Information Bulletin, April 2007

New Definition of Ambulatory Surgery
Operating Room Time Renamed to Procedure Time
Information on X12-837
Changes to E-Code Reporting
Present on Admission (POA) Indicator Information

New Definition of Ambulatory Surgery

In order to add clarity to the ambulatory surgery data being submitted to the Health Department, the definition of Ambulatory Surgery has changed. Specifically, paragraph (1) of subdivision (d) of Section 400.18 of Title 10 of the Official Compilation of Codes, Rules, and Regulations of the State of New York (NYCRR) has been amended to read as follows:

"(1) All facilities licensed under article 28 of the Public Health Law that provide ambulatory surgery services shall submit in an electronic format for each patient surgical visit that requires a stay of less than 24 hours any procedure listed in the American Medical Association Current Procedural Terminology (CPT) as prescribed by the commissioner to be maintained on an annual basis, including but not limited to all procedures in the Surgery Section of CPT".

The new definition is based on CPT codes, and will no longer be dependent on the type of room where the surgery occurred. Any facility licensed with Ambulatory Surgery services that performs a procedure in the following list must report these to SPARCS effective with April 2007 discharges.

CPT-4 Category Code Range
Surgery 10021 – 69990
Cardiovascular 92973 – 92998
Cardiac Catheterization 93501 – 93581
Intra-cardiac Electrophysiological Procedures/Studies 93600 – 93662

Operating Room Time Renamed to Procedure Time

The data element "Operating Room Time" has been renamed to "Procedure Time" since not all procedures take place in an operating room.

Information on X12-837

To assist you in reporting your data in the X12-837 format, we added an X12-837 Resources section to the SPARCS Web site. It contains links to the Public Health Data Standards Consortium, the SPARCS-837 PC Application and Frequently Asked Questions (FAQs).

Following are additional X12-837 resources for SPARCS:

Changes to E-Code Reporting

We want to thank NYHIMA for their cooperation and patience in identifying changes needed with our existing E-code edits. The edit, as described below, has been implemented effective February 13, 2007. NYHIMA's suggestion is particularly useful due to the Emergency Room setting when an exact cause is not given or determined prior to discharge. Basically, ICD-9-CM codes that previously required an E-code, no longer require an E-code. These changes more closely reflect the proper medical coding practices for E-codes and will result in a higher quality of data being reported to SPARCS. These changes are reflected in Appendix N of our Data Dictionary under the "ICD-9-CM External Cause-of-Injury Exceptions" section.

  • New Edit Coding Exceptions 1:  When the following diagnosis codes are reported as either an Other or Principal/Primary Diagnosis Code, an External Cause-of-Injury Code is NOT required.
    • 909.0 (new), 909.1 (new), 909.3 (new), 909.4 (new), 909.5, 909.9 (new), 990, 995.0 (new), 995.1 (new), 995.2 (Valid only with discharges until 9/30/06), 995.20, 995.21, 995.22, 995.23, 995.27, 995.29 (995.2X codes are valid effective 10/1/2006), 995.3 (new), 995.4, 995.60-995.69, 995.7, 995.86 (new), 995.89 (new), 995.90-995.94, 999.8 (new)

  • New Edit Coding Exceptions 2:  When the following diagnosis codes are reported, an appropriate E-code must be reported in either an Other Diagnosis Code field or in the External Cause-of-Injury Code field. If the E-code was as a result of a correct medicinal substance properly administered, the E-code should be reported in an Other Diagnosis Code field. If the E-code was a result of an incorrect medicinal substance and/or substance incorrectly administered, the E-code should be reported in the External Cause-of-Injury Code field.
    • 999.0-999.7, 999.9
      NOTE: The following codes were removed from the edit program: 995.0, 995.1, 995.3, 995.89

Present on Admission (POA) Indicator Information

The UB-04 reporting code "W" has been added. Refer to the following links for reporting guidelines:

According to the 2007 UB-04 Data Specifications Manual, there are five reporting options for all diagnosis and they are as follows:

Codes Values Definition
Y Yes Present at the time of inpatient admission
N No Not present at the time of inpatient admission
U Unknown Documentation is insufficient to determine if condition is present on admission
W Clinically Undertermined Provider is unable to clinically determine whether condition was present on admission or not

In addition, the Present on Admission Indicator variable is taken on added significance due to Centers for Medicare and Medicaid Services (CMS) revising the Medicare hospital inpatient prospective payment systems (IPPS) for operating and capital-related costs. They are implementing changes made by the Deficit Reduction Act of 2005 (Pub. L. 109-171). Under Section 5001(c) hospitals will be required to submit the secondary diagnoses that are present at admission when reporting payment information for discharges on or after January 1, 2008. In the Deficit Reduction Act of 2005, hospitals will be required to report the present on admission diagnoses on all Medicare claims beginning in the federal fiscal year 2008.

  • Medicare will begin POA collection on January 1, 2008.