Section 97212 - Definitions, as Used in this Article(a) Ambulatory Surgery (AS) Data Record. The Ambulatory Surgery Data Record consists of the set of data elements related to an encounter, as specified in Subsection (a) of Section 128737 of the Health and Safety Code and as defined in Sections 97251-97265 and 97267-97268 of the California Code of Regulations.(b) CPT-4. The Current Procedural Terminology, 4th Edition, is published and maintained by the American Medical Association. It is a standard medical code set for healthcare services or procedures in non-inpatient settings.(c) Days. Days, as used in this article, are defined as calendar days unless otherwise specified.(d) Discharge. A discharge is defined as an inpatient who:(1) is formally released from the care of the hospital and leaves the hospital, or(2) is transferred within the hospital from one type of care to another type of care, as defined by Subsection (w) of Section 97212, or(3) leaves the hospital against medical advice, without a physician's order or is a psychiatric patient who is discharged as away without leave (AWOL), or(e) Do Not Resuscitate (DNR) Order. A DNR order is a directive from a physician in a patient's current inpatient medical record instructing that the patient is not to be resuscitated in the event of a cardiac or pulmonary arrest. In the event of a cardiac or pulmonary arrest, resuscitative measures include, but are not limited to, the following: cardiopulmonary resuscitation (CPR), intubation, defibrillation, cardioactive drugs, or assisted ventilation.(f) Emergency Care Data Record. The Emergency Care Data Record consists of the set of data elements related to an encounter, as specified in Subsection (a) of Section 128736 of the Health and Safety Code and as defined in Sections 97251-97265 and 97267-97268.(g) Emergency Department (ED). Emergency Department means, in a hospital licensed to provide emergency medical services, the location in which those services are provided, as specified in Subsection (b) of Section 128700 of the Health and Safety Code. For the purposes of this chapter, this includes emergency departments providing standby, basic, or comprehensive services.(h) Encounter. An encounter is a face-to-face contact between an outpatient and a provider.(i) Error. Error means any record found to have an invalid entry or to contain incomplete data or to contain illogical data.(j) Facility Identification Number. A unique six-digit number that is assigned to each facility and shall be used to identify the facility.(k) Freestanding Ambulatory Surgery Clinic. Freestanding ambulatory surgery clinic means a surgical clinic that is licensed by the state under paragraph (1) of subdivision (b) of Section 1204 of the Health and Safety Code. This type of facility is commonly known as a freestanding ambulatory surgery center.(l) Hospital Discharge Abstract Data Record. The Hospital Discharge Abstract Data Record consists of the set of data elements related to a discharge, as specified in Subsection (g) of Section 128735 of the Health and Safety Code and as defined by Sections 97216-97234 for Inpatients.(m)(1) ICD-10-CM. The International Classification of Diseases, Tenth Revision, Clinical Modification, published by the U.S. Department of Health and Human Services. Coding guidelines and annual revisions to ICD-10-CM are made nationally by the "Cooperating Parties" (the American Hospital Association, the Centers for Medicare and Medicaid Services, the National Center for Health Statistics, and the American Health Information Management Association).(2) ICD-10-PCS. The International Classification of Diseases, Tenth Revision, Procedure Coding System, published by the U.S. Department of Health and Human Services. Coding guidelines and annual revisions to ICD-10-PCS are made nationally by the "Cooperating Parties" (the American Hospital Association, the Centers for Medicare and Medicaid Services, the National Center for Health Statistics, and the American Health Information Management Association).(n) Inpatient. An inpatient is defined as a baby born alive in this hospital or a person who was formally admitted to the hospital with the expectation of remaining overnight or longer.(o) Licensee. Licensee means an entity that has been issued a license to operate a facility as defined by Subsection (d) or (f) of Section 128700 of the Health and Safety Code.(p) MS-DRG. Medicare Severity Diagnosis Related Groups is a classification scheme with which to categorize inpatients according to clinical coherence and expected resource intensity, as indicated by their diagnoses, procedures, sex, and disposition. It was established and is revised annually by the U.S. Department of Health and Human Services (DHHS) Centers for Medicare and Medicaid Services (CMS).(q) Outpatient. An outpatient means: (1) a person who has been registered or accepted for care but not formally admitted as an inpatient and who does not remain over 24 hours, as specified in Subsection (a)(2) of Section of Title 2270053 of Title 22 of the California Code of Regulations, or(2) a patient at a freestanding ambulatory surgery clinic who has been registered and accepted for care.(r) Provider. A provider is the person who has primary responsibility for assessing and treating the condition of the patient at a given contact and exercises independent judgment in the care of the patient. This would include, but is not limited to, a practitioner licensed as a Medical Doctor (M.D.), a Doctor of Osteopathy, (D.O.), a Doctor of Dental Surgery (D.D.S.), or a Doctor of Podiatric Medicine (D.P.M.).(s) Record. A record is defined as the set of data elements specified in Subsection (g) of Section 128735, Subsection (a) of Section 128736, or Subsection (a) of Section 128737 of the Health and Safety Code, for one discharge or for one encounter.(t) Report. A report is defined as the collection of all Hospital Discharge Abstract Data Records, or all Emergency Care Data Records, or all Ambulatory Surgery Data Records required to be submitted by a reporting facility for one reporting period. A report contains only one type of record.(u) Reporting Facility. Reporting facility means a hospital or a freestanding ambulatory surgery clinic required to submit data records, as specified in Subsection (g) of Section 128735, or Subsection (a) of Section 128736, or Subsection (a) of Section 128737 of the Health and Safety Code.(v) SIERA. SIERA means the Department's System for Integrated Electronic Reporting and Auditing that is a secure online transmission system through which reports are submitted and corrected, and report extension requests are submitted using an internet web browser. SIERA is available on the Department's internet web site at: https://siera.hcai.ca.gov.(w) Type of Care. Type of care in hospitals is defined as one of the following:(1) Skilled nursing/intermediate care. Skilled nursing/intermediate care means inpatient care that is provided to inpatients occupying beds appearing on a hospital's license in the classifications of skilled nursing or intermediate care, as defined by paragraphs (2), (3), or (4) of Subdivision (a) of Section 1250.1 of the Health and Safety Code. Skilled nursing/intermediate care also means inpatient care that is provided to inpatients occupying general acute care beds that are being used to provide skilled nursing/intermediate care to those inpatients in an approved swing bed program.(2) Physical rehabilitation care. Physical rehabilitation care means inpatient care that is provided to inpatients occupying beds included on a hospital's license within the general acute care classification, as defined by paragraph (1) of Subdivision (a) of Section 1250.1 of the Health and Safety Code, and designated as rehabilitation center beds, as defined by Subsection (a) of Section 70034 and by Section of Title 2270595 of Title 22 of the California Code of Regulations.(3) Psychiatric care. Psychiatric care means inpatient care that is provided to inpatients occupying beds appearing on a hospital's license in the classification of acute psychiatric beds, as defined by paragraph (5) of Subdivision (a) Section 1250.1 of the Health and Safety Code, and psychiatric health facility, as defined by Subdivision (a) of Section 1250.2 of the Health and Safety Code.(4) Chemical dependency recovery care. Chemical dependency recovery care means inpatient care that is provided to inpatients occupying beds appearing on a hospital's license as chemical dependency recovery beds, as defined by paragraph (7) of Subdivision (a) of Section 1250.1 of the Health and Safety Code and Subdivisions (a), (c), or (d) of Section 1250.3 of the Health and Safety Code.(5) Acute care. Acute care, as defined by paragraph (1) of Subdivision (a) of Section 1250.1 of the Health and Safety Code, means all other types of inpatient care provided to inpatients occupying all other types of licensed beds in a hospital, other than those defined by paragraphs (1), (2), (3) and (4) of Subsection (w) of this section.(x) User Account Administrator. A healthcare facility representative responsible for designating users, which may include agents, and maintaining the facility's online submission system user accounts and user account contact information.Cal. Code Regs. Tit. 22, § 97212
1. New section applicable to all discharges after December 31, 1996 filed 7-15-96; operative 8-14-96 (Register 96, No. 29).
2. Editorial correction of subsections (c)(2) and (g)(2) (Register 97, No. 19).
3. Amendment of section and NOTE filed 7-23-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 30).
4. Repealer of version of section 97212 applicable through 12-31-96 and amendment of version of section applicable beginning 1-1-97 filed 9-21-98; operative 10-21-98 (Register 98, No. 39). For prior history see Register 97, No. 30.
5. Amendment filed 9-23-2003; operative 9-23-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 39).
6. Repealer and new section and amendment of NOTE filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 18).
7. Change without regulatory effect amending subsection (p) filed 8-11-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 32).
8. Change without regulatory effect amending subsection (a), repealing subsection (f), relettering subsections, amending newly designated subsections (g) and (m) and adding subsection (r) filed 8-23-2011 pursuant to section 100, title 1, California Code of Regulations (Register 2011, No. 34).
9. Change without regulatory effect amending subsections (o) and (t) filed 10-2-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 40).
10. Redesignation of subsection (n) as subsection (n)(1) and new subsections (n)(2)-(3) filed 4-3-2014; operative 7-1-2014 (Register 2014, No. 14).
11. Change without regulatory effect amending subsection (h), repealing subsection (n)(1), renumbering subsections and amending subsection (p) filed 7-20-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 30).
12. Change without regulatory effect amending subsections (a) and (g) filed 5-9-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 19).
13. Editorial correction of subsection (m) (Register 2018, No. 25).
14. Change without regulatory effect adding subsection (x), relettering subsections and amending newly designated subsection (z) filed 12-13-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 50).
15. Change without regulatory effect amending subsections (e)(2) and (y)(5) filed 6-22-2020 pursuant to section 100, title 1, California Code of Regulations (Register 2020, No. 26).
16. Change without regulatory effect repealing subsections (d) and (q), relettering subsections and amending newly designated subsections (d)(2), (w)(5) and (x) filed 11-5-2021 pursuant to section 100, title 1, California Code of Regulations (Register 2021, No. 45).
17. Change without regulatory effect amending subsection (v) filed 1-24-2023 pursuant to section 100, title 1, California Code of Regulations (Register 2023, No. 4). Note: Authority cited: Section 128810, Health and Safety Code. Reference: Sections 1250, 1250.1, 128700, 128735, 128736 and 128737, Health and Safety Code.
1. New section applicable to all discharges after December 31, 1996 filed 7-15-96; operative 8-14-96 (Register 96, No. 29).
2. Editorial correction of subsections (c)(2) and (g)(2) (Register 97, No. 19).
3. Amendment of section and Note filed 7-23-97 pursuant to section 100, title 1, California Code of Regulations (Register 97, No. 30).
4. Repealer of version of section 97212 applicable through 12-31-96 and amendment of version of section applicable beginning 1-1-97 filed 9-21-98; operative 10-21-98 (Register 98, No. 39). For prior history see Register 97, No. 30.
5. Amendment filed 9-23-2003; operative 9-23-2003 pursuant to Government Code section 11343.4 (Register 2003, No. 39).
6. Repealer and new section and amendment of Note filed 5-5-2005; operative 5-5-2005 pursuant to Government Code section 11343.4 (Register 2005, No. 18).
7. Change without regulatory effect amending subsection (p) filed 8-11-2005 pursuant to section 100, title 1, California Code of Regulations (Register 2005, No. 32).
8. Change without regulatory effect amending subsection (a), repealing subsection (f), relettering subsections, amending newly designated subsections (g) and (m) and adding subsection (r) filed 8-23-2011 pursuant to section 100, title 1, California Code of Regulations (Register 2011, No. 34).
9. Change without regulatory effect amending subsections (o) and (t) filed 10-2-2013 pursuant to section 100, title 1, California Code of Regulations (Register 2013, No. 40).
10. Redesignation of subsection (n) as subsection (n)(1) and new subsections (n)(2)-(3) filed 4-3-2014; operative 7-1-2014 (Register 2014, No. 14).
11. Change without regulatory effect amending subsection (h), repealing subsection (n)(1), renumbering subsections and amending subsection (p) filed 7-20-2016 pursuant to section 100, title 1, California Code of Regulations (Register 2016, No. 30).
12. Change without regulatory effect amending subsections (a) and (g) filed 5-9-2018 pursuant to section 100, title 1, California Code of Regulations (Register 2018, No. 19).
13. Editorial correction of subsection (m) (Register 2018, No. 25).
14. Change without regulatory effect adding subsection (x), relettering subsections and amending newly designated subsection (z) filed 12-13-2019 pursuant to section 100, title 1, California Code of Regulations (Register 2019, No. 50).
15. Change without regulatory effect amending subsections (e)(2) and (y)(5) filed 6-22-2020 pursuant to section 100, title 1, California Code of Regulations (Register 2020, No. 26).
16. Change without regulatory effect repealing subsections (d) and (q), relettering subsections and amending newly designated subsections (d)(2), (w)(5) and (x) filed 11-5-2021 pursuant to section 100, title 1, California Code of Regulations (Register 2021, No. 45).