Section He-Hea 1503.02 - Elements to be ReportedData collected for each patient discharged from an ambulatory surgical facility shall be compiled into a data base which itemizes the following elements:
(a) The patient's data of birth, which shall be an 8 position numeric field indicated as: (b) Gender, which shall be a one position numeric field indicated as:(1) The number "1" for male; and(2) The number "2" for female;(c) The patient's zip code of residence, which shall be a 5 position alphanumeric field;(d) Admission date, which shall be an 8 position numeric field indicated as: (e) Admission hour, which shall be a 2 position numeric field ranging from the numbers "00" to "23";(f) Discharge date which shall be an 8 position numeric field indicated as:(g) Discharge hour, which shall be a 2 position numeric field ranging from the numbers "00" to "23";(h) Principal diagnosis, which shall be a 5 position alphanumeric field indicated by ICD9-CM code;(i) Other diagnosis, which shall be a 45 position alphanumeric field to record up to 9 additional illnesses of the patient, indicated by ICD9-CM codes;(j) Principal procedure for treating the illness, which shall be a 4 position alphanumeric field indicated by ICD9-CM code;(k) The date the principal procedure was performed, which shall be an 8 position numeric field indicated as:(l) Other procedure(s) performed to treat the patient, which shall be a 20 position alphanumeric field to record up to 5 additional ICD9-CM codes;(m) The date(s) the other procedures were performed, which shall be a 40 position numeric field to record up to 5 additional dates indicated by: (n) E-code, which shall be a 6 position alphanumeric field indicated by ICD9-CM code;(o) The patient's circumstances after the provision of ambulatory services, which shall be specified with the following values:(1) For transfer to or treatment at other acute care facility, the code shall be '01';(2) For transfer to or treatment at a skilled nursing facility, the code shall be '02';(3) For transfer to or treatment at an intermediate care facility, the code shall be '03';(4) For transfer to structured/assisted living, the code shall be '04';(5) For transfer to home, self care, the code shall be '05';(6) For treatment by a home health service, the code shall be '06';(7) For transfer or treatment against medical advice, the code shall be '07';(8) For patient death, the code shall be '08';(9) For transfer to a rehabilitation facility, the code shall be '09';(10) For transfer to rehabilitation in an acute care facility, the code shall be '10';(11) For transfer to a substance abuse facility, the code shall be '11';(12) For transfer to substance abuse unit in an acute care facility, the code shall be '12';(13) For transfer to a psychiatric facility, the code shall be '13';(14) For transfer to a psychiatric unit in an acute care facility, the code shall be '14';(15) For redirection to an appropriate provider, the code shall be '15'; and(16) For leave of the patient before treatment, the code shall be '16';(p) The payment source expected to pay a majority of the patient's bill at discharge, which shall be a 2 position numeric field specified by the following values: (1) For self pay, the code shall be '01';(2) For workers' compensation insurance, the code shall be '02';(3) For Medicare, the code shall be '03';(4) For Medicaid, in and out of state, the code shall be '04';(5) For HMO, the code shall be '05';(6) For other government insurance, the code shall be '06';(7) For Blue Cross, the code shall be '07';(8) For commercial insurance, the code shall be '08';(9) For an unspecified payor, the code shall be '09';(q) The total time spent as an ambulatory surgery patient, which shall be a 3 position numeric field, calculated by subtracting the admission date from the discharge date. When both dates are the same, this field shall be reported as '001';(r) The total charges made to the patient during his or her stay, which shall be a 7 position numeric field;(s) The total charges made to the patient less professional fees, which shall be a 7 position numeric field;(t) Hospital Medicare provider number assigned by HCFA, which shall be a 6 position alphanumeric field;(u) The uniform physician identification number assigned by HCFA specifying the attending physician primarily responsible for the patient's care, which shall be a 6 position alphanumeric field; and(v) The uniform physician identification numbers assigned by HCFA specifying the operating physician(s) who performed the principal and/or secondary procedures on the patient, which shall be a 36 position alphanumeric field to record up to 6 additional codes.N.H. Admin. Code § He-Hea 1503.02