La. Admin. Code tit. 48 § V-15125

Current through Register Vol. 50, No. 9, September 20, 2024

Section V-15125 - Guide-Data Elements

A. Listed below are required and conditionally required data elements. Submission of any other data elements is optional; hospitals do not need to suppress or strip other elements appearing in their claims files. All elements submitted will be treated confidentially.

1. Required Data Elements. If a hospital is currently or temporarily unable to provide any of the data elements listed here, the hospital must apply for a waiver or extension, as detailed in §15119 of this rule.

Data Element	Form Locator	1300 Record Number	1450
			Record Type	Record Number
Patient Control Number· assigned by Provider	3	1	20	3
Type of Bill	4	2	40	4
Federal Tax ID (Facility EIN)· with Sub ID Number if applicable	5	3165	10	45
Statement Covers Period From	6	4	20	19
Statement Covers Period Thru	6	5	20	20
Patient Name	12	(none)	20	4-6
Patient Address	13	6(zip only)	20	12-16
Patient Date of Birth	14	7	20	8
Patient Sex	15	8	20	7
Admission Date	17	9	20	17
Type of Admission	19	11	20	10
Source of Admission	20	12	20	11
Patient Status at time of discharge	22	13	20	21
Medical/Health Record Number	23	14	20	25
Revenue Codes· Include all listed· Must be valid UB92 codes	42	Odd Number's15-59	6050	4, 13, 14, 4, 11, 12, 13
Units of Service· Include all listed	46	Odd Number's 97-141	60	8, 13, 14
Total Charges· Include all listed	47	Even Number's 16-60	6050	97
Payor Classification· Include all listed· HCFA Payor ID number preferred	50	156, 157, 158	30	5
Principal Diagnosis Code	67	69	70	4
Other Diagnosis codes· Include all listed	68-75	70-77	70	5-12
Admitting Diagnosis Code	76	78	70	25
External cause of injury code (E-code)· Must contain data if possible	77	79	70	26
Principal Procedure Code and Date	80	80-81	70	13-14
Other Procedure Codes and Dates· Include all listed	81	82-91	70	15-24
Attending Physician ID· State License Number	82	92	80	5
Operating Physician Number· State License Number· Required if present	83	93	80	6
Other Physician ID· State License Number· Required if present	84	94	80	7-8
Patient Social Security Number	60Only if insured	161	22	5a
Patient Race	none	155	22	7a
*Number of Claims	N/A	N/A	95	6
*Record Type	N/A	N/A	all	1
*Sequence Number	N/A	N/A	21-70, 72, 80-81	2

a. Elements marked with an asterisk are required for submittals of the electronic 1450 only; they are included because they are essential to the 1450.

b. The definitions of most data elements referred to in this rule can be found in the Louisiana UB-92 Users Manual referenced in §15109 of this rule. Hospitals using data sources other than uniform billing should evaluate their definitions for agreement with the definitions specified in this Guide and the Louisiana UB-92 Users Manual. The exceptions to referenced definitions are listed below.

i. Patient's Race-this alphanumeric one-character element contains race category information based on self-identification, which is to be obtained from the patient, a relative, or a friend. The hospital should not categorize the patient based on observation or personnel judgment. The patient may choose not to provide the information. If the patient chooses not to answer, the hospital should enter the code for unknown. If the hospital fails to request the information, the field should be space filled. Code as follows: 1=Native American or Alaskan Native: A person having origins in any of the original peoples of North America, and who maintains cultural identification through tribal affiliation or community recognition. 2=Asian or Pacific Islander: A person having origins in any of the peoples of the Far East, South East Asia, the Indian Subcontinent, or the Pacific Islands. This area includes, for example, China, India, Japan, Korea, the Philippine Islands, and Samoa. 3=African American/Black: A person having origins in any of the black racial groups of Africa. 4=Caucasian/White: A person having origins in any of the Caucasian peoples of Europe, North Africa, or the Middle East. 5=Other: Any possible options not covered in the above categories. 6=Unknown: A person who chooses not to answer the question. Blank Space: The hospital made no effort to obtain the information.

ii. Patient Social Security Number-numeric, 10-character entry containing the Social Security Number of the patient receiving care. This field is to be right justified with zeroes to the left to complete the field. The format of SSN is 0123456789 without hyphens. If the patient is a newborn, use the mother's SSN. If a patient does not have a social security number fill with zeroes. The field is edited for a valid entry.

2. Additional Data Elements Required if Available. These elements are required if the facility systematically collects the data in the ordinary course of operations as part of the facility's standard operating procedures and that data is readily available for inclusion in the claim file.

Date Element	Form Locator	1300 Record Number	1450
			Record Type	Record Number
Provider Name	1	(none)	10	12
Provider Address· Must include zip code and city	1	(none)	10	13-16
Marital Status	16	(none)	20	9
Admission Hour	18	10	20	18
Discharge Hour	21	166	20	22
Provider Number	51	62,144,149	30	24
Insured's Name	58	(none)	30	12-14
Patient's Relationship to the Insured	59	63, 145, 150	30	18
(Insured's) Certificate/SSN/Health Insurance Claim/Identification Number	60	64, 146, 151	30	7
Insured Group Name	61	(none)	30	11
Insurance Group Number	62	65, 147, 152	30	10
Treatment Authorization Code	63	(none)	40	5-7
Employment Status Code	64	66	30	19
Employer Name or EIN	65	67	3121	94
Employer Location	66	68(zip only)	3121	10-135-8

La. Admin. Code tit. 48, § V-15125

Promulgated by the Department of Health and Hospitals, Office of Public Health, LR 24:1940 (October 1998).

AUTHORITY NOTE: Promulgated in accordance with R.S. 40:1300.112(D).