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SC Data Oversight Council

I. Release of Encounter-Level

Encounter-level data will be released upon request and are subject to the confidentiality provisions set forth in Final Regulations, Revenue and Fiscal Affairs Office, Chapter 19, Statutory Authority: 1976 Code Section 44-6-170, Article 9, “Data Release For Medical Encounter Data & Financial Reports.” Failure to comply with the confidentiality provisions in these regulations can result in legal action as specified in Section 44-6-180, as amended, Code of Laws of South Carolina, 1976.
 
Encounter-level data files contain individual patient-level data using encounter-level data elements; release of these files requires an application and a signed Data Use Agreement. However, the RFA has permission to release aggregate customized reports based on encounter-level data without a signed agreement.
 
The following considerations will be applied by RFA in creating encounter-level data files.
 
Dates: All data elements that are date fields will be considered restricted data. Date fields provide unique information that when linked with other databases may identify an individual. On encounter-level files:
  • Age will be reported in five-year age groupings and “under one category” (for children under one year of age),“one to four” (for children one to four years of age) and if over 84, reported in 85 and over category
  • Length of stay will be provided rather than admission and discharge dates
  • Month and day of week will be provided in lieu of admission date and/or discharge date
Procedure Coding: Depending on the instructions in the Uniform Billing Manual (UB04), procedure codes will be coded with the ICD-9 CM procedure codes, the HCPCS procedure codes and/or the CPT4 procedure codes. When using the HCPCS and/or CPT4 procedure codes the units of service will be required according to the UB 04 coding manual.
 
The variables admitting diagnosis, patient reason for visit, admission hour and discharge hour will be added beginning October 1, 2007. Modifications to the E-Codes will become effective October 1, 2007. The variable present of admission code for all diagnoses will be added beginning January 1, 2008. The variable NPI will be added beginning May 23, 2007.

A. Encounter-Level Data Elements

1. Inpatient Hospitalizations Encounter-Level Data Elements

  • Length of stay
  • Day of the week of admission
  • Month of admission
  • Day of the week of discharge
  • Month of discharge
  • Admission source
  • Admission type
  • Patient age in five year age cohorts at admission Patient Age at Admission in Years in 5 year groupings. Except less than 5 years that is reported as “under one category” (for children under one year of age) and “one to four” (for children one to four years of age). If over 84, reported in 85 and over category.
  • Patient gender
  • Patient race/ethnicity
  • County of patient's residence
  • Admitting Diagnosis
  • Present on Admission Code for All Diagnoses
  • Diagnosis codes, primary and all secondary diagnoses codes reported to RFA (including coding methodology)
  • Procedure codes, primary and all secondary procedure codes reported to RFA (including coding methodology)
  • Procedure day in relationship to admission date
  • Time from Admission Hour to Discharge Hour
  • Major diagnostic categories
  • E-codes
  • DRG
  • Primary expected payer classification (i.e., Medicare, Medicaid, TriCare, Worker’s Compensation, Commercial, HMO, Self-pay, Indigent and Other)
  • Charges by summary revenue codes
  • Total charges
  • Days in special units (e.g. ICU, CCU, etc)
  • Physician specialty code (as adopted by the AMA)
  • Patient discharge status
  • Health care professional classification
    • Attending
    • Other
  • All Patient Refined- DRG Level
  • All Patient Refined-DRG Label
The requestor may choose one of the following facility characteristics
  • Urban/rural status of health care facility
  • Bed Size Based on Licensed Beds (100 beds or less, 101-299, 300 or more beds)
  • Teaching status of the facility
  • Level of trauma service
  • Level of perinatal service
  • Other facility and professional characteristics that would not permit the identification of the health care facility or professional
2. Emergency Department Visits and Facilities Reporting Observation Services Encounter-Level Data Elements
  • Day of the week of admission
  • Month of admission
  • Admission source
  • Admission type
  • Patient age in five year age cohorts at admission Patient Age at Admission in Years in 5 year groupings. Except less than 5 years that is reported as “under one category” (for children under one year of age) and “one to four” (for children one to four years of age). If over 84, reported in 85 and over category.
  • Patient gender
  • Patient race/ethnicity
  • County of patient's residence
  • Patient Reason for Visit
  • Diagnosis codes, primary and all secondary diagnoses codes reported to (including coding methodology)
  • Procedure codes, primary and all secondary procedure codes reported to RFA (including coding methodology)
  • Time from Admission Hour to Discharge Hour
  • E-codes
  • AHRQ (Agency for Health Care Research and Quality) broad level diagnostic categories
  • AHRQ detailed diagnostic categories
  • Primary expected payer classification (i.e., Medicare, Medicaid, TriCare, Worker’s Compensation, Commercial, HMO, Self-pay, Indigent and Other)
  • Charges by summary revenue codes
  • Total charges
  • Physician specialty code (as adopted by the AMA)
  • Health care professional classification
    • Attending
    • Other
  • Patient discharge status

The requestor may choose one of the following facility characteristics:

  • Urban/rural status of health care facility
  • Bed Size Based on Licensed Beds (100 beds or less, 101-299, 300 or more beds)
  • Teaching status of the facility
  • Level of trauma service
  • Level of perinatal service
  • Other facility and professional characteristics that would not permit the identification of the health care facility or professional

3. Free Standing and Hospital Based Ambulatory Surgery Center, Imaging and Other Services/Equipment Requiring a Certificate of Need Encounter-Level Data Elements

  • Day of the Week of Admission
  • Primary expected payer classification (i.e., Medicare, Medicaid, TriCare, Worker’s Compensation, Commercial, HMO, Self-pay, Indigent and Other)
  • Month of admission
  • Admission source
  • Admission type
  • Total charges
  • Physician(s) specialty code (as adopted by the AMA)
  • Health care professional classification(s) (attending, etc.)
  • Patient age at admission in years in 5-year groupings. Except less than 5 years that is reported as “under one” (for children under one year of age) and “one to four” (for children one to four years of age). If over 84, reported in 85 and over category.
  • RFA assigned procedure classification code
  • Patient gender
  • Patient race/ethnicity
  • County of patient’s residence
  • Patient discharge status
  • Diagnosis codes, primary and all secondary diagnoses codes reported to (including coding methodology)
  • Procedure codes, primary and all secondary procedure codes reported to RFA (including coding methodology)

4. Home Health Encounter-Level Data Elements

  • Number of months in episode
  • Day of the week of admission
  • Primary expected payer classification (i.e., Medicare, Medicaid, TriCare, Worker’s Compensation, Commercial, HMO, Self-pay, Indigent and Other)
  • Month of admission
  • Year of admission
  • Day of the week discharge
  • Month of discharge
  • Admission source
  • Total charges
  • Physician(s) specialty code (as adopted by the AMA)
  • Patient age at admission in years in 5-year groupings. Except less than 5 years that is reported as “under one” (for children under one year of age) and “one to four” (for children one to four years of age). If over 84, reported in 85 and over category
  • Patient gender
  • Patient race/ethnicity
  • County of patient’s residence
  • Diagnosis codes (including coding methodology)
  • Skilled nursing services number of encounters by month of service
  • Physical therapy services number of encounters by month of service
  • Occupational therapy services number of encounters by month of service
  • Speech therapy services number of encounters by month of service
  • Respiratory therapy services number of encounters by month of service
  • Medical social services number of encounters by month of service
  • Home health aide number of encounters by months of service
  • Discharge status
  • Admission referral source

B. Application for Use of Encounter-Level Data

Persons receiving encounter-level data must complete an application and submit the signed data use agreement to the Revenue and Fiscal Affairs Office, Health and Demographics (RFARFA). The requestor must indicate which data set(s) is(are) being requested: Inpatient Hospitalizations, Emergency Department Encounters, Ambulatory Surgery, Imaging and Other Services/Equipment Requiring a Certificate of Need, or Home Health Encounters by completing the appropriate data elements form(s). The Application for Use of Encounter-Level Data is located: Data Application