Pa. Code tit. 28, pt. VI, ch. 915, MISCELLANEOUS PROVISIONS, app C
Current through Register Vol. 54, No. 45, November 9, 2024
| Field Number | Data Element Name | |
| FRM | PRM | |
| (5/6*) | - | Length of Stay |
| (5/6*) | - | Day of Week, Admit |
| (5/6*) | - | Day of Week, Dchg. |
| 7a | - | Principal Diagnosis Code |
| 7b-e | - | Secondary Diagnosis Codes |
| (8*) | - | Day of Week of Procedure |
| (8*) | - | Pre-operative LOS |
| 8a, b | 8 | Principal Procedure Code |
| 9a1-9c2 | - | Secondary Procedure Code |
| 10 | 9 | Uniform Identifier for Health Care Facility |
| 11 | 10 | Attending Physician ID |
| 12 | 10 | Operating Physician ID |
| 13a1-13w1 | - | Revenue Description |
| 13a2-13w2 | - | Revenue Code |
| 13a3-13w3 | 12 | Units of Service |
| 13a4-13w4 | 13 | Total Charges (by Revenue Code Category) |
| 13a5-13w5 | - | Noncovered Charges (by Revenue Category) |
| 14b1-3 | - | Payor Identification |
| 14c1-3 | - | Deductible Amount |
| 14d1-3 | - | Co-Insurance Amount |
| 17 | - | Uniform Identifier of Primary Payor |
| 18 | - | Zip code of Facility |
| 20 | - | Patient Discharge Status |
| 21a | - | Patient Severity upon Admission |
| 21b | - | Patient Morbidity |
| 21c | - | Unusual Occurrence-Nosocomial Infections |
| 21d | - | Unusual Occurrence-Readmission |
| 22 | - | Type of Bill |
| 24 | - | Diagnosis Related Group |
| 25 | 18 | Procedure Coding Method Used |
| 26 | - | Type of Admission |
| 27 | - | Source of Admission |
| 30 | - | Principal and other Diagnoses Descriptions |
| 31 | - | Principal and other Procedure Descriptions |
| 33a, b | - | Employment Information |
| 34a, b | - | Employment Status Code |
| - | 2 | Place of Service |
| - | 11 | Type of Professional Service |
* constructed data element using submitted data elements
FRM-Facility Reporting Manual
PRM-Payor Reporting Manual
Pa. Code tit. 28, pt. VI, ch. 915, MISCELLANEOUS PROVISIONS, app C
This appendix cited in 28 Pa. Code § 915.3 (relating to definitions); 28 Pa. Code § 915.21 (relating to classes of data collected by the Council); and 28 Pa. Code § 915.24 (relating to release of nonprotected data).