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Appendix M-Input and Output Alphabetic Listing of Data Elements

Select Data Element Name, Number for definitions, codes and values, and edit applications.

NOTE:  Bolded and UPPER CASE are IDENTIFYING DATA ELEMENTS
See Data Protection Review Board (DPRB) or Appendix Z for details.

YEAR COLLECTION
IMPLMT/ENDED

X12-837 DATA DICTIONARY NAME		 INPATIENT
OUTPUT
NUMBER		 OUTPATIENT
OUTPUT
NUMBER
20054 Abortion Flag 139
19943 Accident Hour 48
19823 Accident Related Code 49 38
19943 ACCIDENT RELATED DATE 50 39
1982 Accommodations Days 61
1982 Accommodations Rate 60
1982 Accommodations Total Charges 62
1982 Accommodations Total Non-Covered Charges 63
19823 ADMISSION DATE/START OF CARE 5 5
19823 Admission Hour/Emergency Visit Hour 14 12
20054 Admit Weekday 128
19823 Admitting Diagnosis Code 76
1994 / 1997 After Anesthesia Indicator 1-14 71
20054 AIDS/HIV Flag 138
19823 Age 94 69
20054 Age in Days 130
1996 Age Warning Flag 112 76
1982 / 1999 Alternate Level of Care Days 44
19823 AMBULATORY SURGERY SERVICE DATE (DISCHARGE DATE) 6 & 7 6
2007 AMI (Acute Myocardial Infarction) - Diastolic Blood Pressure on Arrival
2007 AMI (Acute Myocardial Infarction) - Heart Rate on Arrival
2007 AMI (Acute Myocardial Infarction) - Systolic Blood Pressure on Arrival
19823 ATTENDING/EMERGENCY DEPT PHYSICIAN 1 STATE LICENSE NUMBER 84 62
1987 BIRTH WEIGHT (VALUE INFORMATION - NEONATE) 21
1982 Blood Furnished Amount 59
19973 Condition Information - Homeless Patients 114 78
19973 Condition Information - Non-US Resident Patients 114 78
1982 Condition Information - Special Program (DIS) 51
1982 Condition Information - Special Program (FP) 52
1982 Condition Information - Special Program (PHC) 53
1982 Condition Information - Special Program (SFP) 54
20054 Continuation Record Type Flag 122
1982 Covered Days 41
1982 / 1999 DATE ALTERNATE CARE REQUIRED 19
1982 Date Processed 107 71
2007 Diastolic Blood Pressure on Arrival
19823 DISCHARGE DATE (AMBULATORY SURGERY SERVICE DATE) 6 & 7 6
20054 Discharge Weekday 129
19823 Discharge Hour 17 14
20054 Discharge Sequential Number 137
20054 Discharge Year 136
1996 / 1997 Do Not Resuscitate Indicator (DNR) 113
1982 DRG (Current Federal) 95
1982 DRG (Current New York) 97
1982 DRG (New Federal) 103
1982 DRG (New New York) 105
1982 DRG (Prior Federal) 99
1982 DRG (Prior New York) 101
1995 / 1997 DRG Number Billed 110
2003 Emergency Department Indicator 120 80
1990 Exempt Unit Indicator 81
19823 Expected Principal Reimbursement 28 21
1982 Expected Reimbursement Other 1 29
1994 Expected Reimbursement Other 2 30
19903 External Cause-of-Injury Code 77 57
20054 Facility Name 140
1994 File Sequence and Serial Number
20054 Health Service Area Code 124
2007 Heart Rate on Arrival
19973 Homeless Patients 114 78
20054 Hospital County Code 123
1982 Inpatient Ancillary Revenue Code 65
1982 Inpatient Ancillary Total Charges 66
1982 Inpatient Ancillary Total Non-Covered Charges 67
1987 Leave of Absence Days 45
1982 Length of Stay 93
19823 Log Number 108 72
1982 MDC (Current Federal) 96
1982 MDC (Current New York) 98
1982 MDC (New Federal) 104
1982 MDC (New New York) 106
1982 MDC (Prior Federal) 100
1982 MDC (Prior New York) 102
19823 MEDICAL RECORD NUMBER 4 4
19833 Method of Anesthesia Used 80 60
1990 MOTHER'S MEDICAL RECORD NUMBER FOR NEWBORN CHILD 23
1987 NEONATE BIRTH WEIGHT 21
20054 Newborn Flag 131
19823 New York State Patient Status or Disposition 22 16
1999 NON-ACUTE CARE FROM DATE 116
1999 NON-ACUTE CARE THROUGH DATE 117
1999 Non-Acute Care Type 115
1994 Non-Covered Days 42
19973 Non-US Resident Patients 114 78
1994 Number of Claims
19823 Occurrence Information - ACCIDENT RELATED Codes and DATES 49, 50 38, 39
1999 OCCURRENCE SPAN INFORMATION - ALC SPAN DATES 20, 115,116,117
19993 OCCURRENCE SPAN INFORMATION - LOA SPAN DATES 45, 46
20054 Operating Certificate Number 125
19823 OPERATING/EMERGENCY DEPARTMENT PHYSICIAN 2 STATE LICENSE NUMBER 85 63
1983 Operating Room Time/Procedure Time 47
19821 Other Diagnosis Code 1-14 69 50
19823 OTHER/EMERGENCY DEPARTMENT PHYSICIAN 3 STATE LICENSE NUMBER 86 64
19822, 3 Other Procedure Code 1-14 74 54
19822, 3 OTHER PROCEDURE DATE 1-14 75 55
2003 Outpatient Ancillary Revenue Code 41
2003 Outpatient Ancillary Total Charges 45
2003 Outpatient Ancillary Total Non-Covered Charges 46
1982 PATIENT BIRTH DATE 11 10
19823 Patient City 33 25
1994 PATIENT CONTROL NUMBER 3 3
19823 Patient County Code 34 26
19863 Patient Ethnicity 26 19
1982 Patient Postal Service Zip Code and EXTENSION CODE 36 & 37 28
19823 Patient Race 25 18
19823 Patient Reason For Visit Code 56
19823 PATIENT RESIDENCE ADDRESS - ADDRESS LINE 1 31 23
19943 PATIENT RESIDENCE ADDRESS - ADDRESS LINE 2 32 24
19823 Patient Sex 10 9
19823 Patient State 35 27
19823 Payer Identification Number 40 31
1994 Physical Record Count
1994 Physician Qualifier Code
19903 Place-of-Injury Code 78 58
1994 / 1996 Placement of Bed Indicator 82
1986 Point of Origin / Source of Admission 13
1992 POLICY NUMBER 39
20054 POST-OP DAYS 134
20054 PRE-ADMIT INDICATOR 132
1994 / 1997 PRE-HOSPITAL CARE REPORT NUMBER 24
20054 PRE-OP DAYS 133
19901 Present on Admission Indicator 70
1982 Principal/Primary Diagnosis Code 68 49
1982 Principal Procedure Code 72 52
19833 PRINCIPAL PROCEDURE DATE 73 53
1983 Procedure Code - CPT4/HCPCS 42
2003 Procedure Code - CPT4/HCPCS - Modifier 1 43
2003 Procedure Code - CPT4/HCPCS - Modifier 2 44
1994 / 2003 Procedure Coding Method 79 59
2000 Procedure Date Warning Flag 118
1983 Procedure Time/Operating Room Time 47
1982 Processing Date
19823 Provider Identification Number 43 33
1994 Record Sequence Count 9 8
1994 Record Sequence Number 8 7
1994 Record Type
1994 Record Type 2N Count
1994 Record Type 3N Count
1994 Record Type 4N Count
1994 Record Type 5N Count
1994 Record Type 6N Count
1994 Record Type 7N Count
1994 Record Type 8N Count
19973 Residence Indicator 114 78
20054 Same Day Discharge Indicator 126
20054 Service Category Group 127
20054 Source File Type 135
1986 Source of Admission / Point of Origin 13
19943 Source of Payment Code 38 29
2009 Source of Payment Typology I
2009 Source of Payment Typology II
2009 Source of Payment Typology III
19823 SPARCS Collector Code 109 73
19823 SPARCS Identification Number 2 2
19823 SPARCS Region 1 1
1982 Special Program (DIS) 51
1982 Special Program (FP) 52
1982 Special Program (PHC) 53
1982 Special Program (SFP) 54
1982 STATEMENT COVERS PERIOD - FROM DATE 15
1982 STATEMENT COVERS PERIOD - THRU DATE 16
1994 Submitter Name
1982 Surplus, Catastrophic, or Recurring Monthly Income Amount 58
1982 Surplus, Catastrophic, or Recurring Monthly Income Code 57
2007 Systolic Blood Pressure on Arrival
1999 Test/Production Indicator
1982 Total Accommodations Charges 87
1982 Total Accommodations Non-Covered Charges 88
1982 / 1997 Total Acute Certified Days 83
1982 Total Alternate Level of Care Days 20
19823 Total Ancillary Charges 89 66
19823 Total Ancillary Non-Covered Charges 90 67
1982 Total Charges 91
1987 Total Leave of Absence Days 46
1982 Total Non-Covered Charges 92
1994 Total Number of Records
19823 Transaction Code 48 37
1994 Type of Admission 12
1994 / 1998 Type of Alternate Care Required 18
1994 Type of Bill 47 36
2000 UB Accommodation Code 64
19953 UNIQUE PERSONAL IDENTIFIER 111 75
1982 / 2000 Unscheduled/Scheduled Admission 27
1994 Value Information - Accident Hour 48
1982 Value Information - Blood Furnished Code and Amount 59
1983 Value Information - Operating Room/Procedure Time 47
1987 Value Information - NEONATE BIRTH WEIGHT 21
1982 Value Information - Surplus, Catastrophic, or Recurring Monthly Income Code and Amount 57, 58
1982 Value Information - Workers' Compensation/No Fault Indicator and Amount 55, 56
1994 Version Code
1994 Worker's Compensation/No Fault Amount 56
1982 Worker's Compensation/No Fault Indicator 55

1 1982     Other Diagnosis Code 1-4
1992     Other Diagnosis Code 5-8
1994     Other Diagnosis code 9-14
1990     Present on Admission Indicator 1-4
1992     Present on Admission Indicator 5-8
1994     Present on Admission Indicator 9-14
2 1982     Other Procedure Code 1-4
1992     Other Diagnosis Code 5
1994     Other Procedure Code 6-14
1982    OTHER PROCEDURE DATE 1-4
1992    OTHER PROCEDURE DATE 5
1994    OTHER PROCEDURE DATE 6-14

3
This is the first year data element was collected by SPARCS. Please refer to the Inpatient and/or Outpatient data elements for specific year implementation.

4
These fields are derived from reported data and added to all years' record information.
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