/N
Unique Personal Identifier 1847 1856 10 A/N
Age Warning Flag 1857 1857 1 A/N
Do Not Resuscitate Indicator 1858 1858 1 A/N
Residence Indicator 1859 1859 1 A/N
Non-Acute Care Group Definition (Occurs 3) 1860 1913 54 A/N
Non-Acute Care Type 1860 1861 2 A/N
Non-Acute Care From Date (CCYYMMDD) 1862 1869 8 A/N
Non-Acute Care Through Date (CCYYMMDD) 1870 1877 8 A/N
Procedure Date Warning Flag 1914 1914 1 A/N
SPARCS Accommodation Group Definition (Occurs 5) 1915 1934 20 A/N
SPARCS Accommodation Code 1915 1918 4 A/N
Emergency Department Indicator 1935 1935 1 A/N
Filler 1936 1954 19 A/N
Current APR-DRG 1955 1957 3 A/N
Current MDC for APR-DRG 1958 1959 2 A/N
Current Severity of Illness for APR-DRG 1960 1960 1 A/N
Current Risk of Mortality for APR-DRG 1961 1961 1 A/N
Prior APR-DRG 1962 1964 3 A/N
Prior MDC for APR-DRG 1965 1966 2 A/N
Prior Severity of Illness for APR-DRG 1967 1967 1 A/N
Prior Risk of Mortality for APR-DRG 1968 1968 1 A/N
New APR-DRG 1969 1971 3 A/N
New MDC for APR-DRG 1972 1973 2 A/N
New Severity of Illness for APR-DRG 1974 1974 1 A/N
New Risk of Mortality for APR-DRG 1975 1975 1 A/N
Filler 1976 2000 25 A/N
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